CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Background: Neurocognitive impairment (NCI) is a frequent and often disabling comorbidity of HIV. In addition to antiretroviral (ARV) therapies, individuals with HIV infection may commonly use non-ARV medications that are known to cause neurocognitive adverse effects (NC-AE). The contribution of NC-AE to NCI is rarely considered in the context of HIV and could explain part of the variability in neurocognitive performance among individuals with HIV. Methods: This study was conducted with data from the Women’s Interagency HIV Study (WIHS); a prospective, multisite, observational study of U.S. women with and without HIV. After a literature review, 98 non-ARV medications with NC-AE were identified, 78 of which (excluding statins) were reported by WIHS participants. We examined factors associated with self-reported use of these medications over a 10-year period among WIHS women. Multivariable logistic regression was used to assess socio-demographic, behavioral, and clinical characteristics associated with NC-AE medication use. Results: 3,300 women (70.6%with HIV) and data from~42,000 visits were studied. HIV infection was associated with NC-AE medication use (odds ratio =1.52 (95% confidence interval: 1.35-1.71)). HIV-infected women were more likely (p<0.001) to report using antianxiety, opioid, antihistamine, gastrointestinal, or antidepressant NC-AE medications (see Table). After adjustment for HIV infection status, having health insurance, multiple depressive symptoms, prior clinical AIDS, non-injection recreational drug use, and an annual household income <$12,000 were each predictors of NC-AE medication use (all p<0.004). NC-AE medication use was less likely among women who drank 1-7 or 8-12 alcoholic drinks/week (vs. abstaining) (both p<0.04). Conclusion: HIV infection was associated with NC-AE medication use which may influence determinations of HIV-associated NCI. Providers should consider the impact of NC-AE medications when evaluating patients with HIV and concurrent neurocognitive symptoms.

in the blood. The mean IUPM value for blood was determined to be 3.5 (range: 0.5 -3.76); whereas the mean IUPM value for tissue was 16.2 (range 0.5-51). Interestingly, we also observed more replication competent HIV-1 in the semen compared to blood. In one subject tested, the IUPM value was calculated to be 2.0 and 17.0 in the blood and semen, respectively. In the second subject, infectious virus could not be recovered from the blood, but an IUPM of 58.0 was determined in the semen. Conclusion: We have adapted the TZA to quantify inducible replication- competent HIV-1 in the GALT and semen of HIV-1 infected subjects on ART. Preliminary studies suggest a higher frequency of HIV in both GALT and semen compared to blood. Zheng Wang 1 , Yu Cheng 1 , Samantha A. Molsberry 2 , Lawrence Kingsley 1 , Andrew Levine 3 , Eileen Martin 4 , Eric N. Miller 3 , Cynthia Munro 5 , Ann B. Ragin 6 , Ned Sacktor 5 , Eric C. Seaberg 7 , James T. Becker 1 1 University of Pittsburgh, Pittsburgh, PA, USA, 2 Harvard University, Cambridge, MA, USA, 3 University of California Los Angeles, Los Angeles, CA, USA, 4 Rush University Medical Center, Chicago, IL, USA, 5 The Johns Hopkins Hospital, Baltimore, MD, USA, 6 Northwestern University, Chicago, IL, USA, 7 The Johns Hopkins University, Baltimore, MD, USA Background: Estimates of the extent of cognitive impairment among individuals infected with HIV vary widely. This work used a relatively new method of multivariate normative comparisons (MNC) to identify individuals with impaired cognition, and to compare the results with those using the original (Antinori) and modified (Gisslén) Frascati criteria. MNC is a statistical method to control for the increased false discovery rate associated with using multiple intercorrelated measures of cognitive function. Methods: This project used data collected prior to October 2014 from bisexual/ gay men in the Neuropsychological (NP) Substudy of the Multicenter AIDS Cohort Study. These participants have been regularly assessed over 30+ years with a battery of tests measuring performance in working memory & attention, learning, motor speed & coordination, executive functioning, speed of information processing, and memory. The study cohort included 2904 men (mean age 39.7yr, 52.7% HIV-infected, 1314 classified in the preART era) who had complete data in all six domains at their first NP evaluation. T-scores were computed for each domain, adjusting for age, race, and education. The MNC was applied to detect impairment among seronegative and seropositive groups; the seronegative men were treated as healthy controls. For comparisons, the number of impaired men that were identified by Antinori’s and Gisslén’s criteria were also determined. Results: In the seronegative group, the MNC method classified 5.8% of men as being cognitively impaired; as the subjects in the seronegative group were treated as healthy controls, the MNC successfully controlled the false discovery rate at 5% level. Using the Antinori and Gisslén criteria, 24.2% and 11.2% of the HIV- men were classified as impaired, respectively. Among the HIV+men, the MNC classified 7.1% as impaired; the Antinori and Gisslén criteria identified 25% and 11.6% impaired cases, respectively. The rates of abnormality did not differ between groups, nor did they differ in the mean domain T-scores. Conclusion: Among seronegative individuals, the MNC method successfully controlled the false discovery rate at the predetermined error level. In contrast, both the Antinori and Gisslén criteria produced inflated prevalence rates, suggesting low specificity of these two methods. More research is needed to evaluate the sensitivity of this method in a seropositive population which may be sicker or older than the current study sample. Kendra K. Radtke 1 , Peter Bacchetti 1 , Leah H. Rubin 2 , Kathryn Anastos 3 , Howard Crystal 4 , Daniel Merenstein 5 , Roksana Karim 6 , Kathleen M. Weber 7 , Andrew Edmonds 8 , Anandi N. Sheth 9 , Margaret Fischl 10 , David Vance 11 , Ruth Greenblatt 1 1 University of California San Francisco, San Francisco, CA, USA, 2 Johns Hopkins University, Baltimore, MD, USA, 3 Albert Einstein College of Medicine, Bronx, NY, USA, 4 SUNY Downstate Medical Center, Brooklyn, NY, USA, 5 Georgetown University, Washington, DC, USA, 6 University of Southern California, Los Angeles, CA, USA, 7 John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA, 8 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 9 Emory University, Atlanta, GA, USA, 10 University of Miami, Miami, FL, USA, 11 University of Alabama at Birmingham, Birmingham, AL, USA

400 CLASSIFYING COGNITIVE STATUS IN HIV-INFECTED MEN BY MULTIVARIATE NORMATIVE COMPARISON

Poster Abstracts

402 BRAIN NEUROTRANSMITTER GENOMICS AND EFAVIRENZ CENTRAL NERVOUS SYSTEM (CNS) EFFECTS David Haas 1 , Yuki Bradford 2 , Anurag Verma 2 , Shefali S. Verma 2 , Sarah A. Pendergrass 2 , Joseph J. Eron 3 , Roy M. Gulick 4 , Sharon Riddler 5 , Paul E. Sax 6 , Thomas Campbell 7 , Eric Daar 8 , Gene D. Morse 9 , Edward P. Acosta 10 , Marylyn D. Ritchie 2 1 Vanderbilt University, Nashville, TN, USA, 2 Geisinger Health System, Danville, PA, USA, 3 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 4 Weill Cornell Medicine, New York, NY, USA, 5 University of Pittsburgh, Pittsburgh, PA, USA, 6 Brigham and Women’s Hospital, Boston, MA, USA, 7 University of Colorado, Aurora, CO, USA, 8 University of California Los Angeles, Los Angeles, CA, USA, 9 State University of New York at Buffalo, Buffalo, NY, USA, 10 University of Alabama at Birmingham, Birmingham, AL, USA Background: Efavirenz (EFV) is widely prescribed for HIV-1 infection but CNS adverse effects (AEs) are common. CYP2B6/CYP2A6 genotypes predict risk for EFV CNS AEs. Interactions of EFV with neurotransmitter transporters/receptors are thought to cause CNS AEs. We assessed whether predicted brain expression or polymorphisms (SNPs) in candidate genes in brain (SLC6A2, SLC6A3, PGR, HTR2A, HTR2B, HTR2C, HTR6, AR) were associated with EFV CNS AEs. Methods: Antiretroviral therapy (ART)-naïve patients were randomly assigned to EFV-containing ART in protocols ACTG 384, A5095, A5142 and A5202. Genetic consent was obtained under protocol A5128. Cases had new onset grade ≥2 EFV-consistent CNS AEs within 48 weeks of study entry while receiving EFV.

401 USE OF NON-ANTIRETROVIRAL MEDICATIONS THAT MAY IMPACT NEUROCOGNITION

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