CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

409 PREVALENCE OF HIV NEUROCOGNITIVE IMPAIRMENT IN A RURAL TANZANIAN COHORT Montserrat Sanmartí 1 , Ana-Claire Meyer 2 , Angels Jaen 1 , Kevin Robertson 3 , Nora Tan 4 , Leila Samson 5 , Regina Ndaki 5 , Marcel Tanner 6 , Manuel Battegay 6 , David Dalmau 1 , Emilio Letang 6 1 Hospital Universitari Mútua de Terrassa, Terrassa, Spain, 2 Yale University, New Haven, CT, USA, 3 North Carolina Division of Public Health, Raleigh, NC, USA, 4 Stanford University, Stanford, CA, USA, 5 Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of, 6 Swiss Tropical and Public Health Institute, Basel, Switzerland Background: HIV-associated Neurocognitive impairment (HNI) is still highly prevalent and is associated with lower quality of life despite the advances in antiretroviral therapy (ART). Few studies have assessed the neurobehavioral status of people living with HIV (PLWH) on ART in sub-Saharan Africa. We conducted a study to evaluate the prevalence and associated factors for HNI in a rural Tanzanian HIV-infected cohort. Methods: Cross sectional study among a random sample of adult PLWH on ART for >1 year without neither immunological failure nor pre-existing neurological disease, prospectively enrolled in the Kilombero-Ulanga Antiretroviral Cohort and visited between 06 and 08/2015. A neuropsychological test battery was administered, including: verbal fluency test, digit symbol, digit span, WHO/ UCLA auditory verbal learning test and grooved pegboard. Demographically– adjusted normative data were obtained from a sample of 400 HIV-negative adults from Rakai (Uganda). A definition of HNI was applied, requiring a mean Z-score≤-1 in ≥two cognitive domains. Multiple logistic regression identified risk factors for HNI. Results: Among 243 recruited patients, the median age was 44 years (IQR 36-52), 71%were female, 98%were infected heterosexually and 35% had primary education or less. Median nadir CD4 was 243 cells/μL (IQR 80–302) and 53% had a WHO Stage 3 or 4. The median time on ART was 5 years (IQR 3-7), and 68%were on an efavirenz-based regimen. Nearly all patients (97%) reported good self-adherence to ART. The prevalence of HNI was 19.3% (47/243) (figure 1). Group mean Z-scores for memory (Z=-0.22) and psychomotor (Z=–0.81) domains demonstrated the highest impairment. Age (adjusted odds ratio (aOR) 1.6 for 10 years increase; 95% CI 1.1-2.3) and alcohol consumption (aOR 2.7; 95% CI 1-6.7) independently predicted HNI. Also, a trend was observed for a higher risk of HNI in patients who had not disclosed their HIV status (OR 1.7; 95% CI 0.8-3.3). Conclusion: This is the first study evaluating cognition from Tanzania HIV population using normative data from a large African HIV-negative cohort. We have found a moderate prevalence of HNI considering that only healthy and HIV stable population were included. Classical risk factors were not associated to HNI, except age. Further analysis is needed to better understand the association of alcohol consumption with HNI and the protective effect of HIV disclosure. Our results raise differences among patients with HNI from different geographical settings.

410 PREDICTORS OF HIV-RELATED COGNITIVE IMPAIRMENT IN EAST AFRICA Benedetta Milanini 1 , Isabel E. Allen 1 , Emmanuel Bahemana 2 , Yakubu Adamu 3 , Francis Kiweewa 4 , Jonah Jonah Maswai 5 , John Owuoth 6 , Christina Polyak 7 , Julie Ake 7 , Victor Valcour 1 1 University of California San Francisco, San Francisco, CA, USA, 2 Walter Reed Program–Tanzania, Mbeya, Tanzania, United Republic of, 3 Walter Reed Program– Nigeria, Abuja, Nigeria, 4 Makerere Univ Walter Reed Proj, Kampala, Uganda, 5 KEMRI/Walter Reed Proj, Kericho, Kenya, 6 KEMRI/Walter Reed Proj, Kisumu, Kenya, 7 Walter Reed Army Institute of Research, Silver Spring, MD, USA Background: Studies in developed countries show that HIV infection is associated with cognitive impairment (CI). We investigated the clinical and demographic predictors of CI in the African cohort study. Methods: HIV+ individuals from Kenya, Uganda, and Tanzania underwent a 30-minute cognitive testing battery that assessed multiple cognitive domains. CI on neuropsychological testing was defined as -1SD on two tests or -2SD on one test when performance was compared to demographically similar seronegative individuals at the same sites. We performed multivariate logistic and linear models to examine factors associated with CI and global neuropsychological testing performance (NP6; i.e. average of the individual scores). Results: We enrolled 2208 HIV+ participants from Kenya (n=1384), Tanzania (n=368) and Uganda (n=456). The mean (SD) age was 40(10), 39(12) and 39(10), respectively (p=0.007). 1508(68%) were on cART, 554(40%) had plasma viral loads <500 copies/ml and 813(37%) met criteria for WHO clinical stage 1. The overall prevalence of CI was 38% (n=844) and independent of cART use (p=0.178) or plasma viral load (p=0.328). Tanzanians showed higher CI rate (51%) compared to Ugandans (31%) and Kenyans (37%;p<0.001). In the overall multivariate logistic regression model, inability to read (aOR:2.93;95%CI: 2.15-4.00;p<0.001), site (aOR: 0.85;95%CI: 0.76-0.96), and WHO clinical stage 4 compared to stage 1 (aOR:1.73;95%CI:1.08-2.76; p=0.022) were associated with higher risk of CI. Multivariate logistic regression models within country showed similar findings with significant effects of literacy in all countries, WHO stage 4 in Kenya and CD4 cell count between 200 and 500 in Uganda (ps<0.02). The only noted difference in the predictive model of NP6 compared to CI was a significant protective effect of CD4 cell count>500 (b=0.09;95%CI:0.02/0.16;p=0.018) and negative effect of WHO stage 3 (b=-0.08;95%CI:-0.15/-0.01;p=0.024) on NP6. Restricting the logistic analysis to literate participants, we found a significant increased risk for CI with WHO stage 4 (aOR:2.25;95%CI:1.06-4.79;p=0.035) and plasma viral load (aOR:1.1;95%CI:1.00-1.31;p=0.046). Conclusion: We found 38% prevalence of CI in our sample; that was independent of cART use. Inability to read, site and higher WHO stage were strongly associated with increased risk of CI. Further studies are needed to better explore the prevalence of CI among HIV+ individuals on cART with higher degrees of viral suppression in African settings. 411 PLASMA D-DIMER RELATES TO PHYSICAL HEALTH AND MOTOR SKILLS ACROSS THE AGE SPAN IN HIV Jessica L. Montoya , Scott L. Letendre, Ronald J. Ellis, Dilip V. Jeste, David J. Moore University of California San Diego, La Jolla, CA, USA Background: Inflammatory processes have been suggested as culprits for early neurologic abnormalities among persons living with HIV (PLWH), which have been purported to remit with effective antiretroviral treatment (ART). We hypothesized that inflammatory processes likely continue throughout the disease and may be associated with poorer physical health and worse fine motor skills as persons age with HIV. Methods: The sample consisted of 107 PLWH and 95 HIV-uninfected adults, ages 36 to 65, with balanced recruiting in each age decade (36-45, 46-66, 56-65). Biomarkers of inflammation (d-dimer, IL-6, MCP-1, soluble CD14, and TNF-α) were measured. Participants completed the Medical Outcomes Study SF-36 to derive a physical health summary score, and fine motor skills were evaluated using the Grooved Pegboard Test. Standard statistical techniques were used for 1) group comparisons (i.e., Welch’s F Test or Wilcoxon rank sum test), 2) associations among continuous variables (i.e., Pearson’s or Spearman correlations), and 3) overall models (multivariable linear regressions to control for the effects of covariates that showed univariable association with outcome at α <.10).

Poster Abstracts

CROI 2018 144