CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Among HIV+ persons with both HIV and CVDRF, linkage and retention rates were similar for the integrated and referred CVDRF care models. Despite suboptimal retention in CVDRF management, pts in both arms showed improvement in CVDRF control. Integrated HIV and CVDRF services are more convenient for pts; additional provider training may further improve outcomes.

Background: ART programs may promote greater utilization of healthcare services for co-morbid diabetes and hypertension, but the implications of this relationship for blood pressure (BP) and glycemic control remain unclear. In this study, we sought to assess whether the “ART advantage” extends to improved blood pressure and glucose measures among participants with these conditions. Methods: This study was conducted using baseline data from Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). HAALSI is a cohort of 5,059 adults aged 40+ in rural South Africa. Participants in HAALSI were randomly sampled and surveyed between November 2014 and November 2015. Height, weight, BP, blood glucose and HIV infection parameters, including viral load (VL) and ART drug levels, were collected on all consenting participants. Healthcare utilization was self- reported. We first fit log binomial regression models to examine the association between stage in the HIV care cascade ([1] HIV-, [2] HIV+/No ART, [3] ART/ Detectable VL, and [4] ART/Suppressed VL) and diagnosis, treatment and control of hypertension or diabetes. We then used linear regression models to estimate differences in systolic BP and blood glucose among those with diagnosed hypertension or diabetes. In all regression models, we controlled for age, sex, BMI, education and wealth; the model for blood glucose was additionally adjusted for fasting status. Results: In this cohort, ART/Suppressed VL was associated with greater awareness of hypertension diagnosis [adjusted risk ratio (aRR) 1.21, 95% CI: 1.10 – 1.32] and treatment of hypertension [aRR 1.25, 95% CI: 1.09 – 1.44] among those who met criteria for a diagnosis of hypertension, compared to being HIV-. There were no significant relationships between stage in the HIV care cascade and awareness of diagnosis or treatment of diabetes. Among those with diagnosed hypertension or diabetes, ART/Suppressed VL was associated with lower mean systolic BP [-5.94 mm Hg, 95% CI: -9.68 – -2.20] and lower mean glucose [-3.74 mmol/L, 95% CI: -5.95 – -0.58], compared to being HIV-. Conclusion: Progression in the HIV care cascade was associated with improved clinical hypertension and diabetes control. HIV treatment programs may provide a platform for health systems strengthening for cardiometabolic disease. Future studies are needed to assess the causality and mechanisms that underlie ART program use and control of cardiometabolic conditions. 713 PREVALENCE OF NON-COMMUNICABLE DISEASES IN LONG-TERM AIDS SURVIVORS IN HAITI Samuel Pierre 1 , Vanessa Rivera 2 , Grace Seo 2 , Benedict Charles 1 , Gaetane Julmiste 1 , Alexandra Apollon 1 , Emelyne Dumont 1 , Molene Cadet 1 , Myung Hee Lee 2 , Katey Walsh 2 , Adias Marcelin 1 , Patrice Severe 1 , Daniel Fitzgerald 2 , Jean W. Pape 1 , Margaret McNairy 2 1 GHESKIO, Port-au-Prince, Haiti, 2 Weill Cornell Medicine, New York, NY, USA Background: Little is known about the prevalence of NCDs among long-term AIDS survivors in resource-poor settings, which is especially important as life expectancies for many patients who are on antiretroviral therapy (ART) are over 10 years. We describe the prevalence of CVD risk factors (CVDRF) and predictors among a cohort of 10-year AIDS survivors in care at the GHESKIO clinic in Port- au-Prince, Haiti. Methods: As part of GHESKIO’s expansion of HIV services to include CVDRF assessment among long-term AIDS survivors, GHESKIO staff were trained in screening for hypertension (HTN), diabetes (DM), obesity, smoking and cholesterol. Using routinely collected clinical data, we conducted a cross- sectional study among a cohort of patients who initiated ART fromMarch 2003- April 2004 and remained in care at GHESKIO between October 2014-December 2016. CVDRF assessment for long-term AIDS survivors included: HTN defined as 2 measurements of systolic blood pressure (SBP) >140 mmHg or diastolic blood pressure (DBP) >90 mmHg and/or pharmacy pick-up of HTN medication; DM as HbA1c >6.5% and/or pick up of DMmedication; obesity as BMI >30 kg/m2; and hypercholesterolemia (HC) as total cholesterol >200mg/dL. Viral suppression was defined as HIV-1 RNA <1,000 copies/mL. Factors from ART initiation and CVDRF assessment were evaluated for association with HTN using logistic regression. Variables in this model were chosen by backward selection (exit criteria of p>0.05). Results: 397 patients were alive and remained in care at time of CVDRF evaluation. At ART initiation, 59%were female, median age was 38 years (IQR 33-44), and median CD4 count was 117 cells/mm 3 (IQR 34-201). At time of CVDRF assessment, median FU time from ART initiation was 12.1 years (IQR 11.7-12.7), median CD4 count was 574 cells/mm 3 (IQR 378-771), and 77% (282/366) were virally suppressed. At CVDRF assessment, 58% (224/385) had HTN with 24% (91/385) stage II (SBP>160 or DBP>100), 8% (24/297) had DM, 43% (119/275)

711 HIGH PREVALENCE OF HYPERTENSION IN HIV-INFECTED AND HIV- UNINFECTED ADULTS IN BOTSWANA Mosepele Mosepele 1 , Kara Bennett 2 , Tendani Gaolathe 3 , Joseph Makhema 4 , Mompati O. Mmalane 3 , Molly Pretorius Holme 5 , Refeletswe Lebelonyane 6 , Kathleen M. Powis 7 , Jean Leidner 8 , Joseph N. Jarvis 4 , Neo Tapela 6 , Tiny Masupe 1 , Lucky Mokgatlhe 1 , Kathleen Wirth 5 , Shahin Lockman 5 1 University of Botswana, Gaborone, Botswana, 2 Bennett Statistical Consulting, Inc, New York, NY, USA, 3 Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana, 4 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 5 Harvard University, Cambridge, MA, USA, 6 Botswana Ministry of Health, Gaborone, Botswana, 7 Massachusetts General Hospital, Boston, MA, USA, 8 Goodtables Data Consulting, Norman, OK, USA Background: Hypertension is a major risk factor for cardiovascular disease, and treated HIV infection has been associated with hypertension in some but not all studies. The prevalence of hypertension among HIV-infected and – uninfected individuals at a population level in high HIV-prevalence settings in Africa is not well described. Methods: We are following a random sample of ~20% of adults in 30 rural communities in Botswana as part of a community-randomized HIV prevention trial. During the final household survey, we conducted a one-time hypertension assessment, including blood pressure measurement, in 8 communities from February to August 2017. Hypertension was defined as any combination of the following: self-reported prior diagnosis of hypertension, use of any anti-hypertensive medications (prior or current), or either mean systolic blood pressure >140mmHg or mean diastolic blood pressure >90mmHg. We examined differences in hypertension diagnosis and use of anti-hypertensive medications by current HIV-status as crude and adjusted prevalence ratios. Results: Among 2,441 participants assessed (709 [29%] HIV-infected, 1,652 [68%] female, median age 37.4 years [range 18-67]), 732 (30%, 95% CI 27-34%) were hypertensive. HIV-infected individuals were less likely to meet the definition of hypertension than HIV-uninfected (adjusted prevalence ratio [aPR]: 0.7; 95%CI: 0.66-0.8). Of the 732 participants with hypertension, 358 (49%) had a pre-existing diagnosis of hypertension; 90% of these participants were currently taking anti-hypertensive medication, and there was no difference in use of anti-hypertensive medications by HIV status, among those previously diagnosed with hypertension (aPR: 0.99; 95%CI: 0.96-1.03). Fifteen percent of those assessed were found to have elevated BP in the absence of a prior hypertension diagnosis. Undiagnosed hypertension was significantly less common among HIV-infected persons (aPR: 0.7; 95%CI: 0.6-0.9). Conclusion: Nearly one in three adults in rural Botswana had hypertension (previously diagnosed or current). While the vast majority of previously- diagnosed individuals were receiving antihypertensive medications, one-half of those with hypertension had not previously been diagnosed. Consideration should be given to leveraging HIV healthcare infrastructure for diagnosing hypertension among HIV-uninfected individuals in this setting. 712 HYPERTENSION AND DIABETES CONTROL ALONG THE HIV CARE CASCADE IN SOUTH AFRICA Jennifer Manne-Goehler 1 , Mark J. Siedner 2 , Livia Montana 3 , Guy Harling 4 , Pascal Geldsetzer 3 , Julia K. Rohr 3 , Xavier Gomez-Olive 5 , Alisha Wade 5 , Thomas Gaziano 6 , Kathleen Kahn 5 , Stephen Tollman 5 , Till Bärnighausen 7 1 Beth Israel Deaconess Medical Center, Boston, MA, USA, 2 Massachusetts General Hospital, Boston, MA, USA, 3 Harvard University, Cambridge, MA, USA, 4 University College London, London, UK, 5 University of the Witwatersrand, Johannesburg, South Africa, 6 Brigham and Women’s Hospital, Boston, MA, USA, 7 Heidelberg University, Heidelberg, Germany

Poster Abstracts

CROI 2018 265