CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

had HC, 8% (20/248) were smokers, and 10% (25/245) were obese. 80% of patients with HTN were not on HTN medication. Age (decade increment, adjusted OR (aOR) =1.73, p<0.001) and weight at CVDRF assessment (10lb increment, aOR=1.09, p=0.019) were significantly associated with HTN. Conclusion: Long-term AIDS survivors have a high prevalence of CVDRFs, primarily HTN and HC. Improved screening and management of NCDs are needed into routine HIV care in order to maximize health outcomes among aging HIV patients in resource-limited settings 714 PAN AFRICAN PULMONARY HYPERTENSION COHORT COMPARING RISK AND SURVIVAL OF HIV+/HIV- Friedrich Thienemann , Vitaris Kodogo, Feriel Azibani, Karen Sliwa University of Cape Town, Cape Town, South Africa Background: The incidence of pulmonary hypertension (PH) in human immunodeficiency virus (HIV) infected persons is much higher than in the general population. Further, PH is more prevalent in Africa due to the high prevalence of risk factors in the region. Data characterizing risk and survival of HIV infected adults presenting with PH in Africa is lacking. Methods: The Pan African Pulmonary Hypertension Cohort (PAPUCO), a prospective, multinational registry of 254 consecutive patients (97% of African descent) from 9 specialist centers in 4 African countries was implemented. The antecedents, characteristics and management of newly diagnosed PH plus 3 year survival were studied in patients that underwent HIV testing. We compared data of HIV+ to HIV- patients presenting with PH. Results: There were 134 cases of PH (median age 39 years, range 19 to 91 years), 47 (35%) HIV+ (median age 36 years) and 87 (65%) HIV- (mean age 44 years, p=0.0004). 40% HIV+ were living in temporary shelters, compared to 18% HIV- (p=0.0215). Cardiovascular risk factors and co-morbidities were similar except for previous history of TB (HIV+ 62% vs. HIV- 18%, p<0.0001). Six-minute walk test (6MWT) distance less than 300 meters was a common finding in HIV- (36%), but rare in HIV+ (1%, p=0.0030). In contrast, HIV+ were tachycardic (p=0.0160) and tachypnoeic (p=0.0374) at presentation. PAH was more common in HIV+ (36% HIV+ vs. 15% HIV-, p=0.0084), whereas PH due to left heart disease (PH/LHD) was more common in HIV- (72% HIV- vs. 36% HIV+, p=0.0009). PH due to lung diseases and hypoxia (PH/LD) was more common in HIV+, but did not reach statistical significance (HIV+ 19% vs. HIV- 9%, p=0.1102) and was attributed to previous TB in HIV+ (100%) and HIV- (67%). There was a clear trend of poorer survival in patients with HIV PAH, compared to HIV+ diagnosed with PH/LHD or PH/LD (Figure 1, p=0.14). Conclusion: HIV+ patients diagnosed with PH, where younger, poorer, previously co-infected with TB compared to HIV- patients. HIV+ patients appear to be better off at presentation (6MWT) despite raised vital parameters suggestive for early heart failure, but have excess mortality. HIV was a common cause PAH and TB a contributing factor to the overall burden of PH in HIV. Carefully clinical evaluation is warranted and early echocardiography assessment recommended, especially in those with previous TB. Access to specific PH treatment in Africa needs to be established.

infection and hypertension among South African adults accessing HIV testing services in a poor urban township. Since hypertension screening routinely occurs after HIV testing, the goal of this study was to determine if blood pressure measurements and hypertension screening are dynamic around the time of HIV testing in South Africa. Methods: We measured a seated resting blood pressure in adults (≥18 years) prior to HIV testing, and again after receiving HIV test results, in an ambulatory HIV clinic in KwaZulu-Natal, South Africa. We assessed sociodemographics, smoking, body mass index, diabetes, substance abuse, and anxiety/depression. We used blood pressure categories defined by the Seventh Joint National Committee (JNC 7) classifications, which includes normal, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. Results: Among 5,428 adults, mean age was 31 years, 51%were male, and 35% tested HIV-positive. 47% (2,634) had a normal blood pressure, 40% (2,225) had prehypertension, and 10% (569) had stage 1 or 2 hypertension. HIV-infected adults had significantly lower blood pressure measurements and less hypertension, as compared to HIV-negative adults; while also having significantly elevated blood pressures after HIV testing. In separate multivariable models, HIV-infected adults had a 26% lower odds of hypertension, compared to HIV-uninfected adults (aOR=0.74, 95% CI: 0.60- 0.90), and HIV-infected adults with a CD4 ≤200 cells/mm 3 had a 42% lower odds of hypertension (aOR=0.58, 95% CI: 0.38-0.89). The mean arterial blood pressure was 6.8 mmHg higher among HIV-infected adults after HIV testing (p <0.001). Conclusion: Untreated HIV-infected adults, and particularly immunocompromised adults, had lower baseline rates of hypertension compared to HIV-negative adults, and that blood pressure transiently increased after receiving a positive HIV test result. Since hypertension screening may be dynamic around the time of HIV testing, hypertension screening should ideally occur before HIV testing, be repeated again after ART initiation and viral load suppression, and be continued at regular intervals. As ART delivery increase the life expectancy of those with HIV, providing appropriate diagnosis and management of hypertension will become increasingly important.

Poster Abstracts

716 SIGNS OF CARDIOVASCULAR DISEASE IN A RURAL AFRICAN POPULATION; DOES HIV PLAY A ROLE? Alinda Vos 1 , Kerstin Klipstein-Grobusch 1 , Hugo Tempelman 2 , Diederick Grobbee 1 , Roel Coutinho 1 , Walter Devillé 2 , Roos Barth 1 1 University Medical Center Utrecht, Utrecht, Netherlands, 2 Ndlovu Care Group, Groblersdal, South Africa Background: HIV is associated with an increased risk of cardiovascular disease (CVD) in high income countries, but not necessarily in low- and middle income countries. As 70% of people living with HIV reside in sub-Saharan Africa, a good insight into the effects of HIV on the cardiovascular system is mandatory to pursue healthy aging. Increased arterial stiffness, measured with carotid- femoral pulse wave velocity (cfPWV), is regarded as a marker of organ damage and is a strong predictor for CVD. This study investigates the prevalence of abnormal arterial stiffness and whether HIV is associated with arterial stiffness in a rural African setting. Methods: Data were collected as part of the Ndlovu Cohort study. This is a prospective, ongoing study in a rural area in South Africa including HIV- positive and HIV-negative adults without known CVD. Data collection includes assessment of hypertension, body mass index (BMI), dyslipidemia, diabetes mellitus (DM), and cfPWV measurement (SphigmoCor). Abnormal arterial stiffness was defined as a cfPWV of more than 8 m/s as previously suggested to

715 INTEGRATING HYPERTENSION SCREENING AT VOLUNTARY HIV TESTING IN SOUTH AFRICA Paul K. Drain 1 , Ting Hong 1 , Hilary Thulare 2 , Mahomed-Yunus Moosa 3 , Connie L. Celum 1 1 University of Washington, Seattle, WA, USA, 2 AIDS Healthcare Foundation, Durban, South Africa, 3 University of KwaZulu-Natal, Durban, South Africa Background: Guidelines recommend integrating hypertension screening for untreated HIV-infected. We sought to understand the association between HIV

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