CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

719 ARV-NAIVE HIV-INFECTED ADULTS HAD LOWER BONE FORMATION MARKERS THAN HIV-UNINFECTED Lalita Wattanachanya 1 , Jureeporn Jantarapakde 2 , Anchalee Avihingsanon 3 , Reshmie Ramautarsing 2 , Stephen J. Kerr 3 , Deondara Trachunthong 2 , Thanaporn Mansawat 3 , Kanitta Pussadee 3 , Nipat Teeratakulpisarn 2 , Tanate Jadwattanakul 4 , Tawatchai Chaiwatanarat 1 , Nittaya Phanuphak 2 , Sarat Sunthornyothin 1 , Praphan Phanuphak 2 1 Chulalongkorn University, Bangkok, Thailand, 2 Thai Red Cross AIDS Research Center, Bangkok, Thailand, 3 HIV–NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 4 Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand Background: There are limited studies regarding bone health among HIV- infected patients from Asia, especially in females. We determined bone mineral density (BMD), bone markers and vitamin D status in HIV-infected Thais who had not started ART. Methods: The TNT-HIV 003 cohort was established in 2012 to evaluate morbidity and mortality among HIV-infected patients from 3 sites in Thailand. Healthy subjects (free of diabetes, hypertension, fracture, active OI) aged ≥30 years, with and without HIV infection were enrolled. BMD at the lumbar spine, femoral neck, and total hip were measured using Hologic DXA. BMD, serum 25-hydroxyvitamin D levels, and bone turnover markers (serum procollagen type 1 N-terminal propeptide(P1NP), osteocalcin(OC) and C-terminal cross- linking telopeptide of type I collagen(CTX) at the patients’ baseline visit were analysed. Results: BMD from 302 HIV positive (56.2%male) and 269 HIV negative (47.2% male) were analyzed. HIV-positive patients were 1.5 years younger (men:39.7±6 vs. 41.3±6yr; women:39.5±4 vs.41.2±5 yr) and had lower BMI (men:22.5±3vs 24.1±3yr; woman:22.7±4 vs 23.3±4yr). Compared to HIV-negative control, HIV- positive had higher mean serum 25-hydroxyvitamin D level(32.2±10 vs. 26.1±10 ng/ml; women:29.9±9 ±6 vs. 20.7±6ng/ml) but this was not correlated with BMD. There were no differences in the lumbar spine, total femur or femoral neck BMD between subjects with and without HIV. Only few participants were classified as having low BMD. In 296 patients who participated in a bone marker turnover sub-study, the markers for bone formation, serum P1NP and osteocalcin were significantly lower in HIV-infected patients, particularly those with CD4 count<350cells/mm 3 . Conclusion: Middle-aged Thai patients with HIV infection, who were not yet on ART, did not have lower BMD or lower vitamin D levels compared to HIV-uninfected control. However, they had lower bone formation markers, particularly those with low CD4 count < 350 cells/mm 3 . This finding supports the early initiation of ART.

720 TDF PROPHYLAXIS FOR PMTCT OF HBV: EFFECT ON MATERNAL AND INFANT BONE MINERAL DENSITY Nicolas Salvadori 1 , Bo Fan 2 , Waralee Teeyasoontranon 1 , Nicole Ngo-Giang- Huong 3 , Siriluk Phanomcheong 4 , Anita Luvira 4 , Achara Puangsombat 4 , Arunrat Suwannarat 4 , Ussanee Srirompotong 4 , Chaiwat Putiyanun 4 , Athena Kourtis 5 , Marc Bulterys 6 , George K. Siberry 7 , Gonzague Jourdain 3 1 Chiang Mai University, Chiang Mai, Thailand, 2 University of California San Francisco, San Francisco, CA, USA, 3 IRD, Chiang Mai, Thailand, 4 Ministry of Pubic Health, Nonthaburi, Thailand, 5 CDC, Atlanta, GA, USA, 6 WHO, Geneva, Switzerland, 7 NIH, Bethesda, MD, USA Background: Tenofovir disoproxil fumarate (TDF) is increasingly used for hepatitis B virus (HBV) mono-infected pregnant women with high HBV DNA levels to prevent mother-to-child transmission (PMTCT) of HBV. In HIV infected women, TDF may adversely affect maternal and infant bone mineral density (BMD). In a sub-study of a randomized controlled trial of TDF for PMTCT of HBV, we assessed the effect of TDF on maternal and infant BMD one year after delivery/birth. Methods: HBV chronically infected mothers were randomized to receive TDF or a matching placebo from 28 weeks gestational age (GA) to 2 months postpartum, in the iTAP study (NCT01745822) in Thailand. Breastfeeding was encouraged. Maternal hip and lumbar spine BMD and infant lumbar spine BMD were measured at 12 months after delivery/birth using dual-energy X-ray absorptiometry (DXA) at three participating sites (phantoms were circulated for cross calibration). All investigators and operators were blinded to the treatment arm. The analysis was based on DXA scans performed at sites and centrally reviewed by two experts (BF, WT) for accuracy. A sample of at least 45 mother-infant pairs per arm provided over 80% power to detect a 13.5%mean reduction in infant lumbar spine BMD in the TDF arm compared to the placebo arm (two-sided Student’s t-test, significance level 0.05). Results: A total of 135 mother-infant pairs (69 TDF, 66 placebo) plus 5 singleton mothers (2 TDF, 3 placebo) who did not come with their infants and 2 singleton infants (1 mother unavailable, on TDF; 1 mother pregnant, not eligible, on placebo) were included. Median (interquartile range) maternal body mass index before pregnancy was 21.1 kg/m2 (19.1 to 23.9), weight at enrollment 62 kg (56 to 71), age at enrollment 26.7 years (23.3 to 29.2) and GA at delivery 39.1 weeks (38.3 to 40.1). Of the 140 mothers, 135 breastfed for a median 6.1 months (3.8 to 12.0) and 5 did not breastfeed. BMD was assessed at a median 12.2 months (11.9 to 12.5) after delivery/birth. Infant median weight was 8.9 kg (8.2 to 9.8) and length 74 cm (72 to 76). Maternal and infant characteristics were balanced between arms. Results of maternal hip and lumbar spine BMD and infant lumbar spine BMD measurements are provided in the table. Conclusion: One year after delivery/birth, there were no significant differences in maternal hip or lumbar spine BMD or infant lumbar spine BMD between arms. In the hypothesis that BMD was affected by TDF exposure, this did not persist 10 months after treatment discontinuation.

Poster Abstracts

721 OPTION B-PLUS ART, PREGNANCY, LACTATION AND BONE HEALTH IN UGANDAN WOMEN Florence Nabwire 1 , Ann Prentice 1 , MatthewM. Hamill 1 , Mary G. Fowler 2 , Josaphat Byagumisha 3 , Adeodata Kekitiinwa 4 , Gail R. Goldberg 1 1 MRC Elsie Widdowson Laboratory, Cambridge, UK, 2 Johns Hopkins University, Baltimore, MD, USA, 3 Makerere University, Kampala, Uganda, 4 Baylor College of Medicine Children’s Foundation, Kampala, Uganda Background: Pregnancy and lactation are associated with physiological changes in bone mineral (BM), but most evidence shows that this is recovered after weaning. ART may disrupt the normal process of BMmobilisation in the mother, leading to bone loss that is not recovered. However, data are limited on whether HIV-infected (HIV+) women on option B+ ART experience greater reductions in BM during lactation compared to HIV-uninfected (HIV-). The object

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