CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

(-86.5, 11.4) mg/m2, peripheral fat 10.0 (-29.7, 46.7) mg/m2, truncal fat 10.0 (-48.1, 62.3) mg/m2, and lean tissue -33.0 (-86.8, 23.7) mg/m2. Multivariable linear regression adjusted for age, gender, and undetectable plasma HIV RNA showed that percent lean tissue change [(year3-year1)/year1] was associated with IL-10 (β=0.24, p=0.04), sE-selectin (β=-0.31, p=0.008), percentage of the inflammatory intermediate (CD14+CD16+) MO (β=-0.24, p=0.04), and TIGIT+TIM-3+ CD8+ T cell (β=-0.52, p=0.03). Total fat change was associated with TIGIT+ CD4+ T cell (β=-0.58, p=0.01), PD-1+ CD4+ T cell (β=-0.46, p=0.04), and TIGIT+PD-1+ CD4+ T cell (β=-0.61, p=0.008). Peripheral fat change was associated with TIGIT+ CD4+ T cell (β=-0.61, p=0.007), PD-1+ CD4+ T cell (β=-0.54, p=0.01), and TIGIT+PD-1+ CD4+ T cell (β=-0.67, p=0.004). Truncal fat change was associated with TIGIT+ CD4+ T cell (β=-0.56, p=0.02) and TIGIT+PD-1+ CD4+ T cell (β=-0.58, p=0.01). Conclusion: Over two years, modest changes in body composition was seen in our patients with chronic HIV. HIV-associated immune dysregulation, including higher T cell exhaustion, higher intermediate MO subset levels as well as a pro- inflammatory cytokine profile were associated with lean tissue and fat loss. 739 DISPARITIES IN DIABETES SCREENING AND TREATMENT AMONG PATIENTS RECEIVING HIV CARE Kassem Bourgi , Peter F. Rebeiro, John R. Koethe, Stephen P. Raffanti, Megan M. Turner, Sally S. Bebawy, Timothy R. Sterling Vanderbilt University, Nashville, TN, USA Background: The aging HIV population is at increased risk for diabetes mellitus (DM). Prior studies have demonstrated racial and gender disparities in HIV care. However, data regarding possible disparities in chronic non- communicable diseases, including DM, among persons living with HIV (PLWH) are limited. Methods: We performed a retrospective cohort study of adult PLWH seen ≥2 times at the Vanderbilt Comprehensive Care Clinic from 2012 to 2015. Patients with prior DM diagnosis, abnormal hemoglobin A1C (A1C), and/or on antihyperglycemic drugs prior to 2012 were excluded. We assessed demographic and disease-specific factors associated with the likelihood of screening and the incidence of impaired glucose control (IGC) (A1C ≥5.7%). In patients identified as diabetic (A1C≥6.5%), we further examined disparities in the initiation of antihyperglycemic medications. We used multiple logistic regression, adjusting for relevant demographic and clinical factors, to evaluate the odds of screening, diagnosis and treatment. Results: Among 2,944 patients included, 1,649 (56%) were screened for DM. Of those screened, 487 (30%) had incident IGC. Among the 112 (7%) diagnosed with DM, 70% (77/112) were subsequently started on antihyperglycemic drugs. In multivariable analyses, African American (AA) race, male sex, older age, and higher body mass index were significantly associated with higher likelihood of A1C screening, and among those screened, these same factors, with the exception of sex, were associated with a higher incidence of IGC (Table). In contrast, suppressed viremia (i.e., having >50% of HIV-1 RNA measurements <200 copies/mL) was significantly associated with higher likelihood of screening but lower incidence of IGC. While patients on protease inhibitors were more likely to be screened, no significant association was noted between antiretroviral regimen type and the incidence of either IGC or DM. Among patients diagnosed with DM, the odds of starting antihyperglycemic drugs was 52% lower for AA patients, although this was only marginally significant (p=0.08). Conclusion: In our cohort of PLWH, overall DM screening was suboptimal and racial and sex disparities were apparent. Women were less likely to be screened for DM, and, despite AA patients being more likely to receive DM screening and have incident IGC and DM, they were less likely to be started on antihyperglycemic drugs. The reasons for these disparities should be explored in future studies to ensure improved and equitable DM screening and treatment.

740 GESTATIONAL DIABETES IN WOMEN ON DOLUTEGRAVIR- OR EFAVIRENZ- BASED ART IN BOTSWANA Keolebogile N. Mmasa 1 , Kathleen M. Powis 2 , Joseph Makhema 1 , Sikhulile Moyo 1 , Mariana Gerschenson 3 , Terence Mohammed 1 , Erik VanWidenfelt 1 , Justine Legbedze 4 , Elaine J. Abrams 5 , Emilia Bagiella 4 , Irwin J. Kurland 6 , Mitchell Geffner 7 , Jennifer Jao 4 1 Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana, 2 Massachusetts General Hospital, Boston, MA, USA, 3 University of Hawaii at Manoa, Honolulu, HI, USA, 4 Icahn School of Medicine at Mt Sinai, New York, NY, USA, 5 ICAP at Columbia University, New York, NY, USA, 6 Albert Einstein College of Medicine, Bronx, NY, USA, 7 University of Southern California, Los Angeles, CA, USA Background: HIV and antiretroviral therapy (ART), including protease inhibitors, have been associated with gestational diabetes (GDM). Little data exist on GDM in pregnant women living with HIV (PWLHIV) in sub-Saharan Africa or on integrase strand transfer inhibitors such as Dolutegravir (DTG). Methods: We prospectively enrolled PWLHIV and HIV-uninfected pregnant women >18 years from antenatal clinics in Gaborone, Botswana. Women with documented pre-existing diabetes were excluded. We screened for GDM using a 75-g Oral Glucose Tolerance Test (OGTT) performed at 24-28 weeks (wks) gestational age (GA) or at the earliest prenatal visit for those presenting after 28 wks. Fasting, 1-hour (hr), and 2-hr plasma glucose were measured. GDM was defined as meeting any of the following criteria: fasting glucose >92 mg/dL, 1-hr glucose >180 mg/dL, or 2-hr glucose >153 mg/dL. Data were compared between groups using Wilcoxon, Chi-square, or Fisher’s exact test as appropriate. Logistic regression models were fit to assess the association between maternal HIV infection and GDM. Subgroup analyses were performed amongst PWLHIV to assess the association between maternal ART use in pregnancy [DTG- vs. Efavirenz (EFV)-based] and GDM. Results: Of 178 women enrolled, 53%were PWLHIV. PWLHIV were older than HIV-uninfected women (median age 28 vs 24 yr, p <0.01) and more likely to have hypertension prior to pregnancy (5% vs 0%, p =0.05). Median gravida was higher in PWLHIV (3 vs 1, p <0.01). GA at OGTT and body mass index (BMI) did not differ between the two groups. Of PWLHIV, 95% had an HIV-1 RNA level <400 copies/mL and 95%were on ART (31% on EFV- and 69% on DTG-based ART) at the time of OGTT. All PWLHIV received a backbone ART of tenofovir/ emcitritabine. Overall, 10.1% of women in the cohort had GDM. No significant difference between groups was seen (12% for PWLHIV vs 8% among HIV- uninfected women, p =0.62). This relationship persisted even after adjusting for confounders. In multivariable analysis, BMI was positively associated with GDM (Table). In addition, among PWLHIV, rates of GDM did not differ between women receiving DTG- vs. EFV-based ART (8% vs 18%, p =0.27). Conclusion: PWLHIV in Botswana receiving EFV- or DTG-based ART were not at increased risk for GDM compared to uninfected women. These results are reassuring. Further studies in larger cohorts are warranted to confirm these findings with expanding global use of DTG in pregnancy.

Poster Abstracts

CROI 2018 276