CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

745 PROGRESSION OF QUANTITATIVE EMPHYSEMA IN A HIV-INFECTED SPANISH COHORT Francisco Fanjul 1 , Gloria Samperiz 2 , Helem Haydee Vilchez 1 , María Leyes 1 , Antoni Campins 1 , Maria Angeles Ribas 1 , María Peñaranda 1 , Javier Murillas 1 , Luisa Martin 1 , Angel Ríos 1 , Meritxell Lopez Zamora 1 , Jose Luis Valera 1 , Melchor Riera 1 1 Hospital Universitario de Son Espases, Palma de Mallorca, Spain, 2 Hospital Universitario Miguel Servet, Zaragoza, Spain Background: Prevalence of radiological emphysema is higher among patients living with the HIV (PLWH) and could have important clinical implications as it´s been described that emphysema is associated with increased respiratory symptoms, risk of lung neoplasms and mortality when compared to uninfected populations. No previous study has described the radiological progression of emphysema measured quantitatively. Our objective was to report that progression and analyze possible risk factors for accelerated progression Methods: Prospective cohort study started in 2009 including 285 randomly selected adult PLWH being followed at Hospital Son Espases, Spain. Patients underwent at inclusion high resolution chest tomography (HRCT), lung function tests and clinical questionnaires. Smoking status, epidemiologic and clinical variables were also registered. Between 2014-2016, patients who continued being followed-up were offered to repeat the initial evaluation tests. Quantitative emphysema was calculated as percentage of low-attenuation lung areas below -950 HU (%LLA). Progression of emphysema was compared between groups using Paired-Samples T test, Wilcoxon test or ANCOVA adjusted to basal measure for repeated measures depending on variable distribution. Bivariate and multivariate logistic regression analyses were used to explore the Odds Ratio (OR) between potential risk factors and progression of emphysema. Results: 285 patients were included in 2009, 29 patients died during followup and 150 patients ( 55.37 +-6.64 years, 76.5%male) with at least two HRCT were included in the analysis. Smoking status was: 58.4% active, 26.8% former and 14.8% never. Baseline CD4 cell count and CD4/CD8 ratio was 583 cells/ul (IQR 394-814.5) and 0.70 (IQR 0.44-1.01) respectively. 96.4% patients were receiving HAART at inclusion in the cohort and 94.6% had HIV-VL <50 cp/ml. Median quantitative emphysema progression was 0.14% (IQR: 0.00-0.58). Prevalence of patients with >1% emphysema increased from 10,48% to 24,20%. Accumulated incidence rate of >1% emphysema was 20,3 cases/1000 patient-years. Differences between groups and risk factors are represented in [Table 1] Conclusion: Higher progression of emphysema was associated with: (1) Traditional risk factors as smoking (2) Altered baseline spirometric variables as diffusion capacity, residual volume, FEF25-75 and TLC (3) Previous AIDS defining event (CDC C stage) (4) Lower CD4/CD8 ratio at baseline.

744 FOOD INSECURITY IS ASSOCIATED WITH INCREASED INFLAMMATION AMONG HIV-POSITIVE WOMEN Anna Leddy 1 , Annelys Roque 1 , Lila A. Sheira 1 , Edward A. Frongillo 2 , Alan Landay 3 , Mardge H. Cohen 3 , Phyllis Tien 1 , Janet M. Turan 4 , Bulent Turan 4 , Sheri Weiser 1 1 University of California San Francisco, San Francisco, CA, USA, 2 University of South Carolina at Columbia, Columbia, SC, USA, 3 Rush University, Chicago, IL, USA, 4 University of Alabama at Birmingham, Birmingham, AL, USA Background: Chronic inflammation is associated with worse HIV clinical outcomes including opportunistic infections and non-HIV related comorbidities such as cardiovascular disease (CVD). Limited research has considered how social and structural factors influence chronic inflammation among people living with HIV. Food insecurity, which is associated with HIV-related morbidity and mortality, as well as increased risk of chronic diseases such as diabetes and CVD, may be one such factor. This study assessed whether food insecurity is associated with higher levels of inflammation among a large sample of HIV- infected women in the United States. Methods: We analyzed cross-sectional data collected from April-September 2015 from participants of the Women’s Interagency HIV Study, a multi-site prospective cohort study of women with or at risk for HIV at 9 sites in the United States. Our sample comprised 409 HIV-infected women on antiretroviral therapy, with available fasting blood, and without diagnoses of comorbidities associated with high levels of inflammation (e.g., cancer). The primary predictor was any food insecurity measured using the U.S. Household Food Security Survey. Outcomes were natural log transformations of pro-inflammatory cytokines IL-6 and tumor necrosis factor receptor 1 (TNFR1). We conducted multivariable linear regressions adjusting for age, race/ethnicity, education, income, smoking, and viral load. Results: Nearly one-third of the women (30.8%) were food insecure. Less than one-quarter (21%) had detectable viral loads and 6% had CD4 less than 200 cells/mm³. In adjusted analysis, any food insecurity was associated with 1.28 times the level of IL-6 (95% CI: 1.09, 1.51) and 1.14 times the level of TNFR1 (95% CI: 1.06, 1.23). In sensitivity analysis restricted to those who were virally suppressed and with CD4 cell count greater than 500 cells/mm³, findings remained significant. Conclusion: Food insecurity is associated with elevations in markers of inflammation in HIV-infected women independent of viral load or CD4 cell counts. Prior research shows that both IL-6 and TNFR1 are associated with increased HIV-related morbidity and mortality as well as increased risk of cardiometabolic disease. Longitudinal research to assess whether IL-6 and TNFR1 are on the causal pathway between food insecurity and negative HIV and chronic disease clinical outcomes is needed.

Poster Abstracts

746 SMOKING AND ACCELERATED LUNG FUNCTION DECLINE IN THE START PULMONARY SUBSTUDY David MacDonald 1 , Gary Collins 2 , Nicholas Ingraham 1 , Anne Melzer 1 , Kristina Crothers 3 , Anchalee Avihingsanon 4 , Henry Mugerwa 5 , Matti Ristola 6 , Jonathan Shuter 7 , Ken Kunisaki 1 1 Minneapolis VA Health Care System, Minneapolis, MN, USA, 2 University of Minnesota, Minneapolis, MN, USA, 3 University of Washington, Seattle, WA, USA, 4 HIV–NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 5 Joint Clinical Research Centre, Kampala, Uganda, 6 Helsinki University Central Hospital, Helsinki, Finland, 7 Montefiore Medical Center, Bronx, NY, USA Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability globally. Smoking tobacco is the major risk factor for

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