CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Both HIV and METH contribute to premature biological aging with HIV having broader physiologic and epigenetic effects than METH. Consistent with earlier observations, METH was associated with less mtDNA damage, possibly due to induction of autophagy and cell turnover. This may explain the association with improved renal function in METH users, as mitochondrial dysfunction is known to play a significant role in renal disease. 761 SHORT-TERM OUTCOMES FOR MAJOR NON-CARDIAC SURGERY IN HIV INFECTION Keith M. Sigel 1 , Lesley Park 2 , Michael Leapman 3 , Amy C. Justice 3 , Sheldon T. Brown 4 , Joseph T. King 5 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA, 2 Stanford University, Stanford, CA, USA, 3 Yale University, New Haven, CT, USA, 4 James J. Peters VA Medical Center, Bronx, NY, USA, 5 VA Connecticut Healthcare System, West Haven, CT, USA Background: The risk of surgical complications in HIV infected (HIV+) persons is unclear. We identified HIV+ patients on ART and uninfected comparators in a national cohort undergoing major non-cardiac surgeries to determine the rates and risk factors of major complications and death associated with HIV. Methods: We linked clinical data from the Veterans Aging Cohort Study (VACS) to surgical outcomes from the Veterans Affairs Surgical Quality Improvement Project to identify VA patients undergoing major surgeries (2000-2015). We classified surgical procedures according to the Healthcare Cost and Utilization Project Clinical Classification System (CCS), and matched HIV+ patients on ART to uninfected subjects 1:2 by CCS category (N=13,071; 4,357 HIV+). We compared crude 30-day mortality, post-operative infection and other major complication rates by HIV status and fit multivariable logistic regression models, adjusting for confounders (including, but not limited to, age, smoking, surgery year, albumin level, anesthesia risk class, cancer diagnosis, diabetes, heart disease, recent chemotherapy or steroid use). We then evaluated risk of surgical complications in HIV+ subjects according to HIV-specific factors (recent CD4, viral suppression, VACS index score). Results: Patients did not differ by HIV status in age (median 56 years) or race/ ethnicity. HIV+ patients had higher preoperative anesthesia risk scores and more prevalent metastatic cancer, but had lower BMI and were less likely to be diabetic or taking corticosteroids. The most frequent surgical procedures were hernia repair, hip arthroplasty and cholecystectomy. Crude 30-day mortality and frequency of other complications (including infectious) did not differ by HIV status (Table 1). HIV was not significantly associated with increased short-termmortality (odds ratio: 1.4; 95% confidence interval: 0.8-2.4) or other complications after adjustment. Among HIV+ subjects low preoperative CD4 count, lack of HIV viral suppression, and higher VACS index values were associated with mortality in separate models, but in a mutually adjusted model only VACS index score retained significance as a predictor. Conclusion: Compared with procedure-matched uninfected patients, HIV+ patients on antiretroviral therapy undergoing major non-cardiac surgery have similar rates of 30-day post-operative mortality, infections and other complications.

762 HOSPITALIZATION RATES AND OUTCOMES IN A SOUTHEASTERN US CLINICAL COHORT, 1996-2016 Thibaut Davy-Mendez , Sonia Napravnik, Oksana Zakharova, David Wohl, Claire E. Farel, Joseph J. Eron University of North Carolina Chapel Hill, Chapel Hill, NC, USA Background: Hospitalizations in the context of an aging HIV-infected population with increasing co-morbidities are not well known. We examined trends in hospitalization rates, outcomes, and risk factors in the UNC CFAR HIV Clinical Cohort (1996-2016). Methods: Patients contributed time from latter of 01-1996 or HIV care initiation at UNC, until first of 12-2016, or death. Patient time was also censored at loss to follow-up (LTFU-18 months with no clinical visit), with patients contributing additional time if reentering HIV care. We calculated crude annual hospitalization rates per 100 person-years (PY), overall and stratified by CD4 at hospitalization (CD4 Results: The 4327 patients contributed 30,000 PY and were 29% female, 40% MSM, and 60% African-American. Patient CD4 counts increased in more recent calendar years (median 618, IQR 411-845, 6%<200 in 2016 vs 300, 130-464, 36%<200 in 1996, P<0.01). Crude hospitalization rate over the study period was 33.7/100 PY (95% CI 33.0-34.3). From 1996 to 2016, hospitalization rates per 100 PY overall and with CD4<200 decreased from 47.1 to 21.0 (41.5-53.3, 18.9-23.4), and 26.7 to 4.3 (22.4-31.4, 3.3-5.4), respectively, while hospitalizations with CD4>200 remained constant from 14.8 to 14.4 (11.7-18.5, 12.6-16.3) (Figure 1A, P<0.01, P<0.01, P=0.50, respectively). MSM had lower hospitalization rates than heterosexual men, and African-Americans and Hispanics had higher rates than whites (Figure 1A). Older age was associated with increased rates of hospitalization with CD4>200, but lower rates with CD4<200 (IRR per 10-year increase 1.24, 95% CI 1.15-1.34; 0.88, 0.81-0.96, respectively). Overall, mean LOS was 7.1 (95% CI 6.6-7.5) days, inpatient mortality was 1.5% (95% CI 1.3-1.7), with no change over time (Figure 1B, P=0.98 and P=0.30, respectively). Conclusion: Among HIV-infected patients in care, overall hospitalizations decreased substantially over the last 20 years, largely driven by decreased hospitalizations with CD4<200; while hospitalizations with CD4>200 remained constant. Hospitalization outcomes did not change over calendar time.

Poster Abstracts

CROI 2018 285