CROI 2018 Abstract eBook

Abstract eBook

Oral Abstracts

Conclusion: In START, D-dimer, IL-6, CD8 and the CD4:CD8 ratio have similar ability to predict prognosis. When considering only early biomarker assessments, the CD4:CD8 ratio explained the largest percent of TE (immediate vs. deferred ART) in START. Although adding IL-6 and D-dimer to T-cell assessments added to risk prediction and the percent of TE explained, additional study of these and other pathways over time is needed to better understand the causes of clinical risk and the benefits of early ART among HIV+ with high CD4 counts.

Oral Abstracts

76 INCREASED RISK OF PERIPHERAL ARTERY DISEASE IN PERSONS WITH HIV COMPARED TO CONTROLS Andreas D. Knudsen 1 , Jens D. Lundgren 1 , Marco Gelpi 1 , Ashley Roen 2 , Amanda Mocroft 2 , Shoaib Afzal 3 , Børge Nordestgaard 3 , Henrik Sillesen 1 , Andreas Ronit 1 , Anne-Mette Lebech 1 , Lars Køber 1 , Klaus F. Kofoed 1 , Susanne D. Nielsen 1 1 Rigshospitalet, Copenhagen, Denmark, 2 University College London, London, UK, 3 University of Copenhagen, Copenhagen, Denmark Background: Risk of cardiovascular disease (CVD) is higher among persons living with HIV (PLWH) than among the background population. Peripheral artery disease (PAD) is a manifestation of CVD that is less well-explored in PLWH with conflicting reports on prevalence and risk factors. Ankle-brachial index (ABI) is an excellent diagnostic tool for diagnosing PAD. In this study, we aimed to determine the prevalence and risk factors for PAD in PLWH compared to uninfected controls. We hypothesized that prevalence of PAD would be higher among PLWH than among controls and that HIV is an independent predictor of PAD. Methods: PLWH aged ≥40 were recruited from the Copenhagen comorbidity in HIV infection (COCOMO) study. Sex and age matched uninfected controls were recruited from the Copenhagen General Population Study. Blood pressure, lipids, glucose, eGFR and hsCRP were measured. Questionnaires were used to obtain data on smoking history and medication. ABI was measured with the Doppler method. We defined PAD as ABI ≤ 0.9 and non-compressibility as ABI ≥ 1.4 and excluded the latter from PAD analyses. We assessed predictors of PAD using a logistic regression model adjusted for age, sex, smoking status, dyslipidemia, diabetes, hsCRP and hypertension. Results: Among 908 PLWH and 11,106 controls, the PLWH were slightly younger (median 52 vs 53 p=0.0010), had a lower prevalence of hypertension (48 % vs 61% p<.0001), but higher proportions of current smokers (28% vs 13% p<.0001) and persons with intermittent claudication (4 % vs 2 % p<.0001) than controls. PAD was detected in 112 (12% [95% 10-14]) and 623 (6% [95% 5-6]), respectively (p<0.0001); odds ratio (OR)=2.4 [95% 1.9-2.9], adjusted OR=1.7 [95% 1.3-2.3, p=.0002]. Furthermore, age, female sex, smoking status, hypertension, intermittent claudication, and kidney function were independently associated with risk of PAD, irrespective of HIV status (Fig 1). In PLWH, neither previous AIDS, CD4 nadir, CD4 count, CD4:CD8-ratio, HCV coinfection, cART nor duration of infection were associated with PAD. Interaction of HIV with age was borderline significant (p=0.0517). Conclusion: Prevalence of PAD was higher among PLWH compared to healthy controls, and remained so after adjusting for common CVD risk factors. Our findings expand the evidence base that PLWH have excess arterial disease to also include PAD. The exact biological mechanisms causing this excess risk remain to be elucidated. Until then, focus on management of modifiable traditional risk factors is important.

75 SERIOUS CLINICAL OUTCOMES IN HIV-POSITIVE PERSONS WITH CHRONIC KIDNEY DISEASE (CKD) Lene Ryom 1 , Jens D. Lundgren 1 , Matthew Law 2 , Ole Kirk 1 , Wafaa M. El-Sadr 3 , Fabrice Bonnet 4 , Rainer Weber 5 , Eric Fontas 6 , Antonella D’Arminio Monforte 7 , Andrew N. Phillips 8 , Colette Smit 9 , Camilla Ingrid Hatleberg 1 , Caroline Sabin 8 , Amanda Mocroft 8 1 Rigshospitalet, Copenhagen, Denmark, 2 Kirby Institute, Sydney, NSW, Australia, 3 Columbia University, New York, NY, USA, 4 INSERM, Bordeaux, France, 5 University Hospital Zurich, Zurich, Switzerland, 6 CHU de Nice, Nice, France, 7 University of Milan, Milan, Italy, 8 University College London, London, UK, 9 Academic Medical Center, Amsterdam, Netherlands Background: Risk factors for CKD amongst HIV-positive persons have been well established, but insights into the prognosis after CKD including the role of modifiable risk factors for serious clinical outcomes (SCO) are limited. Methods: D:A:D participants developing CKD (confirmed, >3 months apart, eGFR<60mL/min/1.73 m 2 or 25% eGFR decrease when eGFR<60mL/ min/1.73m 2 ) after 2004 were followed from date of CKD date incident SCO (end stage renal (ESRD) and liver disease (ESLD), cardiovascular disease (CVD), AIDS- and non-AIDS defining malignancies (ADM and NADM), other AIDS events or death), 6 months after last visit or Feb 1st 2016. SCO rates in persons with CKD were compared to rates in persons without CKD followed from eGFR> 60mL/ min/1.73 m 2 to CKD, 6 months after last visit or Feb 1st 2016. Poisson regression models considered associations between individual SCO and modifiable risk factors. Results: 2467 persons with and 33427 persons without CKD were included. During 2.7 (IQR 1.1-5.1) years median follow-up after CKD 595 persons with CKD (24.1%) developed a SCO (IR 68.9/1000PYFU [95%CI 63.4-74.4]) with 7.9% [6.9-9.0] estimated to have a SCO at 1 year. In persons without CKD the SCO IR was 23.0/1000PYFU [22.4-23.6] with 2.8% [2.6-3.0] estimated to have a SCO at 1 year. In persons with CKD, death was the most common SCO (12.7%), followed by NADM (5.8%), CVD (5.6%), other AIDS (5.0%), ESRD (2.9%), ESLD (1.0%) and ADM (0.8%). In adjusted models poor HIV control (2.72 [2.01-3.69]), low BMI (1.68 [1.14-2.48]), diabetes (1.60 [1.19-2.15]), smoking (1.48 [1.06-2.07]) and higher eGFR (0.74 [0.68-0.80]) were strongly associated with death; poor HIV control (3.05 [1.87-4.95]), low BMI (1.96 [1.11-3.47]) and smoking (1.75 [1.02-3.00]) with other AIDS; smoking (1.78 [1.07-2.99]) and diabetes (1.65 [1.05- 2.57]) with NADM; dyslipidaemia (2.22 [1.40-3.52]), smoking (1.98 [1.22-3.19]), diabetes (1.81 [1.16-2.81]) and higher eGFR (0.81 [0.72-0.92]) with CVD (figure). Conclusion: In an era where many HIV-positive persons require less monitoring due to efficient antiretroviral treatment, persons with CKD have a high SCO burden requiring close monitoring. Our data suggest modifiable risk factors including smoking, diabetes, BMI, HIV-control and dyslipidaemia play a central role for post-CKD morbidity and mortality.

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CROI 2018