CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

890 LOWER MITOCHONDRIAL DNA COPY NUMBER IS ASSOCIATED WITH HIV & PREDICTIVE OF MORTALITY Jing Sun , Ryan Longchamps, Damani A. Piggott, Jason A. Sumpter, Shruti H. Mehta, Dan Arking, Gregory D. Kirk Johns Hopkins University, Baltimore, MD, USA Background: Lower mitochondrial DNA copy number (mtDNA CN), a marker of mitochondrial depletion, reduced energy reserves, and oxidative stress, was recently found to be predictive of adverse aging outcomes and mortality in the general population. HIV infection and its treatment may impact mitochondrial function, yet little data exist on the relationship of mtDNA CN to health outcomes in HIV infected population. We examine the relationship of mtDNA CN to HIV disease markers and mortality among persons who inject drugs (PWID) with and without HIV. Methods: mtDNA CN was measured using the qPCR of DNA isolated from buffy coats of participants of the AIDS Linked to the IntraVenous Experience (ALIVE) cohort of current and former PWID. We used the difference of cycle threshold value between the nuclear genome (RPPH1), found in 2 copies in all humans, and mt gene (ND1) as a measure of mtDNA CN, and standardized for platelet and white blood cell counts. We further categorized the mtDNA CN into quartiles, and compared the lowest quartile vs. the other 3 quartiles (high mtDNA CN). All- cause mortality was ascertained through linkage to the National Death Index from 1988 to 2015. The relationship of mtDNA CN to HIV clinical parameters was assessed using chi2 and T tests. Cox proportional hazards regression models (controlled for age, race, gender, education, HCV infection, smoking, alcohol consumption, and current IDU) were used to assess the relationship of mtDNA CN to mortality. Results: Of 825 participants, 41%were ≥50 years, 62%male, 86% black, 43% had less than high school education, and 59%were HIV-infected. mtDNA CN was lower among HIV+ vs. HIV- (p<0.01), had a dose-response effect by CD4+ count (HIV+ & CD4+>500: 0.034, HIV+ & CD4+ in 200-500: -0.234, HIV+ & CD4+≤200: -0.317, P=0.03), and was lower among those who were not on ART (p<0.01). Over a median of 7.3 yrs, there were 219 deaths (26.6%). Compared to HIV- individuals with high mtDNA CN, being HIV+ with high mtDNA CN was associated with a 1.69 fold increased risk of death (95% CI: 1.16-2.47), and being HIV+ and in the lowest quartile of mtDNA CN was associated with a 2.6 fold increased risk of death (95% CI: 1.72-3.94). mtDNA CN and HIV infection had a synergistic impact on mortality (p=0.03). Conclusion: mtDNA CN is a novel biomarker strongly associated with HIV infection, particularly with advanced HIV disease, and is predictive of all-cause mortality among people living with HIV.

889 FACTORS ASSOCIATED WITH DELAYED HIV DIAGNOSES IN WASHINGTON, DC, 2006-2015 Rupali K. Doshi 1 , Jessica Li 1 , Kerri Dorsey 1 , Auntre D. Hamp 2 1 The George Washington University, Washington, DC, USA, 2 District of Columbia Department of Health, Washington, DC, USA Background: Delayed diagnosis of HIV, defined by a short interval between HIV diagnosis and meeting criteria for stage 3 HIV (AIDS), is a critical indicator on the HIV care continuum. Washington, DC, has a high burden of HIV disease and the DC Department of Health (DOH) has implemented various public health strategies to increase routine opt-out HIV testing since the number of new infections peaked in 2007. We examined delayed diagnosis of HIV in DC over 10 years and the association with demographic and transmission risk factors. Methods: Reports of HIV cases diagnosed in DC residents over age 12 between January 1, 2006, and December 31, 2015, were extracted from the DC DOH Enhanced HIV/AIDS Reporting System. Cases were matched to CD4 counts reported to the DC DOH. Cases were excluded if AIDS diagnosis or CD4 count were missing or unreported. Delayed diagnosis was defined as stage 3 diagnosis within 90 days of the HIV diagnosis. Covariates assessed were year of HIV diagnosis, gender, race/ethnicity, mode of transmission and age at diagnosis. Cochran-Armitage test of trend and Chi-square were used for univariate analyses. The multivariable analysis was modeled using a log-binomial analysis, and we report adjusted prevalence ratios (aPR). Results: 8172 DC residents were diagnosed with HIV in Washington, DC, between January 1, 2006, and December 31, 2015; 473 were excluded due to missing data, resulting in 7699 eligible for the analysis. 2162 (28.1%) had a delayed HIV diagnosis. Delayed HIV diagnoses declined from 2006 (36.4%) to 2015 (21.8%). In the multivariate analysis, Black or Hispanic/Latino race/ ethnicity (vs. White, aPR 1.45 and 1.51, respectively) and persons with other or unknown mode of transmission (vs. sexual contact, aPR 1.28) were independently associated with the outcome. Female gender (vs. male, aPR 0.91), ages 13-49 at diagnosis (vs. ages 60 and older, aPR range 0.42 to 0.83), and later year of HIV diagnosis (aPR for each 1 year increase beyond 2006 was 0.97) were less likely to have delayed HIV diagnosis. Conclusion: Delayed HIV diagnoses decreased from 2006 to 2015, even while controlling for demographic factors, indicating that over the analysis time period, people were diagnosed with HIV earlier in the disease course. The results suggest a need for better risk assessment and more targeted HIV testing among the populations identified (Black or Hispanic/Latino race/ethnicity, people over 50, men) to optimize health outcomes.

Poster Abstracts

891 SHIFTING MORTALITY TRENDS AMONG PERSONS WITH HIV AND INJECTION DRUG USE OVER 30 YEARS Jing Sun , Damani A. Piggott, Abimereki D. Muzaale, Jacquie Astemborski, Shruti H. Mehta, Gregory D. Kirk Johns Hopkins University, Baltimore, MD, USA Background: With antiretroviral therapy (ART), HIV-infected persons are living longer. Yet severe disparities in morbidity and mortality remain for HIV-infected persons who inject drugs (PWID). Understanding trends in cause- specific mortality are critical to effectively directing interventions to improve health outcomes in this highly vulnerable group. We sought to characterize

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