CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

896 LATE PRESENTATION WITH HIV IN AFRICA: PHENOTYPES, RISK AND RISK STRATIFICATION Abraham Siika 1 , Leanne McCabe 2 , Mutsa Bwakura-Dangarembizi 3 , Cissy Kityo 4 , Jane E. Mallewa 5 , Kath Maitland 6 , Anna Griffiths 2 , Keith Baleeta 4 , Shepherd Mudzingwa 3 , James Abach 4 , Kusum Nathoo 3 , Andrew Prendergast 7 , Sarah Walker 2 , Diana Gibb 2 1 Moi University, Eldoret, Kenya, 2 MRC Clinical Trials Unit at UCL, London, UK, 3 University of Zimbabwe, Harare, Zimbabwe, 4 Joint Clinical Research Centre, Lubowa, Uganda, 5 Malawi–Liverpool–Wellcome Trust Clinical Rsr Prog, Blantyre, Malawi, 6 KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya, 7 Queen Mary University of London, London, UK Background: In sub-Saharan Africa, severely immunocompromized individuals are at high risk of mortality during the first fewmonths after starting ART. We aimed to determine predictors of this early mortality and whether such “late presenters” could be grouped into phenotypes with different mortality risks. Methods: ART-naïve adults/children ≥5y with CD4<100 cells/ul initiating ART in Uganda, Zimbabwe, Malawi and Kenya were included in the REALITY trial (ISRCTN43622374). Baseline predictors of mortality through 48 weeks on ART were identified using Cox regression with backwards elimination (exit p>0.1). Late presenter phenotypes were identified using hierarchical clustering. Results: Final multivariable models included 1711 participants (26<13y) of whom 203(12%) died. Mortality was independently higher in those who were older (p=0.002), with lower CD4s (p<0.001), lower albumin (p=0.001), lower haemoglobin (p=0.01) and weaker grip strength (p=0.01); those in whom physicians reported WHO stage 3/4 weight loss (p=0.04); and in those patients reporting fever (p=0.001), vomiting (p=0.02), some problems with mobility (p=0.005) and inability to wash or dress themselves (p=0.003) at baseline. Five “late presenter” groups were identified (figure), with mortality ranging from 4-25%. Group-1 had the highest mortality (25%) and median CD4 28 cells/ul; they had a high burden of symptoms/signs other than rash, weight loss, and problems with mobility and self-care; they also had lower albumin and haemoglobin. Group-2 (11%mortality; median CD4 43 cells/ul) had higher white blood cells, platelets and neutrophils, despite only 31% reporting infections at baseline. Group-3 (10%mortality) were mainly younger women; they had similarly low CD4s (median 27 cells/ul), haemoglobin and BMI to Group-1, but low symptom burden and maintained fat mass. The remaining two groups had lower (4-6%) mortality, higher CD4 (median 42 and 48 cells/ul) and had predominantly maintained their weight within normal ranges. Of note, the effect of the randomized enhanced prophylaxis bundle on mortality was similar across all groups (interaction p=0.32). Conclusion: Clinical and laboratory characteristics identified groups at highest risk of mortality following ART initiation. A screening tool appropriate to the level of facility could therefore help identify which patients with low CD4 counts should be prioritized, e.g. for same-day ART initiation, more intensive follow-up, and enhanced prophylaxis.

Poster Abstracts

897 SMOKING, CHRONIC DISEASES, AND MORTALITY OF PEOPLE RECEIVING ART IN BRITISH COLUMBIA Erin Ready 1 , Monica Ye 2 , William Chau 2 , Viviane D. Lima 2 , Paul Sereda 2 , Katherine Lepik 2 , Robert S. Hogg 2 , Rolando Barrios 2 , Julio S. Montaner 2 , David Moore 2 1 University of British Columbia, Vancouver, BC, Canada, 2 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Background: Chronic diseases, especially those associated with cigarette smoking, are increasingly recognized as leading causes of premature morbidity and mortality for people living with HIV (PLWH). We conducted a cross-sectional analysis to understand the burden of chronic diseases and their associations with mortality among PLWH receiving antiretroviral therapy (ART) in British Columbia (BC). Methods: In BC, all medically eligible PLWH who are receiving publicly funded ART are enrolled in the HIV Drug Treatment Program (DTP). Beginning in 2014, physicians of DTP patients were mailed Clinical Status Report Forms (CSRF) designed to measure the prevalence of chronic diseases, blood pressure, body mass index (BMI), and cigarette smoking on an annual basis. We analyzed data obtained from CSRFs sent to physicians between June 17, 2014 and September 30, 2016. Follow-up for mortality was conducted through data linkages with the provincial vital statistics agency until August 2017. Multivariate logistic regression models were developed to determine factors associated with mortality. Results: We analyzed data from 3307 DTP patients whose physicians returned at least one CSRF, representing 41.5% of DTP participants. Among these patients, the median age was 50.5 years, 79.4%were male and 86.7% had viral load measurements <200 copies/mL. Among individuals with reported smoking status, 40.8%were current smokers, 20.6%were former smokers, and 38.6% had never smoked. At least one chronic condition was reported for 55.0% of DTP patients whose physicians returned at least one CSRF, with hepatitis C infection (reported for 24.4%), dependence on drugs other than alcohol (20.3%) and depression or bipolar disease (12.6%) being the most common. In multivariate modeling, current smoking (adjusted odds ratio [aOR] 2.73; 95% confidence interval [CI] 1.40-5.33), diabetes mellitus (aOR 1.99; 95% CI 1.05-3.77), alcohol

CROI 2018 341