CROI 2018 Abstract eBook

Abstract eBook

Oral Abstracts

(HIV duration, nadir CD4, current CD4 & CD8) effects on VOI were assessed with multiple regression controlling for a history of HAND. Results: Relative to the HIV- group, the HIV+ group demonstrated subcortical grey (d=0.50-0.60) and WM (d=0.43-0.69) atrophy, with relative cortical sparing (d=0.23). ANI showed reduced medial-orbitofrontal WM compared to NP-normal cases (p=.04, β=-.31). MND showed enlarged lateral ventricles (p=.02, β=.34), reduced caudal-middle-frontal WM (p=.04, β=-.32), reduced caudal-anterior-cingulate WM (p=.006, β=-.42), and reduced inferior-parietal WM (p=.04, β=-.33) compared to NP-normal cases. HIV disease duration predicted greater medial-orbitofrontal WM atrophy only in ANI (p=.002, β=-.51; Fig.1). Higher CD8 were independently associated with atrophy in the inferior-parietal WM (p=.003, β=-.41). Conclusion: ANI is associated with specific frontal WM atrophy. HIV disease duration is a unique contributor to ANI related brain atrophy. These findings give neurobiological validity to ANI and may serve as an ANI biomarker.

Oral Abstracts

122 LONGITUDINAL COGNITIVE OUTCOMES AFTER TREATMENT IN ACUTE HIV INFECTION Phillip Chan 1 , Umit Tokac 2 , Joanna Hellmuth 3 , Eugène Kroon 1 , Donn Colby 1 , Carlo Sacdalan 1 , James L. Fletcher 1 , Somporn Tipsuk 1 , Suteeraporn Pinyakorn 4 , Merlin L. Robb 5 , Jintanat Ananworanich 4 , Victor Valcour 3 , Serena S. Spudich 6 , Robert Paul 2 1 SEARCH, Bangkok, Thailand, 2 University of Missouri St Louis, St Louis, MO, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 US Military HIV Research Program, Bethesda, MD, USA, 5 US Military HIV Research Program, Silver Spring, MD, USA, 6 Yale University, New Haven, CT, USA Background: HIV-infected individuals continue to exhibit cognitive dysfunction despite achieving viral suppression with antiretroviral therapy (ART). It remains unclear if initiation of ART during acute HIV (AHI) results in more favorable long-term cognitive outcomes. Methods: Participants included 445 AHI individuals (Fiebig stages I-V) who initiated ART within 30 days after diagnosis and maintained virologic control over the study period. They completed a brief cognitive battery that measured fine motor speed and dexterity, psychomotor speed, and executive functioning at baseline before ART and then at 2 years (n=262) and 6 years (n=47) after ART with sustained viral suppression. Global cognitive performance (NPZ-4) and frequency of cognitive impairment (performance < -1 SD on ≥ 2 tests, or <-2 SD on ≥ 1 test) were determined at baseline and follow-up. Group-based trajectory analysis (GBTA) compared longitudinal test performance of the AHI group to performance obtained from 99 HIV-negative healthy Thai individuals. Meaningful cognitive change was defined as performance differences ≥ 0.5 SD or > 1 standard error of measurement. Multiple regression models examined the co-variance between test performance and demographic/clinical variables. Results: Most participants were male (>90%), with a mean age of 26 years (Table). Cognitive impairment was identified in 26% at baseline, 10% at 2

121 HIV AND BRAIN ATROPHIC SIGNATURE IN ASYMPTOMATIC NEUROCOGNITIVE IMPAIRMENT

Lucette Cysique 1 , Madeline Nichols 1 , Thomas Gates 2 , James Soares 1 , Kirsten Moffat 2 , Caroline Rae 1 , Bruce J. Brew 1 1 University of New South Wales, Sydney, NSW, Australia, 2 St. Vincent’s Hosp, Sydney, NSW, Australia Background: There is controversy as to whether Asymptomatic Neurocognitive Impairment (ANI) in HIV-Associated Neurocognitive Disorders (HAND) solely represents a statistical neuropsychological entity with no neurobiological underpinning and no HIV causation. We hypothesized that in a sample of non-confounded virally suppressed HIV+ persons versus demographically comparable controls, HIV-related grey and white matter (WM) atrophy could be observed in ANI. Methods: 85 HIV+ (plasma & CSF HIV RNA <50cp/mL, median nadir CD4=180, CD4=528) and 44 demographically comparable HIV- men (mean age=55; mean education=14.5 years; 90%men who have sex with men, 95%White Australian) underwent anatomical MRI, neuropsychological evaluation, and HIV laboratory tests. Volumes of interest (VOI) fromMR images were extracted using Freesurfer to yield grey and WM in regions linked to HIV-related brain injury (total cortical volume, basal ganglia, lateral ventricles, fronto-striatal and fronto-parietal WM, all relative to Total Intracranial Volume, TIV). HAND status was ANI=38%, MND=13%, HAD= 3% based on the Global Deficit Score (GDS≥0.5) and functional decline; others were neuropsychologically (NP)- normal. A history of HAND occurred in 17.6%. We used multivariate analyses controlling for family-wise error rate to assess the effects of HIV status group on VOI. Next, ANI (N=32), MND (N=10) vs. NP-normal (N=40) and HIV biomarker

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CROI 2018