CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Background: The aging population of people living with human immunodeficiency virus (HIV) (PLWH) has resulted in an increase in comorbidities requiring medications. While anticholinergic (AC) medications are sometimes prescribed to older adults for a limited period of time, they have been linked to a greater risk of cognitive impairment in the HIV- population. The effect of AC in older PLWH with regards to brain volumetrics has not yet been well-established. We compared AC burden between older (age ≥50 years) PLWH and HIV- controls (HC) and assessed the interaction of HIV status and AC burden on neuropsychological performance (NP) and brain volumes cross-sectionally and longitudinally at two-year follow-up. Methods: The Anticholinergic Cognitive Burden Scale (ACB; Boustani et al., 2008) was used to categorize 105 HC and 215 PLWH with undetectable viral load (<50 copies/mL) aged ≥50 years as low (ACB score ≤3) or high AC burden (ACB score >3). NP (learning/memory, executive function (EF), psychomotor speed (PM)) and brain volumetrics were acquired. A chi-square test compared rates of high AC burden in HC and PLWH. General linear models examined main effects and interactions of HIV status and ACB group on NP and within the frontal, parietal, temporal, occipital lobes; cortical, subcortical, and total gray matter (GM); and total white matter volumes. Linear mixed models examined change in NP and volumes over two years for a subset of 30 HC and 94 PLWH who had no change in AC burden. Results: PLWH (n=53; 25%) had a greater proportion of individuals with high ACB compared to HC (n=13; 12%) (p=0.01). Overall, PLWH had significantly worse NP and greater reductions in brain volumes compared to HC (p <.001). Individuals with a higher ACB had worse NP and greater reductions in brain volumes compared to individuals who had a low ACB. No significant interactions were observed between HIV status and ACB (p >.05). Longitudinally, both HC and PLWH who had a higher ACB displayed a greater decline in subcortical GM volume over time compared to individuals with low ACB (Figure 1). The observed decline in brain volumetrics significantly correlated with worse PM over time. Conclusion: The significant effect of higher ACB on NP and GM volumes in older adults (regardless of HIV status) supports concerns over their continued use in older individuals. Although both HIV and high ACB are associated with worse NP and reductions in brain volumetric, no interaction was observed.

copies/mL) and 64 had detectable VL (38 LL, 26 VF). NP scores, cortical volumes (frontal, occipital, parietal, and temporal) and subcortical volumes were converted into demographically-corrected z-scores. T-tests analyzed differences in NP domains, global cognition and volumetric z-scores between PLWH and HIV-. Analyses of variance with post-hoc Tukey’s tests were used to examine differences in NP scores and volumetrics between groups. Results: In general, PLWH had significantly decreased NP z-scores in the executive function, language, and psychomotor speed domains as well as significantly smaller subcortical volumes compared to HIV- (p <0.05). When PLWH were subgrouped by VL, results indicated no significant differences between the VS, LL, and VF groups in any of the NP domains, global cognition or volumetric z-score (p¬>0.05). The VS group had significantly lower executive function and language z-scores compared to HIV-, and both the VS and LL groups had lower subcortical z-scores compared to HIV-. The VF group exhibited larger subcortical volume compared to the LL group, although this was non- significant (Figure 1). Conclusion: Results suggest an HIV effect on subcortical volumes and NP scores but not a VL effect. Higher subcortical volumes in the VF group compared to the LL group may indicate inflammation, but increased group sizes are needed to determine if this effect is significant. The lack of a significant VL effect may signify that ART use is critical rather than viral suppression, but longitudinal studies are needed.

Poster Abstracts

397 MULTIMODAL BRAIN ABNORMALITIES ASSOCIATED WITH COGNITIVE IMPAIRMENT IN HIV INFECTION Christina S. Meade 1 , Xiang Li 2 , Sheri L. Towe 1 , Ryan P. Bell 1 , Syam Gadde 1 , Nan-Kuei Chen 3 , Jing Sui 4 1 Duke University, Durham, NC, USA, 2 Chinese Academy of Sciences, Beijing, China, 3 University of Arizona, Tucson, AZ, USA, 4 Georgia State University, Atlanta, GA, USA Background: HIV-associated neurocognitive impairment (NCI) remains a prevalent comorbidity that impacts daily functioning and increases morbidity. While HIV infection is known to cause widespread disruptions in the brain, different MRI modalities have not been effectively integrated. This study applied 3-way supervised fusion to investigate how structural and functional co-alterations affect cognitive function. Methods: Participants completed comprehensive neuropsychological testing and had a multi-modal MRI scan to acquire high-resolution anatomical, diffusion-weighted, and resting-state functional images. Pre-processed data was reduced using voxel-based morphometry (gray matter volume), probabilistic tractography (fractional anisotropy), and regional homogeneity (intrinsic functional connectivity), respectively. We applied multi-modal canonical correlation analysis with reference plus joint independent component analysis (MCCAR+jICA), using global neurocognitive functioning as the reference. Results: The sample includes 70 HIV+ and 69 HIV- adults who were matched on age (M=38.7), gender (70%male), and race (68% African-American). HIV+ participants had lower global neurocognitive functioning (p=.005), with differences in the domains of learning (p=.006), memory (p=.006), and

396 EFFECTS OF VIRAL LOAD ON NEUROIMAGING AND NEUROPSYCHOLOGICAL PERFORMANCE

Sarah A. Cooley 1 , Jaimie Navid 1 , Julie Wisch 1 , Jane A. O'Halloran 1 , Beau Ances 1 1 Washington University in St Louis, St Louis, MO, USA Background: Previous studies have investigated the relationship between viral load (VL) and brain atrophy in people with HIV (PLWH). However, these studies often combine PLWH on and off antiretroviral therapy (ART) including those with and without detectable VL. Here we compare brain volumetrics and neuropsychological performance (NP) in HIV- controls (HIV-) and PWHL receiving ART who are further categorized into: 1) virologic suppression (VS, VL ≤ 20 copies/mL), low-level viremia (LL, 21 - 200 copies/mL) and virologic failure (VF > 200 copies/mL). Methods: 128 HIV- (mean age 42.4, 50%male) and 239 PLWH (mean age 43.7, 62%male) on stable ART regimen completed NP testing (executive function, learning and memory, psychomotor speed, and language domains) and structural neuroimaging. Of the 239 PLWH, 175 (73.2%) demonstrated VS (≤ 20

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