CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

and discounted at 3% per year. We assumed the US healthcare sector perspective. Comprehensive sensitivity and scenario analyses were undertaken. Results: PLHIV receiving pravastatin accrued 0.028 additional QALYs compared with PLHIV not receiving a statin, at an incremental cost of $2,195, giving an incremental cost-effectiveness ratio (ICER) of $79,000/QALY gained. PLHIV receiving pitavastatin accumulated 0.008 additional QALYs compared with PLHIV using pravastatin, at an additional cost of $26,864, giving an ICER of $3,160,000/QALY gained. These findings were most sensitive to the quality-of- life decrement associated with taking an additional daily pill, statin costs and statin efficacy. In scenario analyses, whereby the treatment strategies were only administered to PLHIV at higher risk of CVD, our ICERs improved but did not alter the main conclusions (Table). Conclusion: At a cost-effectiveness threshold of $100,000/QALY gained, pravastatin was projected to be cost-effective compared with no statin. However, pitavastatin was not cost-effective compared with pravastatin as the incremental benefit was modest.

667 FAT GAINS OCCUR AFTER ART WITHOUT CHANGES IN METABOLIC RATE OR CALORIC INTAKE Allison Ross Eckard 1 , Abdus Sattar 2 , Jiao Yu 2 , Heather Y. Hughes 1 , Danielle Labbato 3 , Theresa O. Rodgers 3 , Julia C. Kosco 3 , Grace A. McComsey 3 1 Medical University of South Carolina, Charleston, SC, USA, 2 Case Western Reserve University, Cleveland, OH, USA, 3 University Hospitals Cleveland Medical Center, Cleveland, OH, USA Background: Increases in weight and fat gains with antiretroviral treatment (ART) are serious problems in people with HIV (PWH), but the pathogenesis is poorly understood. Some have suggested changes in resting metabolic rate (RMR) and/or caloric intake are responsible, but no data exists. We examined changes in RMR, oxygen consumption (V02), and dietary intake and associations with changes in weight and body composition after ART initiation. Methods: ART-naïve PWH were prospectively enrolled and underwent a comprehensive clinical and laboratory assessment at baseline and at 6 and 12 months after ART initiation. Fasting RMR/V02 and body composition were measured by indirect calorimetry and whole-body DXA, resp. Nutrient intake was assessed by a registered dietician via 24-hour dietary recalls x3 at each time point and analyzed using dietary analysis software. Changes in variables and associations were assessed using linear mixed effects models. Results: 30 PWH were enrolled (mean age: 31 yrs, 77%male, 74% black; mean baseline CD4 444 cells/mm 3 ; HIV RNA 267,148 copies/mL, BMI 28.6 kg/m 2 , RMR 1420 kcal/day, V02 205 mL/min, 1690 total kcal average daily intake). All but 1 initiated an integrase inhibitor-based regimen (53% DTG; 37% TAF). By 6 and 12 months, all but 3 and 1 participant, respectively, had an HIV RNA <200 copies/ mL. At both time points, there was a significant increase in mean weight, total fat and trunk fat (6 mo/12 mo: +3.8/+10.2 kg, +2.4/+4.6 kg, +1.6/+3.4 kg, resp; all P<0.05), but a nonsignificant increase in total lean body mass (+1.7/+2.7 kg; P=0.09/P=0.71). Over the study period, there were no significant changes in RMR, V02 or dietary intake (kcal, total fat, saturated fat, fiber, protein, total sugars, fructose, branched-chain amino acids, or arginine) (all P>0.70). All body composition changes were significant after adjusting for sex, baseline HIV RNA and RMR (or V02) at both time points except for lean body mass at 12 months. Conclusion: Significant increases in weight and fat gains were seen after ART initiation, despite a lack of significant changes in RMR, V02 or diet. All body composition changes except for lean body mass at 12 months were significant after adjusting for RMR or V02. These data do not support the hypothesis that changes in RMR or caloric intake are responsible for increases in weight and fat gains after ART initiation in PWH. 668 GREATER WEIGHT GAIN AFTER SWITCH TO InSTI-BASED REGIMEN FROM NNRTI VS PI REGIMENS John Koethe 1 , Aihua Bian 1 , Peter F. Rebeiro 1 , Cathy Jenkins 1 , Kassem Bourgi 2 , Richard D. Moore 3 , Michael Saag 4 , Kathryn Anastos 5 , Julia Fleming 6 , Marina Klein 7 , Viviane D. Lima 8 , Joseph B.Margolick 3 , Timothy R. Sterling 1 , Jordan E. Lake 9 , for the NA-ACCORD of IeDEA 1 Vanderbilt University, Nashville, TN, USA, 2 Indiana University, Indianapolis, IN, USA, 3 Johns Hopkins University, Baltimore, MD, USA, 4 University of Alabama at Birmingham, Birmingham, AL, USA, 5 Montefiore Medical Center, Bronx, NY, USA, 6 Fenway Health, Boston, MA, USA, 7 McGill University, Montreal, QC, Canada, 8 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, 9 University of Texas at Houston, Houston, TX, USA

Poster Abstracts

666 DEPRESSION COGNITIVE BEHAVIORAL THERAPY TO IMPROVE HIV-CVD RISK: A PILOT RCT Samir K. Gupta 1 , Ziyue Liu 1 , James E. Slaven 1 , Brittany Polanka 1 , Matthew Freiberg 2 , Jesse C. Stewart 1 1 Indiana University, Indianapolis, IN, USA, 2 Vanderbilt University, Nashville, TN, USA Background: Depression is associated with an increased risk of cardiovascular disease in the HIV+ population. We hypothesized that reducing depressive symptoms would improve cardiovascular risk in HIV. Methods: We conducted a single-center, randomized (1:1), controlled, parallel-group, assessor-blinded trial comparing Beating the Blues (BtB) - an evidence-based, 8-session, internet cognitive behavioral therapy for depression - with usual care (UC) in HIV+ patients receiving virologically-suppressive ART (VL <75c/mL) and with Patient Health Questionnaire (PHQ)-9 scores ≥10. The primary endpoint was change in brachial artery flow-mediated dilation (FMD) at 12 weeks. Secondary endpoints were FMD change at 24 weeks and inflammation, coagulation and metabolic biomarker changes at 12 and 24 weeks. Changes in endpoint comparisons were performed using Student t-tests with a p-value <0.05 considered statistically significant. Pre-specified comparisons were also performed for those completing at least 6 sessions in the BtB arm (BtB6-8). FMD comparisons were further adjusted for baseline characteristics using ANOVA. Results: 54 patients were randomized [17%women, 67% Black, Entry mean age 45.1 yrs, PHQ-9 15.6, Symptom Checklist Depression Scale (SCL)-20 2.2, FMD 3.1%, 69% on antidepressants); 15 in the BtB arm completed at least 6 sessions. Table 1 shows the study results. Mean reductions in PHQ-9 were significantly greater at 12 and 24 weeks with BtB vs. UC; reductions in SCL-20 were significantly greater with BtB vs. UC at 24 weeks. Changes in FMD between arms were no different at 12 or 24 weeks. ANOVA models adjusting for Entry FMD, ART regimen, SCL-20, or antidepressant use or for changes in VL over the study period did not affect FMD comparisons, though significantly worse FMD at 12 weeks (but not 24 weeks) was now found in the BtB6-8 arm compared to UC. Significant reductions in sCD14 and sCD163 were found with BTB at 12 and 24 weeks, respectively. Conclusion: BtB resulted in greater and clinically relevant improvements in depressive symptoms but did not improve FMD compared to usual care. There was an unexpected greater transient worsening in FMD in the BtB group in those who completed a majority of treatment sessions. Monocyte activation may also be reduced by depression treatment. These data support performing larger studies to determine the short and long term effects of depression treatment on HIV-CVD risk.

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