CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Results: 271 patients were enrolled in the original study, of these, 151 patients were ART experienced and had weight and BMI data at baseline and 18m; 35% were female, mean age 46, 61% had a normal baseline BMI and mean weight of 60kgs, 81% switched from TLE and 95%were virally suppressed time of switch (n=130). For patients with a normal baseline BMI there was a statistically significant weight increase of 5kg (p<.01) at 18m, an average 9% increase (p<.01). There was a 1.8kgs increase (p<.01) from 12mweight. Patients of all BMI categories gained 7% (p<.01) from their baseline weight. At 18m, 36% of normal baseline BMI patients had a weight gain of 10% or greater, and 29% had increased BMI category to overweight. There was no interaction of gender and weight gain at 18m. Patients with overweight or obese baseline BMI were not found to gain weight at 18m (p=.95). Conclusion: Supplementing previous findings of a weight increase in the DTG cohort at 6 and 12 months, there was continued weight increase at 18m. Patients with above normal baseline BMI did not show a weight increase at 18m nor a gender association. While the original study was not designed to measure weight changes and has not been compared to a control group, the real world findings show that weight gain may be expected in ART experienced patients that were predominantly virally suppressed at time of switch in African patients. 682 RISK FOR INCIDENT DIABETES IS GREATER IN PREDIABETIC MEN WITH HIV THAN WITHOUT HIV Laurence Slama 1 , Benjamin Barrett 2 , Alison Abraham 2 , Frank J. Palella 3 , Lawrence Kingsley 4 , Jean-Paul Viard 1 , Jordan E. Lake 5 , Todd T. Brown 2 , for the MACS 1 Assistance Publique – Hôpitaux de Paris, Paris, France, 2 Johns Hopkins University, Baltimore, MD, USA, 3 Northwestern University, Chicago, IL, USA, 4 University of Pittsburgh, Pittsburgh, PA, USA, 5 University of Texas at Houston, Houston, TX, USA Background: Abnormalities in glucose metabolism contribute to the pathogenesis of aging-related comorbidities in people with HIV (PWH). Hyperglycemia below the diabetic range has been termed pre-diabetes mellitus (pre-DM) and may be more common in PWH compared to those without HIV. It is unclear whether the progression from pre-DM to DM differs by HIV serostatus. Methods: Fasting glucose (FG) was measured at each semi-annual visit among men in the Multicenter AIDS Cohort Study (MACS) since April 1999. Men who had confirmed pre-DM, defined as a FG 100-125 mg/dL (baseline visit), were included. Men with prevalent DM at the baseline visit were excluded. Incident DM was defined as a FG ≥126 mg/dL, confirmed at a subsequent visit with anti-DMmedication use or a second FG ≥126 mg/dL; self-reported DM, confirmed at a subsequent visit with anti-DMmedication use or two FG ≥126 mg/dL; or report of anti-DMmedication use at a visit. We used binomial transition models to determine whether the progression from pre-DM to DM from one visit to the next differed by HIV serostatus, after adjustment for age, race/ethnicity, body mass index (BMI), and hepatitis C virus (HCV) infection. Results: Between 1999 and 2018, 1548 men (772 with HIV [MWH], 776 men without HIV) men with pre-DM were included. At baseline, MWH were younger (median 48 vs 51 years, p<0.01), had lower BMI (median 25 vs 27 kg/m 2 , p<0.01), were more likely to be non-white (44% vs 28%, p<0.01), and were more likely to be HCV-infected (9% vs 5%, p<0.01) than men without HIV. Over a median of 12 years of follow-up (Q1, Q3 8, 14), 22% (166/772) of pre-DMMWH and 22% (169/776) of pre-DMmen without HIV developed DM. In adjusted analyses, the probability of developing DM among men with pre-DM was 40% [95% CI: 10% to 80%] higher among MWH than men without HIV (p=0.02). Conclusion: Among men with pre-diabetes, HIV serostatus was associated with increased risk of incident diabetes after adjustment for competing DM risk factors. Given the increased risk, diabetes prevention strategies in PWH may be particularly effective and should be investigated. 683 GLYCEMIC STATUS AND PHYSICAL FUNCTION AMONG MEN WITH AND WITHOUT HIV Mary Clare Masters 1 , Jingyan Yang 2 , Jordan E. Lake 3 , Alison Abraham 4 , Lawrence Kingsley 5 , Todd T. Brown 4 , Frank J. Palella 1 , Kristine M. Erlandson 6 1 Northwestern University, Chicago, IL, USA, 2 Columbia University, New York, NY, USA, 3 University of Texas at Houston, Houston, TX, USA, 4 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 5 University of Pittsburgh, Pittsburgh, PA, USA, 6 University of Colorado Anschutz Medical Campus, Aurora, CO, USA Background: Gait speed and grip strength decline faster in persons with HIV (PWH) compared to those without HIV. Abnormal glucose metabolism has been associated with impaired physical function in cross-sectional studies. We

(NNRTI)-based ART from 01/2007-12/2016 with 12-month (±6 months) weights in the North American AIDS Cohort Collaboration on Research and Design (NA- ACCORD). We followed individuals until incident DM (HgA1c >6.5%, initiation of diabetes-specific medication, or DM diagnosis along with diabetes-related medication, precluding prevalent DM or pre-diabetes), virologic failure (≥400 copies/mL), regimen core switch, administrative close, death, or loss to follow-up (≥12 months with no visit or lab before cohort close). We excluded those with incident DM before 12-month weight measure, and we multiply imputed missing baseline data. Cox regression stratified by clinic site and adjusting for age, sex, race, HIV transmission risk, year of ART initiation, and baseline weight, CD4+ cell count, and HIV-1 RNA yielded adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident DM by ART class. We conducted mediation analysis including 12-month weights along with all covariates from the primary analysis. Results: Among 16,305 eligible ART initiators, 8,082 (50%) started NNRTIs, 5,152 (32%) PIs, and 3,071 (19%) INSTIs, with median follow-up of 3.3, 2.8, and 2.1 years, respectively. Among INSTI initiators, 18% started dolutegravir (DTG), 30% raltegravir (RAL), and 52% elvitegravir (EVG). Overall, 333 (2%) developed DM. Tenofovir alafenamide (TAF) was part of <1% of regimens. Those starting INSTIs vs. NNRTIs had elevated incident DM risk (HR=1.30; CI: 0.89-1.90), greater than PI- vs. NNRTI-initiators (HR=1.07; CI: 0.83-1.38). Mediation analysis revealed an INSTI-DM association attenuated 5% (HR=1.24; CI: 0.85-1.81) by including 12-month weight in the full model (Figure). Conclusion: Initiating ART with INSTI- vs. NNRTI-based regimens may confer greater risk of incident DM, and this risk is likely only partially due to 12-month weight gain. Research to elucidate metabolic changes after INSTI initiation and identify interventions to mitigate them continues.

Poster Abstracts

681 WEIGHT GAIN AT 18 MONTHS FOR ART-EXPERIENCED PATIENTS WHO SWITCHED TO DTG IN NIGERIA Jennifer Campbell 1 , Opeyemi Abudiore 1 , Ikechukwu Amamilo 2 , Joseph Harwell 1 , Caroline Middlecote 1 , James Conroy 3 , Williams Eigege 4 , Nere Otubu 4 , Justus Jiboye 4 , Folu Lufadeju 4 , Carolyn Amole 1 , Owens Wiwa 4 , Oche Agbaji 5 , Sulaimon Akanmu 6 , Damien Anweh 7 1 Clinton Health Access Initiative, Boston, MA, USA, 2 Federal Ministry of Health, Abuja, Nigeria, 3 Clinton Health Access Initiative, Kampala, Uganda, 4 Clinton Health Access Initiative, Abuja, Nigeria, 5 Jos University Teaching Hospital, Jos, Nigeria, 6 University of Lagos, Lagos, Nigeria, 7 Federal Medical Centre, Makurdi, Nigeria Background: Weight gain has been associated with dolutegravir (DTG). A pilot study in Nigeria, found an increase in appetite was a prominent self-reported side effect; and an increase in weight at 12 months follow up (12m), in the predominantly antiretroviral therapy (ART) treatment experienced cohort. This analysis looked at weight and body-mass index (BMI) changes for the same cohort at 18 months follow up (18m). Methods: ART experienced adult patients with an intolerance to NNRTIs switched to TDF/3TC/DTG (TLD) over a 6-month period starting July 2017 at 3 pilot sites in Nigeria. Study patients completed 18 months on TLD by end of July 2019 were included in the analysis. We analyzed weight and BMI changes at 18m from 12m and from baseline, using generalized estimated equations adjusted for facility clustering.

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