CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

was assessed by the C-statistics and calibration parameters were expressed as ratio of observed / expected events. Results: In 15,528 participants (71%% female, median age : 38 years; median nadir CD4 : 186 cells/mm 3 ) followed for a median duration of 6 years (interquartile range : 3 to 9), 692 (4.5%) progressed to CKD, with an incidence (95% CI) of 7.6 (7.9;10.7) per 1,000 person-years (PY). The D:A:D score ranged from -7 to 17 with a median of -2. Incidence increased markedly across the risk score groups : 2.4 (2.0;2.8); 8.3 (7.0;9.8) and, 30.1 (27.3;33.2) per 1,000 PY in the low, medium and high risk groups, respectively (Table). In the high risk group, 14.6 % (95% CI: 13.1;16.2) had progressed to CKD at 5 years. Discrimination was acceptable with a C-statistics of 0.81 (95% CI: 0.79-0.82). In predicting CKD, score ≥ 0 and ≥ 5 performed at sensitivities of 78% and 59% and specificities of 67% and 85%, respectively. Conclusion: The performance of the D:A:D score in predicting CKD was acceptable. PLHIV with a score ≥0 could benefit from a closer monitoring of renal function to prevent progression to end-stage renal disease. Introduction of additional predictors such as hepatitis C, hypertension or diabetes should improve the performance of the D:A:D score

discontinued ABC than TAF(15% vs 2%, p<0.001), mainly for drug-related AE (13% vs 2%, p<0.01). HIV-RNA remained suppressed in all but 3 pts. Conclusion: Although improvements in eGFR were observed after TDF discontinuation, a minority recovered >50% of the eGFR lost during TDF. Recovery on TAF and ABC was comparable. 690 CHRONIC KIDNEY DISEASE IN PEOPLE WITH HIV OF AFRICAN ANCESTRY IN THE UK Lisa Hamzah 1 , Rachel Hung 1 , John Booth 2 , Rachel Hilton 3 , Mark Harber 4 , Catherine Cosgrove 5 , Sarah Pett 6 , Fiona M.Burns 4 , Amanda Clarke 7 , Andrew Ustianowski 8 , Beatriz Santana-Suarez 1 , Elizabeth Binns-Roemer 9 , Caroline Sabin 10 , Frank Post 1 , for the GEN-AFRICA Study Team 1 King's College Hospital, London, UK, 2 Barts Health NHS Trust, London, UK, 3 Guy’s and St Thomas’ NHS Foundation Trust, London, UK, 4 Royal Free Hospital, London, UK, 5 St. George's University of London, London, UK, 6 Mortimer Market Centre, London, UK, 7 Brighton & Sussex University Hospitals NHS Trust, Brighton, UK, 8 Manchester Royal Infirmary, Manchester, UK, 9 Frederick National Laboratory for Cancer Research, Frederick, MD, USA, 10 University College London, London, UK Background: Black ethnicity is a risk factor for chronic kidney disease (CKD) due to HIV-associated nephropathy (HIVAN) and hypertensive kidney disease through carriage of apolipoprotein L1 risk alleles. Among Africans, substantial regional variability in CKD prevalence has been reported. We prospectively evaluated kidney function and CKD risk factors in black-African and black- Caribbean people with HIV (PWH) in the UK. Methods: Participants were recruited from HIV and dialysis/transplantation clinics. Renal risk factors including hypertension, diabetes mellitus and smoking status, current kidney function (estimated glomerular filtration rate, eGFR mL/ min/1.73m 2 ; CKD-EPI) and urine protein/creatinine ratio (uPCR) were obtained. Multivariable logistic regression was used to analyze factors associated with CKD (eGFR <60), end-stage kidney disease (ESKD; eGFR <15 or renal replacement therapy) and proteinuria (uPCR >15 mg/mmol in those without ESKD). These cross-sectional analyses were restricted to those with both parents born in the same region (East/Southern/West Africa or the Caribbean). Results: While demographic and HIV characteristics differed by region, the prevalence of hypertension, diabetes mellitus and cardiovascular disease was similar (Table). The prevalence of CKD and ESKD, but not proteinuria, differed by region. In unadjusted analyses, with East African ancestry as reference, West- African ancestry was associated with CKD (HR 1.86 [95%CI 1.17, 2.97] p=0.008) and ESKD (2.02 [1.06, 3.82] p=0.027) but not proteinuria (0.92 [0.67, 1.25] p=0.598). After adjustment for demographic, HIV-associated and renal risk factors, West African ancestry remained associated with CKD (aOR 1.87 [1.09, 3.22] p=0.023) and ESKD (aOR 2.45 [1.21, 4.97] p=0.013). Caribbean ancestry was significantly associated with CKD (aOR 2.23 [1.09, 3.22] p=0.016) but not ESKD (aOR 2.33 [0.98, 5.53] p=0.054) while Southern African ancestry was associated with neither CKD nor ESKD. Among West Africans, the odds of ESKD was greatest among those of Nigerian ancestry (aOR 3.37 [1.57, 7.26] p=0.002). Conclusion: The prevalence of CKD and ESKD, but not proteinuria, varied significantly among black PWH who have universal access to healthcare in the UK, and was not explained by traditional CKD risk factors. The highest rate of ESKD was observed among those of West African, and particularly Nigerian ancestry, highlighting the need for increased renal vigilance in this cohort.

689 eGFR RECOVERY 96 WKS AFTER A TDF TO TAF OR ABC SWITCH FOR TDF- ASSOCIATED eGFR DECLINE Rosanne Verwijs 1 , Ingeborg Wijting 1 , Marjo Van Kasteren 2 , Jan G. Hollander 3 , Inge Derdelinckx 4 , Guido Van Den Berk 5 , Saskia Vrouenraets 6 , Mark Claassen 7 , Wouter Bierman 8 , Casper Rokx 1 , Bart Rijnders 1 1 Erasmus University Medical Center, Rotterdam, Netherlands, 2 Elisabeth–TweeSteden Ziekenhuis, Tilburg, Netherlands, 3 Maasstad Hospital, Rotterdam, Netherlands, 4 University Hospitals Leuven, Leuven, Belgium, 5 OLVG, Amsterdam, Netherlands, 6 Slotervaart MC, Amsterdam, Netherlands, 7 Rijnstate Hospital, Arnhem, Netherlands, 8 University Medical Center Groningen, Groningen, Netherlands Background: Use of tenofovir-disoproxil fumarate (TDF) containing ART can result in an accelerated decline of the estimated glomerular filtration rate (eGFR). Limited data are available on the reversibility of this decline and if a switch to T-alafenamide (TAF) is non-inferior to abacavir (ABC) regarding eGFR recovery. Methods: The BACTAF-studies are 2 multicenter studies; a prospective randomized (NCT02957864) and a retrospective study with similar goals; Evaluate the reversibility of the TDF-associated eGFR decline and compare eGFR recovery between pts switching to TAF or ABC. Pts switched from TDF to TAF or ABC for a significant eGFR-decline, defined as >3mL/min/yr during ≥5yrs of TDF or decline of >25% or eGFR<70mL/min with eGFR>90mL/min at TDF initiation. We excluded pts with ABC resistance, HBV/HCV coinfection and detectable HIV-RNA at switch. To increase the likelihood of TDF-relatedness of the eGFR decline, pts with diabetes, cardiovascular disease, uncontrolled hypertension, use of >1 antihypertensive drug, use of nephrotoxic medication, or with another kidney disease that may explain the eGFR-decline were excluded as well. The prim. endpoint was an eGFR recovery of >50% 48 wks after the switch with the 96 wks results as a sec. endpoint. Results: Of 250 pts included, 130 switched to TAF and 120 to ABC. During 7.5 and 5.5yrs of TDF use, eGFR had declined by 4.4mL/min/yr and 5.9 mL/min/ yr, respectively. eGFR was 73mL/min at TAF and 68mL/min at ABC initiation, and 20% and 28% had an eGFR<60mL/min. W48 results were available for 213 while data were not available for 37 (discontinuation of TAF or ABC before w48 in 17, LTFU in 4, other reasons in 16). Significant eGFR increases were observed by 5.0mL/min with TAF and 6.0mL/min with ABC (p<0.001 compared to baseline for both, p>0.1 for TAF versus ABC). A >50% recovery was observed in 23/121(19%) and 18/99(18%) respectively (p>0.1). Of the 52 pts with an eGFR<60 at TDF discontinuation, 33 (57%) showed an eGFR recovery to >60ml/min at w48. At w96 a >50% recovery was observed in 18/101(18%) and 24/88(27%), respectively(p>0.1). Of the 44 pts with an eGFR<60ml/min at TDF discontinuation, 30(68%) recovered to >60ml/min at w96. More pts

Poster Abstracts

691 FERRITIN AND TRANSFERRIN INDEPENDENTLY REFLECT RENAL FUNCTION IN PEOPLE WITH HIV Harpreet Kaur 1 , Ronald J. Ellis 2 , Donald Franklin 2 , Scott L.Letendre 2 , Asha R. Kallianpur 3

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