CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

697 IMPLEMENTATION OF A LUNG CANCER SCREENING INITIATIVE IN HIV- INFECTED SUBJECTS Patricia Roiz 1 , Jorge Diaz 1 , Javier Martínez-Sanz 1 , Jose L. Casado 1 , Maria Jesus Perez-Elias 1 , Santiago Moreno 1 , Ana Moreno 1 , Sabina Herrera 1 , María J. Vivancos- Gallego 1 , Pilar Vizcarra 1 , Ana M. Ayala-Carbonero 1 , Sergio Perez-Pinto 1 , Luis Gorospe 1 , Sergio Serrano-Villar 1 1 Hospital Ramón y Cajal, Madrid, Spain Background: Low-Dose Computed Tomography (LDCT) screening has shown to decrease mortality in at-risk individuals. While HIV-infected individuals exhibit approximately a two-fold higher risk of lung cancer compared to the general population, the role of LDCT in this population remains controversial. We report the results of a lung screening programwith LDCT in HIV-infected individuals. Methods: HIV-infected individuals on follow-up in a tertiary hospital were offered LDCT for lung cancer screening. Inclusion criteria were: 45 years or years or older, 30 pack-year history of smoking, quit smoking in the previous 15 years, and absence of previous lung cancer diagnosis. We registered the following radiological data: presence of lung nodules, pathological lymph nodes, coronary atherosclerosis, aortic dilatation, bone marrow attenuation, lung emphysema, and non-nodular lung opacities. Results: A total of 141 patients underwent LDCT of whom 86%were men and 14%were women. The median age was 57 years (54-60), 87 (62 %) had positive HCV antibodies, median nadir CD4 count was 179 (75-305), current CD4 count was 666 (403-911), HIV RNA count <20 copies/mL in 138 (97.1%) subjects. The median pack-year was 34 (25-41), 122 (82%) were active smokers. Radiological abnormalities were common, including pulmonary emphysema in 90 patients (64%), lung non-nodular opacities in 29 (21%), lymph nodes >1cm in 10 (7%), aortic dilation in 4 (2.8%), and radiological bone marrow attenuation in 21 (15%). Lung nodules were found in 52 subjects (37%); <4mm in 21 (15%), 4-8mm in 18 (13%) and >8mm in 13 (9%). Lung cancer was diagnosed in 5 cases, yielding a prevalence of 3.6%. Histological examination revealed 4 cases of squamous cell carcinoma and 1 adenocarcinoma. Compared to the rest of our cohort, patients with lung cancer were of similar age (56.5 [53.5-59.5] years), had a lower CD4 nadir count (71 [4-105] cells/uL), lower current CD4 counts (352 [242-517] cells/uL), and higher median pack-year (71 [50-91]). Conclusion: In this program of lung cancer screening with LDCT in HIV-infected individuals we found a high prevalence of lung cancer (3.6%). These results indicate that people living with HIV with additional risk factors for lung cancer are a target population for screening programs. 698 DIMENSIONS OF SLEEP HEALTH: IMPACT ON QUALITY OF LIFE OF PEOPLE WITH AND WITHOUT HIV Davide De Francesco 1 , Caroline Sabin 1 , Alan Winston 2 , Patrick W. Mallon 3 , Nicki Doyle 2 , Susan Redline 4 , Ken M. Kunisaki 5 , for the POPPY-Sleep Study Group 1 University College London, London, UK, 2 Imperial College London, London, UK, 3 University College Dublin, Dublin, Ireland, 4 Brigham and Women's Hospital, Boston, MA, USA, 5 Minneapolis VA Health Care System, Minneapolis, MN, USA Background: Poor sleep quality can affect physical, mental and emotional function and has been frequently reported in people with HIV (PWH). We explored dimensions of sleep health, derived from objectively-measured sleep/ wake activity, and their associations with health- and sleep-related quality of life (QoL) in PWH and lifestyle-matched controls. Methods: A subset of PWH (18-49 and ≥50 yo) and HIV-negative controls (≥50 yo) participating in the POPPY study wore an actigraphy device for 7 days/nights. Physical and mental QoL, sleep-related impairment (perceptions of daytime functional impairment associated with sleep) and disturbance (perceptions of sleep quality) were derived from the SF-36 and PROMIS questionnaires. Exploratory factor analysis of 27 actigraphy variables was performed and 7 dimensions of sleep health were obtained. Linear regression was used to test associations of sleep dimensions with HIV-status and QoL measures (separately in PWH and controls) and whether they differed by HIV- status. All analyses accounted for age, gender and ethnicity. Results: The 343 PWH and 117 HIV-negative controls were predominantly male (87% and 68%) with a median (IQR) age of 57 (52-62) and 61 (57-66) years, respectively. The 7 actigraphy-derived dimensions of sleep health were fragmentation, irregularity in duration/timing, sleep duration, duration/ variability of awake periods (after initial sleep), irregularity in fragmentation, onset latency and timing. None of these significantly differed between PWH and controls (all p’s>0.1). In PWH, longer duration and/or greater variability

696 INTERSTITIAL LUNG ABNORMALITIES IN PEOPLE LIVING WITH HIV AND UNINFECTED CONTROLS Andreas Ronit 1 , Thomas Benfield 1 , Jens D. Lundgren 2 , Jørgen Vestbo 3 , Shoaib Afzal 4 , Børge Nordestgaard 4 , Klaus F. Kofoed 5 , Susanne D. Nielsen 5 , Thomas Kristensen 5 1 Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 2 Department of Infectious Diseases 144, Amager Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; 3 CHIP, Dept of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 4 Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; 5 The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark . Background: Chest computed tomography (CT) findings in people living with HIV (PLWH) remain poorly characterized. We aimed to visually characterize interstitial lung abnormalities (ILAs) in PLWH and uninfected controls and assessed whether these abnormalities are associated with reduced pulmonary function and symptoms. Methods: ILAs that included focal ground-glass opacity (GGO), reticulation, patchy GGO (<5% of the lung), nondependent GGO and non-dependent reticulation (>5% of the lung), diffuse centrilobular abnormality with GGO, honeycombing, traction bronchiectasis, non-emphysematous cysts, and architectural distortion were assessed by chest CT scans in PLWH from the Copenhagen Comorbidity in HIV-infection (COCOMO) Study and in uninfected controls from the Copenhagen General Population Study (CGPS) who were >40 years. Based on these CT findings we defined four outcome variables as: i) any ILA (any of the above findings), ii) equivocal for interstitial lung disease (ILD), iii) suspicious for ILD, and iv) definite ILD. Multivariate logistic regression was used to determine associations between HIV status, any ILA, equivocal and suspicious for ILD. Results: Of 754 PLWH (95.4%with full viral suppression), 82 (10.9%) had any ILA, 59 (7.8%) were classified equivocal, 22 (2.9%) as suspicious and only one (0.1%) as definite ILD. Of 470 uninfected controls, these numbers were 36 (7.7%, p =0.079), 33 (7%, p =0.684), 4 (0.9%, p =0.025) and 0 (0%, p =1). In multivariate analysis adjusting for age, sex, ethnicity and pack-years of smoking, HIV infection were associated with aORs of 1.82 (95%CI: 1.18-2.88), 1.35 (95% 0.85-2.21) and 5.15 (95%CI: 1.72-22.2) for any ILA, equivocal and suspicious ILD, respectively. PLWH with suspicious ILD only seemed to have slightly lower forced vital capacity (FVC%) predicted (86.5% vs. 92.5%, p =0.052) and increased respiratory symptoms (cough 25% vs 12.5%, p =0.163; dyspnea 9.1% vs 8.3%, p =1), although not reaching statistical significance. We found no associations between current and nadir CD4+ T cells counts and any of the outcomes considered. Conclusion: HIV infection was independently associated with ILAs. Moreover, the proportion of individuals with radiographic findings suspicious of ILD was higher in PLWH. Whether these ILAs may develop into more recognizable disease states over time is unknown but warrants ongoing investigation.

Poster Abstracts

CROI 2020 255