CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

consistent vs never users (-0.062 [-0.17, 0.041], p=0.24), but tended to decline more among intermittent users (-0.109 [-0.22, 0.007], p=0.07). HIV serostatus was not associated with gait speed (-0.002 [-0.0162, 0.0123) or grip strength (-0.212 [-0.997, 0.574]; p≥0.60). Although pain was strongly associated with gait and grip decline, severe baseline pain did not confound the association between statin use and physical function. Conclusion: Consistent statin use had no apparent effect on declines in gait and grip strength, suggesting no statin-associated impairments in physical function in this population.

708 CAUSE-SPECIFIC HOSPITALIZATION TRENDS AMONG NORTH AMERICAN PERSONS WITH HIV 2005-2015 Thibaut Davy-Mendez 1 , Sonia Napravnik 1 , Kelly Gebo 2 , Keri N. Althoff 2 , M J. Gill 3 , Michael A. Horberg 4 , W. C. Mathews 5 , Joseph J. Eron 1 , Jeffrey Martin 6 , Bryan Lau 2 , Kate Buchacz 7 , Viviane D. Lima 8 , Marina Klein 9 , Stephen A. Berry 2 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 Johns Hopkins University, Baltimore, MD, USA, 3 Southern Alberta Clinic, Calgary, AB, Canada, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 University of California San Diego, San Diego, CA, USA, 6 University of California San Francisco, San Francisco, CA, USA, 7 CDC, Atlanta, GA, USA, 8 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, 9 McGill University, Montreal, QC, Canada Background: Hospitalization rates among persons with HIV (PWH) may be changing due to demographic and antiretroviral (ARV) therapy changes. Early 2000s evidence suggested hospitalization rates among PWH were increasing for renal, pulmonary, and cardiovascular disease (CVD), possibly due to long-term HIV infection or ARV toxicity. To characterize recent hospitalization trends, we examined all-cause and cause-specific hospitalization rates among US and Canadian PWH 2005–2015. Methods: Among patients ≥18 in care (≥1 CD4 or HIV RNA in a year) in 6 dynamic cohorts in NA-ACCORD 2005–2015, we categorized primary hospital discharge diagnoses with modified Clinical Classifications Software. We calculated all-cause and cause-specific annual hospitalization rates and used Poisson regression with GEE to estimate rate ratios for linear calendar time trends, unadjusted and adjusted for sex, race/ethnicity, HIV risk factor, and time-updated age, CD4, and HIV RNA. Results: Of 27,347 patients, 81%were male, 33% Black, 52%MSM, and 13% with IDU history. From 2005 to 2015, median (IQR) age increased from 43 (38, 50) to 49 years (39, 57), CD4 count from 389 (243, 568) to 579 cells/µL (385, 786), and proportion with HIV RNA <400 copies/mL from 54% to 86%. Over 126,468 person-years (PY) of follow-up, 21,946 hospitalizations occurred. From 2005 to 2015, the annual all-cause hospitalization rate per 100 PY decreased from 22.8 (21.1, 24.6) to 13.5 (12.6, 14.5), with a mean annual change of -4% (-5, -3) [Fig. 1A]. Non-AIDS infection (25%), CVD (10%), liver/gastrointestinal (8%), psychiatric/substance use (8%), non-AIDS cancer (6%), and AIDS-defining illness (ADI, 6%) were the most common discharge diagnosis categories. Crude rates decreased for all categories except injury, endocrine, and musculoskeletal, which had no change (Fig. 1B-D). In adjusted models, rates decreased for CVD (-4%; CI -6, -2) and ADI (-8%; CI -11, -6) and were stable for other categories, including renal (-1%; CI -4, +2) and pulmonary (-2%; CI -5, +1). Conclusion: Crude hospitalization rates decreased during 2005–2015 for most diagnostic categories. Preventing and treating non-AIDS infection, the most common hospitalization cause, remains important in HIV patient management. Adjusted decreases in CVD and ADI hospitalizations may be due to improvements in viral suppression, immunologic status, and outpatient care. Adjusted rates did not increase for organ systems potentially susceptible to cumulative damage from long-term HIV infection or ARV toxicity.

707 PREVALENCE OF PHYSICAL-FUNCTION IMPAIRMENT AND FRAILTY IN MIDDLE-AGED PWH Triin Umbleja 1 , Todd T. Brown 2 , Heather Ribaudo 1 , Jennifer A. Schrack 3 , Constance A. Benson 4 , Benigno Rodriguez 5 , Roberto Arduino 6 , Kathleen V. Fitch 7 , Steven K. Grinspoon 7 , Edgar T. Overton 8 , Kristine M. Erlandson 9 , for the ACTG A5361S (PREPARE) Team 1 Harvard T.H. Chan School of Public Health, Boston, MA, USA, 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 University of California San Diego, San Diego, CA, USA, 5 Case Western Reserve University, Cleveland, OH, USA, 6 UTHealth Medical School, Houston, TX, USA, 7 Massachusetts General Hospital, Boston, MA, USA, 8 University of Alabama at Birmingham, Birmingham, AL, USA, 9 University of Colorado Denver, Denver, CO, USA Background: People with HIV (PWH) are at risk for accelerated development of physical function impairment and frailty with increasing age; both of which are associated with increased risk of falls, hospitalizations and mortality. We evaluated the prevalence of physical function impairment and frailty, and their association with demographics, clinical characteristics and risk factors among middle-aged PWH with low to moderate cardiovascular risk. Methods: At enrollment, REPRIEVE (A5332) participants were 40-75 years of age, on stable antiretroviral therapy (ART) with CD4+ count >100 cells/mm 3 , cardiovascular risk score ≤15%, excluding diabetes if LDL cholesterol ≥70 mg/ dL; those concurrently enrolled into the physical function substudy A5361S (PREPARE) between 2017-2018 at US sites were evaluated at baseline. The evaluations included Short Physical Perfomance Battery (SPPB; 10x repeated chair stand, balance, 4-mwalk), frailty phenotype, Duke Activity Status Index (DASI) and Rapid Eating and Activity Assessment for Patients (REAP). Physical function impairment was defined as a composite SPPB score ≤10. Associations between covariates and physical function impairment were evaluated using logistic regression. Results: Among the 266 participants, the median age was 51 (Q1, Q3: 46, 55) years; 81%were male; 47%white, 45% Black; 18% Hispanic. The median CD4+ count was 610 (437, 840) cells/mm 3 ; 93% had HIV-1 RNA <50 copies/mL; 28% hypertension; 38%were overweight (BMI 25 to <30 kg/m 2 ), 30% obese (BMI ≥30 kg/m 2 ); 33% had high waist circumference (>102 cm in men, >88 cm in women); 89%were physically inactive (REAP). 37% (95% CI: 31%, 43%) had physical function impairment; 6% (4%, 9%) were frail and 42% pre-frail; 31% reported not being able to perform one or more instrumental activities of daily living (DASI). Older age, Black race, ≥10 years on ART, history of thymidine analog (TA), greater BMI, high waist circumference, hypertension and physical inactivity were associated with physical function impairment in univariate analyses (figure). Black race, greater BMI and physical inactivity remained associated with physical function impairment in the multivariate model. Conclusion: Physical function impairment and pre-frailty were common among middle- aged PWH; greater BMI and physical inactivity are important modifiable factors that may prevent further decline in physical function with aging.

Poster Abstracts

CROI 2020 259