CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

710 BASELINE AND ACQUIRED COMORBIDITIES IN PATIENTS INITIATING ART IN THE HOPS, 2008-2018 Ellen Tedaldi 1 , Carl Armon 2 , Jun Li 3 , Gina M. Simoncini 1 , Frank J. Palella 4 , Stacey Purinton 2 , Kate Buchacz 3 1 Temple University, Philadelphia, PA, USA, 2 Cerner Corp, Kansas City, MO, USA, 3 CDC, Atlanta, GA, USA, 4Northwestern University, Chicago, IL, USA Background: Among persons living with HIV (PLWH), the presence of physical and psychiatric comorbidities at baseline and the rate at which they develop may be related to aging, metabolic changes, medication, or socioeconomic factors. Methods: We analyzed antiretroviral therapy (ART)-naïve participants in the HIV Outpatient Study (HOPS) initiating ART from 2008-2018 with ≥2 tests of CD4 counts since ART initiation by demographic factors, HIV risk activity, ART type and comorbid conditions: lipid disorders, diabetes, cardiovascular disease (CVD), cancer and mental health diagnoses at ART-start until last HOPS encounter. Yates-corrected chi-square analyses were used to test for changes in burden of comorbidity by sex during observation. Poisson regression was used to compare outcomes by sex, adjusted by age, race, payor, and individual person-time observation. Results: There were 1236 participants, with 982 (79%) males and 254 (21%) females, median age 36 years, 66% non-white, 44% publicly insured, 53%with smoking history, and 33%with substance use history. The baseline CD4 count was 379 cells/mm 3 for men vs. 360 cells/mm 3 for women. Women were more likely to be older, Black or Hispanic, with public insurance, seen at a public clinic, with high school education or less (all P<0.05). Participants were followed for a median of 4.9 years, with men followed for a median of 4.6 years (interquartile range [IQR]=2.4-7.1), and women followed for a median of 6.1 years (IQR=3.1-8.3). Compared with baseline, there were statistically significant temporal increases for multiple comorbidities among men and women, including for dyslipidemia, hypertension, CVD, renal disease, diabetes, depression, and anxiety at last HOPS encounter (all P<0.05). At the end of observation, women were more likely than men to have a diagnosis of diabetes (Rate Ratio: 1.50, 95% Confidence Interval: 1.01-2.23); no associations of other comorbidities with sex were found. Conclusion: Certain medical and psychiatric comorbidities are already present in persons initiating ART therapy in the past 10 years. There is a predominance of acquired metabolic comorbidities such as dyslipidemia, as well as psychiatric conditions that will complicate the long termmanagement of persons living with HIV. With aging, PLWH who start ART experience a significant increase in the burden of physical and psychiatric non-HIV comorbidities over time that warrants continued surveillance, prevention, and treatment.

709 MODIFIABLE RISK FACTORS AND INCIDENT CKD AND CVD AMONG HIV+ AND HIV– PATIENTS Michael A. Horberg 1 , Wendy Leyden 2 , Rulin Hechter 3 , Jennifer O. Lam 2 , Haihong Hu 1 , Alexandra N. Anderson 2 , Julia L. Marcus 4 , Qing Yuan 3 , Alan S. Go 2 , William J. Towner 3 , Michael J. Silverberg 2 1 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 2 Kaiser Permanente Division of Research, Oakland, CA, USA, 3 Kaiser Permanente Southern California, Pasadena, CA, USA, 4 Harvard Pilgrim Health Care Institute, Boston, MA, USA Background: HIV increases the risk of chronic kidney disease (CKD) and cardiovascular disease (CVD), but whether the association of preventable or treatable (“modifiable”) risk factors with incident CKD or CVD is similar in people with HIV (PWH) and uninfected people is unknown. Methods: We evaluated the association of modifiable risk factors with incident CKD (sustained eGFR <60 ml/min/1.73m 2 ) and CVD (hospitalized CHD, unstable angina or stroke) among adult (≥21 years) PWH and HIV-uninfected patients (“uninfected”, age, sex, race/ethnicity, medical center, and calendar year matched 1:10) from Kaiser Permanente (KP) California (Northern and Southern) and Mid-Atlantic States (DC, MD, VA) healthcare systems during 2000-2016. We excluded patients with prior known CKD or CVD. Modifiable risk factors included diabetes mellitus, hypertension, dyslipidemia, smoking (ever documented history) and alcohol use disorder. We compared adjusted rate ratios (RRs) separately for each risk factor and outcome by HIV status using Poisson regression with terms for HIV status, risk factor of interest, and HIV*risk factor interaction. Models additionally adjusted for sociodemographic characteristics (time-updated age, sex, race/ethnicity, socioeconomic status, insurance type, KP region), years of KP membership, obesity (BMI>25), drug use disorder, CKD (for CVD), CVD (for CKD). Results: Among 38,545 PWH and 384,658 uninfected without prior CKD, there were 3,084 and 10,257 incident CKD events, with rates of 1.7 and 0.5 per 100 person-years, respectively. Among 38,757 PWH and 384,404 uninfected without prior CVD, there were 1,227 and 10,039 incident CVD events, with rates of 0.6 and 0.4 per 100 patient-years, respectively. All modifiable risk factors had a stronger association with CKD among uninfected compared with PWH in adjusted models (all p<0.001; Table). Alcohol use disorder and dyslipidemia appeared protective for CKD among PWH. For CVD, dyslipidemia (p<0.001) and smoking (p=0.06) were stronger risk factors among uninfected compared with PWH. Conclusion: All modifiable risk factors evaluated had a stronger association with CKD, and dyslipidemia and smoking a stronger association with CVD, among uninfected than PWH. Some risks appear protective for CKD among PWH, potentially due to successful treatment for those, and require further study. Mitigation of risks is important but may have a greater effect on CKD and CVD among uninfected people.

Poster Abstracts

711 WOMEN WITH HIV HAVE HIGH OVERALL BURDEN AND EARLY ACCRUAL OF NON-AIDS COMORBIDITIES Lauren F. Collins 1 , Anandi N. Sheth 1 , Cyra Christina Mehta 1 , Elizabeth T. Golub 2 , Phyllis Tien 3 , Kathryn Anastos 4 , Audrey French 5 , Seble Kassaye 6 , Tonya Taylor 7 , Mirjam-Colette Kempf 8 , Margaret Fischl 9 , Adaora Adimora 10 , Frank J. Palella 11 , Igho Ofotokun 1 1 Emory University, Atlanta, GA, USA, 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 Albert Einstein College of Medicine, Bronx, NY, USA, 5 John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA, 6 Georgetown University, Washington, DC, USA, 7 SUNY Downstate Medical Center, Brooklyn, NY, USA, 8University of Alabama at Birmingham, Birmingham, AL, USA, 9 University of Miami, Miami, FL, USA, 10 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 11 Northwestern University, Chicago, IL, USA

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