CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

HIV cure research. We assessed the prevalence of paediatric LTNP in the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC). Methods: 16 cohorts from 12 European countries and Thailand contributed follow-up data from 1980-2016. Confirmed LTNP was defined as having none of these events during the first 5 (or 8) years of life: AIDS diagnosis, initiating ART, death or ever meeting defined CD4 progression criteria. Possible LTNP was defined as no clinical events but unclear timing of CD4 progression relative to age/ART initiation. We explored 4 different CD4 criteria: a)CD4 z-score<-2 relative to HIV-exposed uninfected children, b)CD4 z-score<-3, c)CD4 count<500cells/µL, d)WHO advanced/severe immunodeficiency for age (CD4%<30, <25, <20, <15 at age <11m, 12-35m, 36-59m, >5y, or CD4 count<350/µL at >5y). Inclusion criteria for analysis were perinatal infection or <10years at first visit, ≥1 CD4 record, born pre-2011 (or 2008), not lost to follow-up by age 5/8y. Associations between LTNP and sex, region and birth year were assessed with logistic regression. Data were analysed separately for children born domestically (country of reporting cohort) vs abroad. Results: Of 9621 children followed in EPPICC, 6642 (69%) met the inclusion criteria. Median age at entry to HIV care was 1.6y [IQR 0.2-4.3] and follow-up duration 10.5y [6.6-15.1]. 1468 (22.1%) were born abroad. LTNP prevalence was 9.2-38.9% at 5y and 3.6-24.6% at 8y, 2-3 times higher in those born abroad vs domestically (Figure). In multivariable analysis, for all CD4 criteria and those born domestically and abroad, prevalence was lower in Thailand and Western/Central Europe, higher in Eastern Europe (vs UK/Ireland, p<0.01) and lower in children born in later years. Conclusion: This is the largest multi-country paediatric collaboration to explore LTNP prevalence. Higher prevalence in children born abroad likely reflects selection bias of survivors well enough to migrate. Age 5y may be too early to define LTNP, as prevalence falls by 8y. Introduction of “treat all” approaches likely explains recent declines in prevalence. Data before these changes allow study of the natural history of LTNP, especially in domestic born children.

and 4%were ART-naive. At INSTI initiation, median BMI was 21.4 m/kg2 (IQR: 19.6-24.3), CD4 count was 574 cells/mL (IQR: 348-834), 43% had HIV viral load < 200 copies/mL. Fifty one YPLWH had 720 BMI measurements (median BMI measurements per YLPWH 13 (IQR: 11-17)) with a mean BMI change of +0.37 (p=0.04) and +0.98 kg/m 2 /year (p<0.0001), in the two years pre- and post- INSTI initiation respectively. There was a greater rate of BMI change post- vs. pre-INSTI of +0.6 kg/m 2 /year (p=0.05, Fig. 1a). Sub-cohort of YPLWH (≤19 years of age (n=27)) had 312 BMI-for-age z-score measurements (median z-score measurements per YLPWH 12 (IQR: 10-15)) with a mean z-score change of -0.04 (p=0.51) and +0.21 units/year (p=0.01), pre- and post-INSTI initiation respectively. YPLHIV ≤19 years had a significantly greater rate of BMI-for- age z-score change of +0.25 units/year (p=0.03, Fig. 1b) when comparing trajectories post- vs. pre-INSTI after adjusting for age at INSTI initiation, sex, race, mode of HIV acquisition and most recent CD4 count and VL (β=0.22, p=0.05). Conclusion: Similar to adults, we report a greater rate of BMI and BMI-for- age z-score change following switch to INSTI in predominantly perinatally infected YPLWH. Although the final BMI remained in the normal range, our findings support the need for continued monitoring of BMI trends and potential cardiometabolic implications in YPLWH receiving INSTIs to assess if this represents more than a return to health phenomenon.

Poster Abstracts

826 EFFECT OF INTEGRASE INHIBITORS ON WEIGHT GAIN IN CHILDREN AND ADOLESCENTS WITH HIV Sahera Dirajlal-Fargo 1 , Wei Li A. Koay 2 , Matthew E. Levy 3 , Anne K. Monroe 3 , Amanda D. Castel 3 , Natella Rakhmanina 2 , for the DC Cohort Executive Committee 1 Case Western Reserve University, Cleveland, OH, USA, 2 Children's Research Institute, Children's National Health System, Washington, DC, USA, 3 George Washington University, Washington, DC, USA Background: Weight gain has been associated with integrase strand transfer inhibitor (INSTI) based regimens in adults, but this has not been studied in children and youth with perinatally acquired HIV. We investigated the change in body mass index (BMI) among young persons living with HIV (YPLWH) initiating INSTI-based regimens for the first time within an observational cohort in Washington DC (DC Cohort). Methods: YPLWH (0-24 years of age) who initiated INSTI-based regimens between Jan 2011 and Mar 2018, and had ≥2 BMIs recorded at least 6 months apart within 2 years pre- and post-INSTI initiation were eligible. We compared the trajectory of BMI (or BMI-for-age z-score for those ≤19 years of age) pre- and post-INSTI initiation using piecewise linear mixed effects models, and adjusted for potential confounders. Results: We enrolled 51 YPLWH (median age 18 years (IQR 15-21), 47%male, 94% black, 72% perinatally infected, 59% initiated dolutegravir, 57% had a history of AIDS). Pre-INSTI, 59%were on a protease inhibitor based regimen

827 BODY FAT AND LIPID PROFILE CHANGES IN HIV-INFECTED YOUTHS SWITCHED TO DOLUTEGRAVIR Vania Giacomet 1 , Samuel Lazzarin 1 , Andrea Manzo 1 , Emma Longoni 1 , Katia Maruca 2 , Paola Erba 1 , Federica Forlanini 1 , GianVincenzo Zuccotti 3 , Stefano Mora 2 1 University of Milan, Milan, Italy, 2 San Raffaele Scientific Institute, Milan, Italy, 3 Ospedale dei Bambini Vittore Buzzi, Milan, Italy Background: HIV-lipodystrophy syndrome consists in abnormal distribution of adipose tissue and alteration of glucose and lipids blood concentration. Many studies established a key role of older NRTIs and PIs in lipodystrophy development, but few data are available for newer drugs, such as dolutegravir, a second-generation INSTI assumed to be responsible for weight gain in adults. The aim of this study was to evaluate the effects of dolutegravir on body composition and glico-lipidic metabolism in HIV-infected youths. Methods: We enrolled 14 patients (mean age 16.1 years, 12 girls) previously treated with PI or NNRTI-based regimen and switched to ABC/3TC/DTG. Blood concentration of glucose, total and fractionated cholesterol and triglycerides were measured at baseline and after 3, 6 and 12 months. Body composition was evaluated by dual-energy X-ray absorptiometry and body mass index (BMI)

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