CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

571

Plasma Inflammatory Biomarkers Link to Worse Cognition Among Africans Living With HIV Samuel Wilson 1 , Andjelika Milicic 2 , Rither Langat 3 , Winnie Rehema 4 , Gloria David 5 , Nkechinyere Harrison 6 , Hannah Kibuuka 7 , Hendrik Streeck 8 , Allahna Esber 3 , Shireen Javandel 2 , Isabel Allen 2 , Lishomwa Ndhlovu 9 , Julie Ake 3 , Victor Valcour 2 , for AFRICOS 1 Thomas Jefferson University, Philadelphia, PA, USA, 2 University of California San Francisco, San Francisco, CA, USA, 3 US Military HIV Research Program, Bethesda, MD, USA, 4 HJF Medical Research International, Mbeya, United Republic of Tanzania, 5 Walter Reed Project–Kisumu, Kisumu, Kenya, 6 Walter Reed Program–Nigeria, Abuja, Nigeria, 7 Makerere University Walter Reed Project, Kampala, Uganda, 8 University of Bonn, Bonn, Germany, 9 Weill Cornell Medicine, New York, NY, USA Background: Sub-Saharan Africa (SSA) accounts for nearly two-thirds of global HIV infections. Despite access to therapy, comorbidities in the region remain prevalent, including cognitive impairment (CI). The neuropathogenesis of CI among treated people with HIV is thought to be driven by inflammation, particularly that linked to monocytes. Methods: We characterized the relationship between inflammatory plasma biomarkers (CXCL10, CCL2, sCD163, and sCD25) and cognitive performance in a Sub-Saharan African cohort of people living with HIV and people without HIV at sites in Kenya, Nigeria, Tanzania, and Uganda (AFRICOS). All assessments were completed at the time of enrollment into the AFRICOS cohort. Neuropsychological tests included the WHO/NIMH Auditory Verbal Learning task with recall and recognition trials, Trails A, Action Fluency and the Grooved Pegboard tests. Analyses were completed using linear regression models of the mean (NPZ) summary z-score of individual tests. Results: In all, 473 (17%) were living without HIV, 1393 (51%) were living with HIV and suppressed plasma viremia, whereas 871 (32%) had unsuppressed plasma viremia (>1000 copies/mL). Compared to controls, the group of people living with HIV was older (p<0.001) and less literate (p=0.013). We found inverse relationships (see Table)) between plasma biomarkers and cognitive performance on all measures except sCD163 in the people living with HIV, particularly in the suppressed group. Inflammation was not associated with cognitive performance among controls. The Grooved Pegboard test appeared to have the strongest associations between inflammatory markers and worse cognitive performance. Conclusion: In the sub-Saharan African context, chronic inflammation among people living with HIV is linked to worse cognitive performance. This association persists even in those with suppressed plasma viral load. *First and second authors contributed equally Improving Diagnosis of Central Nervous System Infections in High-HIV Prevalence African Settings James Milburn 1 , Taddy Mwarumba 2 , Rachita Suresh 3 , Kebatshabile Ngoni 3 , Tavengwa Manenji 4 , F. Kathryn Boyd 1 , Lenon Gwuanza 2 , Tiny Mazhani 5 , Ronan Doyle 1 , Katharina Kranzer 1 , Madisa Mine 6 , Margaret Mokomane 5 , Gift Ngwende 2 , Chiratidzo Ndhlovu 2 , Joseph N. Jarvis 1 1 London School of Hygiene & Tropical Medicine, London, United Kingdom, 2 University of Zimbabwe, Harare, Zimbabwe, 3 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 4 Parirenyatwa Hospital, Harare, Zimbabwe, 5 University of Botswana, Gaborone, Botswana, 6 National Health Laboratory, Gaborone, Botswana Background: Central nervous system infections (CNSI) account for approximately 30% of early mortality in ART programmes. The epidemiology of CNSI in high-HIV prevalence African settings is poorly understood making presumptive diagnosis and empiric treatment challenging. Patients with CNSI who do not receive a diagnosis have mortality rates of up to 40% at 10 weeks indicating the presence of serious underlying pathology that needs appropriate diagnosis to guide effective treatment. Methods: Enhanced diagnostic packages were introduced into routine CSF analysis at Princess Marina Hospital, Gaborone, Botswana in June 2021 and Parirenyatwa Hospital, Harare, Zimbabwe in October 2022. BioFIRE FilmArray Meningitis/Encephalitis (FilmArray-ME) & Xpert MTB/RIF Ultra were performed on all samples and results returned to clinicians in real-time. Retrospective analysis was performed on stored samples with Toxoplasma gondii PCR &

Methods: Participants enrolled through the Rakai Community Cohort Study (350 PWH; 250 PWoH) were administered a neuropsychological assessment which included the WHO–Auditory Verbal Learning Test, a list-learning task where participants are asked to recall as many words as possible across five learning trials. The test was administered in Luganda by trained research staff. For delay recall, the participant is asked to recall the original list after a 20-minute delay. Primary outcome measures include total learning across trials and total correct words recalled on the delay recall trial. Demographically adjusted (age, sex, education) z-scores were established using data from PWoH. Impairment was defined as one standard deviation below PWoH (z-score <1). The two groups were compared using a Chi-Square Test. Results: PWH were demographically-similar to PWoH in terms of age (44 vs. 43 years, P=.53), sex (48% vs. 54% male, P=.11), and education (6 vs. 5.8 years, P=.31). Cardiovascular and metabolic comorbidities were low in each group, including obesity (9% vs. 12%, P=.01), history of diabetes (.6% vs. 3%, P=.03) or hypertension (5% vs. 6%, P=.41), as was substance use for the study group (<2%). 94% of PWH were virally suppressed (HIV RNA <40 cp/mL) with the majority (83%) on efavirenz, lamivudine, and tenofovir. Notably, there was no difference in the proportion of impairment on total learning (PWH 14.9% vs. PWoH 15.3%, P=.89) or delayed recall (PWH 14.6% vs. PWoH 14.0%, P=.84) between the two groups. Conclusion: PWH on long term ART with relatively few comorbidities in Uganda demonstrate a low prevalence of verbal learning or memory impairment which is similar to that of PWoH. Possibly, the level of health care for PWH in Uganda may serve as a protective factor for HIV cognitive decline however, as the Rakai cohort ages it may be at risk for developing cognitive impairment and the emergence of age-related health comorbidities. Prevalence of Stigma, Depression and Anxiety in a Cohort of PLWH in Lebanon: A Cross-Sectional Study Remie L. El Helou, Alison Haidar, Nesrine Rizk American University of Beirut, Beirut, Lebanon Background: Adherence to Antiretroviral Therapy (ART) is associated with an improved quality of life and increased life expectancy for People Living with HIV (PLWH). Moreover, compliance with treatment ensures virological success, which, in turn, leads to reduced transmission. The Middle East and North Africa (MENA) region is witnessing a rise in new HIV infections. Stigma, anxiety, and depression are prevalent among PLWH and are often linked to noncompliance with ART. However, there is a lack of research on mental health issues among PLWH in the MENA. Our study aimed to assess the prevalence of anxiety, depression, and stigma in a cohort of PLWH in Lebanon and explore potential correlations between these factors. Methods: We conducted a cross-sectional study between June 2022 and June 2023 at a tertiary care center in Lebanon. The study included adult PLWH with an undetectable viral load for at least six months. We collected demographic and HIV-related data and used the Generalized Anxiety Disorder (GAD-7) assessment, Patient-Health Questionnaire (PHQ-9), and HIV Stigma Scale to measure anxiety, depression, and stigma, respectively. We employed statistical methods such as the Spearman correlation test, multiple regression, and descriptive analysis to characterize the cohort and examine the prevalence of and correlations between stigma, depression, and anxiety. Statistical significance was set at p<0.05. Results: Our analysis included 39 participants, with the majority being males (87.5%) and single (75%). The mean age was 38±9 years, with mean GAD-7, PHQ-9, and stigma scores of 6±5.5, 6±4.7, and 25±9.5, respectively. Approximately 46.2% experienced anxiety (GAD-7 score>5), and 61.5% reported depression (PHQ-9 score>5). The Spearman test revealed a significant positive correlation between anxiety and stigma (p<0.001, rho=0.665), as well as between depression and stigma (p=0.021, rho=0.400). Notably, the correlation between anxiety and stigma remained significant even after adjusting for age (B= 4.3, p=0.033). Conclusion: In our cohort of PLWH, we observed correlations between stigma, anxiety, and depression. Furthermore, anxiety and depression were found to be prevalent among the participants. Considering the socio-cultural context of the MENA region, there is a pressing need for more extensive studies examining the intersection of HIV and mental health. Such research is essential for the development of tailored policies and strategies aimed at mitigating the escalating epidemic in this region.

Poster Abstracts 570

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CROI 2024 156