CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

786

Factors Associated With Smoking Cessation Among Patients in the HIV Outpatient Study, 2007-2022 Jun Li 1 , Carl Armon 2 , Alexander C. Ewing 1 , Jonathan Mahnken 2 , Ellen M. Tedaldi 3 , Frank Palella 4 , Richard Novak 5 , Cynthia Firnhaber 6 , Stockton Mayer 5 , Andrea Wendrow 5 , Gina Simoncini 7 , Linda Battalora 6 , Kimberly Carlson 2 , Kate Buchacz 1 , for the HIV Outpatient Study (HOPS) Investigators 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 Cerner Corp, Kansas City, MO, USA, 3 Temple University, Philadelphia, PA, USA, 4 Northwestern University, Chicago, IL, USA, 5 University of Illinois at Chicago, Chicago, IL, USA, 6 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 7 AIDS Healthcare Foundation, Philadelphia, PA, USA Background: The U.S. Preventive Service Task Force recommends smoking screening and cessation strategies as a part of routine care. However, people with HIV (PWH) are more likely to smoke and less likely to quit than people without HIV. We assessed factors associated with smoking cessation among cigarette smokers seen in care at outpatient clinics of the HIV Outpatient Study (HOPS). Methods: We analyzed HOPS participants' data from clinic electronic medical records (EMR) and from an optional annual participant survey from January 1, 2007 to December 31, 2022. We included PWH with EMR or survey evidence of current cigarette use and no smoking cessation medication use at baseline (i.e., first HOPS visit) and those who began smoking cigarettes during follow-up. We identified smoking-related comorbidities based on lab results, clinical diagnoses, and treatments. Smoking quit attempts were determined via EMR and survey data during follow-up. We studied associations of first quit attempt with comorbidity diagnoses, smoking cessation medications prescriptions, sociodemographics, and clinical factors using the counting process within Cox proportional hazards analyses. Results: Among 1,068 eligible PWH, 77% were men, 32% White persons, 48% Black persons, 18% Hispanic/Latino persons, 47% aged 40 and older. At baseline, 172 (16%) had chronic obstructive pulmonary disease (COPD)/ emphysema, cardiovascular disease (CVD), and/or cancers. During a median follow-up time of 4.4 years (interquartile range: 1.9-8.6), 301 (28%) PWH were prescribed smoking cessation medications (varenicline=87, bupropion=50, nicotine products=235), and 198 (19%) quit smoking. Of these 198, 33 (17%) resumed smoking after first quit. In multivariable analysis, factors positively (p<0.05) associated with smoking cessation included: later year of HOPS enrollment, non-Hispanic/Latino (NH) white race/ethnicity versus NH Black, heterosexual HIV transmission versus men who have sex with men risk group, having a depression diagnosis, being prescribed varenicline, bupropion or nicotine products, whereas factors inversely associated included: being uninsured versus having private insurance, and having diagnoses of psychosis, hypertension, or obesity (Figure). Conclusion: Fewer than one-third of HOPS participants who smoked cigarettes had a prescription for smoking cessation medication, and only one-in-five had a documented quit attempt, highlighting challenges for and need to strengthen prevention of smoking-related chronic diseases in PWH.

IRs decreased from 8.65/1000 PY in 2001–2002 to 3.74/1000 PY in 2019–2021, IR ratio (IRR) 0.30 (95% CI 0.24–0.38, p<0.0001), with a steeper decline up to 2009 (Fig. A). The prevalence of most CVD risk factors was similar or decreased over time except for hypertension, which increased (Fig. B), possibly partly due to increased monitoring. Adjusting for hypertension accentuated the temporal CVD trends (IRR 0.26 [95% CI 0.20–0.32], p<0.0001) while changes in demographics (gender, ethnicity, mode of HIV acquisition), other known CVD risk factors (smoking, chronic kidney disease, body mass index, diabetes, dyslipidemia) or stage of HIV disease (CD4 nadir, prior AIDS) did not influence the decline in CVD IR. Conclusion: Combining data from two large, international collaborations, we have shown a decline in age-standardised CVD incidence in people with HIV from 2001 to 2021, most pronounced from 2001 to 2009. While causes of the decline in CVD incidence need to be investigated further, hypertension may have contributed to a slower decline over time. The CVD decline did not appear to be affected by changes in demographics, HIV disease stage and most known CVD risk factors.

Poster Abstracts

785

The Effect of Dolutegravir on Whole-Body Glucose Disposal and Lipid Metabolism in Healthy Volunteers Shahid A. Bukhari 1 , Roya Movahedi 1 , James Nesbitt 1 , Sujin Kang 1 , Betsabe Rodriguez Mateos 1 , Krestine Elecito 1 , Arnold Xhikola 1 , Graeme Moyle 1 , Ana Milinkovic 2 , Marta Boffito 2 , Ruth Byrne 1 1 Chelsea and Westminster Hospital, London, United Kingdom, 2 Imperial College London, London, United Kingdom Background: Dolutegravir (DTG) is a second-generation HIV integrase inhibitor prescribed in combination with other antiretrovirals (ARVs). Although DTG has shown success in achieving and maintaining virological suppression, there is interest in the effects of DTG on glucose disposal and metabolic outcomes including diabetes mellitus. The aim of this study was to assess glucose disposal in volunteers without HIV, exposed to DTG daily for 28 days using euglycaemic clamp procedures. Methods: An open-label, two-arm, single centre study randomised participants 1:1 to either 28 days of DTG (treatment arm, TA) or no therapy (no treatment arm, nTA). A hyperinsulinaemic euglycaemic clamp was carried out at days 1 and 28 in both arms. Statistical assessments of change in estimated glucose disposal rates were carried out using Wilcoxon signed-rank test (intra arm) and two-sample Wilcoxon rank-sum (Mann–Whitney) test (inter-arm). The primary study outcome was change from baseline in total body glucose disposal by euglycaemic clamp method following 28 days of treatment. Results: Fourteen volunteers in total completed the study, with 6 in the TA, and 8 in the nTA. The median glucose disposal rate for the nTA was 6.18 mg/kg/ min at day 1 and 7.62 mg/kg/min at day 28 (p=0.64), with a median percentage change of +23.3% (1.44). In the TA, the median glucose disposal rate for was 6.95 mg/kg/min at day 1 and 7.93 mg/kg/min at day 28 (p=0.06), with a median percentage change of +14% (0.98). Furthermore, on day 28, no significant difference in glucose disposal rate was measured between the TA and the nTA: 7.93 mg/kg/min versus 7.62 mg/kg/min (p=0.41). In addition, there was a difference of -0.41 (-14.64%) in LDL cholesterol values between the TA (LDL 2.39 mmol/L) and the nTA (LDL 2.80 mmol/L) (p= 0.36). Conclusion: DTG treatment for 28 days was not associated with a statistically significant change in total body glucose disposal, as measured by euglycaemic hyperinsulinaemic clamp technique, or in LDL cholesterol levels in volunteers without HIV. Long term data on DTG metabolic effects are needed.

787

Associations Between Antiretroviral Therapy and Cardiovascular Events in People With Treated HIV Luis Parra-Rodriguez , John Sahrmann, Anne M. Butler, Margaret A. Olsen,

William G. Powderly, Jane A. O'Halloran Washington University in St Louis, St Louis, MO, USA

Background: Several antiretroviral therapy (ART) agents are associated with increased risk of cardiovascular disease but less is known about the safety of contemporary ART. We sought to compare the risk of major adverse cardiac events (MACE) between different ART regimens. Methods: We used the Merative™ MarketScan® Commercial (2008-2020) and Multistate Medicaid (2011-2020) databases to identify adults between

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