CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

791

Hypertension Treatment Gap Among People With/Without HIV in Kenya, Nigeria, Tanzania, and Uganda Matthew Romo 1 , Nicole Dear 1 , Trevor A. Crowell 1 , Seth Frndak 1 , Hannah Kibuuka 2 , John Owuoth 3 , Valentine Sing'oei 3 , Jonah Maswai 4 , Emmanuel Bahemana 5 , Victor Anyebe 6 , Zahra Parker 1 , Julie Ake 1 , J. Sean Cavanaugh 1 , Neha Shah 1 , for the African Cohort Study (AFRICOS) Group 1 US Military HIV Research Program, Silver Spring, MD, USA, 2 Makerere University Walter Reed Project, Kampala, Uganda, 3 US Army Medical Research Directorate - Africa, Kisumu, Kenya, 4 US Army Medical Research Directorate - Africa, Kericho, Kenya, 5 US Military HIV Research Program, Mbeya, United Republic of Tanzania, 6 US Military HIV Research Program, Abuja, Nigeria Background: Mortality associated with hypertension (HTN) in sub-Saharan Africa is among the highest globally and unlike other regions, little progress has been made in diagnosis, treatment, and control. HIV care programs have typically focused on providing HIV-related care, but as life expectancies of people with HIV (PWH) are extending, addressing noncommunicable diseases and risk factors may be increasingly important. Methods: The prospective African Cohort Study enrolls PWH and people without HIV (PWoH), aged ≥15 years, in care at 12 PEPFAR-supported facilities in Kenya, Nigeria, Tanzania, and Uganda. Among participants with at least two 6-monthly study visits, we defined HTN as a persistently elevated systolic and/or diastolic blood pressure (BP) ≥140/90 mmHg at ≥2 consecutive visits, or receipt of any HTN medication. All subsequent study visits were classified as having HTN. Multivariable random intercept log-Poisson models with robust standard errors that included HIV status, time in the cohort, demographic and clinical characteristics, and site service delivery characteristics were used to examine associations with study visit-level rates of untreated HTN and uncontrolled BP (≥130/80 mmHg) among those on HTN treatment. Results: From 1/2013–6/2023, 4114 participants were enrolled; 3638 with a total of 19,507 person-years of follow-up were included. Overall, 693 (19%) ever had HTN, among whom median (IQR) age was 48 (41–54) years, 591 (85%) were PWH, and 380 (55%) were female. Of those with HTN, 414 (60%) never received HTN treatment (figure). Among those on HTN treatment, 87% had one or more study visits with uncontrolled BP, with a median (IQR) proportion of study visits with uncontrolled BP of 73% (43%–100%). At their most recent study visit, 158 (57%) of those on HTN treatment received combination therapy as recommended by WHO guidelines. In multivariable models, HIV status was not significantly associated with untreated HTN (PWH vs. PWoH: adjusted rate ratio [aRR] 0.93, 95% CI: 0.84–1.03) or uncontrolled BP (PWH vs. PWoH: aRR 0.97, 95% CI: 0.81–1.17). Males had a significantly higher rate of untreated HTN (aRR 1.18, 95% CI: 1.08–1.28), but not uncontrolled BP (aRR 1.10, 95% CI: 0.96–1.26). Conclusion: We identified a substantial burden of untreated and uncontrolled HTN, unaffected by HIV status. Strategies are needed to optimally scale up HTN diagnosis and management in the context of existing HIV treatment services for PWH and testing/prevention services for PWoH.

790

Higher Risks of Hypertension With Use of DTG Versus PI/r in the VISEND Trial Lloyd B. Mulenga 1 , Kaitlyn M. McCann 2 , Lameck Chirwa 1 , Manya Mirchandani 2 , Andrew Hill 3 , for the VISEND Study Team 1 University Teaching Hospital, Lusaka, Zambia, 2 Imperial College London, London, United Kingdom, 3 University of Liverpool, Liverpool, United Kingdom Background: Hypertension is a leading cause of death in sub-Saharan Africa. In the general population, risks of hypertension rise with increasing age and body weight. Many African HIV treatment programs do not include funding for treatment of hypertension. Use of tenofovir alafenamide (TAF) and dolutegravir (DTG) have been associated with higher risks of hypertension in some randomized trials and cohort studies, but other studies have not shown these associations. The VISEND study was conducted in Zambia to evaluate the safety and efficacy of second-line treatment, after NNRTI failure. Methods: The VISEND study recruited adults previously taking NNRTI based treatment. People with HIV-1 RNA <1,000 c/mL at screening (Low VL Group) were randomized to TDF/3TC/DTG or TAF/FTC/DTG. People with HIV-1 RNA>1,000 c/mL (High VL Group) were randomized to TDF/3TC/DTG, TAF/FTC/ DTG, ZDV/3TC+LPV/r or ZDV/3TC+ATV/r. Blood pressure was evaluated at study Weeks 24, 48, 96 and 144. The risk of Grade 1 hypertension (SBP/DBP >140/90 mmHg) was compared between the TDF/3TC/DTG and TAF/FTC/DTG arms, and by use of DTG vs PI/r, using Cochrane Mantel-Haenszel tests. Results: At Week 24, there were no significant differences in Grade 1 HTN between treatment arms within either VL Group. Across the VL Groups, rises in BMI were significantly higher for people taking TAF/FTC/DTG versus TDF/3TC/ DTG (p<0.001). In the high VL Group, rises in BMI were significantly greater in the TAF/FTC/DTG or TDF/3TC/DTG arms, versus the ZDV/3TC+LPV/r or ZDV/3TC/ ATV/r arms (p<0.001). Systolic BP increased across TAF/FTC/DTG, TDF/3TC/ DTG, and ZDV/3TC+LPV/r arms, while no changes were noted in the ZDV/3TC/ ATV/r arm. The prevalence of hypertension increased over time in all treatment arms. By Week 144, the percentage with Grade 1 hypertension was significantly higher for people taking TAF/FTC/DTG, compared with TDF/FTC/DTG (p=0.02, stratified by VL Group). By Week 144 there were significantly more people in the TDF/3TC/DTG and TAF/FTC/DTG arms with Grade 1 HTN (173/343, 50%) compared with the ZDV/3TC/LPV/r or ZDV/3TC/ATV/r arms (76/258, 27%) (p<0.001). Conclusion: In VISEND, risks of Grade 1 HTN and changes in systolic BP were higher for TAF/3TC/DTG and TDF/FTC/DTG versus ZDV/3TC/ATV/r or ZDV/3TC/ LPV/r. Results were not consistent when comparing TAF/3TC/DTG and TDF/FTC/ DTG, where there were no significant differences for change in systolic BP, but there were differences when comparing the risk of Grade 1 HTN.

Poster Abstracts

792

HIV-Associated Heart Failure: Phenotypes and Clinical Outcomes in a Safety Net Setting Matthew S Durstenfeld , Anjali Thakkar , Yifei Ma , Priscilla Y. Hsue University of California San Francisco, San Francisco, CA, USA Background: HIV is associated with increased risk of heart failure and with worse outcomes after diagnosis with heart failure. However, whether cardiomyopathy phenotypes vary by HIV status and whether HIV is associated with similarly increased risk within a contemporary population who receives care within a safety-net system is unknown. Methods: In this observational study, using an electronic health record database of all individuals with diagnosed heart failure within the San Francisco Health Network, a municipal safety-net system, from 2001-2019, we compared individuals with and without HIV (defined by ICD code and at least one CD4

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