CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

especially among PWH, should be a best practice. Further research into specific PCC conditions, effects of vaccination, and COVID disease severity among PWH is needed.

correlates of PIP; (3) Evaluate the relationship between PIP, symptom burden and quality of life (QOL.). Methods: We analyzed data from the DC Cohort, a multicenter longitudinal study of 12,000 PWH receiving care in Washington, DC. Participants who completed a survey on symptom burden, social determinants of health (SDOH), and QOL were included. Symptom burden was measured with a continuous global distress index. We used STOPP to identify PIP and evaluated unadjusted/ adjusted logistic regression models to determine demographics, comorbidities, HIV clinical factors, and SDOH associated with PIP. We then used structural equation modeling to evaluate whether symptom burden mediates the relationship between PIP and QOL. Results: Of the eligible DC Cohort participants (n=), 902 (%) completed surveys and 511 (56.6%) had STOPP-designated PIP. The most common PIP were related to the musculoskeletal (n=349 (38.7%)), central nervous (n=335 (37.1%)), and urogenital (n=259 (28.7%)) systems. The strongest predictor of PIP was hypertension (aOR (95% CI): 5.17 (3.15, 8.51)). Non-Hispanic White participants were significantly more likely to have PIP than Non-Hispanic Black participants (aOR: 2.45 (95% CI: 1.42, 4.23)). Older age, having a housing or utility need, or receiving HIV care at a hospital versus a community site were all significantly associated with increased odds of PIP. In mediation models, symptom burden was a statistically significant mediator, but the direct effect (non-mediated) of PIP on QOL was not significant. Conclusion: We found that over half of our participants had a PIP and hypertension is a strong predictor of PIP. Future interventions should use STOPP as a means of alerting clinical teams to clinically relevant PIP, especially among the high-risk groups identified here. The figure, table, or graphic for this abstract has been removed. Effects of HIV Status on Incidence of Post-COVID Conditions in Patients With SARS-CoV-2 (COVID-19) Michael A Horberg 1 , Celeena R. Jefferson 1 , Eric S. Watson 1 , Lily F. Fathi 1 , Seohyun S. Kim 1 , Kelly A. Gebo 2 , Brenna Hogan 3 , Elizabeth Humes 4 , Keri N. Althoff 4 1 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 2 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 The Johns Hopkins University, Baltimore, MD, USA, 4 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: SARS-CoV-2 (COVID) has been linked to long-term effects known as Post-COVID Conditions (PCC), that present post-acute COVID infection. While many studies have estimated PCC incidence, few have focused on immunocompromised patients, such as people with HIV (PWH). We estimated PCC incidence among PWH compared with people without HIV (PWoH) within Kaiser Permanente Mid-Atlantic States (KPMAS), an integrated closed healthcare system with high ascertainment of COVID-19 testing, vaccinations, and diagnoses among our patient membership. Methods: Using KPMAS electronic health records, we identified adult patients (≥18 years) with a positive polymerase chain reaction (PCR) test for COVID between 1/1/2020-1/31/2022. PWH, identified from the KPMAS HIV registry, were matched to PWoH by month of first PCR-positive test, age group (deciles), race, sex, vaccination status prior to test, and service area (to account for physician diagnostic variation), using 1:3 variable ratio matching. Patients were considered to have PCC if diagnosed with one of 17 previously identified PCC related conditions incident in the 30-180 days post first positive test date. From our earlier work, PCC-related conditions included anosmia, cardiac dysrhythmia, diabetes, gastrointestinal, neurologic, and genitourinary disorders, malaise, and non-specific chest pain. Relative risk with 95% confidence intervals were calculated and the association between HIV and PCC was evaluated with Rao-Scott Chi-Square (significance at p<0.05), weighted to account for disproportionate matching. Results: We matched 749 PWH to 2,236 PWoH with >98% having 1:3 matching (1:3 = 740; 1:2 = 7; 1:1 = 2; [table]). The matched cohort was predominately black (80%) and male (64%) with a median age of 47 years. Overall, 22% of PWH and 19% of PWoH developed PCC. Risk of incident PCC among PWH (vs PWoH) was 19% higher (RR=1.19, 95% CI: 1.01-1.40; p=0.035). While PCC incidence was higher among PWH with CD4 ≤200/μL (37%, among 27) compared to those with CD4 >200/μL (22% among 633, p=0.07); PCC incidence did not vary by viral suppression status (> or <200 copies/mL; 22%, p=0.95). Conclusion: We found PWH are at greater risk for PCC compared to PWoH, contributing evidence for enhanced care of immunocompromised populations who are infected with COVID. Assessment for PCC 30-180 days post-COVID,

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Evaluating the Effect of Vaccination on Post-COVID Conditions Among Patients With and Without HIV Michael A Horberg 1 , Eric S. Watson 1 , Celeena R. Jefferson 1 , Lily F. Fathi 1 , Seohyun S. Kim 1 , Kelly A. Gebo 2 , Brenna Hogan 3 , Elizabeth Humes 3 , Keri N. Althoff 3 1 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 2 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: Previous studies have described conditions presenting post-acute SARS-CoV-2 (COVID) infection, known as Post-COVID Conditions (PCC) or as Long COVID; but the effect of vaccination, especially among immunocompromised patients, is unclear. We evaluated the effect of COVID-19 vaccination on PCC within an integrated health system (Kaiser Permanente Mid-Atlantic States; KPMAS), for patients with HIV (PWH) and without HIV (PWoH). KPMAS is a closed healthcare system with high ascertainment of COVID-19 diagnostic and vaccination records. Methods: Using KPMAS electronic health records, we identified adult patients (≥18 years) with a positive SARS-CoV-2 PCR test result between 1/1/2021 1/31/2022. The first positive result in this period defined the index date. Vaccination was defined as having ≥2 doses of mRNA or 1 for J&J COVID-19 vaccine ≥14 days prior to the index date. AHRQ Clinical Classification Software was used to group ICD-10 codes for 17 previously-identified PCC-related conditions, including anosmia, cardiac dysrhythmia, diabetes, gastrointestinal, neurologic and genitourinary disorders, malaise, and non-specific chest pain. PCC was defined as having an incident diagnosis of any of these conditions, 30-180 days after index. Poisson regression models with robust variance determined if the relative risk of PCC by COVID-19 vaccination status was the same among PWH (from KPMAS HIV registry) and PWoH, accounting for sex, race/ethnicity, age at index, service area within KPMAS (to account for diagnostic variation), and COVID-19 variant calendar periods. We tested for effect modification of HIV by vaccination status. Results: Overall, 72,376 patients were identified, including 429 PWH and 71,884 PWoH, of whom 39% and 44% were unvaccinated, respectively (table). No interaction was found between HIV and vaccination (p value=0.81). After removing the interaction term, PWH showed significant increased risk versus PWoH (RR 1.25; p=0.01), while unvaccinated patients versus vaccinated did not (RR 1.02; p=0.27). Sex, age, service area, and race all showed significant risk ratios. Men showed lower risk (RR=0.78) compared to women, while greater age (RR=1.52 85+; Ref =18-29), non-white race and Hispanic ethnicity (RR=1.14 Hispanic; Ref =NH White) showed increased risk. Conclusion: After adjusting for demographic characteristics, risk of PCC did not differ by vaccination status among PWH or PWoH. These findings may suggest COVID-19 vaccination is not protective against PCC after breakthrough infection. The figure, table, or graphic for this abstract has been removed. Post-Acute Sequelae of COVID-19 in an Early-Treated HIV Cohort in Thailand Ferron F Ocampo 1 , Tyler Hamby 2 , Carlo P. Sacdalan 1 , Pasiri Sithinamsuwan 3 , Suteeraporn Pinyakorn 2 , Varaporn Unsombut 1 , Somchai Sriplienchan 1 , Nittaya Phanuphak 4 , Robert Paul 5 , Phillip Chan 6 , Sandhya Vasan 2 , Lydie Trautmann 2 , Serena Spudich 6 , for RV254/SEARCH010 1 SEARCH, Bangkok, Thailand, 2 US Military HIV Research Program, Silver Spring, MD, USA, 3 Phramongkutklao College of Medicine, Bangkok, Thailand, 4 Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand, 5 University of Missouri St Louis, St Louis, MO, USA, 6 Yale University, New Haven, CT, USA Background: People with HIV (PWH) may be at elevated risk of post-acute sequelae of COVID-19 (PASC), but PASC frequency and risk factors in PWH

Poster Abstracts

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CROI 2024 259