CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

adjusted mean difference [AMD] -0.03 (95% CI -0.08, 0.02)). Results were similar for LS-BMAD Z-score (mean -0.71 (1.16) vs -0.64 (1.19; AMD -0.04 (95%CI -0.11, 0.02)). However, among participants with vitamin D insufficiency, there was a significant difference by arm in both the TBLH-BMD- and LS-BMAD- Z-scores (Table 1). There was no evidence of effect in other subgroups. No drug-related severe adverse events were observed. Conclusion: High-dose vitamin D3 and low-dose calcium supplementation, a safe, easily available and cheap intervention, during adolescence may promote bone accrual and mineralization towards maximizing peak bone mass, which may ultimately reduce fracture risk among children growing up with HIV.

regression models were used to compare these components by HIV status adjusting for age and pubertal stage. Results: There were 275 CWH (mean±SD 12.6±2.5 years old, 134[49.6%] girls) and 283 CWOH (12.7±2.5 years old, 149[50.4%] girls) at baseline. No deaths were reported, but 19% were lost to follow-up. ART regimens included either a non-nucleoside reverse-transcriptase or protease inhibitor; 211 (70%) and 89 (29%) respectively. HIV was associated with impaired gains in bone density, particularly among males (Figure 1). While females with and without HIV had similar bone density gains, males living with HIV gained less LS-BMAD (adjusted mean difference[95%CI] -0.14[-0.25 to -0.02], p=0.02) and TBLH-BMC (-0.19[- 0.33 to -0.04], p<0.015) compared to males without HIV. Living with HIV was associated with higher levels of a component representing IL-18, CRP, sCD14 and TNFα for females (βcoefficient[95% CI] 0.63[0.27 to 0.98], p=0.001) and males (0.80[0.45 to 1.15], p<0.001). Conclusion: Children living with HIV on ART have impaired bone density accrual and increased inflammation. Further investigation is ongoing into the effect of higher inflammation on peak bone mass among this population.

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Association Between HIV and Cytomegalovirus and Neuropsychological Outcomes Among Children With HIV Jillian Neary 1 , Daisy Chebet 2 , Sarah Benki-Nugent 1 , Hellen Moraa 2 , Noah Cassidy 3 , Carolyn Fish 3 , Barbra Richardson 1 , Irene Njuguna 4 , Agnes Langat 2 , Evelyn Ngugi 2 , Dara Lehman 3 , Jennifer Slyker 1 , Dalton C. Wamalwa 2 , Grace John-Stewart 1 1 University of Washington, Seattle, WA, USA, 2 University of Nairobi, Nairobi, Kenya, 3 Fred Hutchinson Cancer Center, Seattle, WA, USA, 4 Kenyatta National Hospital, Nairobi, Kenya Background: Children with HIV may experience adverse neuropsychological outcomes despite antiretroviral treatment (ART). Uncontrolled cytomegalovirus (CMV) is common in children with HIV. Among children on ART, we examined the influences of early CMV DNA, HIV DNA, and viral load (VL) on neurocognition. Methods: Children who initiated ART before 12 months of age were enrolled from 2007-2010 in Nairobi, Kenya. Blood was collected at enrollment and every 6 months thereafter. Neuropsychological assessments were conducted when children were a median age of 7 years. Primary outcomes included cognitive ability measured by the Kaufman Assessment Battery for Children 2nd Edition (KABC), executive function measured by Behavior Rating Inventory of Executive Functioning (BRIEF), motor measured by Bruinick's-Oseretsky Test of Motor Proficiency 2nd Edition Brief Form (BOT), and attention measured by Visual Test of Variables of Attention (TOVA). Secondary outcomes included short-term memory, visual-spatial, learning, non-verbal, and delayed memory from the KABC; behavior regulation and metacognition from the BRIEF; and processing speed from the TOVA. Generalized linear models were used to determine associations between HIV VL (pre-ART and cumulative), peak total and intact HIV DNA (by 12 months of age), peak CMV DNA (by 24 months of age) and neuropsychological outcomes. Results: Overall, 39 children completed neuropsychological assessments. Median age at ART initiation was 4.6 months. In adjusted models, higher peak CMV viremia by 24 months of age was associated with lower cognitive ability and motor z-scores. Higher pre-ART HIV VL, total HIV DNA, and intact HIV DNA were associated with lower executive function z-scores. Higher HIV DNA levels also were associated with higher motor z-scores and higher intact HIV DNA with higher attention z-scores. Among secondary outcomes, higher intact HIV DNA levels were associated with lower behavior regulation z-scores and higher pre-ART VL was associated with lower nonverbal and metacognition z-scores. Conclusion: Pre-ART VL, early post-ART total and intact HIV DNA, and CMV DNA in infancy predicted neuropsychological scores in childhood. These findings suggest long-term benefits of early HIV viral suppression, reservoir containment, and CMV control on neurocognition. Regional Brain Volume as Predictor of Cognitive and Mental Health Outcomes in Youth Living With HIV Sedthapong Chunamchai 1 , Anantaporn Sena 2 , Akarin Hiransuthikul 2 , Phillip Chan 3 , Robert Paul 4 , Somchai Sriplienchan 5 , Thanyawee Puthanakit 1 , Serena Spudich 3 , Chaipat Chunharas 1 1 King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 2 Chulalongkorn University, Bangkok, Thailand, 3 Yale University, New Haven, CT, USA, 4 University of Missouri St Louis, St Louis, MO, USA, 5 SEARCH, Bangkok, Thailand Background: Youth living with HIV face a risk of developing cognitive, mental health, and behavioral challenges as they progress into adulthood. However, the specific contributions of biological, neurological, and social factors to these

Poster Abstracts

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WITHDRAWNRandomized Trial of High-Dose Vitamin D Supplementation to Improve Bone Density in Children With HIV Rashida A Ferrand 1 , Nyasha V. Dzavakwa 2 , Lackson Kasonka 3 , Hildah Banda-Mabuda 3 , Tsitsi Bandason 2 , Molly Chisenga 3 , Suzanne Filteau 1 , Katharina Kranzer 1 , Hilda A. Mujuru 4 , Ulrich E. Schaible 5 , Sarah Rowland-Jones 6 , Victoria Simms 1 , Celia Gregson 7 , for the VITALITY Team 1 London School of Hygiene & Tropical Medicine, London, United Kingdom, 2 Biomedical Research and Training Institute, Harare, Zimbabwe, 3 University Teaching Hospital, Lusaka, Zambia, 4 University of Zimbabwe, Harare, Zimbabwe, 5 Research Center Borstel – Leibniz Lung Center, Borstel, Germany, 6 University of Oxford, Oxford, United Kingdom, 7 University of Bristol, Bristol, United Kingdom Background: HIV adversely affects growth and skeletal development in children despite antiretroviral therapy (ART). Vitamin D deficiency, which is highly prevalent among children with HIV in Africa, has a further adverse impact on bone health. We investigated whether adjuvant vitamin D3 and calcium carbonate supplementation improves bone density among individuals with HIV during puberty (a period of rapid growth and bone accrual). Methods: VITALITY was a multi-country individually randomized, double blinded placebo-controlled trial of weekly high-dose (20,000IU) vitamin D3 plus daily calcium carbonate (500mg) supplementation for 48 weeks. Adolescents with HIV aged 11-19 years taking ART for ≥6 months were recruited from HIV clinics in Zimbabwe and Zambia. The primary outcome was total body less-head bone mineral density (TBLH-BMD) Z-score using a UK reference population, measured by dual-energy X-ray absorptiometry (DXA). Lumbar spine bone mineral apparent density (LS-BMAD) Z-score was a secondary outcome. Linear regression was used to compare arms adjusting for site and baseline value of the DXA measure. Pre-specified sub-group analyses by age-group, sex, pubertal stage and baseline vitamin D insufficiency (defined as 25(OH)D level <75nmol/l) were performed. Results: 842 participants, 448 (53.21%) female, were enrolled. 75.9% were vitamin D insufficient. Baseline characteristics were balanced between arms; at 48 weeks DXA outcomes were available for 751 (89.2%) participants. There was no difference by arm in the primary outcome (mean 48-week TBLH-BMD Z-score -1.56 (SD 1.12) in intervention arm vs -1.53 (1.18) in the control arm,

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