CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Background: U.S. Black/African American women have disproportionately high rates of HIV and face challenges to optimal health due to disproportionate burden of poor social and structural determinants of health. In 2022, 5 Quality of Life (QOL) indicators were added to the Medical Monitoring Project (MMP) and included in the National HIV/AIDS Strategy (NHAS) goals to achieve by 2025. We evaluated whether existing trends in these indicators are sufficient to meet NHAS goals for cis-gender Black women with HIV (CgBWH), an NHAS priority population. Methods: We used data from the 2017–2021 cycles of the MMP, an annual probability sample of U.S. adults with diagnosed HIV. We calculated weighted percentages and confidence intervals (CIs) for QOL indicators from baseline (2017 or 2018) to 2021. For each indicator we calculated 1) the estimated annual percent change (EAPC) and associated test for significance (p<0.05) from baseline to 2021; 2) projected annual estimates for 2022 to 2024 to meet NHAS 2025 goals, assuming linear relationships between baseline and NHAS goals; and 3) the EAPC needed from 2021 to 2025 to meet NHAS 2025 goals, based on projected estimates. For each indicator, we compared the EAPCs from baseline to 2021 with EAPCs for 2021 to 2025 to determine whether existing rates of change are sufficient to meet goals. Results: Unemployment, hunger/food insecurity, and unstable housing/ homelessness significantly decreased from baseline to 2021 (Table). Conversely, progress in self-rated health regressed from baseline to 2021. An EAPC of 12% is needed to reach the NHAS goal for self-rated health, compared with an existing EAPC of -3.2%, and an EAPC of at least 18.5% is needed to reach the NHAS goal for unmet need for mental health services, compared with the existing EAPC of -0.2%. Conclusion: If current trends continue, the U.S. will likely meet the NHAS goal for decreasing hunger/food insecurity among CgBWH. However, the magnitude of change needed to reach goals for self-rated good or better health and unmet needs for mental health services is substantial and will require enhanced and coordinated efforts to achieve. A national call-to-action is needed to improve health and QOL among CgBWH to equitably achieve NHAS goals.

2002-12, and to 48.0 (45.7–50.3) in 2012-20. LE for females aged 20 increased, but remained lower, from 22.1 (19.9–24.4), to 32.8 (30.6–34.9), and to 40.9 (37.7–44.2). Patterns were similar at age 40 and 55. The sex gap in LE increased over time, both at age 20 and 40 (from 3.2 in 1996-2002 to 5.3 years in 2012 20), but was not as discernible at age 55. In adjusted models, female sex was significantly associated with all-cause mortality, overall and in 2002-12 and 2012-20 (Table). Similarly, in adjusted models, female sex was associated with mortality from non-communicable disease, but not from injuries/external causes and communicable disease. Further adjustment for CD4 count at ART initiation did not affect the associations significantly. Conclusion: In a setting with universal health care and free ART, the sex gap in LE among PWH continues to increase with time. Clinical and socio-economic factors do not explain that this gap in LE and HRs are increasing over time, but they do largely explain differences in mortality from communicable disease and injuries/external causes. If PWH followed the pattern observed among people without HIV in BC, we would expect the gap in LE to favor females. Our work suggests that addressing socio-structural factors may potentially reduce but not reverse the gap.

Poster Abstracts

1054 Leading Causes of Death Among People With HIV in the US, 2001-2019 Karena Volesky-Avellaneda , Eric Engels, Qianlai Luo, Meredith Shiels National Cancer Institute, Rockville, MD, USA Background: People with HIV (PWH) face elevated risk of death due to AIDS, other comorbidities, and external causes. Yet, no published study has used population-based data to examine cause-specific mortality among PWH in the US. We report the frequency of major causes of death among PWH and compare overall and cause-specific mortality among PWH to the US general population. Methods: Data on the underlying causes of death among PWH aged 20 or older who died during 2001–2019 were obtained from the HIV/AIDS Cancer Match (HACM) Study. HIV registries in the HACM Study capture vital registry data, including cause of death information, from 12 states, DC, and Puerto Rico. We report the number of deaths and proportions overall and for the leading causes of death. To compare the mortality rates of PWH to the general US population, we calculated standardized mortality ratios (SMRs), adjusting for sex, age group, race/ethnicity, and calendar year. An SMR was not calculated for HIV as it is only a cause of death among PWH. Results: During 2001–2019, there were 176,051 deaths among PWH over 7.3 million person-years of follow-up. Among decedents, 71.6% were male, 61.6% were aged 40–59 years, and 49.0% were non-Hispanic Black. The leading cause of death was HIV, accounting for 37.1% of deaths, followed by cancer (7.5% of deaths) and heart disease (6.1% of deaths) (see table). PWH had a 4 times higher risk of death (SMR: 4.15) compared to the general US population. Relative to the general population, mortality rates among PWH were elevated more among females (SMR: 6.18) than males (3.67), individuals aged 20–39 (8.86) vs. those aged 60 and older (2.15), and for Hispanic individuals (5.47) vs. Non-Hispanic Black and White people (3.78 each). SMRs steadily decreased with more recent calendar periods (8.56 during 2001–2004 vs. 2.34 during 2015–2019). SMRs were elevated for all leading causes, and highest for other infections, followed by accidents and adverse events. PWH were at 29% higher risk of death from cancer and 12% higher risk of death from heart disease. Conclusion: Despite improvements over time, death rates among PWH remained more than twice as high as the general population during 2015-2019.

1053 Mind the Gap: Life Expectancy and Mortality in Males & Females With HIV in British Columbia, Canada Katherine Kooij , Wendy Zhang, Jason Trigg, Nance Cunningham, Michael Budu, Viviane Dias Lima, Kate Salters, Rolando Barrios, Julio Montaner, Robert Hogg British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada Background: Life expectancy (LE) of people with HIV (PWH) has risen considerably in the last decades, but LE gains among females with HIV have fallen behind. Methods: We examined trends and sex differences in LE and mortality among all PWH in British Columbia (BC), using data from the Comparative Outcomes And Service Utilization Trends study. LE at ages 20, 40, and 55 was calculated using life tables stratified by sex and period (1996-2002, 2002-12, 2012-20). Using multivariable Cox regression, we modelled the association between female sex and all-cause mortality, adjusted for age and baseline confounders: history of injection drug use, residence in Vancouver's Downtown Eastside area, residence in a rural area, area-level income. Secondly, models were adjusted for CD4 count at antiretroviral therapy (ART) initiation. Models were repeated for each period and for mortality from communicable disease, non-communicable disease, and injuries/external causes (defined using ICD codes). Results: A total of 11,739 males (82%) and 2,534 females (18%) with HIV were included; 92% and 88%, respectively, were ever on ART. LE for males aged 20 increased from 24.5 (95% CI 22.3–26.6) in 1996-2002 to 37.1 (35.4–38.8) in

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