CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1056 Mortality Among People Living With HIV in India: Emergence of Noncommunicable Diseases

Death rates were elevated among PWH for several leading causes of death, including cancer, heart disease, and infections.

Manish Bamrotiya 1 , Neha Garg 2 , Alice Marak 2 , Jade Bell 1 , Maria Salvat Ballester 1 , Allison M. McFall 3 , Shruti H. Mehta 3 , Sunil Suhas Solomon 1 , Bhawani Kushwaha 4 , Chinmoyee Das 4 , Purnima Parmar 4 , Hekali Zhimomi 4 , Nidhi Kesarwani 4 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 National AIDS Control Organisation, New Delhi, India Background: Expanded access to antiretroviral therapy (ART) has significantly reduced HIV-related mortality in adults and children worldwide including a 77% decline in India between 2010 to 2021. Even with this reduction, from January 2019 to March 2020, 79,755 deaths among PLHIV were reported across all government ART centers in the country. While mortality patterns among PLHIV show a shift toward noncommunicable diseases (NCDs) in high income settings, mortality data among PLHIV in low-and-middle-income countries (LMICs) is limited. Methods: Between January 2019 and March 2020, we collaborated with India's National AIDS Control Program to perform verbal autopsy assessments, a method to determine the most probable cause of death by interviewing caregivers of deceased PLHIV when official medical certification is not available. We conducted the exercise in 28 selected ART centers across 18 Indian states. Interviewers employed the WHO-VA-2016 tool, and two independent physicians utilized ICD classifications to determine the cause of death. Results: Among the 1,001 deaths investigated, the median age was 42 years (IQR: 35-50), 68% were men and most deaths occurred in Northern India (32%). The primary cause of death was HIV-related opportunistic infections (76%) with tuberculosis ccounting for 31% of these, followed by cancer (7%), heart disease (6%), renal disease (2%), and liver disease (1%). However, for those who on ART for longer durations, the relative contribution of NCDs was higher – NCDs accounted for only 8% of mortality among those on ART for <1 year compared to 33% among those on ART for more than 5 years (p<0.001). People who died of NCDs were significantly older compared to those who died from OIs (p<0.05). The most common form of malignancy in men was head and neck cancer (24%), while cervical cancer (27%) was the most common in women. Conclusion: Mortality attributable to AIDS-related OIs, particularly TB, remains high in this setting, particularly among individuals who are newly initiating ART. This reflects a continued need to detect and engage PLHIV early after infection and support high levels of adherence. As people living with HIV age, it is likely that the relative contribution of NCDs, including cancer, continues to increase highlighting the importance of screening and managing these conditions within ART programs in LMICs.

1055 Age-Adjusted Mortality Rates Among Persons With HIV, by Race and Ethnicity and Cause of Death Cameron Stainken 1 , Cassandra O. Schember 2 , Nannie Song 1 , Deanna Sykes 1 , Philip Peters 1 , Darpun Sachdev 1 1 California Department of Public Health, Richmond, CA, USA, 2 Centers for Disease Control and Prevention, Atlanta, GA, USA Background: During 2010–2018, the age-adjusted mortality rate (AAMR) among persons with HIV (PWH) in the United States declined by 37%, primarily from a 48% reduction in HIV-associated deaths. We used public health surveillance data to determine how the COVID-19 pandemic affected mortality by race and ethnicity and cause of death (CoD) among PWH in California. Methods: We analyzed death certificate data for PWH from California Vital Records during 2018–2021. We categorized immediate CoD using International Classification of Diseases, Tenth Revision codes and excluded records missing CoD. AAMRs/100,000 persons were calculated by race and ethnicity and by CoD. We calculated percentage changes in AAMRs from 2018–2019 (before COVID-19 pandemic) to 2020–2021 (during COVID-19 pandemic) by race and ethnicity and CoD. Results: AAMR among PWH in California increased 14.6% from 2018–2019 (4.1 deaths/100,000 persons) to 2020–2021 (4.7 deaths/100,000 persons), with larger increases among multiracial (31.2%), Latinx (29.1%), Asian (16.3%), and Black (15.3%) PWH, compared with White (5.2%) PWH (Figure 1). Leading CoD among PWH during both 2018–2019 (29.5% of deaths) and 2020–2021 (25.4% of deaths) periods was HIV. AAMR because of HIV decreased 2.4% from 2018–2019 to 2020–2021. HIV-associated AAMR decreased among White (-7.9%) and Latinx (-0.2%) PWH, but increased among multiracial (13.9%), Asian (9.0%), or Black (4.8%) PWH. Overdose rose from the third-leading CoD (6.3% during 2018–2019) to second-leading CoD (8.8% during 2020–2021), with overdose AAMR increasing by 63.7%. Black (84.1.%), multiracial (83.1%), and Latinx (77.4%) PWH had higher overdose AAMR increases, compared with White (41.7%) PWH. COVID-19 was the fourth-leading CoD (5.9%) among PWH during 2020–2021. COVID-19 AAMRs were higher among Black (0.7/100,000 persons), multiracial (0.7/100,000 persons), and Latinx (0.5/100,000 persons) PWH, compared with White PWH (0.1 deaths/100,000 persons). Conclusion: Mortality increased among PWH in California, particularly among non-White populations. Overall, HIV mortality declined, but increased among certain races and ethnicities. Although COVID-19 contributed to the pandemic mortality increase, overdose death rates increased substantially across all races and ethnicities, compared with prepandemic years. Interventions directed at overdose-associated deaths and disparities in HIV mortality, primarily for Black and multiracial PWH, might help reverse these pandemic-era mortality trends in California.

Poster Abstracts

1057 Registered Causes of Death Remain Largely Unknown Among People With HIV in Latin America Yanink Caro-Vega 1 , Antonio Pacheco 2 , Karu Jayathilake 3 , Gabriela Carriquiry 4 , Paula M. Luz 2 , Daisy Machado 5 , Jorge Pinto 6 , Claudia P. Cortes 7 , Carina Cesar 8 , Marco T. Luque 9 , Vanessa Rouzier 10 , Stephany Duda 3 , Peter F. Rebeiro 3 , for the Caribbean, Central, and South American Network for HIV Epidemiology (CCASAnet) 1 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 2 Oswaldo Cruz Foundation - Fiocruz, Rio de Janeiro, Brazil, 3 Vanderbilt University, Nashville, TN, USA, 4 Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru, 5 Universidade Federal de São Paulo, Sao Paulo, Brazil, 6 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, 7 Fundación Arriarán, Santiago, Chile, 8 Fundación Huésped, Buenos Aires, Argentina, 9 Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras, 10 GHESKIO, Port-au-Prince, Haiti Background: Describing cause-specific mortality helps define public health prevention priorities. However, vital status records may omit causes of death among people with HIV (PWH), even HIV itself or associated conditions,

CROI 2024 340