CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

and respiratory causes (0.88). Discrimination was lowest for suicides/accidental deaths (0.65), unclassifiable causes (0.76), cardiovascular deaths (0.77) and "other" causes (0.78). Predicted probabilities of 5-year mortality were low for except for PWH with very high (>90) VACS 2.0 values e.g. the 5-year probability of AIDS death for those with VACS 2.0 score 40 was 0.1%, increasing to 7.6% for scores of 90. Conclusion: To improve discrimination for causes for which discrimination is lower, future VACS Index analyses could incorporate additional measures, such as psychopathological risk factors, extra biomarkers (for example, lipid profiles and inflammatory markers), or conditions included in the Charlson Comorbidity Index.

particularly in resource-limited settings. We therefore described mortality among PWH in the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) and identified characteristics associated with unknown causes of death. Methods: Mortality and cause-of-death data from adult PWH in care in CCASAnet from 2003-2022 were extracted from local vital status registries and electronic health records (by ICD-10 code). Causes of death, whether primary, secondary, underlying, or contributing, were categorized as: 1. missing/ unknown, 2. HIV or AIDS-defining events (ADEs; if ≥1 cause was: pneumonia, TB, other opportunistic infection, ADE malignancy, unspecified HIV/AIDS), or 3. non-ADEs (NADEs; all other causes, including: renal, liver, cardiovascular, NADE malignancy, trauma, etc.) We described overall mortality and compared characteristics by cause-of-death groups using χ2 and Kruskal-Wallis tests. Results: Among 56,620 PWH, there were 6,507 (11%) deaths: 3,283 (50%) unknown (including 39% entirely missing), 2405 (37%) ADE, and 819 (12%) NADE causes. ADE causes included: 1403 (58%) unspecified HIV/AIDS, 477 (20%) unspecified pneumonia, 276 (11%) TB, 212 (9%) other opportunistic infections, and 125 (5%) ADE malignancies. Common NADE causes were: 284 (35%) NADE infectious diseases, 123 (15%) NADE malignancies, and 111 (13%) traumas. In the unknown-cause group, 45% were women vs. 29% in ADE and 26% in NADE groups. Median age at death was 42 [IQR:33-52] years in unknown-cause vs. 41 [IQR:33-50] in ADE and 47 [IQR:38-56] in NADE groups; median CD4 count at death was 84 [IQR:25-236] cells/µL in unknown-cause vs. 64 [IQR:18-185] in ADE and 211 [IQR:65-421] in NADE groups. Percentage on ART at death was highest in the unknown-cause group (91% vs. 72% for ADE and 83% for NADE groups). P-values were <0.01 for all comparisons. Conclusion: Of the 11% of the cohort that died over two decades, more than half were recorded as from unknown causes, including a third completely missing, and 58% of ADE causes had an unspecified HIV/AIDS code. Unknown causes occurred mostly in women, younger PWH, and those with lower CD4 counts, similar to those dying from an ADE. More complete cause-of-death data is needed to better identify factors associated with, and prevent deaths due to, ADEs. 1058 Predicting Cause-Specific Mortality With the VACS Index 2 0 Among Persons With HIV Julie Ambia 1 , Suzanne M Ingle 1 , John Gill 2 , Sophie Abgrall 3 , Mojgan Hessamfar 4 , Peter Reiss 5 , Christoph Wyen 6 , Heidi M. Crane 7 , Inma Jarrin 8 , Michael J. Silverberg 9 , Kathleen A. McGinnis 10 , Amy C. Justice 10 , Jonathan A. Sterne 1 , Adam Trickey 1 , for the Antiretroviral Therapy Cohort Collaboration (ART-CC) 1 University of Bristol, Bristol, United Kingdom, 2 University of Calgary, Calgary, Canada, 3 University of Paris-Sud, Orsay, France, 4 University of Bordeaux, Bordeaux, France, 5 University of Amsterdam, Amsterdam, Netherlands, 6 University of Cologne, Cologne, Germany, 7 University of Washington, Seattle, WA, USA, 8 Institute of Health Carlos III, Madrid, Spain, 9 Kaiser Permanente Northern California, Oakland, CA, USA, 10 Yale University, New Haven, CT, USA Background: Predicting cause-specific mortality among persons with HIV (PWH) could facilitate targeted care to improve survival. We assessed discrimination of the Veterans Aging Cohort Study (VACS) Index 2.0 in predicting cause-specific mortality among PWH on antiretroviral therapy (ART) in Europe and North America. Methods: The VACS Index 2.0 consists of thirteen variables: age, sex at birth, body mass index (BMI), CD4 count, creatinine, HIV-1 RNA viral load, haemoglobin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), platelet count, white blood cell count, albumin, and hepatitis C infection. Using data from 12 cohorts contributing to the Antiretroviral Therapy Cohort Collaboration, VACS 2.0 was calculated for PWH who initiated ART between 2000 and 2018, around a randomly selected visit date within the period 1 year after ART initiation to last visit. Missingness in VACS 2.0 variables was addressed through multiple imputation. We estimated associations between VACS 2.0 and specific causes of death using Cox models, with discrimination evaluated using Harrell's C-statistic. Absolute mortality risks were modelled with flexible parametric survival models. Results: Among 59,741 PWH, 80% were men and at follow-up start mean age was 43 and mean VACS 2.0 score was 41.0. VACS 2.0 values were measured a median of 3.2 years after ART initiation and ranged from 0 to 129: higher values indicate worse prognosis. There were 3,117 deaths during 217,257 person-years (median follow-up was 2.6 years). Non-AIDS-defining cancers were the most common cause of death (n=569), followed by AIDS (n=527). Discrimination for five-year all-cause mortality was C=0.83). Discrimination for specific causes of death was highest for deaths due to AIDS (0.91), liver-related causes (0.90)

1059 Care Interruptions and Mortality Among Adults on Antiretroviral Therapy in Europe and North America

Adam Trickey 1 , Christopher T. Rentsch 2 , Nikos Pantazis 3 , Rebeca Izquierdo 4 , Andrea Antinori 5 , Gisela Leierer 6 , Greer Burkholder 7 , John Gill 8 , Marc Van der Valk 9 , F. Bonnet 10 , Heidi M. Crane 11 , Michael J. Silverberg 12 , Suzanne M. In-gle 1 , Jonathan A. Sterne 1 , for the Antiretroviral Therapy Cohort Collaboration (ART-CC) 1 University of Bristol, Bristol, United Kingdom, 2 Yale University, New Haven, CT, USA, 3 University of Athens, Athens, Greece, 4 Institute de Salud Carlos III, Majadahonda, Spain, 5 IRCCS Lazzaro Spallanzani, Rome, Italy, 6 Medical Univer-sity of Innsbruck, Innsbruck, Austria, 7 University of Alabama at Birmingham, Birmingham, AL, USA, 8 University of Calgary, Calgary, Canada, 9 Stichting HIV Monitoring, Amsterdam, Netherlands, 10 University of Bordeaux, Bordeaux, France, 11 University of Washington, Seattle, WA, USA, 12 Kaiser Permanente, Oakland, CA, USA Background: Interruptions to the care of people with HIV (PWH) on antiretroviral therapy (ART) are associated with adverse outcomes. Studies to date mostly relied on composite outcomes, such as AIDS and death, due to insufficient number of indi-vidual outcome events. We investigated whether mortality rates following a care interruption differed from mortality rates after first starting ART. Methods: Data from 2004-2020 were combined from 18 European and North American HIV cohort studies of adult PWH starting ART between 2004-19. We defined in-terruptions in HIV specialized health care as breaks of ≥365 days duration (no lab, CD4, RNA, ART, or visit records), with a subsequent return to care without a suppressed viral load; distinct from loss-to-follow up. In sensitivity analyses, we used breaks of ≥180, ≥270, and ≥535 days. Follow-up time for each PWH was allocated across three groups: "no previous interruption", and "early" or "late in-terruption" (reinitiating after a gap starting <6 or ≥6 months of first ART initia-tion). Each PWH contributed follow-up to the pre/no interruption group. We used Cox regression to compare mortality rates across the three groups, adjusting for sex, HIV acquisition mode, year of ART initiation/re-initiation, and time-updated age and CD4 count on initiation or re-initiation of ART. Results: Among 89,197 included PWH, median age at ART start was 39 years (IQR 31-48) and 83% were male. 7796 (9%) of PWH had at least one care interruption. There were 1300 "early interruption" group episodes (1300 PWH), and 9773 "late inter-ruption" group episodes (7832 PWH). Median CD4 count at ART start was 280 (IQR: 143-417), while after early and late interruptions (where available) it was 235 (IQR 95-456) and 352 (IQR 150-600) cells/μl, respectively. There were 6098 deaths in 536,870 person-years (rate 11.4 (95% CI 11.1-11.7) per 1000 person-years). Adjusted hazard ratios for the early and late interruption groups were 1.69 (95%CI: 1.39-2.06) and 1.80 (95%CI: 1.63-1.98), respectively, compared with the no/pre-interruption group. Results were robust in sensitivity analyses assuming ≥180-, ≥270- and ≥535-day gaps. Conclusion: Mortality was higher among PWH reinitiating ART following an interruption with unsuppressed viral loads, compared with when PWH initially start ART, indicat-ing the importance of full adherence to ART. The mechanism for this higher mor-tality requires further investigation as care interruptions may be associated with other factors linked to higher mortality.

Poster Abstracts

CROI 2024 341