CROI 2024 Abstract eBook

Abstract eBook

Oral Abstracts

increase in FEV1 (HR 0.70; P<0.01) and FEV1Q (HR 0.73; P<0.01) was associated with lower all-cause mortality. Higher lung function was protective for HIV related mortality (FEV1, HR 0.52, P<0.01; FEV1Q, HR 0.57, P<0.01). Among PWH, after adjusting for viremic control, lung function remained associated with all cause(HR 0.62; P<0.01) and HIV-related mortality(HR 0.54; P<0.01). Conclusion: We demonstrate that in a high-risk HIV cohort, after accounting for behavioral risk factors and comorbidities, lung function remains highly associated with all cause and HIV related mortality. These results are consistent when using the normalized FEV1Q, which may be less susceptible to bias. The results highlight the importance of lung disease and interventions to preserve lung health in PWH.

after REPRIEVE treatment initiation. Median PREPARE follow-up was 4.7 (4.3, 5.0) years; 81% completed follow-up. Physical function was similar between the two treatment groups at PREPARE entry. There was no evidence of decline in chair rise rate in either treatment group (Figure), and no significant difference in the pitavastatin group compared to placebo (difference -0.10 [95% CI: -0.30, 0.10] rises/min/year; p=0.31). Small declines were observed in other physical function tests in both treatment groups, with no apparent differences between groups (Figure). The findings were consistent in subgroup analyses by age, sex, race, ART duration, CD4 cell count, baseline physical function, and presence of muscle symptoms (not shown). Conclusion: We observed minimal declines in physical function over 5 years of follow-up among middle-aged PWH, with no differences among PWH randomized to pitavastatin compared to placebo. Our findings do not support the use of statins to maintain physical function in this population, but do expand upon the overall REPRIEVE trial findings to support the long-term safety of statin therapy on physical function in PWH.

Oral Abstracts

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Prostate Cancer Characteristics and Outcomes for Veterans With HIV in the Antiretroviral Era Keith Sigel 1 , Lesley S. Park 2 , Amy C. Justice 3 , Michael Leapman 3 , Janet Tate 4 , for the VACS Study Group 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA, 2 Stanford University, Stanford, CA, USA, 3 Yale University, New Haven, CT, USA, 4 VA Connecticut Healthcare System, West Haven, CT, USA Background: Prostate cancer is the leading cancer diagnosis among Veterans with HIV and will soon be the leading cancer among all US persons with HIV (PWH). Despite the substantial prostate cancer burden for PWH, there are little data on prostate cancer clinical characteristics and outcomes. Therefore, we studied prostate cancer characteristics at diagnosis and survival by HIV status in the Veterans Aging Cohort Study (VACS)-HIV, a national cohort of Veterans with HIV and demographically similar Veterans without HIV. Methods: We used data from VACS-HIV (2001-2018) to identify a cohort of male PWH prior to prostate cancer diagnosis (n=791), as well as male comparators without HIV (PWoH n=2,778). We compared patient demographics, prostate specific antigen (PSA) testing and prostate cancer clinical characteristics by HIV status. We then compared prostate cancer risk groupings (D'Amico) and prostate cancer-specific and overall survival by HIV status, stratified by risk group using age-adjusted Cox regression models. Results: VACS-HIV patients with prostate cancer had a median age of 62 years, which did not differ by HIV status. Race/ethnicity proportions were also similar, with non-Hispanic Blacks being the most common group diagnosed with prostate cancer. PWH with prostate cancer frequently had detectable HIV viremia at prostate cancer diagnosis (>60%). HIV infection was associated with higher PSA (median 6.8 vs. 6.3 ng/mL; p=0.005) but no difference in Gleason grade. There was less frequent PSA testing among PWH prior to prostate cancer diagnosis (1.25 fewer tests than PWoH, age adjusted; p<0.001). PWH were more likely to be diagnosed with D'Amico intermediate/high risk localized prostate cancer (68% vs. 63%; p= 0.02) and advanced prostate cancer (either nodal involvement or metastatic disease) than PWoH (4.0% vs. 2.7%; p=0.04). Both relationships persisted after adjustment for age. HIV was significantly associated with worse age-adjusted all-cause mortality for intermediate-, high risk localized and advanced cancers. PWH did not have higher prostate-cancer specific mortality in any cancer risk group compared to PWoH. Conclusion: PWH were diagnosed with higher risk prostate cancers more frequently in VACS-HIV than those without HIV possibly reflecting lower rates of PSA testing in this group. Higher non-cancer mortality seen in those with HIV infection may impact the relative risks and benefits of prostate cancer management strategies- including observation-for appropriate patient groups.

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Lung Function, HIV and Mortality: Analyses From the AIDS Linked to the Intravenous Experience Cohort Sarath Raju 1 , Jacquie Astemborski 2 , Jing Sun 2 , Meredith C. McCormack 1 , Greg Kirk 2 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: Chronic lung disease is an increasingly important comorbidity for persons aging with HIV. Persons with HIV(PWH) can experience accelerated decline in lung function, including spirometry measures(FEV1). The current implications of this lung function decline on all cause and HIV-related mortality warrants further investigation. Additionally, the normalized FEV1Q has recently been developed to improve interpretation of lung function without biases related to sex or race but has not yet been studied in cohorts of PWH. We leveraged the AIDS Linked to the Intravenous Experience(ALIVE) cohort in Baltimore, MD, consisting of PWH and matched HIV-uninfected participants, to study the implications of impaired lung function in a high-risk HIV cohort. Methods: We analyzed 2009-2019 ALIVE participant data. Lung function(FEV1 and FEV1Q) and clinical data(HIV RNA, comorbidity data) were collected at semi annual visits. Mortality was derived from the national death index and clinical records, assessing all-cause and mortality due to HIV and chronic disease. Associations between time-updated lung function and mortality were analyzed in cox-proportional hazard models, adjusted for demographics, smoking(pack years and status), injection drug use(IDU), HIV status, and comorbidity index. Models were also stratified by HIV status with adjustment for viremic control(<400copies/ml). Results: 1534 participants(474 PWH) contributed 10515 lung function measures over 10 years. Mean age at entry was 50, with 34% reporting active IDU and 84% current smokers. Among PWH, 53% had detectable HIV RNA. Mortality was high with 410(26%) deaths during the study period; 35% among PWH. In adjusted models, accounting for comorbidities and risk factors, a 1SD

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CROI 2024