CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

819

Effect of the Transition to Dolutegravir on Blood Pressure in People Living With HIV in West Africa Antoine Jaquet 1 , Thierry Tiendrebeogo 1 , Oliver Ezechi 2 , Armel Poda 3 , Abert Minga 4 , Karen Malateste 5 , Didier Ekouevi 1 , Ighovwerha Ofotokun 6 , Romain Millot 5 , for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration - West Africa 1 University of Bordeaux, Bordeaux, France, 2 Nigerian Institute of Medical Research, Lagos, Nigeria, 3 Centre MURAZ, Bobo-Doulasso, Burkina Faso, 4 PAC-CI Program, Abidjan, Côte d'Ivoire, 5 Bordeaux University Hospital, Bordeaux, France, 6 Emory University, Atlanta, GA, USA Background: Dolutegravir (DTG) has been increasingly linked to metabolic disorders including significant weight gain in people living with HIV (PLHIV) but to which extend these metabolic disorders translate into cardiovascular diseases is still debated. As West Africa bears a particularly high burden of hypertension (HTN) and as PLHIV have regionally transitioned to DTG since 2018, there is a need to document its impact on cardiovascular diseases. This study evaluates the effect of switching to DTG on changes in blood pressure (BP) and incident HTN among West African PLHIV on antiretroviral treatment (ART). Methods: Adult PLHIV with routinely available BP and contributing to the IeDEA West Africa cohorts during the 2016-2023 period were included. We first analyzed the evolution of BP in PLHIV who switched to DTG. BP changes before and after initiating DTG was assessed using a two-slope mixed linear model. A second analysis was conducted to evaluate the risk of HTN in patients receiving DTG versus patients not receiving DTG from the date of site introduction of DTG until 2023. This analysis employed a target trial emulation approach with weighted logistic regression to compare the incidence of HTN between patients on DTG and those on other treatments. Results: Among 15,485 patients actively followed in 3 HIV programs in Burkina Faso, Cote d’Ivoire and Nigeria; 11,482 transitioned to a DTG-based regimen and were eligible for the first analysis. Before DTG initiation, systolic and diastolic BP increased by 0.38 mmHg/year [0.26-0.50] and 0.39 mmHg/year [0.32-0.47], respectively, compared to 1.56 mmHg/year [1.34-1.78] and 1.20 mmHg/year [1.06-1.35] after initiation. Changes in BP were different according to sex and ART regimen prior to switch [Fig 1]. For the second analysis, 9,730 patients were eligible. Switching to DTG was associated increased risk of HTN with incidence rate ratios of 1.31 [1,26 – 1,35] and 1.85 [1,72 – 1,99] in the intention-to-treat and per-protocol analyses, respectively. Conclusions: A significant impact of DTG on BP progression and HTN risk was reported in West African PLHIV. These findings support the integration of HTN screening and management into HIV care programs in West Africa and question the need of alternative first-line regimens such as Doravirine-based regimen in PLHIV at high-risk of cardiovascular diseases. Further analyses are needed to better understand the interplay between DTG, sex, prior ART regimen and BP.

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No Increased Risk for Hypertension With CAB-LA Compared to TDF/FTC for PrEP: Results From HPTN 084 Sinead Delany-Moretlwe 1 , Heather Ribaudo 2 , Younjung Choi 2 , Brett S. Hanscom 3 , Nyaradzo Mgodi 4 , Joseph Makhema 5 , Harriet Nuwagaba-Biribonwoha 6 , Scott Rose 7 , Lydia Soto-Torres 8 , James F. Rooney 9 , Alex Rinehart 10 , Raphael J. Landovitz 11 , Mina Hosseinipour 12 , for the HPTN 084 Study Team 1 University of the Witwatersrand, Johannesburg, South Africa, 2 Harvard TH Chan School of Public Health, Boston, MA, USA, 3 Fred Hutchinson Cancer Center, Seattle, WA, USA, 4 University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe, 5 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 6 ICAP at Columbia University, New York, NY, USA, 7 FHI 360, Durham, NC, USA, 8 Division of AIDS, Bethesda, MD, USA, 9 Gilead Sciences, Inc, Foster City, CA, USA, 10 ViiV Healthcare, Durham, NC, USA, 11 University of California Los Angeles, Los Angeles, CA, USA, 12 University of North Carolina Project–Malawi, Lilongwe, Malawi Background: Several studies have suggested an increased risk for hypertension (HTN) associated with initiation of integrase strand transfer inhibitors (INSTIs) for HIV treatment that may be mediated by weight gain. We investigated whether CAB-LA was associated with an increased incidence of HTN in a post-hoc analysis of the HPTN 084 trial. Methods: HPTN 084 evaluated the effectiveness of long-acting injectable cabotegravir (CAB-LA) compared to daily oral TDF/FTC for PrEP in individuals born female aged 18-45 years in eastern and southern Africa. Of 3224 participants enrolled, 3071 (1543 CAB, 1528 TDF/FTC) with study drug exposure and without pre-existing HTN were analyzed. Incident HTN was defined as a new diagnosis of HTN or new initiation of anti-HTN treatment through 161 weeks of follow-up. Cox regression was used to estimate the hazard ratio (HR) for incident HTN by study arm, unadjusted and adjusted for age, baseline BMI, enrolment region (South Africa, southern or east Africa). Modelling also evaluated time-updated risk factors including percent weight change from baseline (TUWC), incident pregnancy and contraceptive method. Results: Study arms were balanced with 51% of participants <25 years of age, 55% with a BMI ≥ 25 kg/m 2 , and 41% from South Africa. Median BMI increase was similar across both groups (2.2 kg/m 2 CAB and 2.1 kg/m 2 TDF/FTC). Over 8252 person-years of follow up, 234 (8%) had incident HTN (127/1543 CAB, 107/1528 TDF/FTC). Cumulative HTN incidence over 3 years was 8.6% for CAB and 7.2% for TDF/FTC. In unadjusted analyses, incident HTN was higher with CAB compared to TDF/FTC use (HR 1.20, 95% CI 0.93-1.55, p=0.16) and largely unchanged (HR 1.17, 95% CI 0.91-1.50, p=0.26) after adjustment for enrolment region, age, and baseline BMI. The hazard for HTN increased with >10% weight gain (HR 1.58, 95% CI 1.05-2.38), pregnancy (HR 2.20, 95% CI 1.14-4.25), enrolment from the southern Africa region (Botswana, Eswatini, Zimbabwe) (HR 2.24, 95% CI 1.58-3.19), pre-existing obesity (HR 2.35, 95% CI 1.63-3.36), and older age (HR per 10 years 2.50, 95% CI 2.03-3.08). Conclusions: Overall, HTN incidence in this population without HIV was low. Observed HTN incidence was numerically higher with CAB compared to TDF/FTC PrEP use, but this was not statistically significant and slightly diminished with adjustment for key risk factors. Incident HTN is more likely explained by other risk factors like age, BMI, weight gain, pregnancy and enrolment region. Risa Hoffman 1 , Pericles Kalande 2 , Christine Hagstrom 1 , Khumbo Phiri 2 , George Talama 2 , Jiyoung Lee 1 , Joep J. van Oosterhout 2 , Joseph Njala 2 , Corrina Moucheraud 3 , Sam Phiri 4 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Partners in Hope, Lilongwe, Malawi, 3 New York University, New York City, NY, USA, 4 Lighthouse Trust, Lilongwe, Malawi Background: Hypertension is among the most common non-communicable disease comorbidities in people living with HIV (PLHIV) in Malawi. In a previous study, we found that ~80% of PLHIV with hypertension had uncontrolled hypertension (consistently ≥140 and/or ≥90 mmHg). We therefore sought to understand barriers to hypertension control from the perspective of clinical providers. Methods: We deployed an online survey at 14 facilities in central and southern Malawi, which were involved in our prior study of hypertension control in PLHIV. Clinical providers were eligible if they had at least one year of experience prescribing antihypertensive medications. Surveys were informed by the Capability, Opportunity, Motivation, Behavior model for behavior change; and were self-administered in Qualtrics. We describe clinical providers’ knowledge of hypertension (based on nine questions, including clinical vignettes), barriers to providing hypertension care, and self-efficacy for managing clients with hypertension. Low Hypertension Knowledge Among Clinicians Prescribing Antihypertensive Medications in Malawi

Poster Abstracts

821

CROI 2025 247