CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

to cytomegalovirus, Epstein-Barr virus, and herpesvirus antibody peptides (p<0.05). Among D+ and D-, pre-KT antibody peptides of viruses (adenoviruses and cytomegalovirus), toxins (Mycoplasma pneumoniae), and human (glucocorticoid receptor isoform gamma, and melanophilin isoform 1) were associated with rejection in R+ (p<0.05), but the association was not significant after adjusting for multiple comparisons. The median VarScore of Adenovirus A12 was significantly higher among donors whose R+ had rejection, than donors whose R+ did not have rejection (p=3.7×10 -5 ) ( Figure ). Donors’ HIV viral antibodies were not associated with rejection in R+ (p>0.05). Sex stratified analysis gave similar but non-significant results with smaller sample size. Conclusions: Reactivity of donor HIV antibodies was not associated with rejection among R+, adding the evidence of the safety of D+/R+ KT. However, pre-KT adenoviruses infection for both donors and recipients might require special attention.

with diabetes, and a mean eGFR of 81 (SD:26). Among 221 events of ≥30% eGFR decline, rates were 15% in SGLT2i, 6% in GLP-1RA, 12% in DPP4i, and 11% in sulfonylureas. In adjusted models, SGLT2i were associated with a significantly higher risk of ≥30% eGFR decline compared to other antihyperglycemic classes (aHR=1.66, 95%CI:1.16-2.38) and GLP-1RA (aHR=2.03, 95%CI:1.30-3.17) but not significantly different from DPP4i or sulfonylureas. SGLT2i also showed a significantly higher risk of eGFR decline of ≥10 mL/min/1.73m² compared to all other antihyperglycemic classes. Conclusions: Among PWH, SGLT2i were associated with a higher risk of acute eGFR decline compared to other antihyperglycemic classes, with the risk most pronounced vs. GLP-1RA. A ≥30% eGFR decline was more common in PWH than in studies from non-HIV populations, highlighting the need for careful monitoring, particularly after SGLT2i initiation. Further research is needed to evaluate long-term renal effects.

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Associations Between Antiretroviral Therapy Use, Vitamin C Renal Leak, and Vitamin C Deficiency Ifechukwude Ebenuwa 1 , Pierre-Christian Violet 1 , Thom Greene 1 , Irene Rozga 1 , Razi Berman 1 , Nicholas Munyan 1 , Kenneth Wilkins 1 , Seble Kassaye 2 , Mark Levine 1 , Stephanie Teng 1 , for the MACS/WIHS Combined Cohort Study (MWCCS) 1 National Institutes of Health, Bethesda, MD, USA, 2 Georgetown University, Washington, DC, USA Background: Reduced vitamin C concentrations (vitC) in HIV are associated with abnormal urinary loss: a renal leak. Renal leak indicates an underlying disease-related nutritional dysregulation independent of dietary intake. While ART use is associated with renal tubular dysfunction, there is insufficient understanding of the relationships between ART class, renal leak and reduced vitC concentrations. Methods: Women in the DC Women’s Interagency HIV Study and NIH (N=96, 40 HIV+, 56 HIV-), were enrolled in a cross-sectional outpatient study to investigate antiretroviral therapy effects on VitC concentrations. To assess vitC renal leak, participants fasted overnight, and matched urine and fasting plasma samples were collected the following morning. Clinical history was obtained using structured questionnaires. VitC was measured by HPLC with coulometric electrochemical detection. VitC renal leak was defined as presence of urinary vitC at fasting plasma concentrations below 43.2µM, the vitC Minimum Elimination Threshold (MET) in women. Multivariable regression analysis was used to assess outcomes. Results: Among women with HIV (WWH), 32 (86%) were on ART, 32 (86%) were on nucleoside reverse transcriptase inhibitors (NRTIs), 11 (30%) on non nucleoside reverse transcriptase inhibitors (NNRTIs) and 13 (35%) on protease inhibitors (PIs). The most common ART medication was Tenofovir (N=19, 48%), including Tenofovir alafenamide (TAF, N=4) and Tenofovir disoproxil (TDF, N=15). Overall, ART use was significantly associated with increased odds of renal leak (OR=12, p<0.001) and reduced plasma vitC concentrations (p<0.001). Renal leak was associated with NRTIs (OR=12, p<0.001) and NNRTIs (OR=22, p<0.022) but not PIs (OR=4.4, p=0.08). The strongest association with reduced plasma vitC was observed with NRTIs (p<0.001), followed by PIs (p=0.011) and NNRTIs (p=0.027). Tenofovir-use incurred 3-fold higher odds of renal leak when adjusted for HIV status and other ART use but did not reach statistical significance (p=0.21). Users of the newer pro-drug TAF had reduced odds of renal leak vs TDF, although this did not reach statistical significance (OR=0.5, p=0.5). Conclusions: All classes of ART assessed are associated with renal leak and/or reduced vitC concentrations in HIV, with the strongest association observed with NRTIs such as Tenofovir. Longitudinal studies with larger cohorts are needed to study mechanisms and implications of ART-induced vitC dysregulation.

Poster Abstracts

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Acute Drop in eGFR When Initiating SGLT2 Inhibitors vs Other Antihyperglycemic Medications Among PWH Lara Haidar 1 , Robin M. Nance 2 , L. Sarah Mixson 2 , Bridget M. Whitney 2 , Carolyn A. Fahey 2 , Stephanie A. Ruderman 2 , Greer Burkholder 3 , Laura Bamford 4 , Robert Kalayjian 5 , Katerina Christopoulos 6 , Alexander Commanday 7 , April C. Pettit 8 , Joseph A. Delaney 2 , Heidi M. Crane 2 , Sherif Eltonsy 1 , for the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) 1 University of Manitoba, Winnipeg, Canada, 2 University of Washington, Seattle, WA, USA, 3 University of Alabama at Birmingham, Birmingham, AL, USA, 4 University of California San Diego Medical Center, La Jolla, CA, USA, 5 Case Western Reserve University, Cleveland, OH, USA, 6 University of California San Francisco, San Francisco, CA, USA, 7 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 8 Vanderbilt University Medical Center, Nashville, TN, USA Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated cardiorenal benefits in the general population but can cause an acute dip in estimated glomerular filtration rate (eGFR), raising safety concerns, particularly in people with HIV (PWH) who may be more vulnerable to renal complications. Due to limited data in PWH, we aimed to assess the risk of acute eGFR decline with SGLT2i vs. other antihyperglycemic classes. Methods: We conducted an observational study using data from 9 sites from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. PWH initiating SGLT2i, glucagon-like peptide-1 receptor agonists (GLP 1RA), dipeptidyl peptidase-4 inhibitors (DPP4i), or sulfonylureas between 1996 and 2023 were included if they had ≥2 eGFR measurements: 1 at baseline and 1 within 6 months of antihyperglycemic initiation. Outcomes evaluated were time to ≥30% eGFR decline and ≥10 mL/min/1.73m² eGFR decrease within 6 months of initiation. We used Cox proportional hazards models, adjusted for age, sex, race/ethnicity, CNICS site, diabetes and hypertension diagnoses, baseline eGFR, viral load, CD4 count, use of tenofovir disoproxil fumarate, statins, insulin, and metformin at baseline, to compare SGLT2i with other antihyperglycemic classes combined and with each individual class. Results: Among 2111 PWH included, 299 were new users of SGLT2i and 1812 of other antihyperglycemic classes (600 GLP-1RA, 225 DPP4i, 987 sulfonylurea). Mean age at baseline was 52 years (SD:10), with 75% male, 47% Black, 85%

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