CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

880

Housing Instability and Frailty Among People With HIV Engaged in Clinical Care in the United States Carolyn A. Fahey 1 , Stephanie A. Ruderman 1 , Bridget M. Whitney 1 , Joseph A. Delaney 1 , Rob Fredericksen 1 , L. Sarah Mixson 1 , Sonia Napravnik 2 , Allison Webel 1 , Kenneth Mayer 3 , Edward Cachay 4 , George Yendewa 5 , Lydia N. Drumright 1 , Laura Bamford 6 , Michael Saag 7 , Heidi M. Crane 1 1 University of Washington, Seattle, WA, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 The Fenway Institute, Boston, MA, USA, 4 University of California San Diego, La Jolla, CA, USA, 5 Case Western Reserve University, Cleveland, OH, USA, 6 University of California San Diego Medical Center, La Jolla, CA, USA, 7 University of Alabama at Birmingham, Birmingham, AL, USA Background: Living with HIV infection and experiencing housing instability are both independently associated with early onset of aging-related comorbidities including frailty. However, few studies have examined the relationship between housing status and frailty among people with HIV (PWH). Methods: We analyzed data from PWH engaged in care at 6 sites across the US within the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) between 2019-2024. Data were collected during routine clinical visits, including self-administered surveys. We measured frailty using a previously validated approach based on having at least 3 of 4 components (fatigue, weight loss, immobility, inactivity) vs. less than 3 components. Housing status was based on self-reported living situation in the last month, comparing PWH reporting “Homeless” or “Unstable” vs. “Stable.” We estimated the association between most recent housing status and frailty with prevalence ratios (PR) from generalized linear models using complete-case data. Primary models adjusted for site, demographic characteristics, year, HIV clinical indicators (viral load, CD4 count), and substance use (alcohol, illegal substances). Sensitivity analyses removed potential mediators from the adjustment set (HIV clinical indicators and substance use). Results: This analysis included 6,587 PWH (84% male, 16% female; 87% virally suppressed) with a median age of 52 years (IQR: 40-60). Overall, 8% of PWH (n=505) had unstable housing (3% homeless, 5% unstable), and 11% (n=700) were frail. In the primary analysis, housing instability was associated with 2.2 times higher prevalence of frailty (95% CI: 1.8, 2.6) compared to stable housing. This association was similar in models not adjusted for substance use (PR=2.4, 95% CI: 1.9, 2.8) or HIV clinical indicators (PR=2.5, 95% CI: 2.1, 3.0). In stratified analyses, we observed a stronger association among virally suppressed PWH (PR=2.5, 95% CI: 2.1, 3.1) compared to unsuppressed (PR=1.5, 95% CI: 1.1, 2.2; interaction p=0.04) due to a lower prevalence of frailty in stably housed, virally suppressed PWH (9%) than stably housed, unsuppressed PWH (13%), while 22% of unstably housed PWH were frail in both viral load strata (Table). Conclusions: Housing instability and frailty were both prevalent and strongly associated in PWH, including among younger and virally suppressed groups. These findings highlight the importance of social determinants of health, such as housing status, for clinical outcomes among all PWH.

function, and no evidence of pitavastatin effect. However, there was substantial individual variability, with some participants experiencing considerable declines. The purpose of this pre-specified exploratory analysis was to identify participants at a greater risk for physical function decline. Methods: PREPARE conducted physical function assessments annually for up to 5 years. Participant-specific annualized rates of change in chair rise rate, gait speed, the modified Short Performance Physical Battery (mSPPB, composite of the latter two plus balancing time), and grip strength were estimated from linear mixed effect models. Physical function decline was defined as an annualized rate of change below the 20th percentile (P20) of the study population in at least one of the measures. Associations between baseline factors and physical function decline were evaluated with log-binomial regression models. Results: Of the 569 participants, 81% were male and 52% white. The median age was 51 (Q1, Q3: 47, 55) years. The P20 participant-specific annualized rates of change were -0.354 rises/minute/year in chair rise rate, -0.028 meters/ second/year in gait speed, -0.032/year in mSPPB and -0.70 kg/year in grip strength. 52% had a decline in at least one physical function measure: 1% had a decline in all four, 7% in two, 11% in three, and 33% in one. We found a higher risk of physical function decline among females (relative risk: 1.32, 95% confidence interval: 1.12-1.55), non-whites (1.23, 1.05-1.45), and a trend of higher risk with increasing age (1.04, 0.86-1.26 in 50-55 and 1.17, 0.98-1.39 in 55+ vs. 40-<50 years). In models adjusted for age, sex, and race, we found greater risk of decline among those with history of depression treatment, higher BMI, pre-existing functional impairment, frailty (by index), and higher baseline hs-CRP and IL-6 levels (Fig.1). The sex difference was attenuated in models adjusted for BMI, history of depression treatment, and inflammatory markers, which were higher/more prevalent among females (1.16, 0.98-1.38 in females vs. males, when including hs-CRP). Conclusions: PWH with history of depression, high BMI or levels of inflammation and those showing signs of impairment may benefit from early intervention strategies to preserve function with aging.

Poster Abstracts

881

Prognostic Factors of Physical Function Decline in the PREPARE Study Grace Ditzenberger 1 , Triin Umbleja 2 , Todd Brown 3 , Heather Ribaudo 2 , Steven Grinspoon 4 , Jennifer Schrack 5 , Markella V. Zanni 4 , Judith Aberg 6 , Carl Fichtenbaum 7 , Carlos Malvestutto 8 , Sarah Chu 4 , Judith Currier 9 , Pamela Douglas 10 , Gerald Bloomfield 10 , Kristine M. Erlandson 1 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 2 Harvard TH Chan School of Public Health, Boston, MA, USA, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 Massachusetts General Hospital, Boston, MA, USA, 5 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 6 Icahn School of Medicine at Mount Sinai, New York, NY, USA, 7 University of Cincinnati Medical Center, Cincinnati, OH, USA, 8 The Ohio State University, Columbus, OH, USA, 9 University of California Los Angeles, Los Angeles, CA, USA, 10 Duke Clinical Research Institute, Durham, NC, USA Background: The Pitavastatin to REduce Physical Function Impairment and FRailty in HIV (PREPARE) substudy of REPRIEVE found small declines in physical

882

Understanding the Life Expectancy Sex Gap: Disparate Patterns in Non-Communicable Disease Mortality Katherine Kooij 1 , Wendy Zhang 2 , Jason Trigg 2 , Erin Ding 1 , Nance Cunningham 1 , Michael Budu 2 , Megan E. Marziali 2 , Viviane D. Lima 2 , Kate Salters 1 , Rolando Barrios 1 , Julio S. G. Montaner 1 , Robert S. Hogg 3 1 BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2 Columbia University, New York, NY, USA, 3 Simon Fraser University, Burnaby, Canada Background: We have previously shown lower life expectancy among females with HIV in British Columbia (BC), Canada, compared to males and an increasing sex gap in life expectancy from 1996 to 2020 (CROI 2024, Abstract #1053). To better understand the underlying drivers for this finding, we aimed to establish whether female sex is associated with higher mortality from two broad categories of non-communicable disease: (1) cardiovascular disease (CVD) and

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