CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

886

Falls Associated With High Medication Regimen Complexity in People With HIV Yunhan Chen, Archana Asundi, Samantha Roche Boston Medical Center, Boston, MA, USA Background: Polypharmacy (≥5 non-ART medications) is associated with falls. People with HIV (PWH) have higher polypharmacy prevalence due to comorbidity burden, but data is still lacking on its association to falls, particularly compared in non-PWH. We retrospectively examined whether high polypharmacy was associated with fall risk in PWH and non-PWH using a novel measure for both polypharmacy and regimen complexity known as the medication regimen complexity index (MRCI). Methods: We retrospectively abstracted data from randomly selected PWH from the Boston Medical Center (BMC) HIV clinic. Inclusion criteria were age ≥40, ≥2 visits in ID clinic post-3/1/22, and HIV diagnosis for ≥1 year. Non-PWH participants from BMC Geriatrics aged ≥40 and with ≥2 geriatric visits post 3/1/22 were also randomly selected as a comparator. MRCI and polypharmacy were calculated using University of Colorado’s MRCI tool. Past year’s falls were manually abstracted. We stepwise and forward selected multivariable logistic regression models predicting fall occurrence by MRCI and polypharmacy. Chi-square tests assessed how MRCI and polypharmacy relate to fall category (0/1/>1 fall). Results: Of the combined PWH and non-PWH cohort (N=600), 268 (44.7%) were male, 476 (81.2%) were minorities (non-White and/or Hispanic), 58 (10.1%) had recent substance use, and 215 (35.8%) were prescribed psychotropics (Table 1). Non-PWH (80.5) tended to be older than PWH (59.0). Overall MRCI was 35.8 indicating high regimen complexity (>15). 556 (92.7%) had ≥5 medications, 151 (25.2%) had fall occurrence, and 66 (11.0% had >1 fall. MRCI was significantly associated with fall occurrence in PWH (OR=1.03, 95% CI 1.01-1.05) and worse fall category in PWH and combined cohorts (p<0.05). Polypharmacy by medication count was not associated with fall occurrence. Prescribed psychotropic (OR=2.34, 95% CI 1.03-5.32) and recent substance use (OR=2.92, 95% CI 1.24-6.89) were also strongly associated with falls in PWH. Conclusions: PWH with high MRCI have higher risk for fall occurrence and multiple falls, highlighting need for fall monitoring and polypharmacy interventions. MRCI was significantly associated with falls whereas polypharmacy by med count was not, possibly due to its high prevalence in both cohorts, implying MRCI may be a more sensitive screener. Overall, these data indicate the need for geriatric care approaches to screen for and manage polypharmacy and fall risk.

as well as increasing support services for the hearing impaired, potentially through programs like Ryan White, should become higher priorities.

885

Clinical Outcomes of Immune Nonresponse Among Virally Suppressed Adults Living With HIV in Thailand Sirawit Suteetamrong 1 , Vasin Vasikasin 1 , Yanisa Kanjanavithayakul 2 , Monchai Duangpraphat 2 , Tanin Apiyangkool 3 , Worapong Nasomsong 1 1 Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand, 2 Ananda Mahidol Hospital, Lopburi, Thailand, 3 Fort Suranari Hospital, Nakhon Ratchasima, Thailand Background: Despite effective antiretroviral therapy (ART) and achieving virological suppression, a minority of adults living with HIV/AIDS (PLWHA) experience poor CD4+ T cell recovery, known as immune non-response (INR). The clinical outcomes for this population, particularly in relation to serious non AIDS-related events (SNAE), remain poorly understood due to the challenges in controlling confounding factors across multiple cohorts. This study assessed INR clinical outcomes, focusing on SNAE in PLWHA on ART with virological suppression. Methods: We conducted a multicenter, retrospective cohort study across three tertiary hospitals in Thailand. PLWHA aged ≥ 20 years, who received ART, had at least two consecutive HIV-1 viral load tests, and were followed for at least 24 months between January 1997 and March 2023 were included. The primary outcome was the incidence of SNAE between the INR group (CD4 < 350 cells/ µL after sustained viral suppression (VS) < 50 copies/mL for ≥ 2 years) and a control group with adequate immune recovery. Results: Between January 1997 and March 2023, 1,596 PLWHA met the eligibility criteria. After excluding cases with a follow-up period of less than two years, 1,457 PLWHA were included in the analysis. Demographic data indicated that male sex, older age, lower body mass index (BMI), lower CD4 count at diagnosis, earlier treatment era, and the presence of underlying diseases were significant risk factors for INR. The incidence of SNAE was 34 (7.9%) in the INR group compared to 61 (6.0%) in the control group (crude HR 1.20, 95% CI 0.79-1.82, p=0.406). Significant risk factors for SNAE included older age, underlying diseases, male sex, smoking, and a longer time to achieve virological suppression. However, after adjusting for these factors, INR was not significantly associated with SNAE (adjusted HR 1.14, 95% CI 0.74-1.76, p=0.541). The Kaplan–Meier curves demonstrated the time to incident SNAE after sustained VS as cumulative incidence, stratified by immune response status, age at ART initiation, and CD4 level at the time of sustained VS. Age over 50 years at ART initiation revealed a significantly increased incidence of SNAE, while immune response status and CD4 level did not show significant differences. Conclusions: INR was not associated with an increased incidence of SNAE. This suggests that while INR is an important immunological marker, it may not independently predict serious non-AIDS-related outcomes in PLWHA with sustained virological suppression.

Poster Abstracts

887

Integrated Digital Strategy for Stigma Evaluation in Routine Care for PWH Alfonso Cabello, Patricia Torres, Ana Cortés, Beatriz Alvarez, Irene Carrillo, Aws Al-Hayani, Laura Prieto-Pérez, Marta López De Las Heras, Gema Fuensalida, Ainara Durán, Raúl Córdoba, Marta Del Olmo, Javier Arcos, Miguel Górgolas Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain Background: The "fourth 90" assessment of people with HIV (PHIV) is recommended in international guidelines, but it is no defined who and how is the best way to implement in routine care. The aim of this study is to describe the main findings after a standardized assessment of stigma in PHIV.

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