CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

907

Noncommunicable Diseases: A Significant Cause of Death Among People Living With HIV in Nigeria Chiamaka H. Onuoha, Kehinde Balogun, Olaposi Olatoregun, Uchechukwu

Pneumocystis jirovecii pneumonia (PJP) separately from other ADIs due to steroid treatment considerations. Results: Among 18,658 PWH, the mean baseline age was 44 years, 37% were Black, 15% Hispanic/Latine, and 17% were female. During follow up, 276 PWH (1.5%) developed ON. In adjusted analyses, factors associated with increased ON risk included older age (hazard ratio HR 1.21 (1.05-1.39 per 10 years), lower CD4 cell count (0.95: 0.91-0.99 per 100 cells/mm 3 ), ADI without PJP (1.66: 1.28-2.16), PJP (2.03: 1.50-2.76), steroid use (1.73: 1.35-2.22), tobacco use (1.52: 1.18-1.95), and alcohol use (1.40: 1.12-1.76) (see table ). Conclusions: In the current treatment era, HIV-related factors such as lower CD4 cell count and ADIs continue to be significant predictors of ON risk among PWH as well as known risk factors in the general populations such as age and corticosteroid use. Behavioral factors, including tobacco and alcohol use, highlight actionable prevention targets reinforcing the importance of early antiretroviral therapy initiation and lifestyle interventions.

Chinedu, Chinenyenwa Henshaw APIN Public Health Initiatives, Abuja, Nigeria

Background: Antiretroviral therapy (ART) has significantly reduced AIDS related deaths, yet death rates remain higher among people living with HIV (PLHIV) compared with individuals without HIV. This has been partly attributed to a higher risk of non-communicable diseases (NCDs) among PLHIV. Providing insights into NCDs’ contribution to the cause of death among PLHIV will guide priority setting for the reduction of mortality amongst them. Methods: Between August 2021 and October 2024, verbal autopsy (VA) data for 11,239 deceased PLHIVs from 657 ART facilities in 33 states was collected from the Nigeria HIV Mortality Surveillance database. Causes of death (COD) were determined using the SmartVA-Analyze (Tariff 2.0 algorithm), and descriptive data analysis was performed in Microsoft Excel. Results: VA data determined the COD for 11,239 PLHIVs, comprising 6,245 (55.6%) females and 4,994 (44.4%) males. The leading COD was AIDS, accounting for 3,313 deaths (29.5%), followed by non-communicable diseases at 2,136 (19.0%). The most common NCDs were stroke (551; 25.8%), acute myocardial infection (424; 19.9%), diabetes (356; 16.7%), malignancy (265; 12.4%), and chronic kidney disease (235; 11.0%). Among (204: 17.1%) women with malignancies, breast cancer 131; 6.1%) and cervical cancer (26; 1.2%) were the most common. In men, prostate cancer (18; 0.8%) and stomach cancer (6; 0.3%) were most prevalent. For adults aged 15+, the leading NCDs included stroke (550; 25.3%), acute myocardial infection (423; 19.4%), diabetes (356; 16.4%), chronic kidney diseases (229; 10.5%), breast cancer (131; 6.0%) and cirrhosis (126; 5.8%). In the pediatric group (<15), the main causes were digestive diseases (38; 82.6%), childhood cancer (33; 71.7%), chronic kidney disease (6; 13.0%) and other non-communicable diseases (2; 4.3%). Conclusions: This work highlights the importance of closely monitoring the causes of death among PLHIV. Information on mortality trends for PLHIV would guide the implementation of fit-for-purpose interventions to prevent avoidable deaths. Ultimately, these targeted interventions can support the provision of appropriate standards of care, thereby improving their treatment outcomes and reducing mortality rates amongst HIV-positive individuals. Risk Factors for Osteonecrosis Among People With HIV in Care Across the US in the Current ART Era Heidi M. Crane 1 , Robin M. Nance 1 , Stephanie A. Ruderman 1 , Bridget M. Whitney 1 , Paola Nicoletti 2 , Edward Cachay 3 , Lydia N. Drumright 1 , Richard Moore 4 , George Yendewa 5 , Kenneth Mayer 6 , Geetanjali Chander 1 , Michael Saag 7 , Mari Kitahata 1 , Inga Peter 2 , Joseph A. Delaney 1 , for the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) 1 University of Washington, Seattle, WA, USA, 2 Icahn School of Medicine at Mount Sinai, New York, NY, USA, 3 University of California San Diego, La Jolla, CA, USA, 4 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 5 Case Western Reserve University, Cleveland, OH, USA, 6 The Fenway Institute, Boston, MA, USA, 7 University of Alabama at Birmingham, Birmingham, AL, USA Background: The risk of osteonecrosis (ON), or bone death due to inadequate vascular supply, is estimated to be 3-100 fold higher in people with HIV (PWH) compared to the general population. However, most information on ON in PWH is from older case reports or small case control studies and cohort studies limited by small numbers of ON cases. This leaves critical gaps in our understanding of ON risks in the current HIV treatment era as the population of PWH continue to age. Methods: We examined ON among PWH in routine clinical care at 8 sites in the CNICS cohort from ~2012-2023 (dates vary slightly by site). ON cases were identified using diagnoses codes; with one site validating diagnoses through clinical documentation and radiology reports. We used adjusted Cox proportional-hazards models to estimate the association between demographic and clinical characteristics and time to ON, with censoring at the time of event, loss to follow up, death, or study end. Covariates included age, race/ethnicity, sex, CD4 count, viral load, history of AIDS-defining illnesses (ADIs), corticosteroid use, co-infection with hepatitis C virus, liver function (FIB-4), kidney function (eGFR), hypertension, dyslipidemia, diabetes, and use of marijuana, tobacco, and alcohol. CD4 count and viral load were time updated, while other factors were measured at study baseline. We analyzed The figure, table, or graphic for this abstract has been removed.

Poster Abstracts

909

Validation of SCORE and OST for Osteoporosis Risk Estimation in People Aging With HIV in Peru Joselito Malca Hernandez 1 , Ahmed Abdeen 2 , Daniel Granda 3 , Yvett Pinedo Ramirez 4 , Flor Gonzales 5 , Miguel Tapia 5 , Patricia Garcia 3 , Evelyn Hsieh 1 1 Yale University, New Haven, CT, USA, 2 Pennsylvania State University, Hershey, PA, USA, 3 Universidad Peruana Cayetano Heredia, Lima, Peru, 4 Hospital Nacional Arzobispo Loayza, Lima, Peru, 5 Centro de Referencias de Infecciones de Transmisión Sexual (CERITS), Lima, Peru Background: The life expectancy of people living with HIV (PLWH) has improved notably since the advent of antiretroviral therapy (ART). However, studies have shown that persons aging with HIV are disproportionately impacted by comorbidities associated with aging, including osteoporosis. The gold standard tool for diagnosing osteoporosis is dual-energy X-ray absorptiometry (DXA), however its availability in low-resource settings is limited. To address this barrier, low-cost screening tools for osteoporosis, such as the Simple Calculated Osteoporosis Risk Estimation (SCORE) and the Osteoporosis Self-Assessment Tool (OST), have been developed. However, these tools have only been validated for the general population, not for PLWH. Methods: We recruited PLWH (men ≥50 years and postmenopausal women) at three HIV clinics in Lima, Peru between March 2022 to August 2023. Participants completed a survey regarding osteoporosis risk factors, demographics, and clinical characteristics. Osteoporosis was assessed via DXA. SCORE (based upon age, sex, race, weight, rheumatoid arthritis diagnosis, history of non-traumatic fracture and estrogen use) and OST (based upon age and weight) values were calculated as described in the literature. Since OST does not include sex as a predictor, results were analyzed separately for men and women. Sensitivity (S), specificity (Sp), and predictive values (NPV/PPV) with their 95% confidence intervals were calculated for SCORE and OST using the DXA results as the gold standard. Results: A total of 166 PLWH were enrolled (89 women, 77 men), mean age 56.9±6.3. The prevalence of osteoporosis by DXA was 27.1% (43% for women, 9% for men). For SCORE, at the general population recommended threshold of 6, we found a S=97.8% (88.2%-99.9%), Sp=19.8% (13.1%-28.1%), PPV=31.2% (23.7%-39.5%), and NPV=96% (79.6%-99.9%). For the OST among women, we used the recommended general population threshold of -1, resulting in a S=28.9% (15.4%-45.9%), Sp= 84.3% (71.4%-93%), PPV= 57.9% (33.5%-

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CROI 2025 283