CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

912

Uncovering Differential Disparities at the Intersection of Race, Sex, & HIV in Patients With Sepsis Gwenyth L. Day 1 , Anuj B. Mehta 2 , Kristine M. Erlandson 1 , Joshua A. Barocas 3 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 2 Denver Health and Hospital Authority, Denver, CO, USA, 3 University of Colorado School of Medicine, Aurora, CO, USA Background: Sepsis, often due to pneumonia, is a leading cause of death among people hospitalized in the US. HIV was a clear risk for death from pneumonia/sepsis in the pre-antiretroviral therapy (ART) era, but the impact of HIV in the current era is less clear. Sepsis mortality may be impacted by non physiologic factors associated with an HIV diagnosis. We investigated whether a diagnosis of HIV along with race and sex has an impact on pneumonia/sepsis mortality. Methods: We used the Healthcare Cost and Utilization Project State Inpatient Databases to create a cohort of adults with and without HIV hospitalized with pneumonia and/or sepsis from 7 states from 2018-2020. ICD-10 codes defined disease states and exposure characteristics. We calculated crude in-hospital mortality based on race and an intersectional variable of race and sex (Table 1), stratified by HIV status. Risk adjusted odds of death were calculated in multivariable models with the hospital as a random intercept and adjusted for pertinent variables. We tested the interaction between race and intersectional category with HIV status. Results: We identified 2,922,295 encounters with pneumonia and/or sepsis (42,646 with vs 2,879,649 without HIV). Those with HIV were younger (mean age 51.3 vs 66.7), more likely male (67.6 vs 51.6%), and had lower mean predicted mortality (6.7 vs 12.8) than those without HIV. Those with HIV had mostly lower crude in-hospital mortality rates than those without. Overall, non White groups had higher adjusted odds of death than Whites in both those with and without HIV. Across all intersectional groups, there was qualitatively a trend toward higher odds of death in non-White groups with HIV, with the largest statistically significant increase in Asian females. We detected significant interactions between race and HIV (p=0.0031) and race/sex and HIV (p=0.008). Conclusions: In this large retrospective cohort study, crude mortality rates from pneumonia/sepsis differed by race and race/sex within each HIV status strata. The effect of HIV with race/sex was notable in Asian females. These findings highlight the differential impact of race, sex and HIV on sepsis mortality, and suggests that established patterns of racial and intersectional disparity in patients without HIV may not apply to those with HIV. Understanding differential experiences of access to care, ART rates, discrimination and bias across groups is critical to untangling clinical determinants of disease outcomes from social and structural ones.

Methods: This study used AoU controlled tier data, version 7, which covers individuals enrolled in AoU from May 31, 2017, to July 1, 2022. A comprehensive computational phenotyping algorithm incorporating both electronic health records (EHRs) and survey data was used to identify suspected TGD participants in AoU. Then, four broad clusters of psychiatric disorders, including “Any mood disorder,” “Any anxiety disorder,” “Any substance use disorder,” and “Any stress-related disorder,” were identified based on ICD codes from EHR data. Multinomial logistic regression models were used to explore the association of HIV status with the number of psychiatric diagnoses clusters while also exploring the potential moderation effect of race/ethnicity and sex assigned at birth. Results: Among 4,899 TGD individuals identified, 1,439 (29.37%) had a diagnosis in at least one cluster of psychiatric disorders, and 211 (4.31%) were with HIV. Significant correlations were observed across four clusters of disorders, with the values of correlation coefficients ranging from 0.60 to 0.92. TGD individuals with HIV had higher odds of having diagnoses in at least two clusters (Adjusted Odds Ratio [aOR] = 4.48, 95%CI: 3.13~6.49)) or one cluster (aOR = 2.36, 95%CI: 1.42~3.94) compared to TGD individuals without HIV. In addition, sex assigned at birth moderated the effect of HIV status on the likelihood of having one cluster of psychiatric diagnoses. The negative impact of HIV status on the diagnosis in at least one cluster of psychiatric disorders was more pronounced for TGD individuals who were assigned as female than those who were assigned as male at birth (aOR = 0.20, 95%CI: 0.04~0.89). Conclusions: Comprehensive healthcare support that integrates HIV treatment and psychotherapy is needed for TGD people with HIV, and gender-affirmative approaches are needed when conducting mental health intervention for individuals with HIV who were assigned female at birth, considering their unique experience.

Poster Abstracts

914

Kynurenine-Tryptophan (KT) Ratio and Inflammatory Biomarkers Associated With COPD in People With HIV Stephanie A. Ruderman 1 , Kristina Crothers 1 , Engi F. Attia 1 , Lydia N. Drumright 1 , Kenneth Mayer 2 , George Yendewa 3 , Sonia Napravnik 4 , Laura Bamford 5 , Edward Cachay 6 , Michael Saag 7 , Richard Moore 8 , Heidi M. Crane 1 , Joseph A. Delaney 1 , Peter W. Hunt 9 , for the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) 1 University of Washington, Seattle, WA, USA, 2 The Fenway Institute, Boston, MA, USA, 3 Case Western Reserve University, Cleveland, OH, USA, 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 University of California San Diego Medical Center, La Jolla, CA, USA, 6 University of California San Diego, La Jolla, CA, USA, 7 University of Alabama at Birmingham, Birmingham, AL, USA, 8 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 9 University of California San Francisco, San Francisco, CA, USA Background: The prevalence of chronic obstructive pulmonary disease (COPD) is higher and more severe among people with HIV (PWH) compared to those without HIV. Chronic inflammation, immune dysfunction, and pulmonary and other infections associated with HIV may contribute to accelerated COPD among PWH, especially given the high prevalence of smoking in PWH. Methods: We determined associations between a panel of 13 biomarkers and prevalent COPD among PWH in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort at eight sites. CNICS data included demographic information, clinical inpatient and outpatient data, and self-reported smoking and substance use behaviors. COPD was defined by a validated algorithm using international classification of disease diagnoses plus

913

HIV Status and Psychiatric Diagnoses Among Transgender and Gender Diverse Individuals Fanghui Shi, Xueying Yang, Ruilie Cai, Jiajia Zhang, Sayward Harrison, Shan Qiao, Xiaoming Li University of South Carolina, Columbia, SC, USA Background: Transgender and gender diverse (TGD) people with HIV may experience high prevalences of psychiatric diagnoses due to the convergence of two marginalized social identities, HIV infection and gender minority. Utilizing multi-sourced data from the All of Us (AoU) Research Program, the current study aimed to examine the impact of HIV status on psychiatric diagnoses among TGD individuals and the potential moderating effect of sex assigned at birth and race/ethnicity.

CROI 2025 285