CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1159 Life Expectancy Among Virally Suppressed Women and Men With HIV in the Bronx, New York, 1997-2021 Brandilyn A. Peters 1 , Melissa Fazzari 1 , Uriel R. Felsen 1 , Heidi E. Jones 2 , Mindy S. Ginsberg 1 , David B. Hanna 1 , Kathryn Anastos 1 1 Albert Einstein College of Medicine, Bronx, NY, USA, 2 CUNY School of Public Health, New York, NY, USA Background: Life expectancy for people with HIV (PWH) has increased dramatically, but disparities may remain across sub-populations. We aimed to characterize life expectancy over 2 decades by sex and race/ethnicity for virally suppressed PWH in the Bronx, New York – a low income area with a largely Black and Hispanic population and high proportion of women with HIV. Methods: PWH receiving care in the Montefiore Health System in the Bronx with at least 2 viral load measurements obtained at least 30 days apart were included. Viral suppression was defined retrospectively as the earliest date (1997-2021) in a one-year window where at least 80% of all viral load measurements were suppressed (<1000 copies/mL). Follow-up ended at death (via National Death Index), loss to follow-up, or the end of the analysis window (end of 2022). A Poisson regression model with offset for years of follow-up was used to estimate mortality rate ratios and 95% confidence intervals according to time period and age at earliest viral suppression, sex at birth, and race/ethnicity. Based on the Poisson model, expected remaining years of life were estimated for a 30-year-old via Chiang’s method with bootstrapped 95% confidence intervals. Results: PWH (n=10,308; 42% women, 43% non-Hispanic Black, 40% Hispanic, 5% non-Hispanic White) were followed for an average of 10 years (interquartile range 4-15), during which 2,813 (27%) died. As expected, risk of mortality declined over time, corresponding to a ~10 year increase in life expectancy since the late 1990s. Women had 28% (22-34) lower mortality risk than men. Compared to Black PWH, Hispanic PWH had 20% (12-28) lower mortality risk, while White PWH or those with other/unknown race/ethnicity had higher mortality risk (White: 18% [-1,40]; other/unknown: 51% [32,72]). Adjustment for CD4+ T-cell count and health insurance did not materially alter these results. Hispanic women had the highest estimated life expectancy, and men of other/ unknown race/ethnicity had the lowest (50 and 35 years for 30-year-old with earliest viral suppression within 2017-2021, respectively) ( Figure ). Conclusions: Virally suppressed women and Hispanic PWH in the Bronx have longer lifespans than comparable men and other race/ethnic groups, respectively, consistent with sex and race/ethnic disparities in lifespan in the U.S. among people without HIV. Yet, lifespan for non-Hispanic PWH in the Bronx remains lower than the general U.S. population.

Meier to estimate each birth cohort’s survival probability over the duration of the observation period (through 2022). For each treatment era, population-level demographic characteristics and all-cause mortality rates (MR; deaths per 1000 person-years) were also assessed. Results: There were 19,146 PPHIV born and 6,765 PPHIV deaths (35%) between 1978-2022. Ten-, twenty- and thirty-year (where applicable) survival probabilities among pre-ART, early-ART, and early cART birth cohorts (1978 1986: n=2187; 1987-1995: n=10176; 1996-1999: n=2194) were: 60%, 41%, and 33%; 68%, 64%, and 36%; and 94% and 92%, respectively (Figure 1). In contrast, survival for all later birth cohorts remained >96% through 2022. Between 2020-2022, there were 323 deaths among 12,704 PPHIV. Among these, 311 (96%) occurred in PPHIV aged >18 years. Mortality was highest among PPHIV aged >25 years (MR 7.21), followed by those aged 19-24 years (MR 1.09) and 13-18 years (MR 0.13). The median age of death was 29 years, while the median age of PPHIV still alive at the end of 2022 was 28. Deaths occurred most commonly among males (55%), Black/African American persons (55%), and PPHIV born in the South (44%) and Northeast (38%). Conclusions: There have been marked improvements in childhood and adolescent survival among PPHIV since the cART era. However, PPHIV born earlier still face a relatively high burden of mortality despite advances in treatment. As lifetime survivors age into adulthood, understanding their care needs, comorbidities, quality of life, and causes of death will be essential to improving their well-being and survival.

Poster Abstracts

1161 Mortality in the HIV Outpatient Study (HOPS), Trends and Risks: 2007-2022

Kimberly Carlson 1 , Qingjiang Hou 1 , Alexander Ewing 2 , Kate Buchacz 2 , Jonathan Mahnken 1 , Frank Palella 3 , Kalliope Chagaris 1 , Rick Novack 4 , Ellen Tedaldi 5 , Jun Li 2 1 Cerner Corporation, Kansas City, MO, USA, 2 Centers for Disease Control and Prevention, Atlanta, GA, USA, 3 Northwestern University, Chicago, IL, USA, 4 University of Illinois at Chicago, Chicago, IL, USA, 5 Temple University, Philadelphia, PA, USA Background: While persons with HIV (PWH) can live into old age on ART, tailoring interventions to optimize health and lifespan requires ongoing study of determinants of survival. Methods: We studied HOPS participants with >2 visits between 1/1/2007 and 12/31/2022 who received ART continuously for >6 months and for at least 75% of time under observation. PWH were followed from baseline (1/1/2007, or date of first HOPS visit thereafter) until death, last contact date plus 6 months, or 12/31/2022. Deaths included occurred within 6 months of last contact. Univariate Poisson regression generated overall and non-AIDS-related mortality rates by demographic and select risk factors. For longitudinal trends, we used univariate and multivariable Poisson regression with generalized estimating equations (GEE) for crude and adjusted mortality rates and rate ratios (RR). GEE models updated age in years and other death risks annually. Results: Of 4,859 participants, median age (Interquartile range (IQR) at baseline was 43 years (yrs) (33, 49), 20% were women; 396 died, most (n=307) from non-AIDS causes during a median of 7.0 yrs of observation (interquartile range: 3.4–12.0). Median age (-IQR) at death was 56 yrs (49,63). Mortality rates (95% CI) were 1.3 (0.9,1.9) and 1.1 (0.7,1.8) per 100 person-years in 2007 and

1160 Mortality Trends Among Persons With Perinatal HIV in United States and Territories, 1978-2022 Preetam Cholli, Xueyuan Dong, Margaret A. Lampe, Yang Liu, Jessica Fridge,

Athena Kourtis, Alexandra Balaji, Kate Buchacz Centers for Disease Control and Prevention, Atlanta, GA, USA

Background: Recent trends in mortality among people aging with perinatally acquired HIV (PPHIV, “lifetime survivors”) remain poorly characterized. We used National HIV Surveillance System (NHSS) data to analyze survival trends and all-cause mortality among PPHIV since the first cases were identified in the U.S. and describe characteristics of decedent PPHIV between 2020-2022. Methods: PPHIV born between 1978 and 2022, as reported to CDC by December 2023, were identified and categorized into birth cohorts as follows: no ART (1978-1986; cases identified through AIDS case reporting); early-ART (1-2 drug regimens) (1987-1995; identified through AIDS and/or HIV case reporting); and highly active combination ART (cART) era (1996-2022; identified through universal name-based HIV case reporting), subdivided into four-year periods until the end of observation [1996-1999, 2000-2003, etc.]). We used Kaplan

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