CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

PrEP, indicating substantial unmet PrEP needs that CAB-LA can mitigate. We calibrated our model to Dutch HIV epidemic data among MSM. We modelled alternative scenarios of introducing CAB-LA in 2025 to alleviate the estimated unmet PrEP needs. We considered covering 75% of HIV-negative MSM by offering CAB-LA within two years by 2027 as a rapid scale-up, by 2030 as a medium and by 2032 as a delayed scale-up. We assumed that current oral PrEP users with a CAB-LA preference would switch to CAB-LA, informed by data from a Dutch PrEP cohort that suggested around 50% of the current oral PrEP users preferred CAB-LA. We additionally assessed the impact of terminating NPP by 2025. Oral PrEP effectiveness was set at 86%, and CAB-LA efficacy was assumed to be 91% following results from the HPTN083 trial. Results: Closing unmet PrEP needs by offering CAB-LA was shown to further reduce the HIV epidemic in the Netherlands, with the potential to avert 14% (delayed scale-up) up to 21% (rapid scale-up) new infections within ten years of its introduction, and can reach zero new infections within 10 years. However, a delayed CAB-LA scale-up would delay reaching zero by three years compared with a rapid scale-up. While terminating the current NPP would result in more HIV infections (Figure a). The additional number needed to treat (NNT) on CAB-LA to prevent one HIV infection was estimated over 1000+ in all CAB-LA scale-up scenarios between 2025-2035. A rapid CAB-LA scale-up would be 12% more efficient than a delayed scale-up (Figure b). Conclusions: Continuing the NPP is crucial. A swift introduction of CAB-LA could significantly reduce the PrEP unmet needs, paving the way toward ending the HIV epidemic in the Netherlands. The figure, table, or graphic for this abstract has been removed. 1298 Trajectories of Weight Changes After GLP-1 Receptor Agonists Initiation Among Patients With HIV Jing Sun 1 , Pooja Maheria 2 , Carolyn Bramante 3 , Hsing-Yu Hsu 1 , Eric G. Hurwitz 4 , Zachary Butzin-Dozier 5 , Jerrod Anzalone 6 , Todd Brown 7 , Rena C. Patel 8 , for the National COVID Cohort Collaborative (N3C) 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 University of Minnesota, Minneapolis, MN, USA, 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 University of California Berkeley, Berkeley, CA, USA, 6 University of Nebraska Medical Center, Omaha, NE, USA, 7 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 8 University of Alabama, Tuscaloosa, AL, USA Background: Glucagon-like peptide-1 (GLP-1) receptor agonists (RA) have been shown to have marked efficacy in improving blood glucose and reducing weight among individuals in randomized trials. However, real-world data on weight changes after GLP-1 RA initiation among people with HIV remain limited. Methods: Using patient-level data from 82 sites in the U.S. National COVID Cohort Collaborative (N3C), a nationally-sampled electronic health records repository, we conducted a retrospective analysis with all patients with HIV receiving GLP-1 RA (i.e., tirzepatide or semaglutide injection), sodium-glucose cotransporter-2 (SGLT-2, e.g.,empagliflozin), or metformin between January 1, 2018 and November 2, 2023, regardless of indication, with the metformin only group as the reference. Changes in weight per month were modeled since baseline weight at drug initiation (+/- 3 months) up to 12 months after treatment. We used mixed effect linear regression, stratified by sex. Models controlled for age, race/ethnicity, baseline weight, height, diabetes status (pre diabetes, type I, type II diabetes, or none), and Charlson Comorbidity Index. Results: Of 456,558 patients who received GLP-1 RA, metformin, or SGLT-2, 3,955 were people with HIV (PWH). At baseline, the median age of PWH was 59 years (IQR 52–65), with 59% male, 38% white, 42% Black, and 15% Latinx. Among women with HIV, those who received tirzepatide or semaglutide experienced faster weight loss compared to those who only received metformin, with an average of 1.12 kg/month (95% CI: -0.76, -1.49) and 0.87 kg/month (95% CI: -0.54, -1.19), respectively (Figure). No significant difference in weight loss was observed among men with HIV when comparing metformin to GLP-1 RA during the first 12 months. However, men receiving semaglutide had a slightly faster weight loss rate of 0.07 kg/month, though this was not statistically significant. Conclusions: This real-world data suggests that among women with HIV, use of semaglutide or tirzepatide is associated with greater weight loss than use of metformin in the first 12 months. Differences in weight change is less pronounced among men with HIV. Additional work needs to address the sex

differences and underlying mechanisms of weight changes after using weight loss drugs among PWH.

1299 Cardiometabolic Risks and the Transition to InSTIs in Aging PLWH in South Africa Julia K. Rohr 1 , F. Xavier Gómez-Olivé 2 , Jacques Du Toit 2 , Kathleen Kahn 2 , Shafika Abrahams-Gessel 1 , Brendan Maughan-Brown 3 , Carla Roberts-Toler 4 , Thomas A. Gaziano 5 , Stephen Tollman 2 , Till W. Bärnighausen 6 , Jennifer Manne-Goehler 5 1 Harvard TH Chan School of Public Health, Boston, MA, USA, 2 University of the Witwatersrand, Johannesburg, South Africa, 3 University of Cape Town, Cape Town, South Africa, 4 Harvard University, Cambridge, MA, USA, 5 Brigham and Women's Hospital, Boston, MA, USA, 6 Heidelberg University, Heidelberg, Germany Background: The transition to integrase inhibitors has been associated with weight gain and increases in cardiometabolic risk factors, but evidence for the impact of this transition over longer time horizons in populations with HIV negative comparators is limited. We evaluated the impact of the switch from efavirenz to dolutegravir (DTG) on weight and a suite of cardiometabolic risk factors among middle-aged and older adults in South Africa. Methods: We analyzed data from a longitudinal population-based cohort of adults ≥40 years in a rural sub-district of Mpumalanga Province (HAALSA HAALSI: Health and Ageing in Africa: Longitudinal Studies in South Africa Indepth). Wave 2 data were collected in Oct 2018 - Oct 2019 (before DTG rollout in South Africa) and Wave 3 in Jul 2021 - Mar 2022 (after DTG rollout). Household surveys collected data on health, socioeconomic status, anthropometrics (height, weight, hip and waist circumference), and blood pressure. Dried blood spots were tested for HIV Ag/Ab and the following antiretrovirals to define a participant’s regimen: DTG, EFV, LPV, 3TC, FTC. We assessed changes over three years between surveys in (1) BMI, (2) waist circumference, (3) waist-to-hip ratio, and (4) blood pressure. These were analyzed across four groups of people: (1) HIV+ on ART in both waves with switch to DTG [HIV+/ART/DTG]; (2) HIV+ on ART in both waves with no switch to DTG [HIV+/ART/no DTG]; (3) HIV+ not on ART [HIV+/no ART]; and (4) HIV-. Linear regression models controlled for age, sex, education and wealth. Results: 2,071 participants provided data in both waves and were categorized in the following groups: 10% HIV+/ART/DTG, 7% HIV+/ART/no DTG, 1% HIV+/ no ART, and 74% HIV-. The median age was 64 years (IQR: 55-72) and 59% were female. People who switched to DTG (HIV+/ART/DTG group) had greater increases in BMI, waist circumference, and systolic blood pressure over three years compared to the HIV+/ART/no DTG and HIV- groups (Table). The impact of switching to DTG on diastolic blood pressure was greater among females: a relative increase of 2.49 mmHg (95% CI: 0.33-4.64) compared to HIV- individuals. As expected, people in the HIV+/no ART group had relatively large decreases in weight. Conclusions: This study provides real-world evidence that switching to DTG among adults aging with HIV is associated with a risk of weight gain and increased blood pressure, especially for females. Investments in care to offset cardiometabolic health risks in people with treated HIV are urgently needed.

Poster Abstracts

CROI 2025 431