CROI 2019 Abstract eBook

Abstract eBook

Oral Abstracts

irradiation approach with only mild GvHD. To our knowledge this is the longest adult HIV remission observed since the Berlin patient. 30 BREAKING BONES IS BAD: INCIDENT FRACTURE AND MORTALITY IN THE HIV OUTPATIENT STUDY Linda Battalora 1 , Carl Armon 2 , Frank J. Palella 3 , Jun Li 4 , Edgar T. Overton 5 , John Hammer 6 , Jack Fuhrer 7 , Richard Novak 8 , John Spear 1 , Kate Buchacz 4 1 Colorado School of Mines, Golden, CO, USA, 2 Cerner Corp, Kansas City, MO, USA, 3 Northwestern University, Chicago, IL, USA, 4 CDC, Atlanta, GA, USA, 5 University of Alabama at Birmingham, Birmingham, AL, USA, 6 Denver Infectious Disease Consultants, Denver, CO, USA, 7 Stony Brook University, Stony Brook, NY, USA, 8 University of Illinois at Chicago, Chicago, IL, USA Background: Persons living with HIV (PLWH) have higher rates of low bone mineral density (BMD) and fracture than those without HIV infection, but the contribution of bone fractures to mortality among aging PLWH in care in the United States (U.S.) has not been explored. We evaluated the associations of bone fracture with mortality controlling for sociodemographic, behavioral, and clinical factors. Methods: We analyzed data from HIV Outpatient Study (HOPS) participants seen at nine U.S. HIV clinics from January 1, 2000 to September 30, 2017, with ≥2 HOPS encounters. Incident fracture rates and mortality after fracture were compared, adjusted by age, sex, and calendar period: 2000-2004, 2005-2008, 2009-2012, and 2013-2017. We used Cox proportional hazards analyses to determine factors associated with all-cause mortality for all participants and for the subset with incident fracture. Results: Among 6,826 HOPS participants followed for a median of 6.2 years, 502 (7%) had incident fracture recorded and 729 (10%) had died. Of 502 fractures, 97 were major osteoporotic (hip, wrist, spine, shoulder) and 405 were not (47 site unknown). Median age at fracture was 48 years (interquartile range 41-55 years). Of patients, 16.5%with major osteoporotic fractures died (crude mortality 1.5 per 100 person-years [py]), while 14.6%with fractures at other sites died (crude mortality 1.3 per 100 py). Age- and sex-adjusted fracture rates per 100 py increased from 0.9 during 2000-2004 to 1.2 during 2013-2017 (p=0.037 for trend), and all-cause mortality rates per 100 py among those with incident fracture decreased from 8.5 to 1.9 (p=0.001 for trend), (Figure 1a and 1b, respectively). In multivariable analysis, incident fracture was significantly associated with all-cause mortality (Hazard Ratio 1.5, 95% confidence interval 1.2-1.9) as were multiple other factors, notably nadir CD4+ cell count < 200 cells/mm3, non-AIDS cancer, hepatitis C infection, and chronic liver, renal, and cardiovascular disease comorbidity. Among the 502 patients followed after incident fracture, chronic renal disease and hepatitis C infection remained independently associated with all-cause mortality. Conclusion: Incident fracture increased the risk of all-cause mortality by 50 percent among U.S. PLWH in care, underscoring the need for BMD screening and fracture prevention among at-risk patients. Although fracture rates among PLWH increased during follow-up, death rates after fracture decreased, coincident with advances in HIV care.

Oral Abstracts

31 COPD AND THE RISK FOR MYOCARDIAL INFARCTION BY TYPE IN PEOPLE LIVING WITH HIV Kristina Crothers 1 , Barbara N. Harding 1 , Bridget M. Whitney 1 , Joseph Delaney 1 , Robin M. Nance 1 , Susan Heckbert 1 , Matthew Budoff 2 , W. C. Mathews 3 , Joseph J. Eron 4 , Richard D. Moore 5 , Michael J. Mugavero 6 , Michael Saag 6 , Mari Kitahata 1 , Heidi M. Crane 1 , for the CNICS Cohort 1 University of Washington, Seattle, WA, USA, 2 University of California Los Angeles, Los Angeles, CA, USA, 3 University of California San Diego, San Diego, CA, USA, 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 6 University of Alabama at Birmingham, Birmingham, AL, USA Background: People living with HIV (PLWH) are at increased risk for chronic obstructive pulmonary disease (COPD) compared to uninfected persons, in whom COPD is a known risk factor for cardiovascular disease such as myocardial infarction (MI). However, the relationship between COPD and MI in PLWH is less well understood. MIs have been classified into types including type 1 (T1MI, atherothrombotic coronary plaque rupture) and type 2 (T2MI, supply-demand mismatch as with sepsis), with a much higher proportion of T2MI in PLWH than the general population. We hypothesized that COPD would be associated with increased MI risk among PLWH, particularly for T2MI. Methods: We utilized data from six sites in the CFAR Network of Integrated Clinical Systems (CNICS) cohort. MIs were centrally adjudicated by two reviewers (3 if discrepancies) and also categorized by type and cause of T2MI. COPD was defined based on an algorithmwe previously validated against spirometry requiring COPD diagnosis codes and ≥90-day continuous supply of long-acting COPD controller medications. Time to MI was assessed using Cox proportional hazards models. Models were adjusted for baseline age, sex, race/ethnicity, HIV viral load, nadir CD4 count, diabetes, hypertension, statin use, and CNICS site. We subsequently examined whether associations were attenuated by adjustment for smoking status (ever vs. never), as this was potentially an important confounder. Results: In total, 25,509 PLWH were included, of whom 423 met our definition of moderate-to-severe COPD. There were 698 PLWH who had MIs (339 T1MI [54%], 294 T2MI [46%]). COPD was associated with a significantly increased risk of MI [adjusted hazard ratio (aHR) 2.09 (95%CI 1.50-2.91)] even after adding smoking [aHR 1.88 (95%CI 1.34-2.63)]. COPD was significantly associated with T1MI and T2MI in unadjusted analyses, but only T2MI in adjusted analyses, and this was only minimally attenuated by smoking (Table); this association was particularly notable for T2MI due to sepsis/bacteremia. Conclusion: COPD is independently associated with an increased risk for MI in PLWH, particularly T2MI in the setting of sepsis/bacteremia. COPD severity,


CROI 2019

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