CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

1 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 Rush University, Chicago, IL, USA, 4 University of California Los Angeles, Los Angeles, CA, USA, 5 University of California San Francisco, San Francisco, CA, USA, 6 Georgetown University, Washington, DC, USA, 7 University of Pittsburgh, Pittsburgh, PA, USA, 8 University of Illinois at Chicago, Chicago, IL, USA Background: HIV-infected (HIV+) women appear more vulnerable to neurocognitive impairment (NCI) than HIV+men, perhaps due to mental health factors. We assessed the combined effects of depression, HIV-serostatus, and biological sex on NCI. Methods: 858 HIV+ (429 women; 429 men) and 562 HIV- (281 women; 281 men) from the Women’s Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS) completed the Center for Epidemiologic Studies Depression (CES-D; 16 cutoff) scale and measures of psychomotor speed/ attention (Trail Making Test [TMT] Part A, Stroop word reading and color naming trials, Symbol Digit Modalities Test [SDMT]), executive (TMT Part B, Stroop color-word [interference] trial), and motor function (Grooved Pegboard) over multiple visits. WIHS and MACS participants were matched according to HIV-serostatus, age, race, and education. Generalized linear mixed models were used to examine the combined and separate associations of depression (time-varying), sex, and HIV-serostatus on NCI (T-scores<40) after covariate adjustment. Covariates included education, age, income, alcohol, recreational, and cigarette use, and prior test exposure. In HIV+ analyses, we also controlled for antiretroviral use, CD4 count (current and nadir), viral load, and prior AIDS diagnosis. Results: The association between depression and Stroop interference trial performance differed by HIV-serostatus and sex. HIV+ depressed women had a greater odds of impairment versus HIV+ depressed men (OR=3.29, 95%CI 1.25-8.69, P=0.02) whereas HIV- depressed women and men showed a similar probability of impairment. Not only did depression exacerbate the interactive association between HIV and sex, but it also exacerbated the HIV+ female vulnerability as HIV+ depressed women also had a greater odds of impairment versus HIV- depressed women (OR=5.03, 95% CI 1.36-18.61, P=0.01) and HIV- depressed men (OR=3.14, 95%NCI 1.09-9.06, P=0.03). Among HIV+ depressed individuals, women remained at a higher odds of impairment after accounting for HIV-related factors (OR=3.93, 95%CI 1.24-12.46, P=0.02). Regardless of HIV-serostatus and sex, depression was associated with greater impairment on SDMT, Stroop word reading, TMT Part B, and GP non-dominant hand (P’s<0.05). Conclusion: Depression contributes to NCI across a broad range of cognitive domains in HIV+ and HIV- individuals, but HIV+ depressed women show greater vulnerabilities in executive function. Treating depression may help to improve cognition in patients with HIV infection. 517 GENDER AND COINFECTIONS CONTRIBUTE TO IMMUNE ACTIVATION IN TREATED HIV INFECTION Gowoon Son 1 , Daniel Habermann 1 , Trevor A. Crowell 2 , Allahna L. Esber 2 , Leigh Anne Eller 2 , Michael A. Eller 2 , Ajay Parikh 2 , Yakubu Adamu 3 , Francis Kiweewa 4 , Merlin L. Robb 2 , Nelson L. Michael 2 , Daniel Hoffmann 1 , Christina Polyak 2 , Julie Ake 2 , Hendrik Streeck 1 1 University of Duisburg-Essen, Essen, Germany, 2 Walter Reed Army Institute of Research, Silver Spring, MD, USA, 3 Walter Reed Program–Nigeria, Abuja, Nigeria, 4 Makerere Univ Walter Reed Project, Kampala, Uganda Background: Immune activation, a central component of HIV pathogenesis, has been associated with morbidity and mortality even in successfully ART-treated individuals. However, the underlying mechanism of persistent immune activation is not well understood. Here we analyze how gender and co- infections such as hepatitis B (HBV), hepatitis C (HCV) or tuberculosis contribute to persistent, low-level immune activation. Methods: From the observational African Cohort Study (AFRICOS), 2745 specimens were collected from January 2013 to December 2016 along with medical history, sociodemographic, non-infectious comorbidities and co- infection (tuberculosis, hepatitis B/C, syphilis) data at 11 HIV clinical care and treatment sites across 5 programs in the 4 countries (Nigeria, Uganda, Tanzania, and Kenya). In total, 13 soluble immune parameters were measured by Luminex and ELISA and the data were evaluated using univariate and multivariate methods such as random forest, principal component analyses (PCA) and Bayesian multilevel logistic regression models. *P- : Probability of negative effect from Bayesian multilevel logistic regression model

515 HIGH RATES OF VIROLOGIC SUPPRESSION AFTER RAPID ART START IN A SAFETY-NET CLINIC Susa Coffey 1 , Peter Bacchetti 1 , Darpun Sachdev 2 , Oliver Bacon 2 , Clarissa Ospina- Norvell 1 , Sandra Torres 1 , Elizabeth Lynch 1 , Sulggi Lee 1 , Katerina A. Christopoulos 1 , Christopher D. Pilcher 1 , Ling Hsu 2 , Chengshi Jin 1 , Susan Scheer 2 , Diane V. Havlir 1 , Monica Gandhi 1 1 University of California San Francisco, San Francisco, CA, USA, 2 San Francisco Department of Public Health, San Francisco, CA, USA Background: Little is known about long-term viral suppression outcomes for patients initiating antiretroviral therapy (ART) the same day as or shortly after HIV diagnosis (RAPID ART). Methods: The Ward 86 HIV Clinic in San Francisco is a public health funded clinic that adopted immediate ART for persons newly diagnosed with HIV in 2013. Patients were referred from San Francisco testing sites or the hospital to Ward 86, offered same or next-day intake appointments, and received multidisciplinary evaluation, with education, support, and insurance enrollment/optimization. Patients were offered same-day ART and provided 3-5-day starter packs and prescriptions of ART, check-in calls, and follow-up appointments within 1-2 weeks. Demographic characteristics, baseline CD4 counts, and viral loads (VL) were extracted from the medical record. Subsequent VLs were obtained from public health surveillance data, regardless of testing site. Kaplan-Meier curves summarized distribution of times to 1st virologic suppression and suppression at the last VL measurement. Results: Of 225 patients referred to the Ward 86 RAPID ART program from 2013-17, 4 declined ART, 3 were not offered ART and 2 were lost to follow-up before the RAPID visit. Of the 216 patients (96%) started on immediate ART, median age was 31 years; 7.9%women; 11.6% African American, 26.9% Hispanic, 36.6%white; 51.4%with substance use disorder; 48.1%with major mental health diagnosis; 30.6% unstably housed; median baseline CD4 441; median VL 37,011 copies/mL. Median time from HIV diagnosis to ART start: 7 days; from RAPID intake to ART start: 0 days; from HIV diagnosis to VL <200: 60 days. The median follow-up time for the sample was 1.09 years (0-3.92). By 1 year after follow-up, 95.8% had achieved VL suppression to <200 at least once. Among patients who initially suppressed, 15% experienced one or more episodes of viral rebound, but most (75%) resuppressed to <200 copies/mL. The median number of VL measures for the cohort over the period of follow-up was 4 (1-22). At the last recorded VL result, 92.1% of all patients were suppressed. Conclusion: In an urban HIV clinic with high rates of mental illness, substance use and housing instability, immediate ART initiation after HIV diagnosis resulted in virologic suppression in >90% at last VL measurement at a median of 1.09 years after ART start. Rapid ART implementation within safety-net populations is acceptable, feasible, and successful with a multidisciplinary care team and municipal support. 516 DEPRESSION IS A STRONGER PREDICTOR OF EXECUTIVE DYSFUNCTION IN HIV+WOMEN THAN MEN Leah H. Rubin 1 , Gayle Springer 2 , Eileen Martin 3 , Eric C. Seaberg 2 , Ned Sacktor 1 , Andrew Levine 4 , Victor Valcour 5 , Mary Young 6 , James T. Becker 7 , Pauline M. Maki 8

Poster Abstracts

CROI 2019 193