CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

668 HYPERTENSION CONTROL IN INTEGRATED HIV/NCD CLINICS IN THE SEARCH STUDY Dalsone Kwarisiima 1 , Yusuf Mwinike 2 , James Ayieko 3 , Atukunda Mucunguzi 2 , Winter Olilo 3 , Laura B. Balzer 4 , Gabriel Chamie 5 , Tamara D. Clark 5 , Vivek Jain 5 , Edwin D. Charlebois 5 , Craig R. Cohen 5 , Elizabeth A. Bukusi 6 , Moses R. Kamya 7 , Diane V. Havlir 5 , Lillian Brown 5 1 Makerere University Joint AIDS Program, Kampala, Uganda, 2 Infectious Diseases Research Collaboration, Kampala, Uganda, 3 Kenya Medical Research Institute, Kisumu, Kenya, 4 University of Massachusetts Amherst, Amherst, MA, USA, 5 University of California San Francisco, San Francisco, CA, USA, 6 Kenya Medical Research Institute, Nairobi, Kenya, 7 Makerere University College of Health Sciences, Kampala, Uganda Background: There has been a call for integration of non-communicable disease (NCD) care within HIV services and across to HIV-uninfected populations but little data. In the SEARCH study (NCT01864603) where existing HIV chronic care systems are leveraged to provide care for persons with hypertension, with or without HIV, we sought to assess the feasibility, effectiveness, and systems factors that influence hypertension control in HIV-infected and uninfected persons. Methods: Following population screening of HIV and hypertension (HTN) in 34,704 adults living in ten communities in rural Uganda, individuals with either or both diseases were referred to an integrated chronic disease clinic. Based on Uganda treatment guidelines follow-up visits were scheduled every 4 weeks when blood pressure was uncontrolled (SBP > 140 mmHg or DBP > 90 mmHg) and every 12 weeks when blood pressure was controlled. Drug stock-outs sometimes required more frequent visits. We assessed visit interval (whether more or less frequent than clinical indication) and HTN outcomes for HIV-infected and uninfected patients with HTN who linked to NCD care over 3 years of follow-up. We describe univariate distributions of demographic and clinical variables among HIV-infected and uninfected individuals. We then used multilevel mixed-effects logistic regression to evaluate predictors of HTN control. Results: Within 1 year 2,038 participants (89 HIV+ and 1,949 HIV-) with HTN linked to care and contributed 15,653 follow-up visits over 3 years. Median duration of follow-up was 583 days and 742 days among HIV-infected and HIV- uninfected respectively. HTN control was achieved at 46% (44-48%) of follow- up visits. 20% of visits among those with HTN control were scheduled at 4-8 weeks (vs 12 weeks) due to drug shortages. In multivariate analysis adjusting for HTN stage, medication prescription at the previous visit, HIV status, and clinic site, scheduled visit interval more frequent than clinical indication for patients with controlled HTN was associated with lower HTN control (aOR = 0.88; 95% CI 0.77-0.98). HIV-infected patients were more likely than uninfected patients to have controlled blood pressure (aOR 1.33; 95% CI 1.00-1.77). Conclusion: HTN control in an integrated NCD/HIV model was higher than previously reported in SSA and control was more likely among HIV-infected. Similar to HIV care, visit frequency determined by drug supply chain rather than clinical indication is associated with worse HTN control.

Poster Abstracts

669 RISK FACTORS FOR EXCESS WEIGHT GAIN FOLLOWING SWITCH TO INTEGRASE INHIBITOR–BASED ART Jordan E. Lake 1 , Kunling Wu 2 , Kristine M. Erlandson 3 , Sara H. Bares 4 , Paula Debroy 1 , Catherine Godfrey 5 , John R. Koethe 6 , Grace A. McComsey 7 , Frank J. Palella 8 , Katherine Tassiopoulos 2 1 University of Texas at Houston, Houston, TX, USA, 2 Harvard University, Cambridge, MA, USA, 3 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 4 University of Nebraska Medical Center, Omaha, NE, USA, 5 NIH, Bethesda, MD, USA, 6 Vanderbilt University, Nashville, TN, USA, 7 Case Western Reserve University, Cleveland, OH, USA, 8 Northwestern University, Chicago, IL, USA Background: Weight gain following antiretroviral therapy (ART) initiation occurs with all modern regimens. Recent real-world reports from small studies suggest that integrase strand transfer inhibitor (INSTI)-based ART may be associated with excess weight gain. We assessed weight gain following switch to INSTI-based ART among AIDS Clinical Trials Group (ACTG) participants in ACTG protocols A5001 and A5322, which provided long-term observational follow-up of individuals enrolled in randomized interventional trials. Methods: A5001 and A5322 participants in follow-up from 1997-2017 who switched to INSTI were included. Within-person weight and waist circumference trajectories were generated, allowing participants to serve as their own controls for estimation of background/age-related weight gain. Piecewise linear mixed effects models adjusting for age, sex, race/ethnicity, parent study baseline BMI and their interactions, nadir CD4+ T cell count, smoking, diabetes and percent follow-up time with suppressed (<200 copies/mL) HIV-1 RNA examined weight and waist circumference change before and after first switch to INSTI. Linear spline models with a single knot accounted for non-linear trends. Results: Adults (n=972) who switched to INSTI (68% from PI, 31% NNRTI, 2% other non-INSTI at median 7.8 years after parent trial entry) were 81%male and 50% non-white. Median age at switch was 50 years, CD4+ T cell count 511 cells/ μL and BMI 26.4 kg/m2; 539 switched to RAL, 222 to EVG and 211 to DTG. When restricted to persons with suppressed HIV-1 RNA at switch (n=691), women, blacks and persons age ≥60 experienced significantly greater weight gain in the 2 years following switch to INSTI vs 2 years prior to switch; men and persons age <40 experienced less weight gain. In adjusted models, white or black race, age ≥60 and BMI ≥30 kg/m2 were associated with greater weight gain following switch among women, whereas age ≥60 was the greatest risk factor among men. Trends for waist circumference were similar (data not shown). Conclusion: Yearly weight gain increased following switch to INSTI. These increases were particularly significant for women, blacks and persons age ≥60. When compared to pre-switch weight changes on stable suppressive ART and given concomitant increases in waist circumference, these data suggest increases in weight/fat mass greater than expected for age. The cardiometabolic implications of increased weight gain following switch to INSTI need to be established.

CROI 2019 255