CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Results: Among 2,039 participants assessed, 586 (29%) were HIV-infected, 1,369 (67%) were female, and median age was 35.3 years (IQR=26.3-48.3). Six hundred and seventy three (33%, 95% CI 30-36%) met the criteria for central obesity using WC criteria versus 879 (43%, 95% CI 40-47%) by WHR criteria. Using WHR criteria, similar proportions of HIV-positive and HIV-negative adults met criteria for central obesity (48% and 42%, respectively, p=0.0003). However, using the WC criteria, significantly more HIV-positive participants met criteria for central obesity compared to HIV-negative participants (35% versus 32%, p=0.87). After adjustment for age and gender, significantly fewer HIV-infected persons has central obesity according to the WC criteria (aPR; 0.85; 95%CI: 0.78-0.93), but not when using WHR criteria (aPR: 0.99; 95%CI: 0.90-1.09). Conclusion: Up to two-fifths of adults in peri-urban and rural Botswana have central obesity, with WHR defining a larger proportion with central obesity than WC. HIV was associated with a lower risk for central obesity by WC but no risk by WHR criteria in this community-based cohort with very high ART coverage. More studies are needed to clarify appropriate cut-off points and risk factors for central obesity in this setting.

logistic regression analyses adjusted for age, sex, origin, smoking, physical activity, and BMI. Results: Age and sex distribution were similar in PLWH and uninfected controls (54.2 vs 54.4 years and 85.5% vs 85.5%male). 451 (60.5%) PLWH had exposure to TA and/or ddI. Of those, 6 (1.4%) were still exposed. Mean cumulative exposure was 6.6 (SD, 4.2) years and time since discontinuation was 9.4 (SD, 2.7) years. After adjustment, prior exposure to TA and/or ddI was associated with 21.6 cm2 larger VAT (13.8 –29.3) compared to HIV infection without exposure and HIV-negative status was associated with similar VAT compared to HIV infection without exposure (Table 1). After adjustment, HIV infection with exposure to TA and/or ddI was associated with 14.8 cm2 smaller SAT compared to HIV infection without (-23.3 - -6.3) (Table 1). HIV-negative status was associated with 13.0 cm2 larger SAT compared to HIV infection without exposure (5.8 - 20.3) (Table 1). Cumulative exposure to TA and/or ddI (3.7 cm2 per year [2.3 - 5.1]), but not time since discontinuation (-1.1 cm2 per year [-3.4 – 1.1]), was associated with VAT. In PLWH, after adjusting for confounders prior exposure to TA and/or ddI was associated with excess risk of hypertension (aOR 1.62 [1.13 - 2.31]), hypercholesterolemia (aOR 1.49 [1.06 - 2.11]), and low HDL (aOR 1.40 [0.99 – 1.99]). Conclusion: Prior exposure to TA and/or ddI was associated with long-lasting alterations in abdominal fat distribution, persisting after TA and/or ddI discontinuation, which may be involved in the excess risk of hypertension, hypercholesterolemia, and low HDL found in PLWH with prior exposure to TA and/or ddI. Our findings may help to identify a subgroup of PLWH who may benefit frommore intensive monitoring and cardiovascular prevention interventions.

Poster Abstracts

678 SLEEVE GASTRECTOMY VS ROUX-EN-Y BYPASS ON WEIGHT AND METABOLIC COMPLICATIONS IN HIV

Vanessa El Kamari 1 , Julia C. Kosco 2 , Corrilynn O. Hileman 3 , Grace A. McComsey 2 1 Case Western Reserve University, Cleveland, OH, USA, 2 University Hospitals Cleveland Medical Center, Cleveland, OH, USA, 3 MetroHealth Medical Center, Cleveland, OH, USA Background: Obesity and associated metabolic complications remain a major issue in the HIV population. The efficacy and safety of bariatric surgery in HIV-infected individuals remain poorly understood; and the differential effect of different types of surgeries on weight loss and associated comorbidities is unclear. Methods: We retrospectively reviewed a database of all HIV-infected patients who have undergone bariatric surgery at the University Hospitals Cleveland Medical Centers and MetroHealth Medical Center. We included data from 2010 to 2018; 24 patients were identified (6 underwent Roux-en-Y gastric bypass [GB], and 18 had a sleeve gastrectomy [SG]). All included patients met US criteria for bariatric surgery including BMI >35 kg/m2 with ≥2 comorbidities or BMI > 40. Our primary outcome was weight loss. Secondary outcomes included changes in viral load, CD4 count, and metabolic complications. Outcomes were collected 6 months after surgery and then yearly, up to 6 years after the procedure. General linear models were used to compare outcomes between the procedures while adjusting for age, sex, race and baseline weight. Results: 68%were female; mean age was 48 years, CD4 count 771 cells/ mm3 and preoperative BMI 47 kg/m2. All patients were on ART at the time of surgery, and 96% had undetectable viral load. The mean follow-up duration was 37 months (range 3 – 91). Overall, weight loss was maintained up to 6 years following surgery [mean(SD) 62.3 (33) lbs]. Early on, the mean reduction in weight did not differ between GB and SG procedures (66.6 vs. 61.4 at 6 months, and 83 vs. 76 at year 1; p>0.05) after adjustment. However, GB was more effective, with a mean reduction in weight of 98 lbs for GB vs. 62 for SG at year 2; 114 vs. 64 at year 3; 113 vs. 66 at year 4; and 94 vs. 43 at year 5 (all p<0.03 after adjustment). No changes in CD4 count or viral load were observed after either procedure. Patients with diabetes (n=8) had normalization of their HbA1c after surgery, except for one patient who underwent SG. Among 17 hypertensive patients, 4 showed remission after the surgical procedure (3 of them had GB) Conclusion: While the obesity surgery field is moving towards SG predominance, our results suggest greater weight loss and improvement of obesity-related comorbidities with GB compared to SG in HIV-infected obese

677 HIGH PREVALENCE OF CENTRAL OBESITY IN HIV-INFECTED & HIV- UNINFECTED ADULTS, BOTSWANA Mosepele Mosepele 1 , Pinkie Melamu 2 , Kara Bennett 3 , Tendani Gaolathe 2 , Joseph Makhema 2 , Mompati O. Mmalane 2 , Molly Pretorius Holme 4 , Refeletswe Lebelonyane 1 , Kathleen M. Powis 5 , Jean Leidner 3 , Joseph N. Jarvis 6 , Neo Tapela 2 , Lucky Mokgatlhe 1 , Kathleen Wirth 4 , Shahin Lockman 7 1 University of Botswana, Gaborone, Botswana, 2 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 3 Bennett Statistical Consulting, Inc, New York, NY, USA, 4 Harvard University, Boston, MA, USA, 5 Massachusetts General Hospital, Boston, MA, USA, 6 London School of Hygiene & Tropical Medicine, London, UK, 7 Brigham and Women’s Hospital, Boston, MA, USA Background: Central obesity is a major risk factor for cardiovascular disease, and treated HIV infection has been associated with central obesity in some but not all studies. The prevalence of central obesity among HIV-infected and –uninfected individuals in a community setting in high HIV-prevalence settings in Africa is not well described. Methods: We enrolled a random sample of ~20% of adults in 30 rural communities in Botswana as part of a community-randomized HIV prevention trial. During the final household survey, we conducted a one-time central obesity assessment, including waist and hip circumference measurements, in participants in 20 of the communities from February 2017-March 2018. Central obesity was defined using World Health Organization-recommended sex- specific thresholds: waist circumference (WC) > 88 cm and 102 cm for women and men respectively, and waist-hip ratio (WHR) > 0.85 and 0.90 for women and men respectively. Crude and adjusted prevalence ratios for central obesity were estimated using Poisson regression.

CROI 2019 259