CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

patient populations. Increased representation of African American women in HIV/AIDS clinical trials is important to identify issues that may be unique to some populations. Further investigations are needed to determine causality.

1 Amedeo di Savoia Hospital, Torino, Italy, 2 Infectious Disease Institute, Kampala, Uganda Background: Tenofovir disoproxil fumarate (TDF) has been associated with low bone mineral density and renal tubular impairment. As nephrotoxicity in HIV+ patients is poorly documented in resource-limited settings (RLS), where the use of TDF still represents a cornerstone of antiretroviral treatment (ART), we aimed to assess the prevalence of proximal tubular dysfunction in HIV+ Ugandan patients on long-term ART. Methods: We conducted a cross-sectional study at the Infectious Diseases Institute, Kampala, Uganda. We included adult HIV+ individuals on continuous ART that had undergone DXA scan during the previous 12 months; subjects with known renal impairment or diabetes were excluded. Urine samples were collected for dipstick analysis, urine creatinine and retinol binding protein (uRBP); uRBP/Cr normality ranges were <130 and <172 μg/g (patients aged <50 or ≥50 years, respectively). Non-parametric tests were used for all analyses; a multivariate binary logistic regression was performed including age, gender, BMI and nadir CD4 cell count in those receiving and not receiving TDF. Results: We enrolled 101 participants. Median age and BMI were 37.9 years (IQR 31-41) and 23 kg/m² (IQR 20.5-25.9); 47.5%were male. Median ART duration was 12.2 years (IQR 10.6-13.1) and 61%were on TDF. 80 subjects (79.2%) had a HIV RNA <20 cp/mL; median current and nadir CD4 cell count were 468 (IQR 326-674) and 48 (IQR 12-139) cells/mcL. Median uRBP/Cr was 119.9 μg/g (IQR 80-216.3), with 47 individuals (47%) having abnormal values. In univariate analyses, male gender (p=0.044), low BMI (p=0.046) and longer TDF exposure (p=0.002) were associated with abnormal uRBP/Cr. In multivariate analyses, PI use (p=0.007, aOR 7.54, 95% CI 1.74-32.76) and years of TDF exposure (p=0.028, aOR 1.31, 95% CI 1.03-1.68) were independent predictors in TDF-recipients; no factor was identified in participants not receiving TDF. We observed a significant inverse correlation between uRBP/Cr and DXA T-scores [lumbar (p=0.031), femoral neck (p>0.001) and total hip (p=0.002)]; an abnormal uRBP/Cr was associated with greater odds of having a lumbar T-score <-1 (OR 2.35, 95% CI:1.01-5.35). Conclusion: We found a high prevalence of subclinical tubular impairment in a Ugandan cohort of HIV+ patients on long-term ART. These data highlight the importance of expanding access to TDF-sparing regimens (eg. TAF) in RLS, where the HIV infected population is progressively ageing and facing an increase in non-communicable diseases. 696 ALOPECIA AFTER SWITCH TO TENOFOVIR ALAFENAMIDE IN 5 AFRICAN AMERICAN WOMEN Said El Zein, Jennifer Veltman Wayne State University, Detroit, MI, USA Background: Adverse drug reactions have been reported with all antiretroviral drugs and have been a major cause for non-compliance with antiretroviral therapy. Alopecia is a rare but known side effect of some antiretroviral therapies (ART), however, no cases of TAF-induced alopecia have been reported in the literature. Methods: This is a case series reported from an academic outpatient HIV practice located in Detroit Michigan comprised of 5 patients identified between 2017 and 2018. Informed oral consent was obtained from patients for the use of photographs Results: We report 5 cases of alopecia in HIV- infected African American female patients that started after switching TDF to TAF containing regimens. Their age ranged between 40 and 49 years. Hair loss was severe, diffuse and involved the scalp in all patients (Fig. 1A and B). One patient initially had diffuse hair loss that later became patchy, involving the back of the head and forehead. Time-to- onset of alopecia after switching to TAF ranged between 2 months and 1 year, but 4 out of 5 patients reported hair loss after 2-3 months. No pain, pruritus or tenderness were present and there was no evidence of scarring or inflammation on physical exam. All patients had sustained viral suppression and had no clinical evidence of active infections. A basic metabolic panel including liver function tests, complete blood count, sexually transmitted diseases workup, CD4 T-lymphocyte count and HIV viral load were non-revealing. Concomitant use of other medications could not explain the alopecia. Conclusion: Most clinical trials show very low rates of recruitment of African American patients, therefore, some of the side effects of this novel combination might be underreported in this patient. This report aims to raise awareness among healthcare practitioners about alopecia as a potential distressing adverse effect of TAF that could predominate in certain underrepresented

697 IMPACT AND DETERMINANTS OF COMORBIDITY CLUSTERS IN PEOPLE LIVING WITH HIV Davide De Francesco 1 , Sebastiaan Verboeket 2 , Jonathan Underwood 3 , Ferdinand Wit 2 , Emmanouil Bagkeris 1 , Patrick W. Mallon 4 , Alan Winston 3 , Peter Reiss 2 , Caroline Sabin 1 , for the POPPY study group 1 University College London, London, UK, 2 Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands, 3 Imperial College London, London, UK, 4 University College Dublin, Dublin, Ireland Background: Comorbidities in people living with HIV (PLWH) may occur in clusters, potentially affecting quality of life and general health in different ways. We explored associations of risk factors and patient reported health outcomes with common clusters of co-occurring comorbidities. Methods: We considered 65 comorbidities reported by PLWH via a structured interview with trained staff. Principal component analysis was used to identify non-random clusters of co-occurring comorbidities and obtain a score for each cluster proportional to the number of comorbidities included in the cluster and present in an individual. Cluster scores were standardised (mean=0, SD=1), with higher scores indicating a greater number of comorbidities characterising a cluster. Multivariable median regression was then used to investigate associations of sociodemographic, lifestyle and HIV-specific factors with each cluster score. Multivariable linear regression was used to evaluate associations of cluster scores (independently of each other) with physical and mental health summary scores (obtained from SF-36 questionnaire, range 0-100). Results: In 1073 PLWH (85%male, 84%white ethnicity, median (IQR) age 52 (47-59) years) we identified 6 comorbidity clusters (Table). “CVDs”, “metabolic” and “chest/other infections” scores were independently associated with older age and longer time since HIV diagnosis (all p’s<0.001). Higher body-mass index was associated with higher scores in the “CVDs” (p=0.009), “cancers” (p=0.03) and “metabolic” clusters (p=0.006). PLWH with prior AIDS events had higher scores than PLWH without prior AIDS events for all clusters (p<0.05) except “STDs”. Associations with smoking and alcohol consumption were weak across all clusters (all p’s>0.05). Higher scores in the “mental health” and “chest/other infections” clusters were independently associated with poorer SF-36 physical (p’s<0.001) and mental health scores (p<0.001 and p=0.03, respectively - Table). “CVDs” and “cancers” scores were associated with poorer physical (p=0.02, p=0.03) but not mental health (p’s>0.05). Conclusion: Comorbidity clusters in PLWH are associated with different demographic, lifestyle and HIV-related factors, and significantly impact on quality of life, particularly physical functioning. Identifying common comorbidity clusters in PLWH may help prioritise interventions for those at risk for poorer health outcomes and focus research to understand common pathophysiological pathways contributing to comorbidities in treated PLWH.

Poster Abstracts

CROI 2019 267