CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

700 TREATMENT OF PSYCHIATRIC DISORDERS AND TIME WITH HIV VIRAL LOAD ≥200 COPIES/ML Matthew E. Levy 1 , Anne K. Monroe 1 , Michael A. Horberg 2 , Debra A. Benator 3 , Sherry Molock 1 , Rupali K. Doshi 1 , Lindsey Powers Happ 1 , Amanda D. Castel 1 , for the DC Cohort Executive Committee 1 George Washington University, Washington, DC, USA, 2 Kaiser Permanente Mid- Atlantic States, Rockville, MD, USA, 3 VA Medical Center, Washington, DC, USA Background: Psychiatric disorders are common among persons living with HIV (PLWH) and can negatively impact HIV outcomes. We examined the impact of treatment of psychiatric disorders by assessing whether various psychiatric disorders, both treated and untreated, were associated with duration of time with VL ≥200 copies/mL. Methods: Clinical data from electronic medical records were collected between Jan 2011-Mar 2018 for adult PLWH enrolled in the DC Cohort, a multisite observational study of persons receiving HIV care in Washington, DC. Among PLWH ≥18 years old who received primary care at their clinic site, we assessed diagnoses and drug treatment prescriptions for mood, anxiety and stress-/ trauma-related, and psychotic disorders. We assessed associations between time-updated measures for psychiatric disorders/medication prescriptions and the proportion of estimated subsequent days with VL ≥200 copies/mL (out of total days) using multivariable Poisson regression with generalized estimating equations, adjusting for socio-demographic, behavioral, and HIV-related factors. Results: Among 5,904 participants (median age 51; 70%male; 82% Black), 45% had ≥1 psychiatric disorder, including 38%with a mood disorder (26% depression; 9% bipolar), 18%with an anxiety or stress-/trauma-related disorder (12% anxiety; 8% stress-/trauma-related), and 4%with a psychotic disorder. Prevalence of drug treatment for psychiatric disorders was 55% (mood), 40% (anxiety or stress-/trauma-related), and 53% (psychotic). Untreated (vs. no) depression (aRR 1.21; 95% CI: 1.06-1.38) and untreated (vs. no) bipolar disorder (aRR 1.39; 1.16-1.68) predicted more time with VL ≥200 copies/mL; associations were attenuated for treated depression and treated bipolar disorder (Table 1). Treated (vs. no) anxiety disorder (aRR: 0.69; 0.49-0.99) predicted less time with VL ≥200 copies/mL. Covariates predictive of more time with VL ≥200 copies/ mL included female sex (aRR 1.17; 1.01-1.35), Black race (aRR 1.99; 1.51-2.62), smoking (aRR 1.21; 1.05-1.35), and substance use disorder (aRR 1.21; 1.05-1.40). Conclusion: Nearly half of PLWH in this cohort had a diagnosed psychiatric disorder. PLWH with an untreated mood disorder had a greater risk of VL ≥200 copies/mL, while those with a treated anxiety disorder had a lower risk, compared to PLWH without each disorder. The appropriate diagnosis, treatment, and monitoring of psychiatric disorders is critical for promoting sustained viral suppression among PLWH with comorbid psychiatric disorders.

Poster Abstracts

701 BLUNTED MUSCLE MITOCHONDRIAL RESPONSES TO EXERCISE TRAINING IN OLDER ADULTS WITH HIV Catherine M. Jankowski , Melissa P. Wilson, Samantha MaWhinney, Jane Reusch, Leslie Knaub, Kristine M. Erlandson University of Colorado Anschutz Medical Campus, Aurora, CO, USA Background: HIV, antiretroviral therapy (ART), and aging have been associated with mitochondrial dysfunction in skeletal muscle, whereas exercise improves mitochondrial function. We found improved physical function with exercise training among older people living with HIV (PLWH) and thus hypothesized that exercise would increase mitochondrial marker expression in muscle. Methods: Vastus lateralis muscle specimens were obtained by percutaneous needle biopsy before and after completing a supervised 24-week cardiovascular and resistance exercise intervention in previously sedentary, older PLWH (on ART >2 years) and uninfected controls (NEG) who were fasted and had not exercised for >24 hours. Protein expressions of complex (C) I-V, manganese superoxide dismutase (MnSOD), peroxisome proliferator-activated receptor-γ coactivator- 1α (PGC1), and voltage-dependent anion channel 1 (VDAC1) in muscle lysate were measured via Western blot using commercially available antibodies and normalized to vinculin. Citrate synthase (CS) activity (colorimetric assay) was normalized to total protein. Outcomes were log-transformed and modeled with multiple linear regressions. Baseline comparisons were adjusted for age; differences due to training were also adjusted for baseline levels. Results are reported as the geometric mean [95% CI], means (±SD) or percent change from baseline. Results: Baseline and 24-week muscle samples were provided by 40 (18 PLWH, 22 NEG), and 31 (15 PLWH, 16 NEG) participants, respectively, who were majority male (98%), white (78%) and non-Hispanic (82%). PLWH and NEG were of similar age (56 [54, 59]; 57 [54, 60] yr); PLWH had a lower BMI (25±2; 29±5 kg/m ... 2). PLWH had a CD4 count of 563 cells/μl [455, 698] and all had plasma HIV-1 RNA <50 copies/mL. 12 PLWH had prior thymidine analogue exposure. At baseline, PLWH had lower C-III (0.77 [0.58, 1.01] vs 1.15 [0.90, 1.46]) and greater VDAC1 (3.95 [2.40, 6.49]; 1.89 [1.21, 2.96]) (P<.04) compared to NEG. After 24 weeks of exercise, CS, MnSOD, PGC1, and C-IV increased in NEG (P≤.001) with no significant changes in any markers in PLWH. Exercise-induced changes in in CS, MnSOD, PGC1, and C-IV were significantly less among PLWH (P≤.01; Fig). Conclusion: Skeletal muscle mitochondrial responses to exercise training at moderate to high intensity were blunted in PLWH compared to controls. Different types of exercise (e.g., high intensity interval) or longer training periods may be necessary to stimulate mitochondrial adaptations in older PLWH.

CROI 2019 269