CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

735 KIDNEY DISEASE IN AFRICANS WITH HIV AND TUBERCULOSIS

Nicola Wearne 1 , Rachel Hung 2 , Raphaela Bohmer 1 , Ruan Spies 1 , Aadil Omar 1 , Samantha Ash 1 , Fowzia Ibrahim 3 , Robert Miller 4 , John Booth 2 , Sebastian Lucas 3 , Frank Post 5 1 University of Cape Town, Cape Town, South Africa, 2 Barts Health NHS Trust, London, UK, 3 King’s College London, London, UK, 4 University College London, London, UK, 5 King’s College Hospital NHS Foundation Trust, London, UK Background: Tuberculosis (TB) is common in Africans with HIV. TB, HIV and the drugs to treat these infections may all have acute or chronic effects on the kidney although this has not been well studied. We investigated kidney function and kidney pathology in Africans with HIV/TB in three cohorts. Methods: We studied kidney function over 12 months from TB diagnosis in consecutive HIV/TB patients in South London (UK, 2004-2016), and kidney pathology in consecutive HIV/TB autopsies performed in Abidjan (Cote d’Ivoire, 1991) and in consecutive HIV/TB kidney biopsies performed in Cape Town (South Africa, 2014-2017). Acute kidney injury (AKI) was defined by KDIGO stages 2/3, chronic kidney disease (CKD) by estimated glomerular filtration rate (eGFR) <60 (mL/min/1.73m2) for >3 months and severe CKD by eGFR <30. The amount of chronic damage in kidney biopsies was assessed as mild (<25%), moderate (25-50%) or severe (>50%). In the Cape Town cohort, predictors of recovery of kidney function at six months were assessed using Cox regression. Results: In the London cohort (median [IQR] eGFR at TB diagnosis: 118 [88- 129]), the incidence of moderate/severe AKI was 15.1 (95%CI 8.6-26.5) per 100 person-years, and the prevalence of CKD and severe CKD 13.7% and 7.4% respectively. Pathologically-confirmed HIV-associated nephropathy (HIVAN) was diagnosed in 6.3% of patients in London and 6.0% of autopsies in Abidjan. Renal tuberculosis was present in 60% of autopsies in Abidjan. Patients in the Cape Town cohort had severe kidney failure (median eGFR: 9), with often multiple renal pathologies on biopsy: 59% had renal TB, 43% HIVAN and 64% acute tubular necrosis (ATN). The majority of biopsies showed mild (61%) or moderate (23%) chronic damage, and substantial recovery of kidney function was noted at six months with 36%, 53% and 35% of those with HIVAN, ATN and renal TB having eGFR >60 and a further 28%, 19% and 21% having eGFR 30-59. ART status, CD4 count, eGFR at biopsy and renal pathology were not predictive of eGFR recovery (>60 or >30). Conclusion: Acute and chronic kidney disease was common in Africans with HIV/TB. HIVAN, ATN and renal TB were common aetiologies, and improvement of kidney function was frequently observed irrespective of the severity of renal impairment or kidney disease aetiology. Close monitoring of kidney function and provision of renal replacement therapy to those with severe kidney failure is warranted in African patients with HIV/TB.

Poster Abstracts

734 HIGH RATES OF TB IN THE FIRST 6 MONTHS OF DOLUTEGRAVIR-BASED ART IN BOTSWANA Lucy Mupfumi 1 , Sikhulile Moyo 1 , Ava Avalos 2 , Lesedi Bewlay 2 , Kaelo Seatla 1 , Sanghyuk S. Shin 3 , Ishmael Kasvosve 4 , Nicola M. Zetola 3 , Simani Gaseitsiwe 1 , for the BEAT Cohort Study Team 1 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 2 Ministry of Health, Gaborone, Botswana, 3 Botswana–UPenn Partnership, Gaborone, Botswana, 4 University of Botswana, Gaborone, Botswana Background: Tuberculosis (TB) remains a major problem among HIV-infected persons in sub-Saharan Africa with most cases of unmasking TB occurring within the first fewmonths of antiretroviral therapy (ART) initiation. As one of the first countries in sub-Saharan Africa to roll out dolutegravir (DTG)-based ART as first line therapy, we sought to determine the incidence of TB in patients initiating DTG-based ART between March 2016 and June 2018 in Gaborone, Botswana. Methods: The Botswana Epidemiological ART Treatment (BEAT) Cohort is an operational research cohort study that was established in 2017 to determine DTG-vs-Efavirenz (EFV) based ART treatment efficacy, monitor drug resistance and the implementation of the Treat All Strategy. Trained research assistants abstracted data from electronic and manual patient records of those initiating ART at five clinics in Gaborone. Results: We analyzed data from 737 patients with a median time on ART of 7 months (interquartile range [IQR]; 3, 12), mostly female (60%). Among those with baseline CD4+ T-cell count data (n=219, (30%)), the median count was 387cells/µl (IQR; 219, 577). At ART initiation, 1% (n=10) of the patients had an active TB diagnosis. By 3 months on ART, 97% (n=265/273) of the patients had undetectable viral loads. 686 patients contributed 481 person-years of follow-up for an incident rate of 3.75/100py (95% CI: 2.36-5.94). Most (89%) of the TB cases occurred within the first 6 months of initiation (IR= 26.42/100py, 95%CI 16.18-43.12) with only one case occurring post one year of ART (Figure 1). Neither older age (HR 1.03, 95%CI: 0.95-1.11) nor male gender (HR 0.47, 95% CI: 0.08-2.62) predicted TB incidence. Conclusion: We found high rates of TB within the first six months of initiating DTG-based ART, which suggests that most TB cases are due to missed diagnosis or unmasking of subclinical TB. Improved screening strategies for TB prior to ART initiation are needed to reduce the burden of TB in ART programmes.

CROI 2019 283