CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

and Black non-IDU, suggesting the association between drug use and suicide in the general population may also be reflected in men with HIV. Men with HIV warrant targeted suicide prevention efforts, particularly White men with a history of IDU.

894 SUCCESSFUL cART NORMALIZES SURVIVAL FOR HIV-HTLV COINFECTED PATIENTS Fernanda Miranda, Estela Luz, Eduardo M. Netto, Carlos Brites Federal University of Bahia, Salvador, Brazil Background: coinfection by HTLV is associated with shorter survival for adults and children infected by HIV, but the reasons remain controversial. We aimed to evaluate the survival time and associated factors of co-infected and mono- infected patients treated with cART. Methods: we reviewed medical records of 298 HIV-infected patients on cART, 149 (50%) of them co-infected by HTLV-1. Patients in each group were matched by age at HIV diagnosis and gender. Death rates, survival time, baseline and current CD4 count, last HIV-1 RNA plasma viral load (PVL) and causes of death were compared. Results: Most patients were women (59.1%), mean age 39.0 ± 9.1 years. Survival time was 6,622 days for mono-infected, and 6,107 days for co-infected patients (p=<0.001). Survival persisted significantly different for those with PVL>50 ( 3,084 for co-infected, vs. 4,712 days for mono-infected subjects, p=0.02), or PVL>1,000 copies/ml (2,526, vs.3,329 days, for co-infected and mono-infected subjects, respectively, p=0.02). However, overall survival did not differ for patients with PVL<50 (mono-infected: 7,370 days; co-infected: 6,944 days, p=0.5) or <1,000 (7,218 vs. 6,929 days, for mono and co-infected patients, respectively, p=0.3) copies per ml (Figure 1). Baseline CD4 count for deceased patients was higher for co-infected (410±350 cells/ml) than for mono-infected (177±160 cells/ml, p=0.04) patients, but similar for survivors (417±299 vs. 396±336 cells/ml, p=0.7). Last CD4 count was similar for both groups, regardless of survival status. Causes of death were mainly (78%) AIDS-defining diseases and did not differ for groups. Conclusion: In this large cohort, successful cART normalized survival time for HIV-HTLV co-infected subjects. The increased mortality for co-infected patients with uncontrolled HIV PVL, despite a higher baseline CD4 count, suggests HTLV co-infection boosts progression to AIDS in patients with active HIV replication.

893 SUICIDE RATES AMONG US ADULTS LIVING WITH HIV, 2000-2015 Keri N. Althoff 1 , Paul S. Nestadt 2 , Jennifer S. Lee 1 , Stephen J. Gange 1 , Peter F. Rebeiro 3 , Michael A. Horberg 4 , Michael J. Silverberg 5 , Elizabeth Humes 1 , Amy C. Justice 6 , Angel M. Mayor 7 , Charles Rabkin 8 , Frank J. Palella 9 , Anita Rachlis 10 , Richard D. Moore 2 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 Vanderbilt University, Nashville, TN, USA, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 Kaiser Permanente Northern California, Oakland, CA, USA, 6 VA Connecticut Healthcare System, West Haven, CT, USA, 7 Universidad Central del Caribe, Bayamon, estimated suicide rates in PWH in the US and Canada from 2000-2015. Methods: Adults (aged 20-79) in the NA-ACCORD were followed from the later of enrollment into the cohort or 1/1/2000 to the first of death, loss to follow-up (2 years after last CD4 or HIV RNA), or 12/31/2015. Cause of death was ascertained by death certificate or electronic medical record notation. Suicide incidence rates (IR) and 95% confidence intervals (stratified by sex, Black/White race, history of injection drug use (IDU), and calendar year were calculated per 100,000 person years (pys). Adjusted incidence rate ratios (IRR) and 95% confidence intervals ([,]) were estimated using Poisson regression; Black/White race, IDU, diagnosed bipolar affective disorder, major depression, schizophrenia, HIV-associated dementia, efavirenz prescription, calendar year, and decade of age were in the final model. Results: Among 81,123 adults contributing 547,278 pys (median follow-up of 5.6 years), 217 suicides were identified. Women were excluded from analyses due to limited outcomes (N=2 suicides, IR=4.17 [0.51,15.07]). Among men, 17% of White and 35% of Black men had a history of IDU. The suicide rate was 43.06 [37.30, 48.81]. This was higher in White vs. Black men from 2000-15 (Figure 1); overall there was a 4.4-fold greater suicide rate among White (66.55 [56.04, 77.06]) vs. Black (15.16 [9.73, 20.58]) men. Compared to Black non-IDUs, the suicide rate was greater among White IDU (IRR=9.87 [5.08, 19.17]), White non-IDU (IRR=5.52 [2.96, 10.29]), and Black IDU (IRR=2.21 [1.03, 4.72]) in the adjusted model. Under-ascertainment of suicide is possible (and may be differential by subgroups), which would underestimate suicide rates. Conclusion: Suicide rates were much lower in women (vs. men) with HIV, corroborative of US general population findings. Among men with HIV, suicide rates were higher among White (vs Black) men. White men with a history of IDU had the highest rates of suicide, followed by White non-IDU, Black IDU, Puerto Rico, 8 National Cancer Institute, Bethesda, MD, USA, 9 Northwestern University, Chicago, IL, USA, 10 University of Toronto, Toronto, ON, Canada Background: It is unknown if the increasing suicide rate (particularly among White men) and the increased risk of suicide among those who use drugs in the US general population are mirrored among people with HIV (PWH). We

Poster Abstracts

CROI 2019 348