CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

or cause-specific Cox proportional hazard models, adjusted on age, sex, cirrhosis, CD4 and HIV viral load. Results: Before 2011, 1175 patients were included, 212 between 2011 and 2014 and 323 after 2014. Median ages were of 44.9, 52.1 and 52.2 years, 70.3%, 78.3% and 77.9%were men, 17.4%, 42.2% and 20.7%were cirrhotic. Overall the three-year mortality rates were 57.1 [44.4-71.8], 77.8 [42.2-127.6] and 163.6 [66.5-298.4] for 1000 person-years (PY), respectively (p = 0.2203) (Figure 1). HCV was the first cause of mortality before 2011 (25.4 [17.3-35.9] for 1000 PY) and between 2011 and 2014 (39.1 [15.9-79.2] for 1000 PY) but was the third cause after 2014 (13.4 [1.1-64.7] for 1000 PY), p = 0.1796. Incidence rates of death from other causes significantly increased (13.6 [8.0-21.9], 31.9 [11.9-68.8] and 98.3 [24.9-232.9] for 1000 PY, p = 0.0331). Incidence of cardiovascular death tended to increase (2.7 [0.1-7.5] for 1000 PY before 2011 and 13.0 [2.5-43.1] for 1000 PY after 2014, p = 0.0667). All-cause mortality and cause-specific mortality were not significantly different between periods after adjustment. Conclusion: In HIV/HCV co-infected patients, incidence of all-cause mortality did not differ significantly between the pre-DAA period and the post-DAA periods. However, a decrease of HIV related mortality, an increase in mortality from other causes and a trend for increased cardiovascular mortality was observed. These changes could be due to higher-risk profiles in patients included during the DAA period.

explanation was provided for excluding this information. Descriptive statistics summarized results. Results: Of 83 original oral presentations, 16 (19%) were deemed relevant to one sex only and were excluded from the analysis. Of the remaining 67 relevant to both sexes, 35 (52%) presented the distribution of the study sample by sex; 7 (10%) presented sex distributions but mislabeled them as “gender”; and 25 (37%) did not. Basic science and animal studies were less likely to report sex distribution (1/13, 8%) compared to human observational studies and clinical trials (41/54, 76%). Only 16 (24%) of all oral presentations relevant to both sexes included sex-stratified analyses or sex-delineated outcomes. The remaining 51 (76%) did not, with only a subset (8, 12%) providing an explanation for why sex stratification was not presented. Of the 28 presentations from clinical trials, 25 (89%) included sex distribution, but only 6 (21%) presented results by sex. Conclusion: Despite CROI 2018 providing guidelines for presentations consistent with US federal mandates on reporting by sex, more than a third of oral presentations failed to report sex demographics and only a quarter included sex-stratified analyses. Further education of researchers on guidelines requiring reporting of sex as a biological variable is essential to maximize knowledge about sex differences and similarities in HIV and its associated conditions. Background: The global burden for depression and anxiety remain high, and HIV-infected individuals are more vulnerable to experiencing these conditions. Our objective was to determine the association between depression and anxiety on initiation of antiretroviral therapy (ART) and the engagement in HIV care. Methods: We conducted a prospective clinic-based cohort study of HIV-positive adults at HIV testing from the Umlazi township of KwaZulu-Natal, South Africa. We measured depression using the Patient Health Questionnaire (PHQ-9) and anxiety using the Generalized Anxiety Disorder (GAD-7) scale, both of which have been validated in sub-Saharan Africa, before HIV testing. We used cutoff scores of PHQ ≥10 to indicate depression and GAD ≥10 to indicate anxiety, as these are recommended cutoff scores for assessing depression and anxiety in clinical settings. We used univariate and multivariate logistic regression and Cox hazard analyses, adjusted for age and sex, to examine the associations between baseline depression and anxiety on ART initiation and engagement in HIV care over 12 months. Results: Among 1,878 HIV-positive adults enrolled, the mean (SD) age was 33.1 (9.1) years and 1,110 (59.1%) were female. The prevalence of depression and anxiety was 15.3% and 11.1%, respectively. In adjusted models, HIV-infected adults with depression had a lower odds of initiating ART within 90 days of testing positive (odds ratio [OR]=0.72, p=0.03), and slower ART initiation throughout the one-year study period (hazard ratio [HR]=0.84, p=0.01). Among those who initiated ART, depression was associated with a lower likelihood of missing medication refills (OR=0.66, p=0.04) and missing clinic visits (OR=0.56, p<0.01). Among those who initiated ART, individuals who reported anxiety symptoms had a lower likelihood of missing clinic visits (OR=0.58, p<0.01). Conclusion: Our finding in an urban township of South Africa suggest that depression and anxiety are significant barriers to ART initiation and engagement in HIV care. Thus, not only is it important to provide mental health screenings alongside HIV testing, but also more intensive follow-up may be required to ensure that HIV-positive adults initiate ART and remain engaged in HIV care. Integrated care models that offer mental health treatment alongside usual HIV care may improve HIV-related outcomes.

917 DEPRESSION AND ANXIETY AS A BARRIER TO ART INITIATION IN KWAZULU-NATAL, SOUTH AFRICA Michael Truong , Madhura Rane, Ann Vander Stoep, Paul K. Drain University of Washington, Seattle, WA, USA

Poster Abstracts

916 LOW RATE OF SEX-SPECIFIC ANALYSES IN CROI PRESENTATIONS IN 2018: ROOM TO IMPROVE Monica Gandhi 1 , Laura M. Smeaton 2 , Christina Vernon 3 , Eileen P. Scully 4 , Sara Gianella 5 , Selvamuthu Poongulali 6 , Anandi N. Sheth 7 , Marije Van Schalkwyk 8 , Karin L. Klingman 9 , William R. Short 10 , Valarie S. Opollo 11 , Susan E. Cohn 12 , Kimberly K. Scarsi 13 , Rosie Mngqibisa 14 , Elizabeth Connick 15 1 University of California San Francisco, San Francisco, CA, USA, 2 Harvard T.H. Chan School of Public Health, Boston, MA, USA, 3 Social & Scientific Systems, Silver Spring, MD, USA, 4 Johns Hopkins University, Baltimore, MD, USA, 5 University of California San Diego, La Jolla, CA, USA, 6 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 7 Emory University, Atlanta, GA, USA, 8 Stellenbosch University, Cape Town, South Africa, 9 NIH, Bethesda, MD, USA, 10 University of Pennsylvania, Philadelphia, PA, USA, 11 Kenya Medical Research Institute, Kisumu, Kenya, 12 Northwestern University, Chicago, IL, USA, 13 University of Nebraska, Omaha, NE, USA, 14 Enhancing Care Initiative, Durban, South Africa, 15 University of Arizona, Tucson, AZ, USA Background: The National Institutes of Health, Food and Drug Administration, and journal editors require examination of sex as a biological variable in the design, analysis and reporting of studies, including clinical trials. As 52% of adults living with HIV worldwide are women, sex-specific analyses can provide insight into HIV prevention, pathogenesis, treatment, cure and HIV-associated conditions. CROI 2018 guidelines recommended reporting of sex-specific analyses. Members of the Women’s Health Inter-Network Scientific Committee (WHISC) of the ACTG and IMPAACT networks reviewed adherence to these guidelines in oral presentations during CROI 2018. Methods: Two independent reviewers fromWHISC reviewed each original oral presentation’s webcast to determine whether the abstract was relevant to both sexes and if it included human participants, animals, or specimens from humans or animals. If those criteria were met, reviewers assessed whether sex demographics were provided and whether sex-delineated outcomes or sex- stratified analyses were presented. lf not, the reviewer determined whether an

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