CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We conducted a nationally representative retrospective medical chart review of HIV-infected adults aged ≥15 years enrolled in HIV care and treatment facilities in Kenya from October 1, 2003 through September 30, 2013. We estimated proportions of the four NCD categories among PLHIV at enrollment into HIV care, and occurrence and management during subsequent HIV care and treatment visits. We compared proportions and assessed distributions of co-morbidities using the Wald adjusted Pearson’s χ-square test. We calculated NCD incidence rates and their jackknife confidence intervals in assessing cofactors for developing NCDs. Results: We analyzed 3170 patient records; 2115 (66.3%) were fromwomen. Slightly over half (51.1%) of patient records were from PLHIVs aged above 35 years. Close to two-thirds (63.9%) of PLHIVs were on ART. The proportion of any documented NCD among PLHIV was 11.5% (95% confidence interval [CI] 9.3, 14.1), with elevated blood pressure as the most common NCD (87.5%) among PLHIV with diagnosed NCD. Although serial elevated blood pressures were detected among 343 patients, only 17 had a documented diagnosis of hypertension in their medical record. The differences in overall NCD incidence rates for men and women were not statistically significant (42.3 per 1000 person years [95% CI 35.8, 50.1] and 31.6 [95% CI 27.7, 36.1], respectively). No differences in NCD incidence rates were seen by marital or employment status. At one year of follow up 43.8% of PLHIV not on ART had been diagnosed with an NCD compared to 3.7% of patients on ART; at five years the proportions with a diagnosed NCD were 88.8% and 39.2% (p<0.001), respectively. Conclusion: PLHIV in Kenya have a high incidence of NCD diagnoses. In the absence of systematic screening, NCD incidence is likely underestimated in this population. In context of a rising national burden of NCDs and increased survival among PLHIV, Kenya should consider increasing investment in integrated HIV-NCD screening and care.

suppression (VS) as <40 copies/ml. Reasons for admission (up to 2 per patient) were coded as infectious diseases (IDs), non-communicable diseases (NCDs), or unknown as well as by medical specialty (neurology, cardiovascular, renal, etc.). Two physicians coded each admission reason independently, with a third available to resolve disagreement. We displayed differences in the proportion with ID versus NCD admissions by HIV status and by CD4+ and viral load among HIV-infected individuals. Results: From August 2017 to February 2018, we assessed 1,261 inpatients, 140 (11.1%) of whomwere excluded for unknown HIV status. Among those included in analysis, median age was 38 years (interquartile range, 30-48), 564 (50.3%) were women, and 748 (66.7%) were HIV-infected. NCDs accounted for 29.2% of admissions overall and 17.8% among HIV-infected individuals. Among 143 patients with laboratory data (who had similar age and sex [P>0.05] to those without data), median CD4+ was 181 cells/mm³ (interquartile range, 52-299), 42.9% had VS, and in those with CD4+>200 cells/mm³, NCDs were nearly as common as IDs (40.7% versus 51.2%; Figure 1). Among HIV-uninfected individuals, NCDs were slightly more common than IDs (53.6% versus 49.9%). Heart failure (9.5%), anemia (6.3%), stroke (4.3%), and diabetes (3.8%) were most common NCDs. Conclusion: NCDs were a common cause of hospital admission among HIV- infected individuals and others in Zambia. These data inform recommendations to integrate NCD risk factor screening and care for HIV-infected individuals in SSA. Hospital surveillance data can provide useful information to HIV programs regarding emerging causes of non-HIV-related morbidity and mortality.

Poster Abstracts

1065 PROJECTED GROWTH AND NEEDS OF AGING PLWH IN HRSA’S RYAN WHITE HIV/AIDS PROGRAM Stacy Cohen , Pamela W. Klein, Marlene M. Matosky, Robert Mills, R. Chris Redwood, Laura W. Cheever HRSA HIV/AIDS Bureau, Rockville, MD, USA Background: With advances in science and antiretroviral therapy, HIV has become a manageable condition and people living with diagnosed HIV (PLWH) are living longer. In the United States (US), over 450,000 PLWH were aged ≥50 years in 2015, an increase of nearly 40% since 2011. This rapid growth of the aging population of PLWH highlights the need to identify and implement aging- appropriate HIV care and support services. The Ryan White HIV/AIDS Program (RWHAP) supports HIV care, treatment, and support services for more than 50% of PLWH in the US. This analysis examines sociodemographic characteristics, service utilization, and viral suppression (VS) among current RWHAP clients and projects the growth of the aging RWHAP population by 2030. Methods: Client-level data from the RWHAP Services Report were used to calculate distributions among clients aged ≥50 (older) and <50 (younger), by race/ethnicity, gender, transmission risk, poverty level, health care coverage, and housing status, and trends in service utilization from 2010-2016. Among older clients, additional analyses examined differences by gender and race/ ethnicity. VS was calculated among older clients receiving RWHAP outpatient

1064 NONCOMMUNICABLE DISEASES AS REASONS FOR ADMISSION AMONG HIV-INFECTED ADULTS IN ZAMBIA Belinda V. Chihota 1 , Michael J. Vinikoor 2 , Nyakulira Kandiwo 3 , Lottie Hachaambwa 4 , Elvin Geng 5 , Charles B. Holmes 6 , Edford Sinkala 3 , Monika Roy 5 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 University Teaching Hospital, Lusaka, Zambia, 4 University of Maryland, Baltimore, MD, USA, 5 University of California San Francisco, San Francisco, CA, USA, 6 Johns Hopkins University, Baltimore, MD, USA Background: Although rates of non-communicable diseases (NCDs) among HIV-infected individuals are anticipated to increase in sub-Saharan Africa (SSA); quantitative data characterizing the true burden of NCDs are scarce. We investigated the proportion of hospitalizations attributed to NCDs among adults with and without HIV at a hospital in Zambia Methods: We extracted age, sex, HIV status, and reason for admission from a randomly-selected group of adults (18+ years) admitted to the internal medicine inpatient wards at University Teaching Hospital (UTH) in Lusaka. We defined HIV infection by self-reported positivity or a rapid test, and considered self-reported negative patients as unknown status. Among HIV-infected individuals, we also captured CD4+ and HIV viral load and defined viral

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