Abstract P06
Antiviral Therapy 2020; 25 Suppl 1:A27
The influence of HIV infection and antiretroviral treatment on pulmonary function in individuals in an urban setting in sub-Saharan Africa
OE van den Berg
1
, EJ Shaddock
2
, SL Stacey
2
, C Feldman
2
, RE Barth
1
, DE Grobbee
1
, F Venter
3
, K Klipstein-Grobusch
1
, AG Vos
1,3
1Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; 2Charlotte Maxeke Johannesburg Academic Hospital, Division of Pulmonology and Critical Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand; 3Ezintsha, Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
Background and objective: With the roll-out of antiretroviral treatment (ART) life expectancy of people with HIV and hence morbidity from non-communicable diseases, including pulmonary diseases, have increased. This study aims to investigate whether HIV and ART are associated with pulmonary function, taking into account the role of tuberculosis (TB).
Methods: HIV-positive adults (ART-naive, on first- or second-line ART), and age and sex matched HIV-negative controls were included in a cross-sectional study in Johannesburg, South Africa. Spirometry was performed to determine lung function, measuring the forced expiratory volume in one second (FEV1), the forced vital capacity (FVC) and the FEV1/FVC ratio before (pre) and after (post) short-acting bronchodilator. The association between HIV, ART and pulmonary function was analysed using linear regression models, adjusting for age, gender, body surface area (BSA), TB and pulmonary risk factors.
Results: Overall, 548 participants (62% women) were included with a mean age of 38 (sd 9.5) years. No effect of HIV or ART on post-FEV1 was observed in age, gender and BSA adjusted analysis. Additional adjustment for TB resulted in a higher post-FEV1 in HIV-positive participants on ART compared with HIV-negative participants, whereas TB was associated with a decline in FEV1. No effect of HIV and ART on post-FEV1/FVC was observed.
Conclusions: HIV infection and ART use were not associated with a decline in pulmonary function in this urban African population. TB showed a mediating effect on the association between HIV, ART and pulmonary function.
Abstract P07
Antiviral Therapy 2020; 25 Suppl 1:A28
Predictors of long-term progression to chronic kidney disease for people living with HIV in Ghana
DR Chadwick
1
, FJ Barker
1
, C Smith
2
, O Perditer
3
, Y Hardy
3
, D Owusu
3,4
, G Villa
5
, S Sarfo
3,4
, AM Geretti
5
, R Phillips
3,4
1Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, UK; 2Department of Infection & Population Health, University College London, Royal Free Hospital, London, UK; 3Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; 4Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; 5Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
Background: HIV infection is associated with an increased risk of progression to chronic kidney disease (CKD) and this risk is highest in people of West African descent. While antiretroviral treatment has improved outcomes overall in this domain, tenofovir and other antiretroviral therapies (ART) have shown independent associations with renal pathology including CKD and tubular dysfunction (TD). However, to date there is a limited body of research available exploring whether such findings remain consistent across sub-Saharan African populations, which has the highest rates of HIV globally. This study assessed the relationships between key factors such as ART drugs and hepatitis B virus (HBV) status with CKD and TD progression in a population based in central Ghana.
Methods: This single-centre longitudinal study enrolled patients with HIV taking ART in Ghana between 2003 and 2018. All participants required at least two eGFR measurements, one of which upon commencing ART and the second at least 3 years after this date. Hepatitis B status and ART regimen were noted for each participant. In a subgroup of these patients, markers of tubular dysfunction were additionally assessed for. Multilevel model linear regression was carried out to determine predictors of worsening eGFR function. Cox proportional hazards modelling was carried out to assess for development of CKD 3 and TD.
Results: (Still in early stages of statistical analysis at time of abstract submission). 659 participants were included in the study, of which 488 (74.1%) were female. The median participant follow-up time was 6.0 years (IQR 3.6–8.9). 149 (22.6%) had a positive HBV coinfection status, while 210 (31.9%) were negative.
Use of tenofovir was associated with greater levels of annual eGFR decline compared with zidovudine, with a statistically significant mean difference of -1.08 ml/min/1.73 m2 per year (95% CI -1.92, -0.24). Despite this, there was no statistically significant difference in the incidence of rapid progression CKD across NRTI drugs.
Nevirapine use was also associated with a statistically significant increased annual eGFR decline compared with efavirenz use (-0.78 per year [95% CI -1.39,-0.17]) and protease inhibitors (-1.55 per year, 95% CI -2.68, -0.41).
Negative HBV status was associated with a statistically significant increased annual eGFR decline compared with positive HBV status (-1.25 per year, 95% CI -2.20, -0.29) and unknown HBV status (-1.38 per year, 95% CI -2.01, -0.74). See Table 1.
Conclusions: Increased rates of eGFR decline amongst PLH in Ghana have strong statistical associations with both their particular HAART drug regimen and HBV status. The findings add to an important base of research investigating the links between tenofovir and renal pathology in sub-Saharan African settings.
Positive HBV status had associated with more favourable eGFR change compared with negative HBV status. While this result may have been particularly vulnerable to sampling bias due to a large percentage of participants without HBV status available (45.5%), the finding may warrant further investigation.
Abstract P08
Antiviral Therapy 2020; 25 Suppl 1:A30
Greater incident proteinuria in pre-diabetic men with HIV than without HIV: the Multicenter AIDS Cohort Study
L Slama
1,3
, B Barrett
2
, A Abraham
2
, FJ Palella Jr
3
, L Kingsley
4
, JP Viard
1
, JE Lake
5
, TT Brown
2
, the Multicenter AIDS Cohort Study (MACS)
1APHP, Hotel Dieu Hospital, Infectious Diseases Unit F-75004, Université de Paris, France; 2Johns Hopkins University, Baltimore, MD, USA; 3Feinberg School, Northwestern University, Chicago, IL, USA; 4University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA; 5University of Texas Health Science Center, Houston, TX USA
Background: In the general population, prediabetes (pre-DM) is associated with proteinuria, which is a major risk factor for chronic kidney disease. While people living with HIV (PLWH) have a higher risk of proteinuria compared with HIV-seronegative individuals, it is unknown whether among those with pre-DM, incident proteinuria differs by HIV serostatus.
Methods: Urine protein and creatinine were measured at each semi-annual visit among men in the Multicenter AIDS Cohort Study (MACS; April 2006–present). Men with an observed case of confirmed pre-DM on or after April 2006 (baseline visit), no prevalent proteinuria at the baseline visit and no use of anti-diabetic medications at the baseline visit or during follow-up, were included in the analysis. Confirmed pre-DM was defined as fasting glucose (FG) of 100–125 mg/dl confirmed within a year by an additional FG 100–125 mg/dl or haemoglobin A1c 5.7–6.4%. Incident proteinuria was defined as protein-to-creatinine ratio >200 mg/g, confirmed at a subsequent visit within a year. We used Poisson regression models to determine whether incident proteinuria in pre-DM participants differed by HIV serostatus, and among men with HIV, whether factors related to HIV treatment and disease severity were related to incident proteinuria.
Results: Between 2006 and 2019, of the 1,138 men with pre-DM (547 with HIV [MWH], 591 without HIV), 161 (14%) developed incident proteinuria (121 [22%] with HIV [MWH], 40 [7%] men without HIV) over a median of 10 years of follow-up (IQR: 5–12 years). After adjustment for age, race/ethnicity, education, smoking status, hepatitis C virus serostatus, BMI, dyslipidaemia, hypertension and eGFR ever <60 ml/min/1.73 m2, MWH had an incidence of proteinuria that was 4.2 times (95% CI: 2.8, 6.4) greater than that of men without HIV (P<0.01). Among MWH, history of AIDS (P=0.06) and current CD4 cell count <500/mm3 (P<0.01) were both associated incident proteinuria in multivariable models, whereas HIV viraemia (>500 copies/ml) and cumulative exposure to tenofovir, stavu-dine or protease inhibitors showed no association.
Conclusions: Among men with pre-DM, men with HIV have a fourfold higher risk of incident proteinuria compared with men without HIV. Strategies to preserve renal function should be evaluated in this population.
Abstract P09
Antiviral Therapy 2020; 25 Suppl 1:A31
Risk factors, screening, diagnosis and treatment of osteoporosis in HIV-infected adults in an HIV primary care clinic
K Kwok
, C Olatunbosun, E Ready, O Sin, J Toy, A Spears, V Lau, G Bondy, S Stone
St. Paul's Hospital, Vancouver, BC, Canada
Objectives/aim: The HIV-positive population is ageing and with that comes emergent comorbidities such as osteoporosis. The prevalence of osteoporosis in people living with HIV (PLHIV) has been shown to be three times greater than HIV-uninfected controls. Despite often pressing needs in primary care, screening and treating chronic diseases such as osteoporosis is becoming a crucial part of care. For this reason, our objective was to assess osteoporosis risk factors, screening, diagnosis and treatment for bone disease among patients with HIV over age 50 at a multidisciplinary HIV primary care clinic.
Methods: A retrospective chart review was completed at the John Ruedy Clinic, a low-barrier HIV clinic at St. Paul's Hospital in Vancouver, BC, Canada. HIV-positive patients ≥50 years old with ≥1 annual appointment with their clinic physician between 1 June 2016 and 1 June 2019 were included.
Results: We analysed data from 146 patients, representing 25% of the clinic's population of patients ≥50 years old. The majority of patients were male (n=134, 92%), with a median age of 55 years and median of 15 years since HIV diagnosis. In addition to age and HIV status, patients had a median of 3 osteoporosis risk factors, and 145 patients (99%) had ≥1 risk factor. All screening was done with dual-energy X-ray absorptiometry (DXA) scans ordered by a physician. A total of 93 patients (63%) were not screened, 15 patients (10%) had previously been diagnosed with osteoporosis and 39 patients (27%) were screened with DXA. Of those 39 patients screened with DXA, 7 patients (18%) had normal bone mineral density, 22 patients (56%) were diagnosed with osteopenia and 10 patients (26%) were diagnosed with osteoporosis. Management of the 25 patients with osteoporosis included no treatment (n=6, 24%), vitamin D or calcium supplementation (n=4, 16%) and bisphosphonate treatment (n=15, 60%). Of those with osteoporosis, 17 patients were on TDF and 10 patients (59%) were changed to another antiretrovi-ral for bone health.
Discussion/conclusions: This study showcases the high frequency of risk factors for osteoporosis in PLHIV at the John Ruedy Clinic who are ≥50 years old. Despite this, rates of screening and treatment for osteoporosis were low. Similar findings have been described elsewhere and this may be a common problem in primary care clinics for PLHIV. While the osteoporosis rates in this sample was similar to prevalence rates described in the literature, this is likely an underestimate due to under-screening of patients with a number of risk factors. Treatment uptake for osteoporosis in this population was found to be low and it is an important area to address. Optimizing the use of the multidisciplinary team in a coordinated approach to screening and treatment can help to comprehensively manage osteoporosis in this population.
Abstract P10
Antiviral Therapy 2020; 25 Suppl 1:A32
Evaluation of a decentralized model of HCV treatment in a disadvantaged, inner city population; efficacy and effectiveness
DP Kotler
1,2
, K Thompson
2
, G Searson
2
1Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY; 2Coalition on Positive Health Empowerment (COPE), New York, NY
Introduction: Despite great advances in the treatment of chronic hepatitis C infection, the disease persists in many people who are not stably engaged with the health-care system. We tested the efficacy and effectiveness of a decentralized care model for HCV treatment in this population.
Methods: We designed a care model in which the primary caregiving role was assumed by a community-based, non-governmental organization (COPE) rather than the medical centre (Jacobi). COPE has performed HCV point-of-care testing (Orasure) in non-medical settings in New York City since 2012, with a seropositivity rate of 12.1% in 7,141 tests performed through 12/31/2020. In this IRB-approved study performed in the Bronx, NY in 2018–2019, subjects provided written, informed consent for serotesting and limited demographic information, plus oral consent for further evaluation, if sero-positive. Upon PCR confirmation of active infection, a reflex panel of laboratory tests and an abdominal ultrasound examination were performed, then the subject was evaluated medically. Medical appropriateness and potential exclusionary comorbidities or drug interactions were determined by the physician, therapy was prescribed, and follow-up was coordinated through patient navigation from COPE, who provided other patient support as needed individually. The control group included 429 HCV+ subjects treated with dual antiviral agents between 2014–2016, in a hospital clinic. Treated subjects were matched with controls on a 1:1 basis, controlling for sex, race, HIV infection, presence or absence of advanced fibrosis and age within 5 years.
Results: A total of 126 seropositive subjects were found in 1,199 tested (10.5%). Almost all were aware of their hepatitis infections and 19 had received some form of HCV treatment at some point in the past. HCV RNA was detected in 53/104 seropositives tested. Evaluation was completed and treatment initiated in 31. End of treatment responses were seen in 90% in the study group versus 87% in matched controls (Chi Sq 0.161, P=0.69), while SVR was documented in 74% of the study group versus 87% in controls (Chi Sq 1.65, P=0.20), the former due to loss to follow-up and not to viral rebound.
Conclusion: A strikingly high proportion of antibody-positive subjects with undetectable RNA contents were seen (49%), possibly reflecting the influence of active infection on all-cause mortality. There was a high proportion of dropouts throughout the treatment cascade, though viral suppression was detected on PCR testing at least once in every treated subject. Viral outcomes using this treatment model did not differ from those in a demographically comparable treatment group treated at an academic medical center. A community-centric treatment model may successfully treat HCV infection in around one half of a population that is not being seen in a formal health-care setting.
