CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

914 Testosterone Use and HIV Serostatus Among MenWho Have Sex With Men in the MACS

Sabina A. Haberlen 1 ; Lisa Jacobson 2 ; Frank J. Palella 3 ; Adrian S. Dobs 4 ; MichaelW. Plankey 5 ; Jordan Lake 6 ; Lawrence Kingsley 7 ; Ron Stall 8 ;Wendy S. Post 4 ;ToddT. Brown 2 1 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 2 Johns Hopkins Univ, Baltimore, MD, USA; 3 Northwestern Univ, Chicago, IL, USA; 4 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; 5 Georgetown Univ Med Cntr, Washington, DC, USA; 6 David Geffen Sch of Med at Univ of California Los Angeles, Los Angeles, CA, USA; 7 Univ of Pittsburgh, Pittsburgh, PA, USA; 8 Sci Cntr for LGBT Hlth Rsr, Univ of Pittsburgh, Pittsburgh, PA, USA Background: Testosterone therapy (TTh) use has increased markedly in the U.S over the past decade, with current prevalence of about 3% among men >40 years. Given the possible cardiovascular risks associated with TTh use and high burden of cardiovascular disease (CVD) in HIV-infected (HIV+) men, data on the levels and reasons for TTh use in this population are needed. We describe the incidence, prevalence, and characteristics of TTh use among HIV+ and HIV-uninfected (HIV-) men who have sex with men (MSM) in the Multicenter AIDS Cohort Study (MACS). Methods: Data on self-reported testosterone use was collected semiannually since 2012. Our analytic sample included 2319 (1223 HIV+/1096 HIV-) men in Baltimore, Chicago, Pittsburgh, and Los Angeles who completed one or more study visits from 2012-2014. We calculated incident and prevalent TTh use and compared reasons for TTh use by HIV serostatus using Chi-square tests. We used multivariable Poisson regression models with robust variance to estimate prevalence ratios (PR) for TTh use by HIV serostatus and demographic factors. Results: Compared to the HIV- men, HIV+men were older (median and intraquartile range 59 years (53-66) v 54 years (46-60)) and more likely to be non-white (47% v 27%). TTh prevalence at the most recent visit among HIV+ compared to HIV- men was nearly 4-fold higher in men aged 60 and older (26% v 7%, p<0.001), and almost 3-fold higher among men younger than 60 (18% v 7%, p<0.001 among 50-59 years; 6% v 2%, p=0.03 among <50 years). The TTh initiation rate from 2012-2014 was 21.4/1000 person years. Among the 266 men (197 HIV+/69 HIV-) on TTh, the major self-reported reason for use was low testosterone (88%). HIV+men were more likely than HIV- men to use TTh to improve strength or energy (36% v 22%, p=0.04), build muscle (26% v 7%, p=0.001), or combat wasting (15% v 1%, p<0.01). In multivariable analysis, the prevalence of TTh was 3.8 times greater in HIV+ compared to HIV- men (p<0.001), and was significantly less prevalent among non-white men (Table 1). We observed strong geographic differences, with the prevalence of TTh use 2.7 and 1.7 times higher among LA and Baltimore men, respectively, compared to Pittsburgh men. Conclusions: MSM in the MACS reported very high rates of TTh use, particularly among older HIV+men. Given the high TTh use and CVD burden among HIV+men, the benefits and risks of TTh use should be carefully examined in future studies and closely monitored in clinical practice.

Poster Abstracts

915 Prevalence of Opioid Prescriptions and Risk Factors for Abuse in HIV-Infected Adults Alejandro Pérez ; Heather Bradley; Shikha Garg; Luke Shouse CDC, Atlanta, GA, USA

Background: Prescription of opioid pain relievers (OPR) has been increasing in the United States, leading to increased opportunities for OPR abuse and overdose deaths. OPR abuse has been linked to HIV infection and transmission, as evidenced by a recent HIV outbreak in Indiana. Knowing the percentage and attributes of HIV-infected persons who were prescribed OPR may help to identify opportunities for prevention of OPR abuse and related HIV transmission. Methods: We used 2009–2013 cycle data from the Medical Monitoring Project, a surveillance system designed to provide nationally representative estimates of clinical and behavioral characteristics of HIV-infected persons receiving medical care in the United States. Using interview and medical record data from 23,125 persons, we estimated the weighted prevalence of OPR prescriptions during the 12 months prior to interview. We assessed associations between OPR prescription and several risk factors for opioid abuse – mental illness, drug use, and low income – using Rao-Scott chi-square tests. Mental illness was defined as medically diagnosed depression or anxiety, and drug use was defined as injection or non-injection drug use in the previous 12 months. Results: Overall, 20.8% (95% CI 19.3 – 22.3) of patients had at least one OPR prescription documented in their medical record during the previous 12 months. Patients with anxiety or depression were more likely to be prescribed OPRs than those without either condition (31.6% vs 16.2%; P <0.01). Patients living below the federal poverty level were more likely to be prescribed OPRs than those living above the federal poverty level (23.2% vs 17.8%; P <0.01). Patients who reported injection or non-injection drug use were more likely to be prescribed OPRs than those who did not use drugs (23.4% vs 19.9%; P <0.01). Patients who reported injection drug use were more likely to be prescribed OPRs than those who did not use injection drugs (37.2% vs 20.5%; P <0.01) (Table 1). Conclusions: The recent HIV outbreak in Indiana highlights the connection between opioid abuse and HIV transmission. One fifth of HIV-infected persons receiving medical care in the United States during 2009–2013 were prescribed OPRs in the year before interview, and one-third of HIV-infected persons with anxiety or depression had been prescribed OPRs. Increased counseling and monitoring of HIV-infected persons prescribed OPRs for medical purposes may reduce the potential for OPR abuse and HIV transmission.

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CROI 2016