CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

353 DECREASE IN EXECUTIVE FUNCTION IS ASSOCIATED WITH DETECTABLE PLASMA HIV DURING CART Albert Anderson 1 , Josue Perez-Santiago 2 , Andrea Knezevic 1 , Xiaohe Yang 1 , Eugene Huang 1 , Jennifer Iudicello 3 , David Moore 2 , Ronald J. Ellis 2 , Robert K. Heaton 3 , Scott Letendre 2 1 Emory Univ, Atlanta, GA, USA, 2 Univ of California San Diego, San Diego, CA, USA, 5 Univ of California at San Diego, La Jolla, CA, USA Background: HIV- associated neurocognitive impairment (NCI) continues to be prevalent, even in patients on combination antiretroviral therapy (cART). Growing evidence shows that NCI is associated with adverse clinical outcomes. To assess the influence of neurocognition (NC) on virologic suppression, we pooled data frommultiple studies in which participants underwent comprehensive NC testing. We hypothesized that worse NC would be associated with detectable plasma HIV RNA despite self-reported adherence to cART. Methods: Longitudinal data frommultiple studies nested within the HIV Neurobehavioral Research Programwere analyzed. Subjects were included in the analysis if, at all visits, the following criteria were met: 1) on cART with ≥3 drugs; 2) ≥ 95% cART adherence reported for the prior two weeks; 3) Use of plasma HIV RNA assay with lower limit of ≤50 copies/ml. Data were analyzed using generalized estimating equation (GEE) models for repeated measures. Covariates included demographic characteristics, global and domain- specific neurocognitive performance, and the use of addictive drugs. Variables significant in univariate analysis at alpha 0.05 were included in multivariable modeling, which was performed using backward stepwise selection. Results: The 1,943 included participants had a total of 5,555 visits. In the univariate analysis, the variables associated with HIV RNA ≤ 50 included white race, older age, higher nadir CD4+ count, higher CD4+/CD8+ ratio, and higher mean T score for the executive function domain. Hepatitis C virus seropositivity as well as current use of illicit drugs and opioids were associated with HIV RNA >50. In the final multivariate model, undetectable plasma HIV RNA was associated with: white race (OR 1.46, 95%CI 1.08-1.98); increasing age per 5 years (OR 1.10, 95% CI 1.01-1.19), higher CD4/CD8 ratio (OR 1.13, 95% CI 1.08-1.18), and better executive function (OR 1.16 per T-score increase of 10, 95% CI 1.03, 1.31). Current use of cocaine (OR 0.31, 95% CI 0.2-0.48), opiates (OR 0.59, 95% CI 0.38-0.93), or methamphetamine (OR 0.52, 95% CI 0.33-0.83) were associated with decreased odds of undetectable plasma HIV. Conclusion: HIV-infected adults on cART who report excellent adherence are more likely to have undetectable plasma HIV RNA if they have better executive functioning, even after accounting for traditional risk factors. These findings provide more evidence that neurocognition is important in the management of HIV-infected individuals. 354 DAAS IMPROVE VACS BUT DO NOT INFLUENCE COGNITIVE IMPAIRMENT IN HIV/HCV COINFECTED Ilaria Mastrorosa , Patrizia Lorenzini, Martina Ricottini, Gabriele Fabbri, Pietro Balestra, Alessandra Vergori, Carmela Pinnetti, Mauro Zaccarelli, Adriana Ammassari, Andrea Antinori Natl Inst for Infectious Diseases, Rome, Italy Background: The role of HCV as an independent risk factor for HIV-associated neurocognitive impairment (NCI) is still controversial. VACS Index, a composite marker of disease severity, has been associated with increased risk for mortality and with concurrent risk for NCI. Aimwas to evaluate changes over time after DAA treatment on neurocognitive performance and VACS index in HIV/HCV co-infected (HIV/HCV) patients (pts). Methods: HIV/HCV pts starting DAA treatment were enrolled in a prospective study. All patients underwent neuropsychological assessment (NPA) before starting DAA (T1) and 12-24 weeks after (T2) end of treatment (EOT). NPA was carried out through a standardized battery of 14 tests on 5 different domains. We used NPZ-8 as a summary measure of z-scores of neuropsychological testing performance. Pts were classified as having NCI if they scored >1 standard deviation (SD) below the normal mean in at least 2 tests, or >2 SD in 1 test. HAND was classified according to Frascati’s criteria. VACS Index was calculated through standard methods at T1 and 6 months after EOT. Paired Wilcoxon and Mc Nemar test were used for statistical comparisons. Results: A total of 62 patients included: male 74.2%, median age 54 years (IQR 51-56); injection drug users (IDUs) 85.4%; on cART 100%; median CD4 563 cell/mmc (IQR 340-761); HIV-RNA not detectable 83.3%; baseline log10 HCV RNA 5.8 (IQR 5.3-6.3). Fibrosis was F1/F2 in 11, F3 in 12, F4 in 39 pts. Half of the patients was HCV treatment experienced. DAA regimen was SOF-based for 32 pts and non-SOF-based for 30 pts. At baseline 23/62 were neurocognitively impaired. HAND criteria were limited by high frequency of confounding comorbid conditions (substance use). No significant changes over time in NPA was observed after DAA (Table). Similarly, when considering only pts achieving SVR12, neurocognitive performance did not improve. For 51 pts, VACS index was calculated at T1 and 6 month after EOT: at month 6 compared to T1, median values were significantly lower after DAA treatment (Table).

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