CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

358 POST-TRAUMATIC STRESS AND NEUROCOGNITIVE IMPAIRMENT IN A US MILITARY COHORT Robert Deiss 1 , Raeanne Moore 2 , Nancy Crum-Cianflone 1 , Scott Letendre 2 , Anuradha Ganesan 1 , Jason Okulicz 3 , Mary F. Bavaro 4 , David J. Moore 2 , Brian K Agan 1 1 Uniformed Services Univ of the Hlth Scis, Rockville, MD, USA, 2 Univ of California San Diego, San Diego, CA, USA, 3 Infectious Disease Service, San Antonio, TX, USA, 4 Naval Med Cntr of San Diego, San Diego, CA, USA Background: Neurocognitive impairment (NCI) is a well-known complication of HIV infection and may be influenced by mental health disorders. We examined the relationship between NCI and mental health disorders including post-traumatic stress disorder (PTSD) in a cohort of HIV-infected military personnel. Methods: We analyzed data from 189 HIV+ active-duty (72%) and retired (28%) US military men. Participants completed selected modules of the Composite International Diagnostic Interview to ascertain the presence of PTSD, major depressive disorder (MDD), alcohol use disorder (AUD) and other mental health diagnoses. NCI functioning was assessed with a comprehensive battery of standardized neuropsychological tests. We performed chi-square and logistic regression to characterize the relationship between NCI and mental health disorders. Results: The median age of study subjects was 36 years (interquartile range [IQR] 28-43) and median total years of education was 14 (IQR 12-16). NCI was diagnosed in 19% of subjects. The lifetime prevalence of serious head trauma (12%), MDD (25%) and AUD (37%) did not significantly differ between individuals diagnosed with or without NCI. However, individuals with a lifetime history of PTSD (PTSD+) were more likely to be diagnosed with NCI than those without PTSD (PTSD-); (43% vs 16%, p<0.01). While we found no significant differences between PTSD(+) and PTSD(-) with respect to total years of education, current or nadir CD4 count, or highest HIV RNA level, PTSD(+) were more likely to have a prior AIDS diagnosis (29% vs 4.0%, p<0.01) than PTSD(-). In multivariate analysis adjusting for age, education, race, history of AIDS diagnosis and history of head trauma, lifetime history of PTSD remained independently associated with NCI (OR 4.2; 95% CI 1.5, 15.3). Conclusion: Among US HIV-infected military personnel, individuals with a history of PTSD were four-times more likely to be diagnosed with NCI than those without a PTSD diagnosis. PTSD may be an under-appreciated determinant of cognitive functioning, an important finding given its high prevalence among military personnel and vulnerable populations living with HIV. HIV-infected individuals with cognitive difficulties should be screened for mental health disorders including PTSD. Prospective studies of the longitudinal relationship between PTSD and NCI as well as the impact of PTSD treatment on future NCI should be evaluated. 359 ANTIRETROVIRALS IMPROVE HAND STAGE IN HIV+ PATIENTS WITH SUBTYPE D AND A IN UGANDA Ned Sacktor 1 , Deanna Saylor 1 , Gertrude Nakigozi 2 , Kevin Robertson 3 , Noeline Nakasujja 4 , Ronald H. Gray 1 , Maria Wawer 1 1 The Johns Hopkins Univ, Baltimore, MD, USA, 2 Rakai Hlth Scis Prog, Kalisizo, Uganda, 3 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 Makarere Univ, Kampala, Uganda Background: The predominant HIV subtypes in Rakai, Uganda are D (45%), A (35%) and D/A recombinants (20%), in contrast to the US where subtype B predominates. Combination antiretroviral therapy (CART) improves HIV-associated neurocognitive disorder (HAND) stage in the US, but the effect of CART on HAND stage in individuals with subtypes D and A is largely unknown. The objective of this study was to evaluate the change in HAND stage after CART initiation in 400 HIV+ individuals in Rakai, Uganda. Methods: 400 ART naive HIV+ individuals and 400 HIV seronegative (HIV-) individuals in Rakai, Uganda received detailed medical, neurological, and functional assessments, neurological examination, and neuropsychological testing. As of September 28, 2016, 277 of the 312 HIV+ individuals (89%) who had reached their 2 year follow-up visit had returned for evaluation. 233 of these HIV+ individuals were on CART with data available for HAND classification. HAND stage was determined at each visit based on normative data developed from the 400 HIV- age-, gender- and community-matched controls. Baseline frequencies of cognitive impairment between HIV+ and HIV- individuals were assessed with chi square tests. Among HIV+ patients on CART, baseline and follow-up HAND stages were compared using Wilcoxon sign rank tests. Results: Demographic characteristics of the 400 HIV+ individuals were as follows: Age [mean (SD)] = 35 (8) years, Education [mean (SD)] = 5 (3) years, Gender (male, %) = 53]. At baseline HIV+ individuals had more dementia (HAD) (dementia frequency % for HIV+’s =16%) than HIV- individuals {dementia frequency % for HIV-’s = 6%), (p<0.001), but there were no differences in asymptomatic neurocognitive impairment (ANI) [HIV+ (10%) vs HIV- (8%)], or mild neurocognitive disorder (MND) [HIV+’s (20%) vs HIV-’s (21%)]. At

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