CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Persons with CD4<200 have higher levels of inflammatory cytokines (IL-6, MMP-1, MMP-7), T-cell growth factors (IL-2, IL-7), Th1 cytokine (IL-12), Th2 cytokines (IL-4, IL-5), and lower levels of amyloid β 42 present in the CSF as compared to those with CD4 >350. Lower levels of amyloid β 42 may be secondary to degradation by reactive astrocytes and microglial cells. Those with MND or dementia also have higher mean levels of INF-G than those classified as normal or ANI. The differences in CSF cytokine and neurodegenerative biomarker expression suggest that inflammation plays an important role in the progression of immunodeficiency in HIV+ adults. 455 A Comparison of 5 Brief Screening Tools for HAND in the USA and South Africa John A. Joska 1 ; JadeWitten 1 ; KevinThomas 1 ; Corne Robertson 1 ; Martine Casson-Crook 1 ; Heidi Roosa 2 ; Jason Creighton 2 ; Jennifer Lyons 3 ; Justin McArthur 2 ; Ned Sacktor 2 1 University of Cape Town, Cape Town, South Africa; 2 Johns Hopkins University School of Medicine, Baltimore, MD, US; 3 Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, US Background: A screening test for HIV associated neurocognitive disorders (HAND) is urgently needed in busy HIV clinics. We compared the sensitivity and specificity of five brief screening tools for HAND and HIV-dementia. We hypothesised that the International HIV Dementia Scale (IHDS), the Montreal Cognitive Assessment (MOCA) and the Cognitive Assessment Tool-rapid version (CAT-rapid) would be more sensitive than the Mini-Mental State Examination (MMSE) and the Simioni Symptom Questions (SSQ) in screening for HIV-D and all types of HAND. Methods: We recruited individuals established on CART in Cape Town, South Africa, and Baltimore, USA. Participants underwent the 5 screening tests, a neuropsychological test battery, an assessment of activities of daily living, subjective adherence measures and neuromedical assessment, and cases were classified into HAND categories. We calculated the sensitivity and specificity of each tool to correctly identify HIV-D and any form of HAND (including ANI, MND and HIV-D) across the full sample, using a receiver operating characteristic analysis. Results: The sample included 156 participants (89 from SA, 67 from the USA): median age of 40 years, 11 years of education, %women=62.80%, median CD4 cell count=460 cells/ml. Nearly half of the participants had symptomatic HAND [46 were classified as mild neurocognitive disorder (MND) and 19 as having dementia (HIV-D)]. To screen for HIV-D, using conventional cut-offs, the IHDS, MOCA, SSQ the CAT-Rapid displayed fair to good sensitivities of 68%, 100%, 79% and 94% respectively, while the MMSE was poor with a sensitivity of 26%. The specificities of the tools varied, with scores of 86% (IHDS), 23% (MOCA), 32%(SSQ) and 52% (CAT-rapid) respectively. To screen for HAND the sensitivities were as follows: IHDS (41%), MOCA (89%), SSQ (78(%), and CAT-rapid (52%), MMSE (24%). To screen for HAND the specificities were as follows: IHDS (86%), MOCA (22%), SSQ (32%), CAT-rapid (52%), and MMSE 98%). Conclusions: The IHDS and CAT-rapid performed similarly and seem to be useful tools to screen for dementia and any form of HAND, while the MMSE showed poor sensitivity, and the MOCA and SSQ showed poor specificity. 456 Subtype Associations With HIV-Associated Neurocognitive Dysfunction Tyler R. Day ; Davey M. Smith; Robert Heaton; Donald Franklin; MyresW.Tilghman; Josué Pérez-Santiago University of California San Diego, San Diego, CA, US Background: Despite effective antiretroviral therapy, HIV - associated neurocognitive disorders (HAND) continue to be a problem. Many factors, including CD4 count and nadir, HIV viral load and HIV-1 subtype, have been associated with HAND. However, variability of the associations of these factors including subtype with HAND has not been evaluated in ethnically and culturally similar populations in Asia. We investigated several clinical and immunological markers in two different provinces of China, Anhui and Yunan, and evaluated the influence of HIV-1 subtype on association with HAND. Methods: Blood-derived HIV-1 env sequences were obtained from 124 subjects in Anhui and 184 subjects in Yunan. We determined the infecting subtype (B, C or B/C) by evaluating for inter-subtype recombination using the Recombinant Identification Program 3.0 and TreeMaker on LANL. As a measure of viral diversity, we calculated a mixed base index (MBI) based on the number of ambiguous bases and the length of each sequence. We evaluated subtype, MBI, and clinical and demographical variables in the context of neurocognitive impairment (NCI), defined as having a global deficit score >0.5 based on a standardized neurocognitive battery. Statistical analyses were performed using R software. Results: Including subjects from both regions, we found that individuals with NCI had significantly lower nadir (p=0.0005) and absolute (p=0.03) CD4 counts than those without NCI (Mann-Whitney test). Higher viral population diversity (MBI), lower CD4 nadir counts and lower CD4 absolute counts were associated with worse impairment (r=-0.16, p=0.005, r=-0.17, p=0.003, and r=0.14, p=0.01, respectively) by regression analysis. We also found that AIDS was significantly associated with HAND (p=0.001), but HIV-1 subtype was not associated with presence of HAND (p=0.35) by Fisher test. In a multivariate analysis that included HIV-1 subtype, results from all analyses remained similar except for CD4 nadir, which became a trend only for the region of Yunan (p=0.06).

Poster Abstracts

314

CROI 2015