CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

and “classical” monocytes (p=0.01). Regarding the expression of CD11b, IF patients showed significantly lower levels on “classical” monocytes (p=0.05) and higher levels on “intermediate” monocytes (p=0.05) compared to IS group. No differences in the expression of HLA-DR, CD38 and CD69 on M/M were found in the two groups. NCI was observed in 20/84 patients (19 defined as ANI and 1 as MND). NCI prevalence was not different between the two groups (25.7% in IF and 22.2% in IS). There was no correlation between overall NCI and monocyte phenotypes neither expression of activation markers on M/M. Conclusions: A shift on M/M phenotype from the “classical” towards “intermediate” and altered expression of monocyte activation markers, CD163 and CD11b, correlate with immune failure on ART. HIV-infected subjects with NCI on ART do not have a distinct monocyte phenotype using the variable we studied. 467 The VACS Index Predicts Change in Neurocognitive Functions in PeopleWith HIV Sean B. Rourke 1 ; John Gill 2 ; Anita Rachlis 1 ; Amy Justice 7 ; Colin Kovacs 3 ; Gordon Arbess 4 ; Jason Brunetta 3 ; Adriana Carvalhal 4 ; Chris Power 6 ; Ann N. Burchell 5 1 University of Toronto, Toronto, Canada; 2 University of Alberta, Calgary, Canada; 3 Maple Leaf Medical Clinic, Toronto, Canada; 4 St. Michael’s Hospital, Toronto, Canada; 5 The Ontario HIV Treatment Network, Toronto, Canada; 6 University of Alberta, Edmonton, Canada; 7 Yale University School of Medicine, New Haven, CT, US Background: Recent work by Marquine et al (2014) has shown an association between higher Veterans Aging Cohort Study (VACS) Index and increased risk of neuropsychological (NP) impairment; but there is limited evidence on longitudinal association between the VACS index and NP functioning and the potential clinical utility of the VACS index for HAND. Methods: Study participants were from recruited from the city of Toronto, Canada. Baseline and one follow-up NP assessments were done (median follow-up time: 12 months) using a brief NP battery that included Hopkins Verbal Learning Test- Revised (HVLT-R), Grooved Pegboard, and WAIS-R Digit Symbol tests. Overall NP functioning was assessed using an unadjusted raw NP score (z-score), demographically adjusted NP score (Global T-score), and summary regression-based change scores. The VACS Index was computed by summing pre-assigned risk points for age, CD4 count, plasma HIV viral load, haemoglobin, fibrosis, renal glomerular filtration, and HCV infection following guidelines. Hierarchical linear regression method was used to determine the association between the VACS index score at baseline and change in NP functioning adjusting for NP performance, demographic factors, cognitive symptoms, depression, HIV disease markers, and medical comorbidities at baseline. Results: Data from 523 participants (78%male, 85% on ART, and 71%with suppressed viral load) were included in the analyses. In an unadjusted analyses, higher VACS index score at baseline was associated with a decline in overall NP function measured by changes in z-score (B= -0.06, p<0.001), summary regression-based score (B= -0.03, p=0.009), or Global T-score (B=-0.27, p=0.001). This association persisted after adjustment for baseline NP performance, cognitive symptoms, depression, HIV disease markers, medical comorbidities, and demographic variables. In adjusted analyses, higher VACS index score at baseline predicted a decline in raw NP z-score (B= -0.06, p<0.001), summary regression-based change score (B= -0.02, p=0.004), and Global T-score (B=-0.25, p<0.001). The VACS index score also accounted for considerable proportion (9% -17%) of the total variances explained by the regression models. Conclusions: Our results validate recent findings from the CHARTER study and suggest that the VACS index may be a useful clinical tool to identify and target those at higher risk for HIV–associated Neurocognitive Disorders. 468 When Diagnosing HAND, Should Visuospatial Functioning be Evaluated? Talia Shirazi 1 ; Angela Summers 1 ; Sally Steinbach 2 ; Suad Kapetanovick 1 ; Avindra Nath 2 ; Bryan Smith 2 ; Joseph Snow 1 1 National Institute of Mental Health (NIMH), Bethesda, MD, US; 2 National Institute of Neurological Disorders and Stroke, Bethesda, MD, US Background: Prior research has demonstrated that visuospatial functioning is often deleteriously affected in HIV-Associated Neurocognitive Disorders (HAND). Nevertheless, tests of visuospatial abilities are often omitted in current HAND research. We sought to determine whether the addition of visuospatial measures to an established HIV neuropsychological battery would increase the rate of HAND diagnoses. Additionally, to determine the relative likelihood that visuospatial functioning is impaired in HAND, we compared the rate of deficit on a visuospatial test to that of other tests in an established battery. Methods: Seventy HIV-seropositive (69 currently on ART) and 11 healthy control participants completed neuropsychological testing as part of a NIH Intramural HIV screening protocol (NCT01875588). Participants were administered the Benton Judgment of Line Orientation (JLO), a test of visuospatial abilities, as well as the CHARTER battery, an established HAND battery assessing attention, executive function, information processing, motor speed, verbal fluency, and memory. Results: Using the CHARTER battery alone, 21.4% (15/70) of patients met criteria for HAND. However, with the addition of a visuospatial measure, HAND prevalence rose to 30% (21/70), an 8.6% increase. The rate of deficient performance on JLO in HIV patients was one of the highest observed (25.7%), fourth to PASAT, a measure of attention (28.6%), BVMT (a visual memory test) total recall (28.6%) and BVMT delayed recall (30%), with the average rate of individuals with deficient performance across all tests being 16% (see Table). Mean T-scores were significantly lower in patients than controls for the PASAT (t=2.1, p =0.04), BVMT total recall (t=2.25, p =0.03), BVMT delayed recall (t= 2.19, p =0.03), and JLO (t=3.26, p =0.004), but not on the other 11 of 14 CHARTER measures.

Poster Abstracts

Conclusions: Our preliminary data suggest that visuospatial functioning may be a commonly affected cognitive domain in HIV patients in the HAART era. The omission of visuospatial measures on established HAND batteries may lead to an incomplete understanding of the neuropsychological impairments associated with HIV, as well as to possibly underestimating HAND prevalence. Future research should consider evaluating visuospatial functioning in addition to the other commonly assessed cognitive domains.

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CROI 2015