CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

486 Hepatitis C Infection and Cognition in Older HIV+ Adults: Data From the Center of Excellence on Disparities in HIV and Aging (CEDHA) Oluwatoyin M. Adeyemi 1 ; Sue Leurgans 2 ; Alan Landay 2 ; David Bennett 2 ; Lisa Barnes 2 1 Ruth M Rothstein CORE Center, Cook County Health and Hospitals System, Chicago, IL, US; 2 Rush University Medical Center, Chicago, IL, US

Background: Neurocognitive impairment in patients with controlled HIV is well reported. Chronic hepatitis C (HCV) has also been associated with poor neurocognitive and neuropsychiatric outcomes. We sought to evaluate the impact of HCV co-infection on neurocognition and quality of life (QOL) among older adults with well controlled HIV infection enrolled in CEDHA. Methods: Data come from CEDHA, a prospective study of older adults with and without HIV living in Chicago, IL. The current analysis included 166 HIV+ persons (mean age = 58 (+5.5) yrs; 124 (74.7%) male, 69% black) without active drug or alcohol use who completed a structured clinical evaluation including a battery of 19 cognitive tests and 3 quality of life questions. Cognitive data included composite measures of global cognition and five different cognitive domains: episodic memory, semantic memory, working memory, perceptual speed and visuospatial ability. Linear regression models were used to examine the relationship between HCV infection and neurocognition, and logistic regression models were used to examine the association of HCV with quality of life. Results: The mean education of participants was 13.1 (+2.8) years and the mean CD4 was 621(+286) cells/mm; 97.0% had undetectable HIVRNA. Sixty-four persons (38.6%) were HCV+ and were more likely to be black (OR=2.8, p=0.009) and have lower education 12.1yrs vs 13.8yrs (p<0.0001) when compared with HCV- participants. In linear regression models that controlled for age, sex, education, and race, HCV infection was significantly associated with lower global cognition, episodic memory, and perceptual speed. In models that further adjusted for nadir CD4 count, only the association with episodic memory remained. In logistic regression models adjusted for the same terms, HCV infection was related to fair/poor self-rated health, after controlling for nadir CD4 count (OR=3.1, p=0.004). Conclusions: HCV infection is associated with poorer episodic memory and QOL rating in patients with well controlled HIV. These impairments may have adverse effects on adherence and other long term outcomes in HIV patients. The effect of HCV direct acting antivirals on these outcomes needs further exploration. 487 Neurocognitive Screening Tests Are AssociatedWith Cardiovascular Risk and VACS Scores Andrea Calcagno 1 ; Marielisabetta Scarvaglieri 1 ; DanielaVai 2 ; Alessandro Livelli 2 ; Letizia Marinaro 1 ; Giancarlo Orofino 2 ; Nicole Pagani 1 ; Daniele Imperiale 2 ; Giovanni Di Perri 1 ; Stefano Bonora 1 1 University of Torino, Torino, Italy; 2 ASLTO2, Torino, Italy; 3 ASLTO2, Torino, Italy Background: HIV-associated neurocognitive disorders (HAND) are still highly prevalent despite effective antiretroviral treatment; several associated factors have been identified including cardio- e cerebrovascular risk factors. Despite the recommendation to perform screening neurocognitive (NC) tests in all HIV-positive patients there is still uncertainty regarding the optimal tools as well as the selection criteria. Methods: In adult HIV-positive patients cardiovascular risk assessment [5-year D:A:D (DAD5) and 10-year Progetto Cuore (Cuore10) risk scores], mortality risk (VACS-index) as well as screening NC tests (IHDS, Clock Drawing Test, Frontal Assessment Battery) were performed. Patients with IHDS below 10 received a full NC testing by a trained neuropsychologist. Data are expressed as average ( ± standard deviation, SD) and parametric tests were used for all analysis (Pearson’s test for continuous variables). Results: 441 patients (78%male, 95.4% Caucasian) were enrolled. Age, BMI and eCRCL were 48 years ( ± 11.5), 24.8 kg/m 2 ( ± 4.1) and 81.9 ml/min ( ± 19.5) respectively. Average current and nadir CD4 were 538 cell/uL ( ± 309) and 219 ( ± 177); out of 407 patients on treatment (91.7%), 289 (71%) showed HIV RNA below 50 copies/mL. Average DAD5 and Cuore10 were 3.2% ( ± 3.8%) and 5.5% ( ± 9%) and respectively 3.9% and 5.1% of patients fell in the high-risk strata (>10% and >20%, respectively). VACS index was 27.5 ( ± 16.9). Average IHDS, Clock and FAB scores were 10.6 ( ± 1.3), 1.28 ( ± 1.25), 15.4 ( ± 2); they were abnormal in 87/422 (20.6%), 88/354 (24.9%) and 13/101 patients (12.9%) respectively. IHDS scores were associated with clock (r=-0.15, p=0.007) and FAB scores (r=0.583, p<0.001); they were also significantly associated with VACS (r=-0.417, p<0.001), DAD5 (r=-0.333, p<0.001) and Cuore10 (r=-0.276, p<0.001) risk scores. With increasing DAD5 risk profiles patients presented higher prevalence of altered IHDS: 14.1% (low risk), 32.7% (intermediate risk) and 57.1% (high risk). Similar results were observed with Cuore10 risk strata (both for IHDS and FAB tests). Conclusions: A significant proportion of HIV-positive efficaciously treated patients present altered neurocognitive screening tests (12.9% to 24.9%); this prevalence increases significantly in patients with high cardiovascular risk (28.6% to 57.1%). Beyond supporting the possible influence of cardio- and cerebrovascular abnormalities in HAND, these data suggest to screen for neurocognitive disorders patients with high cardiovascular risk profile. 488 Aerobic Exercise Attenuates Cognitive Decline and Brain Volume Loss AssociatedWith HIV Brian Basco 1 ; Mario Ortega 1 ; Jodi M. Heaps 3 ; Laurie Baker 2 ; FlorinVaida 4 ; Beau Ances 1 1 Washington University School of Medicine, St. Louis, MO, US; 2 University of Missouri St. Louis, St. Louis, MO, US; 3 Missouri Institute of Mental Health, St. Louis, MO, US; 4 University of California San Diego, San Diego, CA, US Background: HIV infected (HIV+) individuals are now reaching an advanced age, through stable treatment with highly active anti-retroviral therapy (HAART). However, HIV and aging are still risk factors for cognitive decline and neuropathologic deterioration seen in magnetic resonance imaging (MRI). Healthy lifestyle factors such as regular exercise may provide benefits to HIV+ individuals. Few studies have shown definitive benefit of aerobic exercise (AE) to HIV+ cognitive status, and none have used MRI. In this study we determine if a history of AE is beneficial to brain integrity and neurocognitive test scores in a cohort of HIV+ individuals. Methods: A cross-sectional cohort of 70 HIV+ individuals (19-82 age range) had neuropsychological performance (NP) testing, neuroimaging, and completed an extensive self-report AE questionnaire that split the cohort into physically active (n=22) and sedentary (n=48) groups. Student’s t-tests were used to analyze demographics. Analysis of variance (ANOVA) was used to study main effects of exercise on a brief NP battery, which consisted of the following tests: Trail Making Tests A and B, Hopkins Verbal Learning Test, Digit-Symbol Coding, F-A-S and Verbal Fluency. NP tests were grouped by executive and motor function for analysis. ANOVAs were also used to study the effects of exercise upon brain volumes. This included brain volumes affected by HIV, such as the caudate and putamen, regions affected by exercise, such as the hippocampus, and general brain regions like total gray and total white matter Results: Active and sedentary HIV+ individuals were similar for age, sex, education, and laboratory values. Physically active HIV+ patients performed significantly better than sedentary HIV+ participants on NP tests of executive (p=.04, mean Z scores of -0.654 and -0.956 respectively, [95% CI, 0.27, 0.72]) but not motor function (p=.13, mean Z scores of -0.331 and -0.827, respectively). Additionally, physically active HIV+ individuals had a significantly larger putamen ( p =0.028) across the lifespan compared to the sedentary cohort. Conclusions: Across a range of ages, AE may maintain healthy brain volumetrics in HIV+ individuals and led to improved cognitive performance. Future studies should consider exercise as an adjunctive therapy to HAART for HIV+ individuals.

Poster Abstracts

327

CROI 2015