CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

581 WITHDRAWN 582 Impact of Specific Antiretroviral Drugs on Non-AIDS Mortality; the D:A:D Study Camilla I. Hatleberg 1 ; Lene Ryom 1 ; Andrew N. Phillips 2 ; Amanda Mocroft 2 ; Peter Reiss 3 ; Matthew Law 4 ; RainerWeber 5 ; François Dabis 6 ; Jens D. Lundgren 1 ; Colette Smith 2 On behalf of the D:A:D Study group 1 Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 2 University College London, London, United Kingdom; 3 Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; 4 University of New South Wales, Sydney, Australia; 5 University Hospital Zurich, Zurich, Switzerland; 6 University of Bordeaux, Bordeaux, France Background: In previous studies, protease inhibitors (PIs) have been associated with an increased risk of death and non-AIDS events, such as cardiovascular events and non-AIDS cancers. We investigated whether specific PIs and non-nucleoside transcriptase inhibitors (NNRTIs) are associated with increased non-AIDS mortality. Methods: D:A:D study participants were followed from study enrolment until earliest of death, 1/2/2013 or last clinic visit. Exposure to specific PIs/NNRTIs was classified as recent (current use/use in last 6 months) or cumulative (/year). Poisson regression compared relative death rates (RR) for both types of exposure in two separate models. Follow-up among individuals dying from AIDS-related causes was censored on date of death. Results: 3276 non-AIDS deaths occurred in 371,333 person years (PYRS) (incidence: 8.8/1000 PYRS; 95% CI; 8.5-9.1). In follow-up for which the current CD4 count was >500 cells/ mm3, death rates were highest for those currently receiving indinavir (rate: 7.4; 5.4-9.5) and lowest for those currently receiving efavirenz (EFV 4.2; 3.6-4.9). Relative differences were similar across time-updated CD4 /viral load (VL) strata. After adjustment, there was no significant association between recent exposure to commonly used PIs and increased death rates. In contrast, recent exposure to EFV (RR: 0.86) was significantly associated with a decreased death rate (Figure). For cumulative exposure (RR/year longer), the commonly used PIs/NNRTIs lopinavir/ritonavir (LPV/r), atazanavir (ATV), saquinavir (SQV) and nevirapine (NVP) were significantly associated with small increases in death rates (Figure). Corresponding RR/10 years longer were; LPV/r (1.69; 1.36-2.09), ATV (1.69; 1.24; 2.30), SQV (1.50; 1.18- 1.89) and NVP (1.34; 1.14-1.58). Results were consistent across CD4/ VL strata; when restricting analyses to those currently on antiretroviral drugs; excluding unknown causes of deaths and excluding intravenous drug users.

Poster Abstracts

Conclusions: Our findings, based on a substantial sample size, suggest that cumulative exposure to some PI/NNRTIs is associated with a small but gradual increased risk of non-AIDS mortality. This effect is consistent among various types of PIs and of an extent comparable to earlier findings for non-AIDS events. Conversely, recent exposure to EFV was associated with a reduced risk of non-AIDS mortality. Choice of PIs/NNRTIs may affect long-term prognosis and although potential confounding cannot be ruled out, results argue for continued pharmacovigilance. 583 HIV-Related Causes of Death in the Era of Antiretroviral Therapy: Analysis of Verbal Autopsy Data Clara Calvert 1 ; Zehang Li 2 ;Tyler McCormick 2 ; Alison Price 1 ; Kobus Herbst 4 ; Denna Michael 3 ; Estelle McLean 1 ; Basia Zaba 1 ; Samuel Clark 2 On behalf of the ALPHA network 1 London School of Hygiene and Tropical Medicine, London, United Kingdom; 2 University of Washington, Seattle, WA, US; 3 National Institute for Medical Research, Mwanza, United Republic of Tanzania; 4 Africa Centre for Health and Population Studies, Mtubatuba, South Africa Background: Mortality rates remain higher in HIV positive than HIV negative individuals despite the introduction of antiretroviral therapy (ART). Understanding the causes of death in HIV positive individuals, and how these have altered with ART treatment, will help direct interventions to prevent these deaths. Since causes of death are not medically certified in sub-Saharan Africa we rely on interpretation of verbal autopsy data to generate cause of death information.

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CROI 2015