All CROI conference materials are online now. Here are a few more abstracts focused on HIV and aging issues from CROI 2016. Be sure to go online and check the full posters and summaries for more details.
Central Nervous System Related Abstracts:
Cognitive Function in HIV:
In an interesting study looking at the antidepressant paroxetine and the antifungal fluconazole together and separately in cognitive function, the investigators found that the fluconazole had anti-inflammatory properties but no effect on performance. The fluconazole also reduced oxidative stress and improved immune markers. The paroxetine was shown to improve cognitive performance.
Abstract 146: Paroxetine and Fluconazole Therapy for HAND: A Double-Blind, Placebo-Controlled Trial. Sacktor et al. Johns Hopkins Univ Sch of Med, Baltimore, MD, USA;2NIH, Bethesda, MD, USA
This was the first time at CROI there was a dedicated themed discussion session on Stroke. There were also other stroke focused abstracts included in other sessions (Complications Head to Toe). We’ve highlighted one of the abstracts from the “Complications Head to Toe” Session and encourage everyone to check the Themed Discussion (Abstracts 636-640) which included confirming stroke diagnoses in research, types of stroke in HIV (ischemic vs hemorrhagic), strokes in co-infected patients and more on women’s risk of stroke. The session confirmed the importance (as in the abstract below) of traditional risks factors like smoking and blood pressure as well as the role of immunosuppression and viremia as risk factors.
In a study of almost 7000 participants in ALLRT (longitudinal ACTG trials cohort), the researchers examined incidence of stroke or TIA and risk factors for stroke and TIA. In age adjusted analyses, risk factors that were significantly associated with increased risk of stroke included both traditional (hypertension, LDL >160, renal dysfunction) as well as HIV related factors (detectable viral load). There was also a trend towards higher age adjusted risk of stroke in women and higher risk was also seen in black participants.
Abstract 43 Stroke Incidence Highest in Women and Black HIV-Infected Participants in ALLRT Cohort
Chow et al. UCSF, Harvard PH. UCSD. BU Med.
A few posters focused on risk prediction tools as there is an ongoing need for providers to have CVD risk tools to help predict risk in PLWH. We have highlighted Abstract 42, an oral presentation from “Complications Head to Toe” here below. Of note, Abstract # 643 also discussed that the ACC/AHA guidelines underestimated the need for statins in HIV+ persons who had carotid artery plaque in the study. Abstract #642 which was a study of male Veterans, showed DAD risk score had slightly better prediction than the ACC/AHA guidelines and also presented a new model for risk prediction in Veterans. It is clear that this is a needed area of ongoing work and that it may mean new models for risk prediction in HIV will be needed.
Crane et al. Using data on MI from CNICS, the performance of 3 risk scores developed in the general population (Framingham, ACC/AHA, ATP-3 ) and the DAD risk score (developed in PLWH) were compared for both type 1 and type 2 MIs. ACC/AHA had better test characteristics (AUC) for Type 2 MI and was similar to other tests for other outcome measures and the authors plan to do additional work to determine the utility of this test.
Abstract #42: Comparing Cardiovascular Disease Risk Scores for Use in HIV-Infected Individuals
Crane et al.
Frailty and Functional Impairment:
Erlandson et al. looked at the impact of initial and ongoing ART selection on frailty in HIV+ adults age 40 and older who were enrolled in the HAILO study, a longitudinal study of participants who received initial ART in an ACTG randomized trial. Smoking, low physical activity, obesity and neurocognitive impairment were associated with increased risk of frailty. With regards to ART, being on a NNRTI regimen was associated with frailty. They also examined factors associated with slower gait speed and found that D4T/DDI use was associated with slower gait speed, while integrase inhibitor use seemed to be protective of developing slower gait speed. The authors concluded it appears modifiable risk factors such as smoking and low physical activity could be important for decreasing risk of frailty and that more research is needed to understand the effects of ART on frailty and slow gait speed.
Abstract #719:Frailty Is Associated With NNRTI-Based Initial ART and Modifiable Risks in ACTG 5322
Erlandson et al.
Erlandson et al examined the prevalence of impairment in Instrumental Activities of Daily Living (IADL) and factors associated with IADL impairment. They found that 18% of adults age 40 and older had impairment with at least 1 IADL, with needing assistance with housework, transportation, and shopping most common. Lower education, public insurance (compared to private), smoking, and low physical activity were all associated with IADL impairment. IADL impairment was also more common in people with frailty and neurocognitive impairment. The findings suggest working on modifiable risk factors such as smoking and linking persons to services could help to maintain independence.
Abstract #721: Factors Associated With Limitations in Daily Activity Among Older HIV+ Adults
Erlandson et al.