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OBJECTIVES: To determine baseline prevalence of proteinuria and albuminuria among REPRIEVE participants and evaluate associated risk factors. DESIGN: Cross sectional analysis of a baseline sample of participants from the REPRIEVE Trial. METHODS: REPRIEVE is an international primary cardiovascular prevention RCT of pitavastatin calcium vs. placebo among PWH on antiretroviral therapy. A representative subset (2791 participants) had urine collected at study entry. Urine protein to creatinine ratios (uPCR) and albumin to creatinine ratios (uACR) were classified as normal, moderately increased and severely increased. These were dichotomized to Normal or Abnormal for log-binomial regression analysis. Demographic, cardiometabolic, and HIV-specific data were compared among those with normal versus abnormal results. RESULTS: Overall, median age 49 years, 41% female sex, 47% black or African American race, 36% had eGFR <90 mL/min/1.73 mm2. For uPCR, 27% had moderately or severely increased values. For uACR, 9% had moderately or severely increased values. In the fully adjusted model for proteinuria, female sex, older age, residence in sub-Saharan Africa or East Asia, lower BMI, lower CD4 cell count, and use of TDF were associated with abnormal values. In the fully adjusted model for albuminuria, a diagnosis of HTN was associated with abnormal values. CONCLUSIONS: Abnormal proteinuria and albuminuria remain common (27% and 9%) despite controlled HIV. Lower current CD4 count and TDF use were strongly associated with proteinuria. Certain modifiable comorbidities, including HTN and smoking, were associated with abnormal values. In PWH with preserved eGFR, urine measures identify subclinical kidney disease and afford the opportunity for intervention.

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OBJECTIVE: Diabetes mellitus (DM) is associated with lower antiretroviral (ART) drug exposure among persons with HIV (PWH) compared to PWH without DM. The association between DM and virologic control in PWH, however, remains unknown. METHODS: We included participants in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) who had initiated ART between 1999 and 2020 and had a suppressed HIV viral load (≤200 copies/mL) within 1 year of ART initiation. We compared the frequency of incident HIV viremia (HIV-1 RNA >200 copies/mL) between adult PWH with and without DM. Poisson regression was used to examine the rate of incident viremia based on the diagnosis of DM among PWH. DM was defined as two consecutive fasting glucose measurements ≥126 mg/dL, use of anti-diabetic medications, pre-existing DM diagnosis, or a confirmed HbA1c >6.5%. RESULTS: 1,061 women (112 with DM, 949 without DM) and 633 men (41 with DM, and 592 without DM) were included in the analysis. The relative rate (RR) of incident HIV viremia for women with HIV and DM was lower when compared to women without DM (0.85 [95% CI: 0.72-0.99]; p = 0.04). The RR of incident viremia for women with uncontrolled DM (HbA1c>7.5%) was higher when compared to women with controlled DM (HbA1c <7.5%) (1.46 [95%CI: 1.03-2.07]; p = 0.03). In contrast, the RR of incident viremia for men with HIV and DM was not statistically different compared to men without DM (1.2 [95%CI: 0.96- 1.50]; p = 0.12). The results were stratified by adherence levels (100%, 95-99%, and less than 95% based on self-report). CONCLUSIONS: Women with DM who are highly adherent to ART (100% self-reported adherence) have a lower risk of viremia compared to women with HIV without DM. However, women with poorly controlled DM were at higher risk of HIV viremia than women with controlled DM. Further research is necessary to understand the impact of sex, DM, and ART adherence on HIV viremia.

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We report 12 patients with persistent viremia on oral antiretroviral therapy who were initiated on injectable cabotegravir/rilpivirine (iCAB/RPV) without oral lead-in. All patients achieved viral suppression without any virologic rebound. iCAB/RPV may be considered as an option for patients unable to maintain suppression on oral antiretroviral therapy.

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Adherence to antiretroviral therapy (ART) and engagement in HIV care is critical to decrease HIV transmissions and optimize outcomes in people with HIV (PWH). In 2016, the CDC reported that 63% of incident HIV diagnoses were transmitted by PWH who were aware of their status but not virally suppressed. Adult Special Care Clinic (ASCC) designed and implemented a quality improvement (QI) program to facilitate linkage and increase viral suppression rates in PWH. ASCC utilized identified barriers to create a Linkage to Care (LTC) program with multiple components, including a LTC coordinator, proactive outreach, and standardized protocols. Logistic regression was used to compare 395 PWH enrolled during the post-QI phase (01 January 2019-31 December 2021) to 337 PWH enrolled during the pre-QI phase (01 January 2016-31 December 2018). Newly diagnosed PWH enrolled during the post-QI phase had significantly higher odds of achieving viral suppression compared to those enrolled during the pre-QI phase (aOR 2.22, 95% CI 1.37-3.59, p = .001). There was no significant difference between previously diagnosed but unengaged PWH enrolled during pre- and post-QI phases, although absolute viral suppression increased from 66.1 to 71.5% in this group. Both increasing age and having private insurance increased the likelihood of achieving viral suppression. Results highlight the potential impact on linkage to care and viral suppression rates of a standardized LTC program, addressing barriers to care for PWH. Additional focus should be placed on previously diagnosed but unengaged PWH to determine what parts of the intervention may be modified to increase viral suppression rates.

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