Prevalence and Evolution of Renal Impairment in People Living With HIV in Rural Tanzania

Abstract Background We assessed the prevalence, incidence, and predictors of renal impairment among people living with HIV (PLWHIV) in rural Tanzania. Methods In a cohort of PLWHIV aged ≥15 years enrolled from January 2013 to June 2016, we assessed the association between renal impairment (estimated glomerural filtration rate < 90 mL/min/1.73 m2) at enrollment and during follow-up with demographic and clinical characteristcis using logistic regression and Cox proportional hazards models. Results Of 1093 PLWHIV, 172 (15.7%) had renal impairment at enrollment. Of 921 patients with normal renal function at baseline, 117 (12.7%) developed renal impairment during a median follow-up (interquartile range) of 6.2 (0.4–14.7) months. The incidence of renal impairment was 110 cases per 1000 person-years (95% confidence interval [CI], 92–132). At enrollment, logistic regression identified older age (adjusted odds ratio [aOR], 1.79; 95% CI, 1.52–2.11), hypertension (aOR, 1.84; 95% CI, 1.08–3.15), CD4 count <200 cells/mm3 (aOR, 1.80; 95% CI, 1.23–2.65), and World Health Organization (WHO) stage III/IV (aOR, 3.00; 95% CI, 1.96–4.58) as risk factors for renal impairment. Cox regression model confirmed older age (adjusted hazard ratio [aHR], 1.85; 95% CI, 1.56–2.20) and CD4 count <200 cells/mm3 (aHR, 2.05; 95% CI, 1.36–3.09) to be associated with the development of renal impairment. Conclusions Our study found a low prevalence of renal impairment among PLWHIV despite high usage of tenofovir and its association with age, hypertension, low CD4 count, and advanced WHO stage. These important and reassuring safety data stress the significance of noncommunicable disease surveillance in aging HIV populations in sub-Saharan Africa.

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Causes of death and associated factors over a decade of follow-up in a cohort of people living with HIV in rural Tanzania

BMC Infectious Diseases ◽

10.1186/s12879-021-06962-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Getrud Joseph Mollel ◽

Lilian Moshi ◽

Hoda Hazem ◽

Anna Eichenberger ◽

Olivia Kitau ◽

...

Keyword(s):

Associated Factors ◽

Causes Of Death ◽

Proportional Hazards ◽

Cd4 Count ◽

People Living With Hiv ◽

Factors Associated ◽

Rural Tanzania ◽

Living With Hiv ◽

Related Mortality

Abstract Background Nearly half of HIV-related deaths occur in East and Southern Africa, yet data on causes of death (COD) are scarce. We determined COD and associated factors among people living with HIV (PLHIV) in rural Tanzania. Methods PLHIV attending the Chronic Diseases Clinic of Ifakara, Morogoro are invited to enrol in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). Among adults (≥ 15 years) enrolled in 2005–2018, with follow-up through April 2019, we classified COD in comprehensive classes and as HIV- or non-HIV-related. In the subset of participants enrolled in 2013–2018 (when data were more complete), we assessed cause-specific mortality using cumulative incidences, and associated factors using proportional hazards models. Results Among 9871 adults (65% female, 26% CD4 count < 100 cells/mm3), 926 (9%) died, among whom COD were available for 474 (51%), with missing COD mainly in earlier years. The most common COD were tuberculosis (N = 127, 27%), non-AIDS-related infections (N = 72, 15%), and other AIDS-related infections (N = 59, 12%). Cardiovascular and renal deaths emerged as important COD in later calendar years, with 27% of deaths in 2018 attributable to cardiovascular causes. Most deaths (51%) occurred within the first six months following enrolment. Among 3956 participants enrolled in 2013–2018 (N = 203 deaths, 200 with COD ascertained), tuberculosis persisted as the most common COD (25%), but substantial proportions of deaths from six months after enrolment onwards were attributable to renal (14%), non-AIDS-related infections (13%), other AIDS-related infections (10%) and cardiovascular (10%) causes. Factors associated with higher HIV-related mortality were sex, younger age, living in Ifakara town, HIV status disclosure, hospitalisation, not being underweight, lower CD4 count, advanced WHO stage, and gaps in care. Factors associated with higher non-HIV-related mortality included not having an HIV-positive partner, lower CD4 count, advanced WHO stage, and gaps in care. Conclusion Incidence of HIV-related mortality was higher than that of non-HIV-related mortality, even in more recent years, likely due to late presentation. Tuberculosis was the leading specific COD identified, particularly soon after enrolment, while in later calendar years cardiovascular and renal causes emerged as important, emphasising the need for improved screening and management.

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Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study

BMC Infectious Diseases ◽

10.1186/s12879-019-4676-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Zahra Gheibi ◽

Zahra Shayan ◽

Hassan Joulaei ◽

Mohammad Fararouei ◽

Shohreh Beheshti ◽

...

Keyword(s):

Immune Deficiency Syndrome ◽

Older Age ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Mena Region ◽

Infected People ◽

Clinical Stages ◽

Living With Hiv ◽

Related Mortality

Abstract Background Human Immunodeficiency Virus (HIV) infection has become a global concern. Determining the factors leading to death among HIV patients helps controlling Acquired Immune Deficiency Syndrome (AIDS) epidemic. Up to now, little is known about mortality and its determinants among people living with HIV in the Middle East and North Africa (MENA) region, including Iran. The purpose of this study was to assess the risk factors of AIDS-Related Mortality (ARM) and Non-AIDS-Related Mortality (NARM) among people with HIV in Iran. Methods This 20-year retrospective study was conducted on 1160 people with HIV whose data were collected from 1997 to 2017. The association of the study outcomes (ARM and NARM) with various study variables, including demographic status at the time of diagnosis and clinical indexes during the follow-up were examined to define the predictors of mortality among the patients. Regarding, Cox proportional hazard and competing risk models were fitted and Adjusted Hazard Ratios (AHR), Sub-distribution Hazard Ratio (SHR) and the 95% Confidence Intervals (CI) were reported. Results during the follow-up period, 391 individuals (33.7%) died with 86,375 person-years of follow-up. Of the total deaths, 251 (64.2%) and 140 (35.8%) were ARM and NARM, respectively. Rates of the mortality caused by AIDS and non-AIDS were 3.2 and 4.5 per 1000 person-months, respectively. Responding to combined Antiretroviral Treatment (cART) 6 months after initiation, receiving Pneumocystis Pneumonia (PCP) prophylaxis, and higher CD4 count at diagnosis, reduced the hazard of ARM and NARM. However, older age, late HIV diagnosis, and last HIV clinical stages increased the hazard of AIDS related to mortality. Additionally, male gender, older age, incarceration history, and last HIV clinical stages increased the non-AIDS mortality. Conclusions Mortality caused by AIDS and non-AIDS remains high among people with HIV in Iran, particularly among males and those with late diagnosis. It seems that applying effective strategies to identify infected individuals at earlier stage of the infection, and targeting individuals with higher risk of mortality can decrease the mortality rate among HIV infected people.

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11. People Living with HIV During the COVID-19 Pandemic: Who Did (or Did Not) Receive Annual Influenza Vaccination?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.213 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S129-S130

Author(s):

Deborah A Kahal ◽

Brian Wharton ◽

Christopher James ◽

Richard Caplan ◽

Bincsik K Arlene

Keyword(s):

Logistic Regression ◽

Influenza Vaccination ◽

Multivariable Analysis ◽

Older Age ◽

High Rate ◽

Categorical Variables ◽

People Living With Hiv ◽

Virologic Suppression ◽

Poverty Level ◽

Living With Hiv

Abstract Background Nationally, younger adults and racial minorities have lower levels of influenza vaccination (influenza vaccination = vaccine) than non-Hispanic White adults. During the 2015-16 season, most vaccine decliners in our program were male, black, and 45-66 years of age. As part of a quality improvement (QI) initiative to increase 2020-21 vaccine coverage amongst PLWH, we sought to compare patient characteristics between vaccine recipients and non-recipients. Methods Our program cares for 60% of Delawareans with HIV. The largest site in Wilmington was the QI site. IRB exemption was received, and pre-defined sociodemographic and HIV-specific variables were extracted from the EMR and CareWare from 1 Oct 2020 through 31 March 2021. Patient reports of external vaccine required confirmation. All PLWH ≥ 18 years of age, including those newly establishing care, met eligibility criteria. Comparisons between vaccinated and unvaccinated PLWH were performed using Wilcoxon rank sum tests for continuous variables and chi-squared tests for categorical variables. A multivariable logistic regression model, including age, sex, race, insurance, poverty level, HIV status, and virologic suppression, was used to predict vaccine. Results 780 patients met study inclusion criteria and 86% (667/780) received vaccine. Characteristics of PLWH with and without vaccine are presented in Table 1. Older age, lower HIV viral load, and virologic suppression had a statistically significant (p< 0.05) association with vaccine receipt in unadjusted analysis. Only older age (p< 0.01) was significantly associated with vaccine in logistic regression modeling (Table 2), however this relationship was non-linear. Table 1. Characteristics of patients living with HIV during the 2020-2021 Influenza vaccination season Table 2. Multivariable Analysis of Baseline Characteristics Conclusion A very high rate of PLWH received vaccine, far exceeding local and national benchmarks, with EMR data unlikely to have fully captured all vaccines. The role of the COVID-19 pandemic in vaccine amongst PLWH is not yet known. While older age was associated with vaccine in adjusted analysis, the number of unvaccinated patients was small, confidence intervals wide, and associations consequently weak. Larger studies are needed to further investigate factors associated with vaccine receipt amongst PLWH. Disclosures Deborah A. Kahal, MD,MPH, FACP, Gilead (Speaker’s Bureau)Viiv (Speaker’s Bureau)

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Viral load as a risk factor of reverse transcriptase inhibitor drug resistance mutation in antiretroviral-treated people living with HIV/AIDS

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2021.v40.243-253 ◽

2021 ◽

Vol 40 (3) ◽

pp. 243-253

Author(s):

Hotma Martogi Lorensi Hutapea ◽

Tri Nury Kridaningsih ◽

Khoirul Huda Prasetyo ◽

Milton Boaheng Antwi

Keyword(s):

Drug Resistance ◽

Logistic Regression ◽

Viral Load ◽

Reverse Transcriptase ◽

Cd4 Count ◽

People Living With Hiv ◽

Multiple Logistic Regression ◽

Living With Hiv ◽

Hiv 1 ◽

Hiv Aids

Background The human immunodeficiency virus type 1 (HIV-1) is a major contagion faced by the population of Indonesia. The success of antiretroviral treatment (ART) is threatened by the emergence of drug resistance mutations (DRM). The aim of this study was to determine the association between CD4 count, CD4 count changes, viral load, adherence to therapy, and therapy history in the presence of DRM in people living with HIV/AIDS (PLWHA). MethodsThis was a cross-sectional study involving 269 adults who underwent antiretroviral (ARV) therapy for at least 6 months. The frequencies of DRM and polymorphisms were measured by partial amplification of the reverse transcriptase (RT) gene using RT-nested PCR on samples with viral loads of >1000 copies/mL. Sequencing was performed using the Sanger method, and edited by BioEdit. The edited sequences were submitted to http://hivdb.stanford.edu for DRM determination. Respondents’ medical data, CD4 count, viral load, and DRM were analyzed by simple and multiple logistic regression. ResultsThe multiple logistic regression analysis showed a significant association of CD4 count (aOR=12.47; 95% CI: 1.45 -107.39; p=0.023) and viral load at the time of study (aOR=29.56; 95% CI: 3.47-251.52; p=0.002) with the presence of DRM in respondents. ARV substitution history was not associated with the presence of DRM. There were 17 respondents (6.3%) carrying HIV-1 DRM, with M184V/I (11 sequences) as the most frequent pattern of NRTI resistance, and K103 (9 sequences) as that of NNRTI resistance. ConclusionThis study demonstrated that viral load at the time of the study was the most influential determinant factor for the presence of DRM in PLWHA.

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Mortality Rate in a Cohort of People Living With HIV in Rural Tanzania After Accounting for Unseen Deaths Among Those Lost to Follow-up

American Journal of Epidemiology ◽

10.1093/aje/kwaa176 ◽

2020 ◽

Author(s):

Fiona Vanobberghen ◽

Maja Weisser ◽

Bryson Kasuga ◽

Andrew Katende ◽

Manuel Battegay ◽

...

Keyword(s):

Proportional Hazards ◽

Clinical Stage ◽

World Health ◽

People Living With Hiv ◽

Hospital Inpatient ◽

Cd4 Cell Count ◽

Rural Tanzania ◽

Lost To Follow Up ◽

Mortality Estimates

Abstract Mortality assessment in cohorts with high numbers of persons lost to follow-up (LTFU) is challenging in settings with limited civil registration systems. We aimed to assess mortality in a clinical cohort (the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO)) of human immunodeficiency virus (HIV)-infected persons in rural Tanzania, accounting for unseen deaths among participants LTFU. We included adults enrolled in 2005–2015 and traced a nonrandom sample of those LTFU. We estimated mortality using Kaplan-Meier methods 1) with routinely captured data (method A), 2) crudely incorporating tracing data (method B), 3) weighting using tracing data to crudely correct for unobserved deaths among participants LTFU (method C), and 4) weighting using tracing data accounting for participant characteristics (method D). We investigated associated factors using proportional hazards models. Among 7,460 adults, 646 (9%) died, 883 (12%) transferred to other clinics, and 2,911 (39%) were LTFU. Of 2,010 (69%) traced participants, 325 (16%) were found: 131 (40%) had died and 130 (40%) had transferred. Five-year mortality estimates derived using the 4 methods were 13.1% (A), 16.2% (B), 36.8% (C), and 35.1% (D), respectively. Higher mortality was associated with male sex, referral as a hospital inpatient, living close to the index clinic, lower body mass index, more advanced World Health Organization HIV clinical stage, lower CD4 cell count, and less time since initiation of antiretroviral therapy. Adjusting for unseen deaths among participants LTFU approximately doubled the 5-year mortality estimates. Our approach is applicable to other cohort studies adopting targeted tracing.

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The Impact of Immediate Initiation of Antiretroviral Therapy on Patients' Healthcare Expenditures: A Stepped-Wedge Randomized Trial in Eswatini

AIDS and Behavior ◽

10.1007/s10461-021-03241-9 ◽

2021 ◽

Author(s):

Janina I. Steinert ◽

Shaukat Khan ◽

Emma Mafara ◽

Cebele Wong ◽

Khudzie Mlambo ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Standard Of Care ◽

Cd4 Count ◽

World Health ◽

Hiv Care ◽

People Living With Hiv ◽

Stepped Wedge ◽

Healthcare Expenditures ◽

Art Initiation ◽

Living With Hiv

AbstractImmediate initiation of antiretroviral therapy (ART) for all people living with HIV has important health benefits but implications for the economic aspects of patients' lives are still largely unknown. This stepped-wedge cluster-randomized controlled trial aimed to determine the causal impact of immediate ART initiation on patients’ healthcare expenditures in Eswatini. Fourteen healthcare facilities were randomly assigned to transition at one of seven time points from the standard of care (ART eligibility below a CD4 count threshold) to the immediate ART for all intervention (EAAA). 2261 patients living with HIV were interviewed over the study period to capture their past-year out-of-pocket healthcare expenditures. In mixed-effects regression models, we found a 49% decrease (RR 0.51, 95% CI 0.36, 0.72, p < 0.001) in past-year total healthcare expenditures in the EAAA group compared to the standard of care, and a 98% (RR 0.02, 95% CI 0.00, 0.02, p < 0.001) decrease in spending on private and traditional healthcare. Despite a higher frequency of HIV care visits for newly initiated ART patients, immediate ART initiation appears to have lowered patients’ healthcare expenditures because they sought less care from alternative healthcare providers. This study adds an important economic argument to the World Health Organization’s recommendation to abolish CD4-count-based eligibility thresholds for ART.

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Failure to return pillbox is a predictor of being lost to follow‐up among people living with HIV on antiretroviral therapy in rural Tanzania

HIV Medicine ◽

10.1111/hiv.13223 ◽

2021 ◽

Author(s):

Robert C. Ndege ◽

James Okuma ◽

Aneth V. Kalinjuma ◽

Julius Mkumbo ◽

Elizabeth Senkoro ◽

...

Keyword(s):

Antiretroviral Therapy ◽

People Living With Hiv ◽

Rural Tanzania ◽

Living With Hiv ◽

Lost To Follow Up

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A retrospective study of survival and risk factors for mortality among people living with HIV who received antiretroviral treatment in a resource-limited setting

AIDS Research and Therapy ◽

10.1186/s12981-021-00397-1 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Weerawat Manosuthi ◽

Lantharita Charoenpong ◽

Chalor Santiwarangkana

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Resource Limited Setting ◽

Cd4 Count ◽

Hiv Care ◽

People Living With Hiv ◽

Resource Limited ◽

Living With Hiv ◽

Limited Setting

Abstract Background The availability and accessibility of effective antiretroviral therapy (ART) for people living with HIV (PLWH) has substantially improved in the past two decades in resource-limited settings. Therefore, evaluation of survival is needed in the current setting. Method We retrospectively analyzed secondary data of the national AIDS program database from national health security region number 4 among PLWH who were ART-naive between January 2014 and December 2018. All PLWH were followed until December 2019 to evaluate their survival status and possible risk factors related to death. Results A total of 42,229 PLWH were identified, of which 14,053 were ART-naive and thus enrolled in the study. Sixty-seven percent were male, the mean ± SD age was 35 ± 12 years, and the median (IQR) baseline CD4 count was 162 (44–353) cells/mm3. Regarding medical care benefits, 46% had a universal health coverage scheme, 34% had a national social security scheme, and 2% had a civil servants medical benefit scheme. A total of 2142 (15%) mortalities occurred during the total follow-up period of 28,254 patient-years. The mortality rate was 7.5 (95% CI 7.2–7.9) per 100 person-years. Survival rates at 1, 2, 3, 4 and 5 years after HIV registration were 88.2% (95% CI 87.6–88.7%), 85.3% (95% CI 84.6–85.9%), 82.9% (95% CI 81.9–83.4%), 81.3% (95% CI 80.5–82.0%) and 75.1% (95% CI 73.5–76.8%), respectively. The Cox proportional hazards model showed that all-cause mortality was associated with a history of ART switching (HR = 7.06, 95% CI 4.53–11.00), major opportunistic infections during ART (HR = 1.93, 95% CI 1.35–2.77), baseline CD4 count ≤ 200 vs. > 500 cells/mm3 (HR = 4.00, 95% CI 1.45–11.11), age ≥ 50 vs. < 30 years (HR = 1.77, 95% CI 1.12–2.78), and receiving nevirapine-based regimens(HR = 1.43, 95% CI 1.04–1.97). Conclusions This study demonstrated the substantial mortality rate over the consecutive 5 years of the follow-up period among PLWH who received ART in a resource-limited setting. Early case finding and prompt initiation of ART as well as continuous HIV care are a cornerstone to improve survival.

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Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania

PLoS ONE ◽

10.1371/journal.pone.0261367 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261367

Author(s):

Herry Mapesi ◽

James Okuma ◽

Fabian Franzeck ◽

Herieth Ismael Wilson ◽

Elizabeth Senkoro ◽

...

Keyword(s):

Renal Impairment ◽

Arterial Hypertension ◽

Protease Inhibitors ◽

Cox Regression ◽

Older Age ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

First Line ◽

Rural Tanzania ◽

Sub Saharan

Objective Ritonavir-boosted protease inhibitors (bPI) in people living with HIV (PLWH) have been associated with renal impairment. Limited data are available from rural sub-Saharan Africa. Methods Using data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we assessed the prevalence of renal impairment (estimated glomerular filtration rate <60 mL/min/1.73m2) at the time of switch from first-line antiretroviral treatment (ART) to bPI-regimen and the incidence of renal impairment on bPI. We assessed risk factors for renal impairment using logistic and Cox regression models. Results Renal impairment was present in 52/687 PLWH (7.6%) at the switch to bPI. Among 556 participants with normal kidney function at switch, 41 (7.4%) developed renal impairment after a median time of 3.5 (IQR 1.6–5.1) years (incidence 22/1,000 person-years (95%CI 16.1–29.8)). Factors associated with renal impairment at switch were older age (adjusted odds ratio (aOR) 1.55 per 10 years; 95%CI 1.15–2.11), body mass index (BMI) <18.5 kg/m2 (aOR 2.80 versus ≥18kg/m2; 95%CI 1.28–6.14) and arterial hypertension (aOR 2.33; 95%CI 1.03–5.28). The risk of renal impairment was lower with increased duration of ART use (aOR 0.78 per one-year increase; 95%CI 0.67–0.91). The renal impairment incidence under bPI was associated with older age (adjusted hazard ratio 2.01 per 10 years; 95%CI 1.46–2.78). Conclusions In PLWH in rural sub-Saharan Africa, prevalence and incidence of renal impairment among those who were switched from first-line to bPI-regimens were high. We found associations between renal impairment and older age, arterial hypertension, low BMI and time on ART.

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Improved HIV markers and decreased emergencyroom usage and hospital admission with initiation of a pilot specialty pharmacy at a southeastern Ryan –White –funded clinic over a three year period

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1048 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S419-S419

Author(s):

Minh Ly Nguyen ◽

Alton Condra ◽

Della Corbin-Johnson ◽

Kay Woodson ◽

Manish Patel ◽

...

Keyword(s):

Hospital Admission ◽

Emergency Room ◽

Cd4 Count ◽

People Living With Hiv ◽

Assistance Program ◽

Ryan White ◽

Specialty Pharmacy ◽

Living With Hiv ◽

Hiv Aids

Abstract Background Specialty pharmacy (SP) provides timely medication delivery to patients and seeks to improve patient adherence through monthly pharmacist medication therapy management (MTM). Patients living with HIV/AIDS have both high cost medications and complex disease states and thus will benefit from SP. We report on the outcome of HIV therapy after 3 years of a pilot SP ina southern inner city RW funded clinic. Methods This is a single center retrospective chart review of patients at our clinic who were enrolled in the SP from 6/3/13–5/1/16 for at least 6 months. Baseline demographic characteristics and HIV markers (CD4, viral load) were collected. Outcomes of interest were: change in CD4 count, percent with viral suppression (VS), emergency room (ER) and hospital admission usage, as well as percent of scheduled providers’ appointment kept. Each individual had the same follow up time before and after SP initiation. Bivariate analysis compared outcomes preSP and during SP using Chi-square or Fisher exact tests for categorical and Wilcoxon rank-sum test for continuous variables. Results During the 3-year period, there were 212 individuals referred to SP, of which 170 participated in the program. There were 92(54%) men, 136(80%) black. The median age was 48.3 years (IQR: 28.5–56.3). The average duration of follow up pre and during SP was 22.1(IQR: 16.5–27) months. In terms of insurance, 69(40%) had Medicare, 22(13%) had Medicaid, 22(13%) had private insurance, 54(32%) received AIDS drug Assistance Program (ADAP), and 3(2%) had Ryan White. Patients resided an average distance from the clinic of 17.4(IQR: 8.8–25) miles. The respective outcomes before and during SP were: CD4: 350(IQR: 181–551) vs. 413(IQR: 263–611 cells/mL (P < 0.0001), VS in 78 ± 30% vs. 91 ± 20% (P < 0.0001). The proportion of patients with emergency room usage or hospital admissions was 68(40%) vs. 49(29%) (P = 0.036). There was no difference in the rate of kept providers’ appointment (66.6 %(IQR: 53.8–78.6%) vs. 63.8 %(50-77%) (P = 0.19). There was no reported death during the follow –up period. Conclusion This pilot SP program at the RW clinic showed statistically significant improvement of CD4 count and VS, as well as 40 % decrease in odds of using ER or hospital admission. Further studies are needed to determine whether SP is beneficial to people living with HIV/AIDS in other settings. Disclosures M. Patel, ViiV: Scientific Advisor, Consulting fee

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