Autonomic Neuropathy as a Predictor of Morbidity and Mortality in People Living with HIV: A Retrospective, Longitudinal Cohort Study (P9-9.006)

Abstract

<h3>Objective:</h3> This study aimed to evaluate whether HIV-AN is predictive of important adverse clinical outcomes. <h3>Background:</h3> HIV-associated autonomic neuropathy (HIV-AN) is common, however, its clinical impact is unclear. It is known that the composite autonomic severity score (CASS) is associated with markers of morbidity such as the Veterans Affair Cohort Study (VACS) index. Additionally, it is known that cardiovascular autonomic neuropathy due to diabetes is associated with poor cardiovascular outcomes. <h3>Design/Methods:</h3> The electronic medical records of HIV-infected participants who underwent autonomic function tests at the Mount Sinai Hospital between April 2011 and August 2012 were reviewed. The cohort was stratified into those who had no or mild autonomic neuropathy (HIV-AN [-], CASS&lt;/=3) and those with moderate or severe autonomic neuropathy (HIV-AN [+], CASS&gt;3). The primary outcome was a composite of the incidence of death from any cause, new major cardiovascular or cerebrovascular event, or development of severe renal or hepatic disease. Time to event analysis was performed. <h3>Results:</h3> 111 of 114 participants had follow-up data (median follow up for HIV-AN[-] was 94.00 months and HIV-AN[+] was 81.29 months) and were analyzed. Participants were followed until March 1^st, 2020. The HIV-AN[+] group (N=42) was significantly associated with the presence of hypertension, higher HIV-1 viral load, and more abnormal liver function. 17 (40.48%) events occurred in the HIV-AN[+] group, and 11 (15.94%) occurred in the HIV-AN[−] group. 6 (14.29%) cardiac events occurred in the HIV-AN[+] group, whereas 1 (1.45%) occurred in the HIV-AN[−] group. The other subgroups of the composite outcome had a similar trend. The adjusted Cox proportional hazards model showed that the presence of HIV-AN predicted our composite outcome (HR 3.85, CI 1.61–9.20). <h3>Conclusions:</h3> HIV-AN is associated with the development of severe morbidity and mortality in people living with HIV. People living with HIV with autonomic neuropathy may benefit from closer cardiac, renal, and hepatic surveillance. <b>Disclosure:</b> Dr. Kwon has nothing to disclose. Mr. Lawrence has nothing to disclose. Mr. Figueroa has nothing to disclose. The institution of Dr. Robinson Papp has received research support from NIH. Dr. Robinson Papp has received publishing royalties from a publication relating to health care.