CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

a number of benefits, potentially useful to lower CVD risk and prevent disease in the HIV population. Statins have been shown to reduce arterial inflammation, reduce monocyte activation and trafficking, and target key systemic inflammatory pathways. In addition, this class of agents reliably lowers LDL and thus may have advantages in reducing both traditional and nontraditional risk factors. Large scale NIH funded studies are now underway to test whether statins can safely prevent CVD in HV and the mechanisms by which this effect may occur.

Session PL-2 Plenary

4AB Auditorium

9:00 am– 9:30 am The Price of Selling Sex: HIV Among Female Sex Workers—The Context and the Public Health Response 135 The Price of Selling Sex: HIV Among Female Sex Workers—The Context and the Public Health Response Frances M. Cowan University College London, London, United Kingdom

Background: HIV prevalence among female sex workers (FSW) remains disproportionately high, on average 13 times higher than among the general population in low and middle income countries. FSW in sub-Saharan Africa are most severely affected. Effective HIV prevention interventions among FSWs include condom promotion, STI management, HIV testing and counselling, gender-based violence prevention, and community organising, but have not been taken to scale in many parts of the world. Structural and social factors further limit uptake of HIV prevention and care services. Mathematical modelling indicates that newer biomedical prevention technologies such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) may provide additional prevention benefits over and above existing interventions, if mechanisms to support uptake, delivery and adherence can be developed and successfully implemented. Additionally, modelling suggests that PrEP is likely to be most cost-effective if used among those at highest risk of infection. Participation by FSW in the design and implementation of programs to ensure that they address local social and structural barriers to their health and rights has been shown to enhance program effectiveness. Modelling the impact of structural interventions suggests that decriminalisation of sex work would provide the greatest prevention gain across a range of settings through its combined effects on violence, police harassment, safer work environments, and HIV transmission pathways. Interventions to increase access to and retention in treatment and care services among FSW also need to be optimised, evaluated and taken to scale in a way that meets their needs. Achieving UNAIDS goal of 90:90:90 will not occur without sex worker led interventions that actively seek to address the social and structural barriers that FSW face when accessing HIV prevention and care services. Conclusions: The presentation will i) describe the epidemiology of HIV among FSWs including the extent of, and the barriers to, their engagement in prevention and care, ii) present research on effective prevention interventions and the novel combination prevention and care approaches that are currently under evaluation iii) review recent modeling studies to look at the potential additive impact of adding these novel approaches. 10:00 am– 12:15 pm Cardiovascular, Bone, and Kidney Health 136 Statin Therapy Reduces Coronary Noncalcified Plaque Volume in HIV Patients: A Randomized Controlled Trial Janet Lo 1 ; Michael Lu 2 ; Ezinne Ihenachor 1 ; JeffreyWei 1 ; Sara Looby 1 ; Kathleen Fitch 1 ; Suhny Abbara 2 ; Gregory Robbins 1 ; Udo Hoffmann 2 ; Steven Grinspoon 1 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA, US; 2 Massachusetts General Hospital, Boston, MA, US Background: Statins reduce cardiovascular events and deter progression of atherosclerosis. No studies have yet assessed the ability of statin treatment to achieve regression of coronary atherosclerosis in HIV-infected patients, a population demonstrated to have elevated risk of myocardial infarction. Methods: In a randomized, double-blind, placebo-controlled trial, 40 HIV-infected participants with subclinical coronary atherosclerosis and low density lipoprotein (LDL)- cholesterol < 130mg/dL were randomized to one year of treatment with atorvastatin or placebo to determine the effect on coronary atherosclerotic plaque as assessed by coronary computed tomography angiography. We quantitatively assessed non-calcified plaque and high risk plaque features (low attenuation, spotty calcification, and positive remodeling index). Results: After 12 months, atorvastatin reduced noncalcified coronary plaque volume compared to placebo (-19.4% [-39.2%, 9.3%] vs. +20.4% [-7.1%, 94.4%], p =0.009). In addition, the number of high risk plaques was significantly reduced by atorvastatin compared to placebo (change in number of low attenuation plaques -0.2 ± 0.8 vs. 0.4 ± 0.7 lesions , p =0.03 and change in number of positively remodeled plaques -0.2 ± 0.5 vs. 0.4 ± 0.9, p =0.04). Direct LDL-cholesterol (-38 ± 29 vs. 11 ± 21 mg/dL, p <0.0001) and lipoprotein-associated phospholipase A 2 (-52.2 ± 36.6 vs. -13.3 ± 42.8 ng/dL, p =0.005) significantly decreased with atorvastatin compared to placebo. Statin therapy was well- tolerated, with low incidence of clinical adverse events or laboratory abnormalities. Conclusions: As compared to placebo , statin therapy reduces noncalcified plaque volume and high risk plaque features in HIV-infected patients with subclinical coronary atherosclerosis. Further studies should assess whether reduction in high risk coronary artery disease may translate into effective prevention of cardiovascular events in this at risk population of HIV patients. 137 Rosuvastatin Arrests Progression of Carotid Intima-Media Thickness in Treated HIV ChrisT. Longenecker 1 ;Ying Jiang 1 ; Sara M. Debanne 1 ; Danielle Labbato 2 ; Bruce Kinley 2 ; Norma Storer 2 ; Grace A. McComsey 1 1 Case Western Reserve University, Cleveland, OH, US; 2 University Hospitals of Cleveland, Cleveland, OH, US Background: Statins slow progression of carotid intima-media thickness (IMT) and prevent cardiovascular events in HIV uninfected subjects. To what degree they may slow progression of carotid disease in HIV-infected patients on antiretroviral therapy (ART) is unknown. Methods: SATURN-HIV was a 96-week double-blind, randomized clinical trial of 10 mg daily rosuvastatin versus placebo among 147 HIV-infected subjects on stable ART with LDL-cholesterol ≤ 130mg/dL and evidence of heightened T-cell activation (CD8+CD38+HLA-DR+ ≥ 19%) or increased inflammation (high sensitivity C-reactive protein ≥ 2mg/L). Randomization was stratified by protease inhibitor use and coronary artery calcium (CAC) score. Common carotid artery IMT (CCA-IMT) and presence of carotid plaque were assessed by ultrasound using semi-automated edge detection software. CAC was measured by gated cardiac CT. The study was designed to have >80% power to detect a 0.118 mm difference in the primary outcome of mean-mean CCA-IMT change. All analyses were intent to treat. Results: Median (Q1, Q3) age was 46 (40, 53) years; 78%were male and 68% African American; 49%were on a protease inhibitor. Baseline median CCA-IMT was similar between groups [0.664 (0.624, 0.772) vs. 0.670 (0.602, 0.752) mm, statin vs. placebo, p=0.50]. At baseline, at least a third had carotid plaque (33% vs. 43%, statin vs. placebo, p=0.24) or detectable CAC (33% vs. 40%, statin vs. placebo, p=0.40). Overall, CCA-IMT progression was slower than anticipated [mean (standard deviation) 96 week change +0.015 (0.071) mm]. Within the placebo group, mean CCA-IMT progressed significantly over 96 weeks, but was unchanged in the statin group (see Figure). Mean difference in annualized rate of CCA-IMT Session O-11 Oral Abstracts Room 6C

Oral Abstracts

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CROI 2015