CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

Conclusions: The four risk prediction equations underestimated the 10-year risk of CVD in our large, diverse cohort of HIV-infected adults. To better estimate CVD risk in HIV- infected persons in the U.S., additional risk factors, such as immunologic or virologic status may need to be considered. 748 Incidence and Risk of Myocardial Infarction (MI) by Type in the NA-ACCORD Daniel R. Drozd 1 ; Mari M. Kitahata 1 ; Keri N. Althoff 2 ; Jinbing Zhang 2 ; Susan R. Heckbert 1 ; Matthew J. Budoff 3 ; Frank J. Palella 4 ; Daniel B. Klein 5 ; Richard D. Moore 6 ; Heidi M. Crane 1 1 University of Washington, Seattle, WA, US; 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US; 3 University of California Los Angeles, Los Angeles, CA, US; 4 Northwestern University, Chicago, IL, US; 5 Kaiser Permanente Northern California, Hayward, CA, US; 6 Johns Hopkins University, Baltimore, MD, US Background: HIV-infected persons may be at increased risk for cardiovascular disease (CVD) and MI, but the role of HIV in the pathogenesis of MI is unclear. The Universal Definition of MI (UDMI) classifies MIs by underlying pathophysiology into classic primary (type 1) MIs due to atherothrombotic coronary plaque rupture and secondary (type 2) MIs resulting from supply-demand mismatch caused by a heterogeneous set of clinical conditions including sepsis and cocaine-induced vasospasm. In the general population, primary MIs are more common than secondary MIs. Prior studies in HIV have not classified the type of MI and therefore, have examined primary and secondary MIs as a single endpoint, which may limit their ability to define the contribution of HIV to CVD and primary MI risk. We determined the incidence of adjudicated primary MIs distinct from secondary MIs and examined baseline risk factors for primary MIs. Methods: MIs were centrally adjudicated in 7 NA-ACCORD clinical cohorts between 1996-2010 in patients who screened positive and classified according to the UDMI; primary events included invasive cardiac interventions (CABG, stent placement). Incidence rates (IRs) per 1,000 person-years (PY), adjusted incidence rate ratios (aIRRs), and 95% confidence intervals ([,]) were estimated using Poisson regression adjusted at baseline for sex, race/ethnicity, HIV risk group, year of enrollment, cohort, ever smoked, hypertension (HTN), diabetes (DM), dyslipidemia, chronic kidney disease (CKD), CD4 count, and HIV RNA (viral load); age was time-updated. Results: There were 24,919 patients who experienced 262 primary and 205 secondary MIs in 95,728 PYs of follow-up: primary MI IR=2.74 [2.42, 3.09] and secondary MI IR=2.14 [1.87, 2.46]. Significant predictors of primary MI included age, HTN, DM, dyslipidemia, smoking, stage 4/5 CKD, and CD4 count (Table 1). Sepsis (33%), cocaine (8%), respiratory failure (5%), and hypertensive emergency (4%) combined accounted for 50% of all secondary MIs.

Oral Abstracts

Conclusions: Traditional CVD risk factors and immunosuppression significantly predict primary MIs. The high rate of secondary MIs emphasizes the need for greater clarity in outcome ascertainment in studies seeking to study the pathogenic role of HIV in CVD. Future analyses will examine the complex longitudinal relationship between primary MIs and HIV-specific factors including CD4 count, viral load, and ART. 750 HIV-Infected Veterans and the New ACC/AHA Cholesterol Guidelines: Got Statins? Meredith E. Clement 1 ; Lawrence Park 1 ; Ann Marie Navar-Boggan 1 ; Nwora L. Okeke 1 ; Michael Pencina 1 ; Pamela Douglas 1 ; Susanna Naggie 1 1 Duke University, Durham, NC, US; 2 Duke University, Durham, NC, US; 3 Duke University, Durham, NC, US Background: Cardiovascular disease, an HIV-associated non-AIDS related (HANA) condition, is an emerging threat to people living with HIV; thus, appropriate primary and secondary prevention is critical. In November 2013 updated guidelines for cholesterol treatment from the American College of Cardiology and the American Heart Association (ACC/ AHA) substantially expanded recommendations for statin use among the general population for cardiovascular disease (CVD) prevention compared to the prior Adult Treatment Panel (ATP-III) guidelines. How these new recommendations impact adults with HIV-infection is unknown. Methods: We used the Veterans Affairs (VA) Clinical Case Registry (CCR), one of the largest clinical databases of HIV-infected patients worldwide, to determine the impact of the new the new cholesterol guidelines on statin recommendations for HIV-infected veterans. Electronically available laboratory, medication, and comorbidity data from 2008 to 2010 were used to assess statin recommendations under the ATP-III and the 2013 AHA/ACC guidelines among male patients aged 40 to 75 years. Descriptive statistics are presented comparing the proportion of adults recommended under each guideline. Results: 13293 male veterans with HIV-infection met inclusion criteria for the analysis. The average age was 54.6 years. Cardiovascular disease was present in 8.2% and diabetes in 15.4%. Of 13293 veterans, 5185 (39.0%) had been prescribed statin therapy (32.2% for primary prevention and 6.8% for secondary prevention). Overall, 11.6% of adults not previously eligible for statin therapy under ATP-III were newly recommended under ACC/AHA guidelines, with 7085 (53.3%) veterans recommended for statin therapy under the ATP-III guidelines compared to 8630 (64.9%) under the ACC/AHA guidelines. The majority of the increase in statin eligibility was in adults recommended for primary prevention; with 9.1% newly recommended based on 10-year risk score, 1.7% newly recommended based on diabetes, and 0.8% newly recommended based on presence of CVD.

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CROI 2015