CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: In a large contemporary cohort of HIV-positive individuals we observed a strong relation between confirmed impaired kidney function and incident CVD. This finding highlights the need for an intensified monitoring for emerging CVD, in particular in older individuals with continuously low eGFR levels, and an increased focus on renal preventive measures. 743 Smoking, Other Substance Use and Coronary Atherosclerosis Among HIV-Infected and Uninfected Men Sean G. Kelly 1 ; Michael Plankey 3 ;Wendy Post 2 ; Xiuhong Li 2 ; Ron Stall 4 ; Lisa P. Jacobson 2 ; MalloryWitt 5 ; Lawrence Kingsley 4 ; Christopher Cox 2 ; Frank J. Palella 1 1 Northwestern University, Chicago, IL, US; 2 Johns Hopkins University School of Medicine, Baltimore, MD, US; 3 Georgetown University, Washington, DC, US; 4 University of Pittsburgh, Pittsburgh, PA, US; 5 University of California Los Angeles, Los Angeles, CA, US Background: HIV infection is associated with subclinical atherosclerosis. Recreational substance use is prevalent among HIV-infected (HIV+) persons. Associations between substance use and coronary plaque by HIV serostatus are not well-characterized. Methods: We studied 1005 men who have sex with men in the Multicenter AIDS Cohort Study (612 HIV+ and 384 HIV-uninfected [HIV-]), all of whom had non-contrast CT scanning to measure coronary artery calcium (CAC) and 764 had coronary CT angiograms. Self-reported recreational substance use, including alcohol (ETOH), tobacco, stimulants, marijuana, inhaled nitrites, and drugs to treat erectile dysfunction (EDD) was obtained at each semiannual visit beginning 10 years prior. Logistic (for plaque presence) and linear (for log-transformed plaque scores if >0) regression models were performed stratified by HIV serostatus and adjusted for age, race, education, cardiovascular disease risk factors and, for HIV +men, HIV clinical factors. Results: In HIV+men, current smoking was more prevalent than in HIV- men (31% vs. 22%), as were greater pack years (pk-yrs) of smoking (HIV+, 14 ± 19; HIV-, 12 ± 18). In HIV+ men only, current smoking was positively associated with presence of CAC, any plaque, calcified plaque (CP) and coronary artery stenosis >50% (OR 2.3 [1.3-3.9], 2.3 [1.1-4.7], 2.0 [1.1-3.9], 2.6 [1.1-6.0]), former smoking with CP and stenosis (OR 2.2 [1.2-3.8], 2.2 [1.1-4.7]) and heavy ETOH use (>14 drinks/week) with stenosis (OR 4.7 [1.5-14.8]). In HIV- men, cumulative pk-yrs of smoking was associated with CAC (OR 1.02 [1.002-1.03] per year) and stenosis (OR 1.02 [1.0001-1.04]), moderate (1-14 drinks/week) and heavy ETOH use were inversely associated with CAC extent ( β -0.69, -1.14; p=0.02, p=0.02), heavy ETOH use inversely with CP extent ( β -0.89, p=0.001) and binge drinking (> 5 drinks > once in the prior 30 days) positively with CP extent ( β 0.85, p=0.02). Marijuana use was positively associated with CAC extent in HIV- men ( β 0.005, p=0.02) and EDD use with CP extent in HIV+men ( β 0.06, p=0.02). No significant associations between plaque and cumulative stimulant or nitrite use were seen. Conclusions: Smoking is common and strongly associated with subclinical coronary atherosclerosis among HIV+men. Our findings underscore the value of effective smoking cessation strategies targeting HIV+ persons to decrease cardiovascular disease burden. Other forms of substance use, other than ETOH, were not consistently associated with atherosclerosis. 744 Pericardial Fat Density: A Novel Marker of Cardiometabolic Risk in HIV Infection Chris T. Longenecker ; Mark Schlucter;Yiying Liu; Grace A. McComsey Case Western Reserve University, Cleveland, OH, US Background: Pericardial fat volume is associated with inflammation, insulin resistance, and vascular disease in HIV-infected patients on antiretroviral therapy (ART). The relationship between pericardial fat density, inflammation, and cardiometabolic risk in this population is unknown. Methods: Pericardial fat volume and density [mean Hounsfield Units (HU)] were measured by cardiac computed tomography in 147 HIV-infected patients on ART. Pearson correlations were used to examine the relationship between fat density and markers of cardiometabolic risk. Multivariable linear regression was used to explore the relationship of pericardial fat to insulin resistance. Non-normally distributed variables were log-transformed for all analyses. Results: Median (Q1, Q3) age was 46 (40, 53) years; 78%were male and 68% African American; 49%were on a protease inhibitor. Median homeostatic model of insulin resistance (HOMA-IR) was 1.84 (1.06, 3.33). Median pericardial fat volume was 68 (47, 92) ml and density was -86.8 (-88.7, -85.0) HU. Pericardial fat volume and density were modestly negatively correlated (r= -0.366, p<0.001). Pericardial fat density negatively correlated with duration of ART use (r= -0.206, p=0.017) and protease inhibitor use (r= -0.227, p= 0.014). In contrast to volume, density did not correlate with measures of total body adiposity (BMI r=0.057 and total body fat by DEXA r=-0.034, both p>0.4), but was negatively correlated to waist-hip ratio (-0.337, p<0.001). In a multivariable model, pericardial fat density was associated with insulin resistance independent of pericardial fat volume, BMI, metabolic syndrome, and biomarkers of monocyte immune activation and systemic inflammation (see Table). .

Poster Abstracts

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CROI 2015