CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Results: There were 2392 participants with a median age of 43 years; 76%were male, 50%were non-Hispanic white, and 87%were antiretroviral experienced at baseline. Common co-morbid conditions included hypertension (50%), diabetes (10%), and high cholesterol (17%). In this cohort, 204 incident CVD events occurred during a median follow- up time of 6.5 years. All equations underestimated 10-year CVD risk to a variable degree (Table 1). The FPS, PCE, and D:A:D equations showed moderate discrimination (C-statistic range, 0.68 to 0.72), whereas SCORE showed poor discrimination (C-statistic=0.59).

Comparison of 10-year cardiovascular disease (CVD) risk estimation and discrimination in four CVD risk calculators in HIV-infected adults from the HIV Outpatient Study (HOPS). 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.

Poster 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.

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CROI 2015