CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

749LB Abacavir Use and Risk for Myocardial Infarction in the NA-ACCORD Frank J. Palella 1 ; Keri N. Althoff 2 ; Richard Moore 3 ; Jinbing Zhang 2 ; Mari Kitahata 4 ; Stephen J. Gange 2 ; Heidi M. Crane 4 ; Daniel R. Drozd 4 ; JohnT. Brooks 5 ; Richard Elion 6 1 Northwestern University, Feinberg School of Medicine, Chicago, IL, US; 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US; 3 Johns Hopkins University, Baltimore, MD, US; 4 University of Washington, Seattle, WA, US; 5 US Centers for Disease Control and Prevention, Atlanta, GA, US; 6 George Washington University, Washington, DC, US Background: Whether abacavir (ABC) exposure contributes to myocardial infarction (MI) risk remains unclear. Large observational studies, including D:A:D, found ABC use associated with nearly 2-fold increased MI risk; other studies have found no association. We evaluated MI risk associated with recent ABC use among patients in the largest North American cohort study: NA-ACCORD. Methods: Incident MIs from seven U.S. cohorts of HIV-infected persons in NA-ACCORD were centrally adjudicated using MESA criteria and classified per the Universal Definition of MI as either atherothrombotic (type 1) or demand ischemia (type 2). Adults who were ABC-naïve at entry were included and followed until MI, death, one year after last CD4 or HIV RNA measurement, or 12/31/2010. Recent ABC use was defined as prescription within the prior 6 months. We used pooled logistic regression models to estimate adjusted hazard ratios and 95% confidence intervals for MI risk associated with recent ABC use adjusting for demographics, cigarette smoking, diabetes, hypertension, renal impairment, high total cholesterol, high triglycerides, statin use, CD4, previous protease inhibitor use, calendar year, and cohort. Results: 16,733 adults contributed 301 incident MIs and 64,607 person-years of follow up. Persons who initiated ABC were significantly more likely to have traditional MI risk factors (older age, smoking, hypertension, low HDL, high total cholesterol, and black race) and factors linked to inflammation (history of IDU, HCV infection, CD4 <200 cells/mm 3 , detectable HIV RNA, and history of AIDS). Without adjustment, the MI risk associated with recent ABC use was 1.88 (1.35, 2.60). In an adjusted model similar to that used in the D:A:D study, the MI risk associated with recent ABC use was 1.71 (1.11, 2.64). In a model that further adjusted for traditional MI and HIV-related risk factors measured prior to ABC use as confounders of the ABC/MI relationship, the MI risk associated with recent ABC use was 1.34 (0.96, 1.88); results stratified by MI type were similar. Conclusions: We found an increased risk for MI associated with recent ABC use that diminished in magnitude and statistical significance after adjusting for traditional and HIV- associated MI risk factors, many of which were significantly more prevalent in ABC users. Further analyses are underway to account for potential time-dependent confounding of risks for MI. 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.

Poster Abstracts

Conclusions: In our study population of HIV-infected veterans, application of the new ACC/AHA cholesterol guidelines resulted in an approximate 12% absolute increase in the proportion of patients for whom statin therapy is indicated. The increased recommended use of statins is primarily related to risk assessed by the 10-year risk score of cardiovascular disease. It will be important to assess the benefit of this expanded prevention measure prospectively.

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CROI 2015