CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

751 Evaluation of the ACC/AHA CVD Risk Prediction Algorithm Among HIV-Infected Patients Susan Regan 2 ; James B. Meigs 2 ; Joseph Massaro 3 ; Ralph B. D’Agostino 3 ; Steven Grinspoon 2 ; Virginia A. Triant 2 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA, US; 2 Massachusetts General Hospital, Harvard Medical School, Boston, MA, US; 3 Boston University, Boston, MA, US; 4 Massachusetts General Hospital, Harvard Medical School, Boston, MA, US Background: The 2013 American College of Cardiology (ACC)/ American Heart Association (AHA) cardiovascular disease (CVD) risk prediction algorithm (Pooled Cohorts Equations) has not previously been evaluated in HIV populations. Methods: Framingham Risk Scores (FRS) and ACC/AHA risk scores were calculated for patients in a longitudinal HIV clinical care cohort during a 3-year interval ending January 1, 2009. Patients were not eligible if they were under age 18, had expired prior to January 1, 2009, were missing relevant data to populate the risk score, or had undergone a relevant outcome event prior to the date of risk score calculation. CVD risk was considered high if 10-year predicted risk of the relevant outcome event was ≥ 10 percent for FRS and ≥ 7.5 percent for ACC/AHA. Outcome events were coronary heart disease (CHD) for FRS and atherosclerotic CVD (ASCVD) for ACC/AHA. Results: The FRS was calculated for 2270 patients, with a median follow-up time of 6.3 years, and the ACC/AHA risk score was calculated for 2152 patients, with a median follow- up time of 6.2 years. Risk scores were discordant in 17 percent of patients, with the ACC/AHA score only predicting high risk in 10 percent and the FRS only predicting high risk in 7 percent. In comparisons of these discordant subgroups, patients classified as high-risk by ACC/AHA but low-risk by FRS were older (median age 56 for ACC/AHA high vs. 48 for FRS high) and more likely to be female (68% vs. 0%), diabetic (52% vs. 6%) and black (22% vs. 12%) but less likely to be smokers (44% vs. 66%) than those low-risk by ACC/AHA and high-risk by FRS. Actual event rates were estimated and compared with predicted rates. As shown in the figure, actual 6-year event rates were similar to 10-year predicted rates for the FRS and were similar to or exceeded predicted rates for the ACC/AHA risk score.

Conclusions: Our findings suggest that CVD risk prediction scores designed for the general population, and particularly the new ACC/AHA risk score, may underestimate risk for HIV-infected patients. Accurate CVD risk prediction is an important component of the long-termmanagement of chronic disease complications in HIV.

Poster Abstracts

TUESDAY, FEBRUARY 24, 2015 Session P-P6 Poster Session

Poster Hall

2:30 pm– 4:00 pm Biomarkers and Atherosclerosis 752 IL-6 and CD8 Senescence Independently AssociateWith Atherosclerosis in Treated HIV Denise C. Hsu 1 ; Zonghui Hu 1 ; Courtney Carroll 2 ; Kristinalisa Maka 2 ; Adam Rupert 3 ; Steven Deeks 2 ; S. C. Kalapus 2 ; Priscilla Hsue 2 ; Irini Sereti 1 1 National Institute of Allergy and Infectious Diseases, Bethesda, MD, US; 2 University of California San Francisco, San Francisco, CA, US; 3 Leidos Biomedical Research, Inc, Frederick, MD, US Background: Increased cardiovascular (CV) risk persists among patients with treated HIV disease, and chronic immune activation is thought to contribute to this excess risk. Carotid intima-media thickness (CIMT) assesses atherosclerotic burden and predicts future CV events. We studied the immunologic correlates of CIMT in patients on ART with suppressed viral load (VL). Methods: Cryopreserved mononuclear cells and plasma from the SCOPE study were used to evaluate T-cell and monocyte activation by flow cytometry and soluble markers of inflammation/coagulation by ELISA-based methods. CIMT was measured by high resolution ultrasound. Mean CIMT was calculated as the average of 12 segments (near and far wall of the common, internal, and bifurcation region of the right and left carotid arteries). Plaque was defined as a focal region of IMT>1.5mm. Associations between CIMT and immunologic markers were assessed by Spearman’s rank correlation and multivariate regression adjusting for traditional CV risk factors and CD4 count. Associations between the presence of plaque and immunologic markers were evaluated by Wilcoxon test. Results: Participants (N=132) were on ART with VL <75 copies/mL, 93%male, 67% Caucasian. The median age was 48 yrs, 32%were on anti-hypertensive drugs, 41%were on cholesterol lowering drugs, 7% had diabetes, 7% had CVD and 26%were smokers. The median CD4 was 525 cells/ m L. The mean CIMT was 1.04 mm and plaque was present in 54% of patients.

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CROI 2015