CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

and the American College of Cardiology/American Heart Association 2013 guidelines using the Pooled Cohort Equations (PCE). Veterans with prior history of CVD, low density lipid-cholesterol (LDL-C) <70 or >190, diabetes with LDL-C>70, receiving statins, and all women were excluded. Events were defined per respective risk model (myocardial infarction [MI], bypass/angioplasty, stroke, carotid artery endarterectomy or death from coronary heart disease for D:A:D; acute coronary syndrome, MI, stable/unstable angina, revascularization, stroke, transient ischemic attack, or peripheral arterial disease for PCE). Kaplan-Meier analyses were used to compare PCE and D:A:D risk models. We also developed our own model specific to the HIV population using proportional hazards modelling of CCR data and PCE event definitions. Results: In 3171 male veterans infected with HIV, observed ten-year events numbered 1165 (36.7%) by PCE criteria and 1088 (34.3%) using D:A:D criteria. As shown in the figure (by quintiles of risk score), the D:A:D model performed better than the PCE model for risk of outcome. In our newmodel, Hepatitis C (HCV) coinfection was associated with 50% increased hazard (adjusted HR 1.495, CI 1.275-1.752) of PCE event. HIV viral load (aHR 1.062, CI 1.033-1.092) was significantly associated with risk of outcome while CD4 count and CD4 nadir were not. Traditional risk factors were also incorporated into the model, with older age and systolic blood pressure demonstrating significant association with increased hazard of outcome. Conclusions: There was a high rate of ten-year observed CVD events in HIV-infected veterans. The D:A:D model had better discrimination than the PCE for risk of outcome. Our new model additionally takes into account viral load and HCV-coinfection, which were important risk factors for PCE events.

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2013 ACC/AHA Guideline Undertreats HIV-Infected Adults With Atherosclerosis BernardWeigel ; Binh An P. Phan;Yifei Ma; Rebecca Scherzer; Danny Li; Sophia Hur; S.C. Kalapus; Steven G. Deeks; Priscilla Hsue Univ of California San Francisco, San Francisco, CA, USA

Background: While HIV infection is associated with increased risk of ASCVD (atherosclerotic cardiovascular disease), it is unknown whether cholesterol guidelines can identify HIV-infected adults who may benefit from statins. The purpose of our study was to compare the 2013 ACC/AHA and 2004 ATP III recommendations in a HIV population, and to evaluate associations with carotid artery intima-media thickness (cIMT) and plaque. Methods: We used ultrasound to measure cIMT at baseline and 3 years later in 352 HIV-infected adults with no ASCVD and not on statins. Plaque was defined as IMT > 1.5mm. We compared 2013 ACC/AHA and 2004 ATP III recommendations, and evaluated associations with cIMT and plaque. Results: At baseline, the median age was 43 (IQR 39-49), 85%were male, 74%were on antiretroviral medication, and 50% had plaque. At followup, the median IMT progression was 0.052 mm/year (IQR: 0.025-0.094), and 66% had plaque. The 2013 guideline was more likely to recommend statins compared with the 2004 guideline, both overall (26% vs. 14%, p<0.001), in those with plaque (32% vs. 17%, p=0.0002), and in those without plaque (16% vs. 7%, p=0.025). In unadjusted linear regression, the 2004 and 2013 risk scores were both strongly associated with cIMT levels (0.010 mm per 10% increase in risk, p<0.001) and with cIMT progression (0.010mm/year per 10% increase in risk, p<0.001). In multivariate analysis, older age, higher LDL-C, pack-years of smoking, and history of opportunistic infection were associated with baseline plaque. Conclusions: While the 2013 ACC/AHA guideline recommendeds statins to a greater number of HIV-infected adults compared to the 2004 ATP III guideline, both failed to recommend therapy in the majority of HIV-affected adults with carotid plaque. Both the 2004 and 2013 guidelines predicted higher levels of baseline cIMT and faster progression; although associations were stronger for the 2004 guideline. HIV-specific cholesterol guidelines that include detection of subclinical atherosclerosis may help to identify HIV- infected adults who are at increased ASCVD risk and may benefit from statins.

Poster Abstracts

644 Differences by HIV Serostatus in Coronary Artery Disease Following Stress Testing Matthew J. Feinstein 1 ; Brian Poole 1 ;Tim S. Provias 1 ; Frank J. Palella 2 ; Chad Achenbach 2 ; Donald M. Lloyd-Jones 1 1 Northwestern Univ, Feinberg Sch of Med, Chicago, IL, USA; 2 Northwestern Univ, Chicago, IL, USA

Background: HIV-infected persons develop coronary artery disease (CAD) more commonly and earlier than uninfected patients. The role of noninvasive cardiovascular testing to stratify CAD risk in this population is not well-defined; no prior studies have evaluated cardiovascular stress testing in this group. We hypothesized that, among persons with abnormal stress tests, HIV-infected patients have a greater burden of CAD on coronary angiography than uninfected matched controls.

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CROI 2016