CROI 2016 Abstract eBook

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Poster Abstracts

Methods: Cohort study using a cohort created in the Northwestern Medicine Enterprise Data Warehouse (NMEDW) of HIV-infected patients and age, sex, and race-matched controls who underwent cardiovascular stress testing and subsequent coronary angiography from 2000 to 2015. Persons with incomplete data for either stress tests or coronary angiography were excluded, as were persons whose stress tests did not precede coronary angiography. Relative risks were used to assess differences in CAD burden by HIV serostatus for persons with abnormal stress tests. The cutoffs for moderate and severe CAD on angiography were at least one coronary artery stenosis of ≥50% and ≥70%, respectively. Results: There were 239 HIV-infected patients (mean age at stress test 53.5 years, 44.6% black, 43.6%white, 18.5%women) and 346 uninfected matched patients (mean age at stress test 53.0 years, 42.2% black, 43.9%white, 20.1%women) with abnormal stress tests (73% nuclear, 23% echocardiographic, 4% other) that prompted coronary angiography. HIV infection was associated with significantly greater risk for moderate or severe CAD on angiography (RR 1.18, 95% CI 1.01-1.38, P=0.03) and subsequent percutaneous coronary intervention (RR 1.59, 95% CI 1.17-2.18, P<0.01) following abnormal stress testing (Table). Among HIV-infected patients with abnormal stress tests, those with a nadir HDL cholesterol level under 30 mg/dl were at significantly elevated risk for severe CAD (RR 1.53, 95% CI 1.05-2.23, P=0.02); this remained true when analyses were restricted to men only (RR 1.75, 95% CI 1.12-2.77, P=0.01). Risks for severe CAD among HIV-infected persons with abnormal stress tests did not significantly differ by peak total cholesterol level, CD4 nadir, and plasma HIV RNA nadir. Conclusions: HIV-infected patients with abnormal cardiovascular stress tests had significantly greater CAD burden and were more likely to undergo PCI compared with uninfected controls. The implications of these findings for CAD screening for HIV-infected persons require further study.

645 HIV & Obesity Synergistically Increase Interleukin 6 but Not Soluble CD14 or D-dimer Barbara S. Taylor 1 ; Kaku So-Armah 2 ; JanetTate 3 ;Vincent C. Marconi 4 ; Roger Bedimo 5 ; Adeel A. Butt 6 ; Cynthia Gibert 7 ; Matthew Goetz 8 ; Maria Rodriguez-Barradas 9 ; Matthew S. Freiberg 10 1 Univ of Texas Hlth Sci Cntr San Antonio, San Antonio, TX, USA; 2 Boston Univ Sch of Med, Boston, MA, USA; 3 VA Med Cntr, West Haven, CT, USA; 4 Emory Univ Sch of Med, Atlanta, GA, USA; 5 Dallas VA Med Cntr, Dallas, TX, USA; 6 Hamad Hlthcare Quality Inst, Doha, Qatar; 7 VA Med Cntr, Washington, DC, USA; 8 VA Greater Los Angeles Hlthcare System, Los Angeles, CA, USA; 9 Michael E. DeBakey VA Med Cntr and Baylor Coll of Med, Houston, TX, USA; 10 Vanderbilt Univ Sch of Med, Nashville, TN, USA Background: Obesity prevalence among people living with HIV (HIV+) is rising. HIV and obesity are associated with atherosclerosis, which is mediated by inflammation. Both are pro-inflammatory states, but their combined effect on inflammation (measured by interleukin 6, IL-6), altered coagulation (D-dimer), and monocyte activation (soluble CD14, sCD14) is unknown. We hypothesized that HIV infection and obesity (BMI≥30 kg/m 2 ) synergistically increase IL-6, sCD14 and D-dimer in the Veterans Aging Cohort Study Biomarker Cohort (VACS BC). Methods: VACS is a prospective, observational longitudinal study of HIV+ and HIV uninfected (HIV–) participants. VACS BC is a subset of VACS participants who provided blood samples for research. VACS BC participants with BMI<18.5 kg/m 2 (underweight, N=48) were excluded since they were too few to stratify by HIV status (N=4 underweight HIV–). Dependent variables were IL-6, sCD14, and D-dimer quartiles. BMI was categorized as 18.5-24, 25-29, and ≥30kg/m 2 . Covariates included demographics, smoking, diabetes, CVD, hypertension, lipids, liver and renal function, HCV and statin use. Unadjusted and fully adjusted logistic regression models were constructed. Results: We analyzed data on 1495 HIV+ (66% of whom had HIV-1 RNA<500 copies/mL) and 837 HIV– participants. The mean age was 53 years. The majority were African American (68%); half were current smokers (49%). Over a quarter were obese (27%) or had prevalent CVD (22%). HIV+ obese participants were more likely to have diabetes, dyslipidemia, statin use, and HCV, and less likely to smoke than HIV– non-obese participants (p≤0.05 for all). IL-6 showed a stepwise increase from HIV– non-obese, to HIV+ non- obese, to HIV– obese, to HIV+ obese. Elevated IL-6 was more prevalent in obese HIV+ than HIV– non-obese, which persisted after adjustment for potential confounders (adjusted odds ratio, aOR [95% confidence interval, CI]: 1.69 (1.13-2.51); Table). The inverse was true for sCD14 (aOR (95% CI): 0.43 (0.27-0.66); Table). No significant differences were seen for D-dimer. Conclusions: HIV-obesity comorbidity is associated with higher prevalence of elevated IL-6, lower prevalence of elevated sCD14 and no significant difference in D-dimer. These findings are clinically significant as all three biomarkers are associated with mortality. Future studies should assess 1) whether other biomarkers of monocyte activation and altered coagulation show similar trends and 2) potential mechanisms for the unanticipated sCD14 and D-dimer findings.

Poster Abstracts

264

CROI 2016