CROI 2016 Abstract eBook

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Poster Abstracts

646 BNP Prediction of Cardiovascular Diseases in HIV+ Patients and the General Population Stefan Esser 1 ; Marina Arendt 2 ;Till Neumann 3 ; Lewin Eisele 4 ; Raimund Erbel 3 ; Karl H. Jöckel 2 ;Volker Holzendorf 5 ; Nico Reinsch 3 ; for the HIV HEART Study Group and Heinz Nixdorf Recall Investigative Group 1 Univ Hosp Essen, Essen, Germany; 2 Inst for Med Informatics, Biometry and Epi (IMIBE), Univ Hosp Essen, Essen, Germany; 3 West German Heart Cntr, Univ Hosp Essen, Essen, Germany; 4 Inst for MIMIBE, Univ Hosp Essen, Essen, Germany; 5 Univ Leipzig, Leipzig, Germany Background: B-type Natriuretic Peptide (BNP) is elevated in patients with congestive heart failure and is also an independent prognostic marker for overall mortality. HIV-positive patients (HIV+) have higher BNP-levels than general population. We investigate the association between BNP and the incidence of cardiovascular diseases (CVD) in subjects without prevalent CVD. Methods: We compare BNP measured at baseline and incident CVD during the follow-up in HIV+ individuals of the HIV HEART study (HIVH) and in controls of the population- based Heinz Nixdorf Recall study (HNR), both recruited from the German Ruhr area since 2000. To assess impact of BNP (>=100pg/mL vs. <100pg/mL) on incident CVD (myocardial infarction, PCI stent, Coronary Artery disease, Coronary Artery Bypass Graft, cardiac death) we used the pooled data of both studies and computed Cox proportional Hazard ratio (HR) with time to CVD or last observation and BNP and study (HIVH vs. HNR) as predictors. Also the interaction between BNP and affiliation to study cohort was tested. We controlled for age and Framingham risk score (FRS) variables. Analyses were stratified by sex. We restricted the analysis to the age range of 45 -75 years and to subjects without prevalent CVD. Results: Our analysis data set included 268 HIV+ of the HIVH and 3905 HNR controls (Table 1). Male HIV+ had a 3.6-fold increased risk of incident CVD (95%-CI 1.3; 9.9, p=0.0128) compared to HNR males and independent of the affiliation to the study cohort BNP >=100 pg/mL in male subjects was associated with a HR of 3.4 (95%-CI 2.0; 5.9, p=<0.0001). In females, HRs were 22.9 (95%-CI 2.8; 185.5, p=0.0034) for study cohort and 2.6 (95%-CI 1.00; 6.8, p=0.0513) for BNP >=100 pg/mL. In both sexes no significant interaction between study cohort and BNP was found. No other classic risk factor (HR Smoking: Male: 1.2 (95%-CI 0.8; 1.7); Female: 1.1 (95%-CI 0.6; 2.0), HR Diabetes mellitus Male: 1.8 (95%-CI 1.3; 2.7); Female: 1.5 (95%-CI 0.7; 3.1)) reached such high HRs for CVD as BNP >=100 pg/mL and HIV-infection. Conclusions: Incidence of CVD was higher in HIV+ compared to the general population controlling for differences in FRS. Additionally, BNP >=100 pg/mL was independently associated with incident CVD in HIVH and HNR. Thus, as was shown in the general population, BNP may improve prediction of CVD also in HIV+. BNP should be measured serially in HIV+>= 45 years and elevated or increasing levels should lead to intensification of care.

647 9-Year Trends in Non-Lipid Cardiovascular Disease Prevention Strategies in HIV+Women

David B. Hanna 1 ; Molly Jung 1 ; Kathryn Anastos 1 ; Jennifer M. Cocohoba 2 ; Mardge Cohen 3 ; Elizabeth Golub 4 ; Nancy A. Hessol 2 ;Tracey E.Wilson 5 ; MaryYoung 6 ; Robert C. Kaplan 1 1 Albert Einstein Coll of Med, Bronx, NY, USA; 2 Univ of California San Francisco, San Francisco, CA, USA; 3 John H. Stroger Jr. Hosp of Cook County and Rush Med Coll, Chicago, IL, USA; 4 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 5 State Univ of New York Downstate Med Cntr, Brooklyn, NY, USA; 6 Georgetown Univ Med Cntr, Washington, DC, USA Background: Cardiovascular disease (CVD) is increasingly prominent among women with HIV. While there is a major clinical trial of statins in people with HIV, less is known about other non-lipid prevention strategies. Evaluating trends in these strategies is important to understand how well women with HIV manage CVD risk. Methods: Participants were from the Women’s Interagency HIV Study, a longitudinal cohort of HIV-infected (HIV+) and uninfected (HIV-) women at 6 US sites, during 2006-2014. We examined semiannual trends in medication use and/or achievement of treatment targets by HIV status for women at risk for CVD based on hypertension (HTN), diabetes or smoking. “At-risk” was defined as: for HTN, systolic BP ≥140 mmHg, diastolic BP ≥90 mmHg, self-report of HTN or HTN medication history; for diabetes, history of fasting glucose [FG] ≥126 mg/dL or HgbA1c ≥6.5%, self-report of diabetes or diabetes medication history; for smoking, report of smoking at previous visit. Poisson regression with generalized estimating equations tested time trends and differences between HIV+ and HIV- women. Results: During 2006-2014, prevalence was 40% (HIV+) and 38% (HIV-) for HTN, 21% and 22% for diabetes, and 37% and 48% for smoking. There were 10,546 eligible person- visits for HTN (N=1,444), 6,394 for diabetes (N=474) and 11,258 for smoking (N=1,206). Use of anti-HTN medication was higher among hypertensive HIV+ women (77% vs 67%, P<.001) and increased over time among both HIV+ (72% in 2006 to 81% in 2014, P<.001) and HIV- (63% to 73%, P<.001), with no difference in trend by HIV status. HTN control (<140/90 mmHg) was higher among HIV+ than HIV- (P<.001) and differed over time by HIV status, increasing among HIV+ (55% to 59%, P=.01) but not HIV- (45% to 46%, P=.31). Use of anti-diabetic medication was similar among diabetic HIV+ and HIV- women (48% vs 49%, P=.99) and increased similarly over time (37% to 63% among HIV+ and 34% to 64% among HIV-, both P<.001). Diabetes control (FG <130 mg/dL) was higher among HIV+ than HIV- (73% vs 64%, P=.03) and did not change over time. Smoking cessation was similar between HIV+ and HIV- smokers (10% vs 9%, P=.33) and did not change over time. Conclusions: HIV+ women more effectively manage HTN and diabetes than HIV- women. Despite this, >40% of hypertensive and >25% of diabetic HIV+ women do not achieve target control levels. Providers should continue to emphasize preventive strategies (including lifestyle and pharmacologic interventions when indicated) to reduce CVD risk. 648 Background: Human immunodeficiency virus (HIV) infection is now considered a chronic, treatable disease. Nevertheless, treatment is associated with increased rates of coronary artery disease (CAD). Screening of this at-risk population remains contentious; we therefore assessed the utility of CTCA in the screening and prediction of adverse cardiac outcomes. Methods: HIV positive men (n=32) who had undergone CTCA for risk assessment were matched 2:1 for age, sex and Framingham risk with 65 HIV negative CTCA patients. CTCA data was assessed along with the occurrence of coronary events and intervention. HIV Patients Have More High-Risk Plaque and Cardiac Events but Less Intervention James Nadel ; Eoin O’Dwyer; Sam Emmanuel; James Otton; Justyn Huang; Cameron Holloway St Vincent’s Hosp, Sydney, Australia

Poster Abstracts

265

CROI 2016