CROI 2016 Abstract eBook

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Poster Abstracts

Results: Patients with HIV had higher rates of soft plaque (0.8±1.5 versus 0.3±0.7, p=0.03) and soft plaque ratios (0.2±0.3 versus 0.1±0.2, p<0.03) compared to negative controls. At a median follow-up time of 38 months, patients with HIV were at greater risk of non-ST elevation acute coronary syndrome (15.6% versus 3.2%, p<0.04), although there was no difference in the combined endpoint of all-acute coronary syndromes despite a threefold greater risk conferred to those with HIV (18.8% versus 6.4%, p=0.08). Conversely, on survival analysis there was a higher rate of intervention with either; invasive angiogram, percutaneous coronary intervention or coronary artery bypass grafting in patients without HIV (mean time to event 20.6±4.9 versus 9.9±3.3 months, p<0.04). Conclusions: Patients with HIV have high-risk plaque and higher rates of adverse cardiac events compared to negative controls, but lower rates of coronary angiography and intervention following CTCA. The data suggests that CTCA may have a role in predicting cardiac events in patients with HIV and further management may be suboptimal in this population group.

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Page 1 Background: HIV-infected women face a three-fold increased rate of myocardial infarction (MI) compared to non-HIV-infected women. Previous studies among HIV-infected women have explored ways in which traditional cardiovascular disease (CVD) risk factors and systemic immune activation may contribute to this heightened MI risk. To date, no study has explored how reproductive aging relates to CVD risk in this population. Here, we investigate differences in subclinical coronary atherosclerotic plaque and markers of immune activation among HIV-infected women and non-HIV-infected women categorized by degree of ovarian reserve and menopause status. Methods: Seventy-four women (49 HIV-infected, 25 non-HIV) without known CVD were classified as premenopausal, premenopausal with reduced ovarian reserve, or postmenopausal based on menstrual history and levels of antimullerian hormone (AMH) (Figure 1). Participants underwent contrast enhanced coronary computed tomography angiography and immune phenotyping. Comparisons in coronary atherosclerotic plaque burden and immune markers were made between the HIV-infected and non-HIV-infected women overall and within the HIV-infected and non-HIV-infected women by reproductive aging classification group. Results: Among the overall group of HIV-infected women, the women with reduced ovarian reserve (undetectable AMH) had a higher prevalence of coronary plaque (52% versus 6%, p=0.0007) and noncalcified plaque (48% versus 6%, p=0.002), as well as higher levels of log sCD163 (p=0.0004) and log MCP-1 (p=0.006), compared with the premenopausal women with measurable AMH. Furthermore, reduced ovarian reserve in the HIV-infected group related to noncalcified plaque, controlling for traditional CVD risk factors (p=0.04) and sCD163 (p=0.03). 649 Diastolic Function Correlates With Pericardial Fat and Vascular Remodeling in HIV Chris T. Longenecker 1 ; Sadeer Al Kindi 2 ; Maya Serhal 2 ; Bruce Kinley 1 ; Danielle Labbato 1 ; Grace A. McComsey 1 1 Case Western Reserve Univ, Cleveland, OH, USA; 2 Univ Hosps Case Med Cntr, Cleveland, OH, USA Background: In patients with treated HIV infection, higher pericardial fat volumes are associated with coronary artery plaque and systemic inflammation, but the relationship to left ventricular (LV) structure and function is unknown. Methods: We prospectively enrolled 46 patients with HIV on stable antiretroviral therapy and 23 age- and gender-matched HIV-uninfected controls (2:1), both groups without known cardiovascular disease. We measured LV volume, LV mass, systolic function (ejection fraction (EF) and global longitudinal strain) and diastolic function (graded categories, E/A, and E/E’ ratio) using echocardiography. For all HIV+ subjects, pericardial fat volume and density (mean Hounsfield units) and coronary artery calcium (CAC) score were measured by CT scan; common carotid artery intima-media thickness (IMT) and distensibility were measured by ultrasound. T-tests were used to compare HIV+ and control groups. Within the HIV+ group, Spearman correlations were used to assess associations with measures of LV structure and function. Results: HIV+ participants had a mean(SD) age of 55.7(5.9) years and were 87%male and 67% African American. Demographics were similar to controls (all p >0.05). Mean CD4 count was 628(279) cells/µL and all had HIV-1 RNA <200 c/ml (67%<48c/ml). LVEF, diastolic function, and LV mass index were similar between HIV and controls (p>0.05 for all comparisons), but HIV+ participants had lower LV volume index (50.7±14.0 vs 70.3±21.7 ml/m2, p<0.001). Pericardial fat volume negatively correlated with E/A ratio (r=-0.392, p=0.015), and positively with diastolic dysfunction (r=0.369, p=0.023), while pericardial fat density positively correlated with E/A ratio (r=0.455, p=0.004) and negatively with diastolic dysfunction (r=-0.479, p=0.002). In contrast, pericardial fat measures were not associated with EF or global longitudinal strain (all p>0.05). Diastolic dysfunction was also positively associated with CAC score (r=0.296, p=0.046) and carotid IMT (r=0.317, p=0.032), and negatively correlated with carotid distensibility (r=-0.304, p=0.045). Conclusions: Measures of LV diastolic function are associated with altered pericardial fat volume and density and measures of vascular remodeling in this population of HIV- infected subjects on antiretroviral therapy. Altered ectopic fat distribution may be a risk factor for heart failure in HIV-infected patients with and without coronary heart disease. 650 Reduced Ovarian Reserve Relates to Cardiovascular Disease Risk inWomenWith HIV Sara E. Looby 1 ; Kathleen Fitch 1 ; Suman Srinivasa 1 ; Janet Lo 1 ; Danielle Rafferty 1 ; Amanda Martin 1 ; Judith S. Currier 2 ; Steven Grinspoon 1 ; Markella V. Zanni 1 1 Massachusetts General Hosp, Boston, MA, USA; 2 David Geffen Sch of Med at Univ of California Los Angeles, Los Angeles, CA, USA

Poster Abstracts

266

CROI 2016