CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

Methods: We conducted a secondary analysis of 147 HIV+ participants in the SATURN-HIV study, a 96-week RCT testing the effect of rosuvastatin on markers of CVD. Dietary intake was assessed using a dietary recall; serum biomarkers were collected; CIMT was measured by high resolution ultrasound; and coronary calcification was assessed by cardiac CT using the Agatston method. Quantile regression and generalized estimating equations were used to analyze cross-sectional and longitudinal relationships. Results: Median age was 45 years and 78%were male. On average, participants had HIV for 12 years and been on antiretroviral therapy (ART) for 7.2 years. Participants consumed an average of 2395 calories per day of which 43%was carbohydrates, 41% fat (14% saturated), and 16% protein. Diet was stable over time. IFAB and LBP were elevated at baseline and did not change over time. At baseline, saturated fat and polyunsaturated fat were both negatively associated with IFAB ( p =0.04 and p =0.08, respectively), but not with LBP, after controlling for age, sex, raced, PI duration and BMI. During study follow up, IFAB levels were negatively associated with sTNFRII ( p =0.02) but not the other inflammation markers, and also negatively with CIMT ( p =0.06) and coronary calcification ( p <0.01), after controlling for age, sex, race, and BMI. Conclusions: We found that dietary fat, both saturated and unsaturated, were associated with IFAB in HIV+ adults. IFAB levels are elevated in HIV+ adults compared with HIV uninfected populations and did not change after statin therapy. Over time we found consistent unexpected evidence that high IFAB is associated with more favorable subclinical CVD markers. 658 Does Pulse-Wave Velocity NormalizeWith Increasing Time on ART? Evidence From CHER Steve Innes 1 ; Mark F. Cotton 1 ; Kennedy Otwombe 2 ; Philip G. Herbst 3 ; Barbara Laughton 1 ; Richard Haubrich 4 ; Sara H. Browne 4 1 Stellenbosch Univ and Tygerberg Children’s Hosp, Cape Town, South Africa; 2 Univ of the Witwatersrand, Johannesburg, South Africa; 3 Stellenbosch Univ and Tygerberg Academic Hosp, Cape Town, South Africa; 4 Univ of California San Diego, San Diego, CA, USA Background: Cross-sectional evidence strongly suggests increased prevalence of vascular disease in HIV+ children on antiretroviral therapy (ART) after adjusting for traditional atherosclerosis risk factors. Vascular abnormalities are typically associated with advanced HIV disease and with ART, particularly lopinavir/ritonavir (LPVr). Thus far, pediatric studies have focused on children initiating ART much later than 3 months of age. Whether very early ART will prevent HIV-related vascular disease is unknown. Aorto-femoral pulse wave velocity (PWV) is a sophisticated and sensitive measure of elevated arterial wall stiffness, typically due to atherosclerosis or subclinical arteritis. Reduced arterial wall elasticity leads to progressively faster propagation of the arterial pulse wave. Early PWV elevations strongly predict subsequent incident cardiovascular events in asymptomatic adults. Aim: To determine the trajectory of PWV in HIV-infected school children who initiated LPVr-based ART very early in life with minimal HIV disease and normal CD4 counts in a well-resourced trial setting. Methods: PWV measurements on primary-school-age children who initiated LPVr-based ART in the CHER trial. HIV-uninfected control group from the same communities and socio-economic background. Simple linear regressions of PWV z-scores on age and on cumulative time on ART. Results: 89 HIV-infected (median age 7.7 [IQR 7.6 – 8.5] years; 54% female) who initiated ART [zidovudine, lamivudine, LPVr] at median 9 [7 – 12] weeks of age, with cumulative time on ART of median 7.1 [6.7 – 7.5] years and normal CD4 counts. 53 uninfected (median age 8.5 [7.8 – 8.7] years; 40% female) with similar weight, height, body mass index z-scores and waist circumference to height ratio (p>0.10). In HIV-infected children, all PWV measures improved consistently with increasing cumulative time on ART and with increasing age (figure 1). In socio-economically-matched uninfected controls, PWV measures did not improve or worsened with increasing age (figure 1). Conclusions: In children who initiated ART very early in life, PWV progressively normalizes with accumulating time on ART.

Poster Abstracts

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Changes in CVD Risk Factors With Early and Deferred ART in the START Trial Jason V. Baker 1 ; Shweta Sharma 2 ; for the INSIGHT START (StrategicTiming of AntiRetroviralTreatment) Study Group 1 Hennepin County Med Cntr, Univ of Minnesota, Minneapolis, MN, USA; 2 Univ of Minnesota, Minneapolis, MN, USA

Background: HIV infection and certain antiretroviral medications appear to contribute to cardiovascular disease (CVD) risk. CVD events were similar between the early (at CD4 >500cells/µL) and deferred (to CD4 <350cells/µL) antiretroviral therapy (ART) arms in START. We studied individual risk factor changes over time in START to understand the net influence on CVD risk. Methods: Clinical and laboratory measures were ascertained annually among START participants. Mean change from baseline in risk factors between the early and deferred ART arms were compared over follow-up. Framingham and D:A:D 10yr CVD risk scores were calculated using published equations. Incident dyslipidemia (LDL >160mg/dL or use of lipid lowering drug), diabetes (diagnosis or fasting blood glucose ≥126 mg/dL) and hypertension (diagnosis or use of blood pressure medication) during follow-up were assessed using unadjusted Cox proportional hazards regression. Results: Characteristic among 4,685 START participants across 35 countries at entry were: median age was 36 years, CD4 count 651cells/mm 3 , HIV viral load 12,759 copies/mL, 73%male, 32% smokers; median CVD risk variables were SBP/DBP 120/76 mmHg, Total Cholesterol (C) 168 mg/dL, LDL-C 102 mg/dL, HDL-C 43 mg/dL, fasting glucose 85 mg/dL. At entry median 10 year risk for CVD was 2.3% and 1.8% (Framingham and D:A:D, respectively). Mean follow-up was 3.0 years. The early and deferred ART groups spent 94% and 28% of follow-up time on ART, respectively. Differences in CVD risk factors between early and deferred ART over time are shown in the table. Early ART increased fasting glucose and all lipid parameters, with a minimal decline in Total:HDL-C. Incident dyslipidemia was greater among early vs. deferred groups (hazard ratio 1.62 [95% CI: 1.33-1.94]), though incident diabetes or hypertension did not differ between groups. The use of lipid-lowering therapy increased overall during follow-up, but use did not differ between ART groups over time.

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CROI 2016