CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

574 LIPID LEVELS AND THE RISK OF ACUTE MYOCARDIAL INFARCTION AMONG HCV+ AND HCV- PERSONS

Adeel A. Butt 1 , Peng Yan 2 , Kara Chew 3 , Judith S. Currier 3 , Kathleen Corey 4 , Raymond Chung 4 , Abdul-Badi Abou-Samra 5 , Javed Butler 6 , Matthew Freiberg 7 , for the ERCHIVES 1 Hamad Hlthcare Quality Inst and Hamad Med Corporation, Doha, Qatar, 2 VA Pittsburgh Hlthcare System, Pittsburgh, PA, USA, 3 Univ of California Los Angeles, Los Angeles, CA, USA, 4 Massachusetts General Hosp, Boston, USA, 5 Hamad Medica Corporation, Doha, Qatar, 6 SUNY Stonybrook, Stony Brook, NY, USA, 7 Vanderbilt Univ Sch of Med, Nashville, TN, USA Background: Risk of acute myocardial infarction (AMI) among HCV+ persons compared with HCV- persons with similar lipid levels is unknown. Methods: We used ERCHIVES to identify two populations of HCV infected and uninfected persons: 1) a propensity score matched (PSM) population, and 2) a low cardiovascular disease (CVD) risk population. We excluded those with baseline CVD, HIV, females (due to small numbers), and those who received HCV treatment. AMI was diagnosed based on previously established ICD-9 codes. We compared AMI rates among lipid strata based on NCEP defined lipid strata. Results: We identified 85,863 HCV+ and HCV- persons in the PSM population and 55,814 HCV+ and 84,772 HCV- persons in the low CVD risk population. In the PSM population, the incidence rates [95% CI] for AMI among those with TC 200-239 were 5.3 [4.89,5.71] for HCV+ vs 4.71 [4.42,5] for HCV- persons (P=0.02) and for TC>240 mg/dL were 7.38 [6.49,8.26] vs. 6.17 [5.64,6.71] (P=0.02), with a hazard ratio (HR) [95%] CI for AMI for HCV+ vs HCV- of 1.13 [1.02,1.25] and 1.19 [1.03,1.38], respectively. For LDL of 130-159 mg/ dL, AMI rates were 5.44 (4.97,5.91) for HCV+ and 4.81 (4.48,5.14) for HCV- persons (P=0.03), with HR [95%] CI for AMI for HCV+ vs HCV- of 1.13 [1.01,1.26]. In the low CVD risk population, the incidence rates among those with TC of 200-239 mg/dL were 4.01 [3.57, 4.44] for HCV+ vs. 3.47 [3.22,3.71] for HCV-, P=0.03) and numerically higher but not statistically significant for those wtih TC of >240 mg/dL (5.13 [4.24, 6.03] vs. 4.35 [3.94,4.77], P=0.12). For LDL of > 160 mg/dL, the rates were higher for HCV+ vs. HCV- persons (5.43 [4.54,6.32] vs. 4.30 [3.88,4.72], P=0.02). For HDL and TG, there were no significant differences among HCV infected vs. HCV infected persons at the higher strata. The rise in risk with increasing lipid levels was greater in younger HCV+ than in HCV- persons, and more profoundly altered in HCV+ persons by lipid lowering therapy. Conclusion: HCV+ persons may be at a higher risk of AMI than HCV- persons with similar TC and LDL levels, and this risk is more pronounced at a younger age. Lipid lowering therapy significantly reduces this risk, with a more profound reduction among HCV+ vs. HCV- persons at similar lipid levels.

Poster and Themed Discussion Abstracts

575 EFFECT OF INTERFERON-FREE TREATMENT ON LIPID AND GLUCOSE METABOLISM IN HEPATITIS C Elisa Biliotti , Donatella Palazzo, Marco Serani, Rozenn Esvan, Paola Maida, Paola Perinelli, Martina Spaziante, Alessandro Maria Silvestri, Lorenzo Volpicelli, Gloria Taliani Sapienza Univ of Rome, Rome, Italy Background: Chronic HCV infection may affect host lipid metabolism and induce hypocholesterolemia, insulin resistance (IR), diabetes, atherosclerosis and steatosis. Low density cholesterol (LDL-C) is an atherogenic lipoprotein, its oxidated form (oxLDL) is involved in the formation of atherosclerotic plaques and is a marker of cardiovascular disease. We investigated the changes of serum lipids, oxLDL and IR during and after DAA treatment of HCV. Methods: We enrolled 77 HCV pts (57.1%males, age 58.7±11.2 yrs, BMI 24.7±3.9, 74% HCV Genotype 1, 28%with metabolic syndrome, 36%with steatosis) with advanced fibrosis or cirrhosis (liver stiffness 19.1±9.9 KPa) treated with DAA (70%with ribavirin). HOMA-score, total, low and high density cholesterol (TC, LDL-C, HDL-C), tryglicerides (TG) and oxLDL levels have been evaluated at baseline (T0), end-of-treatment (EOT) and after 12-weeks of follow-up (FU). Results: A significant decrease of HOMA-IR occurred during therapy and remained stable during FU (Table). The baseline proportion of patients with HOMA-IR≥4, diagnostic for a pre-diabetic state, was 45.5% and significantly decreased after treatment to 32.5% (p=0.03). The decline of HOMA-IR during antiviral treatment was gender-related, since men experienced a marked reduction of IR both during treatment and FU while women had no changes. TC and LDL-C levels significantly increased during antiviral therapy and FU (Table). The proportion of pts with optimal TC (TC<200 mg/dL) and LDL-C (LDL-C<129 mg/dL) significantly decreased during the study period from 88.3% to 70% (p=0.0075) and from 89% to 76.2% (p=0.04), respectively. Notably also oxLDL levels increased during the study period (Table), while HDLC did not change and TG levels declined only during treatment. Conclusion: The improvement of insulin resistance and the significant reduction of the proportion of pts with a pre-diabetic state suggest that DAA treatment might revert HCV related metabolic alterations and prevent the development of diabetes. The modulation of the metabolic changes observed during treatment according to gender is an interesting aspect of the interplay between virus and host and an area of future research. The rapid and significant increase in total, LDL and oxLDL cholesterol levels observed in pts with advanced liver disease treated with DAA might increase their cardiovascular risk, suggesting the potential benefit of statin co-administration during or immediately after DAA therapy.

CROI 2017 242