CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

associated with increased mortality in HIV infected individuals (HR 1.71, 95%CI 1.21-2.40) after adjusting for age, gender, race, HF, LVEF, COPD, and exposure to antiretroviral therapy (ART). Receipt of ART conferred a reduced risk of mortality that approached statistical significance (HR 0.76, 95%CI 0.55-1.04, p=0.08). Conclusion: PH is common among HIV infected individuals referred for a clinical echocardiogram. The presence of PH is associated with increased mortality compared to those without PH, which persisted after adjusting for likely confounders. Further studies are warranted to identify the HIV populations at greatest risk for development of PH and explore the viral and immune mechanisms contributing to this condition

Poster and Themed Discussion Abstracts

622 BODY-MASS INDEX AND ADJUDICATED HEART FAILURE IN A LARGE ELECTRONIC HIV COHORT Matthew J. Feinstein , Alexandra B. Steverson, Anna Pawlowski, Daniel Schneider, Prasanth Nannapaneni, Sadiya S. Khan, Mercedes Carnethon, Chad J. Achenbach, Sanjiv J. Shah, Donald M Lloyd-Jones Northwestern Univ, Chicago, IL, USA Background: Heart failure (HF) is increasingly recognized as a cause of morbidity and mortality in HIV and may reflect a final common manifestation of diverse HIV-related pathologies. The association between body-mass index (BMI) and HF in HIV is unknown. Whereas some HIV-infected (HIV+) persons at low and low-normal BMI may be at risk for HF due to advanced HIV with associated wasting, obese HIV-infected persons may be at risk for HF due to traditional risk factors such as hypertension and diabetes. Our central hypothesis was that underweight and obese HIV+ persons would have significantly greater risks for HF than HIV+ persons with high-normal BMI. Methods: Using an electronic data repository, we identified all HIV+ adults who received care at a large academic medical center between January 1, 2000 and June 1, 2016 and had complete demographic and anthropometric data. Baseline BMI was determined using the earliest available concurrent height and weight measurement for each participant. Possible HF events were identified using a broad screening protocol that incorporated physician diagnoses, biomarkers, and/or use of intravenous diuretics; HF events were then independently adjudicated by two physicians. Associations between BMI category at baseline and HF were assessed using multivariable logistic regression. Results: Of the 5039 HIV+ patients included for analysis, 216 (4.3%) experienced HF. HF was most common among patients at BMI extremes and least common among mildly overweight patients (BMI 25-29.9 kg/m2) (Figure). After adjustment for demographics, cardiovascular risk factors, and HIV-related markers (nadir CD4 T cell count, HIV viral load, antiretroviral use, and protease inhibitor use), odds ratios (95% confidence interval) for HF for patients with baseline BMI <18.5, 18.5-19.9, 20-22.4, 22.5-24.9, 25-29.9 (referent), 30-34.9, 35-39.9, and >40 kg/m2 were 1.87 (0.75-4.70), 3.19 (1.67-6.11), 1.73 (1.01-2.95), 1.84 (1.15-2.93), 1, 1.39 (0.79-2.45), 1.96 (0.96-4.01), and 1.11 (0.51-2.45), respectively. Conclusion: Heart failure is significantly more common among underweight and low-normal weight HIV+ patients and somewhat more common among obese HIV+ patients when compared with mildly overweight HIV+ patients. This “reverse J-shaped” association may reflect diverse pathophysiologies of HF in HIV, including chronic disease-related wasting for HIV+ patients with low-normal BMI versus traditional cardiovascular risk factor burden among obese HIV+ patients.

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