CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

694 MYOCARDIAL STEATOSIS IN RELATION TO CARDIAC DYSFUNCTION AMONG WOMEN LIVING WITH HIV Mabel Toribio , Tomas G. Neilan, Lauren Stone, Adam Rokicki, Corinne Rivard, Jacob C. Calkins, Mary O’Hara, Magid Awadalla, Virginia Triant, Lidia S. Szczepaniak, Markella V. Zanni Massachusetts General Hospital, Boston, MA, USA Background: Among women living with HIV (WLHIV) with access to ART, heart failure incidence is increased and outcomes are poor. Heart failure is typically preceded by an asymptomatic stage of diastolic dysfunction. Studies in diverse patient populations have suggested myocardial steatosis, or increased intramyocardial triglyceride content, predisposes to diastolic dysfunction. Among WLHIV, data on cardiac structure and function are scarce. We hypothesized asymptomatic WLHIV would demonstrate myocardial steatosis and diastolic dysfunction as compared with women without HIV. Methods: In this prospectively recruited cross-sectional cohort study, 18 asymptomatic WLHIV on ART and 6 asymptomatic women without HIV completed cardiac magnetic resonance spectroscopy, cardiac magnetic resonance imaging, and metabolic phenotyping procedures. Women with heart failure, diabetes, and current use of lipid-lowering medications were excluded. Intramyocardial triglyceride content and left atrial passive ejection fraction (a measure of diastolic function) were compared between groups and intra-group correlations were assessed. Results: WLHIV and women without HIV did not differ with respect to age (52.1 vs. 51.7 years, p=0.84), BMI (31.5 vs. 29.7 kg/m2, p=0.61), prevalence of hypertension (22 vs. 33%, p=0.62), HbA1c (5.6 vs. 5.5%, p=0.51), or LDL cholesterol (113 vs. 109 mg/dl, p=0.76). Circulating triglyceride levels were higher among WLHIV (107 vs. 69 mg/dl, p=0.01). Among WLHIV, duration of known HIV was 19±9 years, 100%were on ART, median VL was 19 copies/ml (IQR 19, 19), and median CD4 was 558 cells/mm 3 (IQR 450, 773). Notably, the intramyocardial triglyceride content was over three-times higher among WLHIV (0.49 [0.39, 2.09] vs. 0.13 [0.11, 0.23] %, p=0.004) (Figure, Panel A). Further, left atrial passive ejection fraction was reduced among WLHIV (28±9 vs. 38 ±6 %, p=0.02) (Figure, Panel B). Among WLHIV, intramyocardial triglyceride content was not related to BMI (p=0.92) or to circulating triglyceride levels (p=0.34), but was inversely related to left atrial passive ejection fraction (rho -0.51, p=0.03). Conclusion: Asymptomatic WLHIV on ART evidence a more than three- fold increase in intramyocardial triglyceride content in relation to diastolic dysfunction, as compared with age- and BMI-matched women without HIV. Further studies are needed to determine whether strategies targeting myocardial steatosis also improve diastolic function and potentially prevent heart failure among WLHIV.

693 ZINC TO REDUCE MORTALITY AND CVD RISK AND HIV DISEASE PROGRESSION IN RUSSIAN DRINKERS

Matthew Freiberg 1 , Natalia Gnatienko 2 , Debbie Cheng 3 , E Blokhina 4 , Sharon Coleman 3 , Margaret F. Doyle 5 , Carly Bridden 2 , Kaku So-Armah 3 , Sally Bendiks 2 , Russell Tracy 5 , Kendall J. Bryant 6 , Evgeny Krupitsky 4 , Jeffrey H. Samet 3 1 Vanderbilt University, Nashville, TN, USA, 2 Boston Medical Center, Boston, MA, USA, 3 Boston University, Boston, MA, USA, 4 First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation, 5 University of Vermont, Colchester, VT, USA, 6 NIH, Bethesda, MD, USA Background: Zinc deficiency is common among HIV+ heavy drinkers and linked to high mortality rates. In HIV negative people, zinc reduces levels of inflammatory biomarkers that are strongly linked to mortality and cardiovascular disease (CVD) risk. Given that alcohol use among HIV+ individuals is common, determining whether zinc supplementation reduces mortality risk, CVD risk, and HIV disease progression is of interest. Methods: We conducted a double-blinded randomized placebo-controlled trial of zinc supplementation among HIV-infected, ART-naïve heavy drinkers recruited 2013-2015 in St. Petersburg, Russia. We randomly assigned 254 participants, in a 1:1 ratio, to receive either zinc (15 mg men; 12 mg women) or matching placebo, daily for 18 months. We assessed the following study outcomes at 18 months: 1) VACS index (a validated predictor of total mortality, primary); 2) CD4 count; and 3) Reynolds CVD Risk Score. We performed linear regression analyses controlling for gender and baseline past week heavy drinking using the intention-to-treat approach. Results: Participants had the following baseline characteristics: 72%male; age 34 years; 86% regular smokers; 88% HCV antibody positive; CD4 cell count 521 cells/mm 3 ; and BMI 23 kg/m2. Randomization groups were balanced demographically and clinically. VACS index score increased between baseline and 18 months in both arms, the increase was smaller in the zinc group (0.49 point) than in the placebo group (5.5 point); adjusted mean difference in change between groups was -4.68 points (95% confidence interval [CI] -9.62, 0.25; p=0.06). Mean CD4 cell counts decreased between baseline and 18 months in both zinc (-128.8) and placebo (-176.2) groups; adjusted mean difference in change between groups was 41.8 (95% CI -20.3, 103.8; p=0.19). At 18 months there was no significant difference in mean log-transformed Reynolds risk score between the two groups (see Table, p=0.85). Conclusion: While participants in the zinc group had a clinically significant smaller increase in VACS index scores and a smaller decline in CD4 counts compared to the placebo group, the differences were not statistically significant. We detected no differences in Reynolds CVD risk scores between the zinc and placebo groups at 18 months. Additional analyses examining factors such as the role of ART use during the follow-up period, measured zinc deficiency and study medication adherence are needed to further understand these preliminary findings.

Poster Abstracts

CROI 2018 258