CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

695 SUB-CLINICAL CARDIAC SYSTOLIC DYSFUNCTION AMONG WOMEN LIVING WITH HIV Magid Awadalla , Markella V. Zanni, Mabel Toribio, Lauren Stone, Adam Rokicki, Corinne Rivard, Virginia Triant, Tomas G. Neilan Massachusetts General Hospital, Boston, MA, USA Background: Among women living with HIV (WLWH), there is a markedly increased risk of incident heart failure and once clinical heart failure develops, outcomes are poor. Traditional non-invasive imaging measures such as ejection fraction are limited predictors of incident heart failure. In broad populations, abnormal cardiac strain has been shown to predict the development of heart failure. There are no data assessing cardiac strain specifically among WLWH. We hypothesized that cardiac strain would detect impaired cardiac systolic function among WLWH despite a normal ejection fraction. Methods: We performed a prospective cross-sectional study using cardiac MRI and metabolic phenotyping. We compared measures of cardiac strain (global longitudinal strain (GLS), longitudinal strain rate (SR), global circumferential strain (GCS) and global radial strain (GRS)) between 19 WLWH without cardiovascular symptoms to 7 confirmed HIV-uninfected controls. Images were analyzed using Medis Q-strain software by two readers blinded to HIV status. Results: The mean age of WLWH was 52±4 years with a median duration of HIV of 21 years (range 2.4 to 31) and all were on ART. The mean CD4 count was 828±354 cell/mm 3 , and 13 (68.4%) had an undetectable viral load. Women with and without HIV were similar in respect to age, cardiovascular risk factors, body mass index, and blood pressure. On MRI, there was no difference in the left ventricular (LV) volumes (LV end diastolic volume, 134±24 vs. 139±32 mls, p=0.62), LV ejection fraction (58±4 vs. 59±4%, p=0.77), LV mass (88±26 vs. 86±21 grams, p=0.93), right ventricular (RV) volumes (RV end diastolic volume, 128±28 vs. 132±27 mls, p=0.67) or RV ejection fraction (52±6 vs. 54±5%, p=0.4) between the groups of women with and without HIV. However, we found that GLS (-19 ±3 vs -24±2%, p=0.004, Figure, Panel A), GCS (-27±4 vs -31±4%, p=0.03), GRS (47±9 vs 57±10% p=0.03) and SR (-0.7±0.2 vs. -1.0±0.2 s-1, p=0.009, Figure, Panel B) were reduced among WLWH as compared to women without HIV. Within the group of WLWH, there was no association between the reduction in GLS and duration of HIV or HIV control (CD4 count). Conclusion: Women living with HIV without heart failure demonstrated impaired strain and strain rate despite having normal cardiac chamber size and ejection fraction. Future work will be needed to determine the factors associated with impaired cardiac strain and whether impaired cardiac strain predicts those women with HIV who go on to develop heart failure.

outcomes were stratified by CD4 count and viral load (VL) and the association between traditional and HIV-specific parameters with 30-day HF readmission were tested. Results: There were no differences in age, sex, race, LVEF or traditional CV risk factors. Amongst PLHIV, pulmonary artery pressure and cocaine use were higher. In follow-up, PLHIV had a higher 30-day HF readmission rate (55 vs. 30%, p ∠ 0.001), and increased CV (27 vs. 14%, p ∠ 0.001) and all-cause mortality (41 vs. 26%, p ∠ 0.001). Among PLHIV hospitalized with HFrEF, those with a lower CD4 count had a higher 30-day HF readmission rate (68% vs. 44%, p ∠ 0.001), and higher rates of CV (36% vs. 19%, p ∠ 0.001) and all-cause (54% vs. 29%, p ∠ 0.001) mortality. PLHIV with a detectable VL had a higher 30-day HF readmission rate (65 vs. 37%, p ∠ 0.001), and higher rates of CV (34% vs. 14%, p ∠ 0.001) and all-cause mortality (53% vs. 20%, p ∠ 0.001). Finally, among PLHIV, traditional (e.g. CAD, HF medications), non-traditional (cocaine use), and HIV-specific risk parameters (CD4 count, viral load) were predictors of 30-day HF readmission. Conclusion: PLHIV hospitalized with HFrEF have increased 30-day HF readmission rates and CV and all-cause mortality as compared with uninfected individuals hospitalized with HFrEF. These outcomes were more common among those with lower CD4 count and higher VL.

Poster Abstracts

697 SLEEP APNEA AND HEART FAILURE WITH REDUCED EJECTION FRACTION AMONG HIV PATIENTS Raza M. Alvi 1 , Magid Awadalla 1 , Atul Malhotra 2 , Noor Tariq 3 , Adam Rokicki 1 , Virginia Triant 1 , Markella V. Zanni 1 , Tomas G. Neilan 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 University of California San Diego, La Jolla, CA, USA, 3 Yale University, New Haven, CT, USA Background: Among patients with heart failure with a reduced ejection fraction (HFrEF), sleep apnea (SA) is common and associated with worse outcomes. People living with HIV (PLHIV) exhibit increased rates of both HFrEF and SA; however, there are no data characterizing SA among PLHIV with HFrEF. The aim of this study was to characterize the presence, associations and prognostic significance of SA among PLHIV with HFrEF. Methods: We conducted a single center study of PLHIV admitted with HFrEF (LVEF of ∠ 50%) and analyzed the relationship between SA (and traditional and HIV-specific risk factors) with 30-day HF hospital readmission rate (primary outcome), as well as cardiovascular (CV) and all-cause mortality (secondary outcomes). Among PLHIV with SA, we also assessed whether SA disease severity (apnea hypopnea index (AHI)), CPAP use and duration influenced HF outcomes. Results: Our cohort included 1,124 individuals admitted to a US tertiary care hospital with HFrEF; 15% (172/1,124) were PLHIV. Sleep apnea was noted in 28% of PLHIV (48/172) and 26% (248/952) of uninfected controls. Patients with HFrEF with SA were compared according to HIV status; those with HIV had a lower BMI (32.1±5.4 vs. 39.2±4.6 kg/m2, p ∠ 0.001), lower LVEF (37±8 vs. 41±6%, p ∠ 0.001), a higher pulmonary artery systolic pressure (PASP, 50±9.5 vs. 40±9.0 mmHg, p ∠ 0.001), were more likely to have obstructive rather than central SA (66 vs 45%, p=0.33), higher rates of CPAP use (79 vs. 64%, p=0.03) and for a longer duration (6 vs. 4 hours/night, p=0.001). In a multivariable model among PLHIV with HFrEF, traditional HF risk factors (CAD, PASP), non-traditional HF risk factors (cocaine use), HIV-specific parameters (low CD4 count, high viral load) and SA parameters (AHI, CPAP use and duration) were predictors of 30-day HF

696 SYSTOLIC HEART FAILURE AND HEART FAILURE OUTCOMES AMONG PERSONS LIVING WITH HIV Raza M. Alvi 1 , Maryam Afshar 2 , Noor Tariq 3 , Jaime Gerber 3 , Virginia Triant 1 , Markella V. Zanni 1 , Tomas G. Neilan 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 Bronx–Lebanon Hospital Center, Bronx, NY, USA, 3 Yale University, New Haven, CT, USA Background: Persons living with HIV (PLHIV) have an increased risk of heart failure with a reduced ejection fraction (HFrEF). However, little is known about outcomes among PLHIV with HFrEF. We aimed to compare HF outcomes among PLHIV with HFrEF vs. individuals without known HIV with HFrEF. Methods: Our cohort included 1,124 individuals admitted with decompensated HF and an LVEF of ∠ 50%; of these, 15% (172/1,124) were PLHIV. We compared baseline characteristics, 30-day HF readmission rate (primary outcome), and cardiovascular (CV) and all-cause mortality (secondary outcomes). Within PLHIV,

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