CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

hospital readmission rate. Each 1 hour increase in CPAP use was associated with a 14% decreased risk of 30-day HF hospital readmission. Conclusion: As compared to uninfected controls with HFrEF and SA, PLHIV were more likely to have obstructive SA rather than central SA and were more likely to use CPAP and for a longer duration. Apnea severity was positively associated with 30-day HF hospital readmission rate whereas CPAP use and increased duration of CPAP use conferred protection.

study. This novel technique could help recognize HIV infected individuals with high cardiac risk.

699 ACUTE HIV INFECTION RESULTS IN SUBCLINICAL AND REVERSIBLE INFLAMMATORY CARDIOMYOPATHY Christopher Schuster , Florian Mayer, Corinna Wohlfahrt, Rodrig Marculescu, Michael Skoll, Robert Strassl, Maximilian Aichelburg, Noemi Pavo, Theresia Popow-Kraup, Martin Hülsmann, Armin Rieger, Georg Goliasch Medical University of Vienna, Vienna, Austria Background: Acute HIV infection (AHI) is characterized by high plasma levels of plasma HIV-1 RNA in the absence of HIV-1 antibodies accompanied by symptoms of acute infection in around 70% of patients. It has recently been shown that viral replication is associated with subclinical cardiac dysfunction in chronic HIV infection. However, the impact of excess viral RNA on myocardial function and morphology in the setting of acute HIV infection remains unknown. The objective of this study is to assess the impact of AHI on the heart using functional (i.e. NT-proBNP) and morphological (i.e. troponin T) cardiac markers and to determine whether a correlation to inflammatory parameters (CRP, leukocyte numbers, platelet count, HLA-DR + CD3 + T cells, Il-6, serum amyloid A) exists. Methods: A total of 49 patients with AHI showing a normal cardiac and renal status were enrolled in this retrospective study. Laboratory measurements were performed at the time of diagnosis and at the first follow-up demonstrating suppression of viremia below the limit of quantification (BLQ, after a median of 22 months (12-42). Results: During AHI, median level of NT-proBNP was 79 pg/ml (31-179) compared to 28 pg/ml (10-39) after suppression of viremia BLQ (P<0.001; Fig. 1). NT-proBNP showed a significant correlation with absolute CD4 count (r=0.29; p=0.044) and viral load (r=0.48; P=0.002). Concomitantly, the median level of the cardiac cell injury marker troponin T was 4.9 ng/ml (2.9-12.8) during AHI and 1.5 (1.5-3.9) after attainment of plasma HIV-1 RNA BLQ (P<0.001). Similar to NT- proBNP, Troponin T also showed a significant correlation with viral load (r=0.44; P=0.001). In a multivariate linear regression model, levels of NT-proBNP were determined by the humoral and cellular inflammatory activation reflected by CRP, Il-6, serum amyloid A, leukocyte numbers, platelet count, HLA-DR+CD3+ T cells, resulting in a R2 of 0.71 [F(9,39)=10.36; p=0.001] at the time of AHI diagnosis. Upon suppression of viremia BLQ this association vanished (R2=0.24; F(10,36)=1.15; p=0.357). Conclusion: We observed a significant functional as well as morphologic myocardial impairment during AHI fueled by both humoral and cellular inflammatory activation resulting in a subclinical inflammatory cardiomyopathy, which appears to be fully reversible owing to treatment effects or the abatement of AHI after some weeks.

698 CARDIAC VENTRICULAR DISFUNCTION IN YOUNG VERTICALLY INFECTED HIV PATIENTS Lidia Capotosto, Eugenio Nelson Cavallari , Giuseppina Cusano, Ivano Mezzaroma, Giancarlo Ceccarelli, Luigi Celani, Camilla Ajassa, Gabriella Background: Ventricular disease is common among HIV infected subjects. Vertically infected patients offer the possibility to study young individuals with a long history of infection and antiretroviral treatment. The evaluation of left ventricular (LV) and right ventricular (RV) function trough standard echocardiographic measures commonly provides normal evidences during early stages of ventricular disease. Clinical implementation of 3D Speckle-Tracking Echocardiography (3DSTE) represents a novel opportunity for an accurate evaluation of ventricular function. Methods: 16 HIV infected subjects and 16 age and gender matched controls were enrolled in this study. Pulmonary hypertension (>35 mmHg), abnormal findings at standard echocardiography, history of cardiac disease, chronic systemic disease other than HIV infection and detectable plasma HIV RNA represented exclusion criteria from the study. LV and RV function, as well as Tricuspid annular systolic plane excursion (TAPSE), were assessed trough standard echocardiography in all participants. LV global longitudinal, circumferential and radial strains were calculated and 3DSTE was applied to measure global area strain (percentage variation in surface area defined by the longitudinal and circumferential strain vectors) and RV 3D global and free-wall longitudinal strains. Results: Main characteristics of the HIV infected population are shown in Table1. Reduced values of LV global longitudinal strain and global area strain were observed among HIV infected subjects compared to controls (-15.9% vs. -19.1%, p=0.013 and -33.9% vs. -38.7%, p=0.004), while no differences were observed in LV ejection fraction between the two groups. We also observed a significant reduction of RV free-wall longitudinal strain among HIV positive participants (-19.8% vs. -23.7%, p=0.025). A trend toward a lower TAPSE was noted in the HIV positive group (20.2±2.3mm vs. 23.4±2.6mm, p=0.08). Between the evaluated echocardiographic parameters, LV mass index resulted correlated with age (r=0.395, p=0.036) and CD4 count (r=0.331, p=0.048) of HIV infected participants and LV longitudinal strain was correlated with age (r=0.453, p=0.032), CD4 count (r=0.312, p=0.041) and DAD risk score (r=0.342, p=0.047) of the same group. Conclusion: With 3DSTE we found early bi-ventricular disfunction, in the absence of pulmonary hypertension, among HIV infected participants to our d’Ettorre, Vincenzo Vullo, Antonio Vitarelli Sapienza University of Rome, Rome, Italy

Poster Abstracts

CROI 2018 260