CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

700 CORONARY WALL THICKENING AND ASSOCIATION WITH MYOCARDIAL DIASTOLIC FUNCTION IN HIV Julia Purdy 1 , Khaled Z. Abd-Elmoniem 1 , Hwaida Hannoush 1 , Vandana Sachdev 1 , Colleen Hadigan 2 , Ahmed M. Gharib 1 1 NIH, Bethesda, MD, USA, 2 NIAID, Bethesda, MD, USA Background: Cardiovascular disease (CVD) is a rising cause of morbidly and mortality in human immune deficiency virus (HIV) infected patients. Coronary vessel wall (VW) thickening as measured by MRI in young HIV patients has demonstrated early coronary artery pathology. Further, early diastolic dysfunction and myocardial strain abnormalities were detected in HIV patients despite a preserved global myocardial function. The goal of this study is to assess both coronary vascular disease burden and its relation to myocardial function in adults with and controls. Methods: In this prospective, cross-sectional study, a total of 100 HIV+ adults without known CVD and 30 matched healthy controls underwent time resolved phase-sensitive dual inversion recovery black-blood vessel wall magnetic resonance imaging (TRAPD) at 3T to measure proximal right coronary artery (RCA) wall thickness, and echocardiography to assess left ventricular function. Coronary Computer Tomography Angiography (CCTA) was also obtained to measure coronary calcification and overall coronary plaque burden. The presence of coronary calcification and Agatston score were recorded. Addition other non-calcified plaque was accounted for in segment involvement (SIS) and segment severity scores (SSS). Results: There was no difference in age (HIV+48.6 ± 10.1 vs. controls = 46.3 ± 7.8 years), sex, body mass index and Framingham risk score between groups. VWmeasurements by MRI were successful obtained in 74 HIV-infected patients and 25 controls. HIV+ patients demonstrated a significantly thicker (p<0.05) coronary VW (1.5 ± 0.22mm) compared to controls (1.3 ± 0.18mm). Echocardiography measured ejection fraction (EF) and early (E) to late (A) ventricular filling velocities ratio (E/A) and all CCTA-based coronary plaque burden were not different between the two groups. However, in a regression analysis of HIV+ subjects, there was significant negative correlation between VW thickness and E/A ratio (p<0.05). Conclusion: Subclinical coronary artery disease (CAD) is present in HIV- infected patients without a known history of CVD as shown by increased coronary VW thickness compared to controls. Furthermore, coronary VW thickness measured by MRI was associated with a detrimental effect on the myocardial function as demonstrated by the significant negative relationship between early mild diastolic dysfunction (impaired relaxation) depicted by decrease in E/A ratio on echocardiography. 701 CONTRIBUTION OF HIV, HCV, AND VASCULAR RISK FACTORS TO PERIPHERAL ARTERIAL DISEASE Emily Cedarbaum 1 , Yifei Ma 1 , Rebecca Scherzer 1 , Jennifer Price 1 , Michael Plankey 2 , Margaret Fischl 3 , Eric C. Seaberg 4 , Mardge H. Cohen 5 , Marcas Bamman 6 , Jason Lazar 7 , Adaora Adimora 8 , Michael T. Yin 9 , Phyllis Tien 1 1 University of California San Francisco, San Francisco, CA, USA, 2 Georgetown University, Washington, DC, USA, 3 University of Miami, Miami, FL, USA, 4 Johns Hopkins University, Baltimore, MD, USA, 5 Cook County Health & Hospitals System, Chicago, IL, USA, 6 University of Alabama at Birmingham, Birmingham, AL, USA, 7 SUNY Downstate Medical Center, Brooklyn, NY, USA, 8 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 9 Columbia University, New York, NY, USA Background: Peripheral artery disease (PAD) increases cardiovascular disease (CVD) risk by 3-6 fold and is associated with physical function decline and increased mortality. Studies of PAD in HIV have been mostly small in sample size and lacked a comparison seronegative group. None have studied the impact of HCV coinfection. We examine the association of HIV, HCV, and traditional CVD risk factors with PAD in the Women’s Interagency HIV Study (WIHS), a multicenter US cohort of women with and at risk for HIV. Methods: Ankle-brachial index (ABI) was calculated using Doppler ultrasound with manual sphygmomanometer measurement of ankle and brachial pressures in 1865 participants (1064 HIV+/HCV-;94 HIV-/HCV+;283 HIV+/HCV+;424 HIV-/HCV-) age >40. Multivariable logistic regression was used to determine the association of HIV and HCV with PAD (defined as ABI≤0.9 or >1.3) after controlling for demographics, behavioral and vascular risk factors. Results: HIV+/HCV+ and HIV-/HCV+ women were older than HIV+/HCV- and HIV-/HCV- women (median age:54-55 vs 49-50) and more likely to be a current smoker (>50% of HIV+/HCV+ and HIV-/HCV+ vs 35% of HIV+/HCV-;47% of HIV-/HCV-). Over 67% of the cohort was Black. PAD prevalence was high but

showed little difference by HIV and HCV status (29% in HIV+/HCV+;28% in HIV-/HCV+;27% in HIV+/HCV-;29% in HIV-/HCV-). In adjusted models, women with HIV and HCV infection did not have greater odds of PAD compared to uninfected women (Table). Rather, greater odds of PAD were associated with Black race (OR:1.98(95% Confidence Interval[CI]:1.33,2.95), longer pack-year smoking history (OR:1.02 per year increase; 95%CI:1.01,1.03), and greater waist circumference (OR:1.04 per 5cm increase;95%CI:1.00,1.08) and pulse pressure (OR:1.01 per 1mm Hg;95%CI:1.00,1.02). Higher HDL (OR:0.93 per 10% increase;95%CI:0.87,0.99) and DM (OR:0.77;95%CI:0.61,0.98) were associated with lower PAD risk. CVD risk factors showed similar associations with PAD in each infection group. In the HIV+ women, there was little association of CD4 count, HIV RNA, or HIV duration with PAD. Conclusion: HIV and HCV infections are not associated with greater PAD risk in WIHS. However, the high PAD prevalence in our cohort is striking; general population studies show a >25% prevalence at ages >20 years older. Our findings suggest that smoking cessation, weight loss, and blood pressure control are important to target early in women with and at risk for HIV. Investigation of factors associated with PAD progression is underway. 702 CARDIAC ABNORMALITIES IN PERINATALLY INFECTED HIV+ SOUTH AFRICAN ADOLESCENTS ON ART Sana Mahtab, John Lawrenson, Norme J. Luff, Nana Akua Asafu-Agyei, Liesl Zülke, Landon Myer , Heather Zar University of Cape Town, Cape Town, South Africa Background: Little is known about the cardiac health of perinatally HIV- infected adolescents (PHIV+) in African settings. We studied cardiac structure and function in PHIV+ on antiretroviral (ART) compared to age matched HIV- controls. Methods: Echocardiograms were performed on PHIV+ and controls enrolled in the Cape Town Adolescent Antiretroviral cohort(CTAAC).Participants were eligible if they were aged 9-14 years and had been on ART for at least 6 months. Lipid profile was measured on fasting serum samples.Echo parameters were adjusted by using z-scores according to body surface area.Logistic regression were used to examine the adjusted association between echo measures and HIV-related and traditional cardiovascular risk factors Results: Overall 474 PHIV+ (median age,12 years; 51%male; mean age at ART initiation 5 years,SD ±3.5) and 109 controls (median age,11.8 years; 45% male) were included. Mean duration on ART was 7 years (SD±3.0) with 36.5% initiating <2 years of age. Median total cholesterol (4.1 vs 3.8 mmol/L,p<0.01), low-density lipoprotein (2.2 vs 2.0 mmol/L,p=0.01) and triglyceride (0.9 vs 0.7 mmol/L,p<0.01) were higher in PHIV+. PHIV+ had lower mean z-scores for left ventricular (LV) internal dimension at the end of diastole (-0.16 vs -0.49,p=<0.01), LV posterior wall thickness at the end of systole (-0.45 vs -0.65,p=0.01) and right ventricular (RV) internal dimension at end diastole (0.24 vs 0.43,p=0.01) and higher for thickness of inter-ventricular septum at the end of systole (0.7 vs 0.6,p=0.04) vs controls. Only 2 PHIV+ had mild pulmonary hypertension.There was no difference in ejection fraction or simple diastolic function assessment between groups. Later initiation of ART between age 6-14 years was associated with increased risk of LV hypertrophy (LVH) (>88/102 g/m²-female/male) (OR 2.9,p=0.01) compared to those who started ART earlier (before age of 6 years).PHIV+ with WHO HIV stage IV at diagnosis were at increased risk (OR 2.14,p=0.05) of having LV diastolic dysfunction (LVDD)(abnormal mitral E/A ratio for age) compared to those with less advanced clinical disease. Conclusion: ART is cardioprotective in our participants despite delayed onset of therapy, with no difference in systolic or diastolic function between groups. However, starting ART at an older age was a significant risk factor for LVH while more advanced clinical disease was associated with LVDD. Surprisingly PHIV+ had less dilated left and right ventricles than controls;the clinical significance of this is uncertain.

Poster Abstracts

CROI 2018 261