CROI 2018 Abstract eBook

Abstract eBook

Oral Abstracts

78 CAROTID ARTERY ATHEROSCLEROSIS IS ASSOCIATED WITH MORTALITY IN HIV+WOMEN AND MEN David B. Hanna 1 , Jee-Young Moon 1 , Kathryn Anastos 1 , Sabina Haberlen 2 , Audrey French 3 , Frank J. Palella 4 , Stephen J. Gange 2 , Mallory Witt 5 , Seble Kassaye 6 , Jason Lazar 7 , Phyllis Tien 8 , Lawrence Kingsley 9 , Wendy Post 10 , Robert C. Kaplan 1 , Howard Hodis 11 1 Albert Einstein College of Medicine, Bronx, NY, USA, 2 The Johns Hopkins University, Baltimore, MD, USA, 3 Cook County Health & Hospitals System, Chicago, IL, USA, 4 Northwestern University, Chicago, IL, USA, 5 Harbor–UCLA Medical Center, Torrance, CA, USA, 6 Georgetown University, Washington, DC, USA, 7 SUNY Downstate Medical Center, Brooklyn, NY, USA, 8 University of California San Francisco, San Francisco, CA, USA, 9 University of Pittsburgh, Pittsburgh, PA, USA, 10 Johns Hopkins Hospital, Baltimore, MD, USA, 11 University of Southern California, Los Angeles, CA, USA Background: Using carotid artery intima-media thickness (cIMT) measured by ultrasound as a surrogate marker for cardiovascular disease is standard, yet long-term studies of carotid artery ultrasound parameters predicting major health events in persons with HIV are lacking. We evaluated associations of carotid artery measurements with all-cause mortality in the Women’s Interagency HIV Study (WIHS) and the Multicenter AIDS Cohort Study (MACS). Methods: Participants without self-reported coronary heart disease underwent B-mode carotid artery ultrasound in 2004-2006, with measurement of 1) cIMT at the common carotid artery; 2) plaque (focal cIMT >1.5 mm) at the common or internal carotid arteries or carotid bifurcation; and 3) Young’s modulus of elasticity, a measure of arterial stiffness. Participants were followed for a median 9 years (total 22,432 person-years), and death was ascertained by active surveillance and the National Death Index. Cox models estimated the association of each measure at baseline with time to death, controlling for HIV status and demographic, behavioral, cardiometabolic, and HIV-related factors. We tested interactions by cohort and HIV status. Results: Among 1,722 women (median age 40 years, 88% black or Hispanic, 71% HIV+, 62% on ART at baseline) and 880 men (median age 49, 35% black or Hispanic, 66% HIV+, 72% on ART), 10% (206 women, 83 men) died during follow-up. In adjusted analyses, cIMT was not associated with mortality. Presence of carotid artery plaque was associated with 56% greater mortality risk (95% CI 1.13-2.15) and varied by cohort (HR 1.25 among women, 95% CI 0.83-1.89; HR 2.48 among men, 95% CI 1.35-4.38; p for interaction 0.045). The highest quartile of Young’s modulus, indicating greatest stiffness, was associated with 58% greater mortality risk compared with the lowest quartile (95% CI 1.05-2.38, p for interaction by cohort 0.29). While the association of plaque with mortality was more pronounced in HIV- vs. HIV+ participants (p for interaction=0.01), potentially owing to AIDS deaths in the HIV+ group, the relationship was statistically significant in each group (Table). The association of Young’s modulus showed a similar pattern, but the interaction by HIV status was marginally significant (p=0.08). Conclusion: Carotid artery measurements were independently associated with all-cause mortality in both HIV+ and HIV- persons. To our knowledge our study is the first to show that carotid artery plaque is predictive of major health events in HIV+ adults.

Oral Abstracts

77 HIV INFECTION IS ASSOCIATED WITH PROGRESSION OF HIGH RISK CORONARY PLAQUE IN THE MACS Wendy Post 1 , Sabina Haberlen 2 , Long Zhang 2 , Mallory Witt 3 , Lisa Jacobson 2 , Todd T. Brown 2 , Frank J. Palella 4 , Lawrence Kingsley 5 , Matthew Budoff 3 1 The Johns Hopkins University, Baltimore, MD, USA, 2 Johns Hopkins University, Baltimore, MD, USA, 3 Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, CA, USA, 4 Northwestern University, Chicago, IL, USA, 5 University of Pittsburgh, Pittsburgh, PA, USA Background: HIV infection is associated with coronary atherosclerosis, especially non-calcified plaque (NCP) and mixed plaque; however, development and progression of atherosclerosis associated with HIV has only been shown with coronary artery calcium scanning, which cannot detect more potentially unstable plaques. We prospectively evaluated the association between HIV serostatus and the progression and composition of coronary plaque among men in the Multicenter AIDS Cohort Study (MACS). Methods: We performed baseline and follow-up coronary CT angiography in 409 men (253 HIV+, 156 HIV-; median interscan interval=4.5 yrs). Calcified and NCP volumes, including lipid-rich low attenuation plaque (LAP), were measured in each coronary segment. We used Poisson regression to test the association between HIV serostatus and incident plaque among men without baseline plaque, and generalized gamma regression to test the association with progression among men with baseline plaque, adjusting for time between scans, demographics and CVD risk factors. We also evaluated plaque progression differences between HIV- men and HIV+men with suppressed viral load (<50 copies/mL, ≤ 1 “blip” <500 copies/mL) and those with viremia during the inter-scan interval. Results: Mean age was 54 yrs (53 HIV+, 57 HIV-) and 32%were black (35% HIV+, 27% HIV-). 70% of HIV+men were aviremic during the interval. There were 118 men (74 HIV+, 44 HIV-) with no baseline plaque. Incident plaque was seen in 36 (30%) men; 24 developed both NCP and calcified plaque (mixed plaque) and 12 developed only NCP. LAP developed in 27 men. HIV+men had a greater adjusted incidence of NCP (IRR 2.13, p=0.03), LAP (IRR 2.84, p=0.05) and mixed plaque (IRR 3.09, P=0.01) than HIV- men. In addition, compared to HIV- men, the incidence of LAP was greatest among HIV+men with viremia (IRR 5.4, p=0.009; aviremic men IRR 2.4, p=0.096). There were 291 men with baseline plaque (179 HIV+, 112 HIV-). Among men with the greatest NCP volume change, the adjusted increases were significantly greater among HIV+ compared to HIV- men (e.g. 80th %tile of change in NCP was 175 mm 3 for HIV+ compared to 112 mm 3 for HIV-, P=0.03), with similar trends for total plaque and LAP. Conclusion: This is the first study to demonstrate that HIV infection is associated with an elevated incidence and progression of high risk coronary plaque and suggests the need for additional studies to determine the importance of controlling viremia to limit the excess burden of CVD events in this population.

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CROI 2018