CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Despite low CAVI demonstrated in our HIV-infected adolescents, individuals with risk factors should be monitored for the progression towards significant arterial diseases.

857 SUBSTANTIAL GENDER DIFFERENCES IN LONGITUDINAL ARTERIAL STIFFNESS IN CHILDREN ON ART Steve Innes 1 , Mark Cotton 1 , Kennedy N. Otwombe 2 , Barbara Laughton 1 , Philip Herbst 1 , Innocent Karangwa 1 , Sara H. Browne 3 1 Stellenbosch University, Cape Town, South Africa, 2 Perinatal HIV Research Unit, Soweto, South Africa, 3 University of California San Diego, La Jolla, CA, USA Background: Atherosclerotic vascular disease (AVD) is the major determinant of morbidity and survival in adult HIV+ persons on long-term suppressive antiretroviral therapy (ART), with women affected less severely than men. Whether this gender difference is present before puberty is unknown. HIV- specific mechanisms of AVD pathogenesis are uncertain but there is good evidence that AVD originates in childhood. AVD progression is reflected in pulse wave velocity (PWV), a direct measure of arterial stiffness. Methods: Prospective PWV over 2 years in a long-standing cohort of well- suppressed HIV+ children (all prepubertal at entry) and an existing well- matched HIV-uninfected control group consisting of HIV-exposed (HEU) and -unexposed (HUU) children from the same communities and socio-economic background. Possible risk factors were modeled using forward stepwise regression: age, gender, serum cotinine (measures tobacco smoke exposure), fasted total cholesterol, HDL, LDL, triglycerides, glucose, blood pressure, extensive anthropometrics including waist circumference, waist-hip ratio, and body mass index. Linear mixed effects model used to compare longitudinal change in PWV in HIV+ and HIV- boys and girls. Results: 87 HIV+ (median age 7.7 [IQR: 7.6–7.8] years, 46%male) who initiated ART at median 9 (7–12) weeks of age, with cumulative time on ART of median 7.1 (6.7–7.5) years and normal CD4 counts. 53 uninfected (31 HUU; 22 HEU) of median age 8.5 (7.8–8.7) years, 60%male, with similar anthropometric z-scores between groups (p>0.10). PWV z-score for height and gender (PWVz) was abnormally elevated in HIV+ children compared with HIV-unexposed (median 3.9 versus 3.4, p=0.02). In the HIV+model, arterial stiffness was predicted by fasting glucose (p<0.0001), waist circumference (p<0.0001) and gender, but not by lipids. Among HIV+, PWVz was higher in boys than girls at baseline (median 4.0 versus 3.3, p=0.006), but both slowly improved with accumulating time on suppressive ART (Figure 1). PWVz improved more quickly in boys than girls (mean improvement -0.53 per year in boys versus -0.27 in girls; p<0.0001) but remained higher than girls after 2 years (Figure 1). No change in arterial stiffness was seen in HIV-uninfected over time in either gender. Conclusion: In prepubertal children on suppressive ART, arterial stiffness is abnormally elevated in both genders, with boys more severely affected. Over 2 years, boys improved more quickly than girls but remain more severely affected.

856 CARDIO-ANKLE VASCULAR INDEX AMONG PERINATALLY HIV-INFECTED THAI ADOLESCENTS Tavitiya Sudjaritruk 1 , Linda Aurpibul 2 , Suvaporn Anugulreungkit 3 , Tawalchaya Chotecharoentanan 2 , Siwanart Thamsala 4 , Rattika Thummalangka 2 , Kittipan Rerkasem 1 , Thanyawee Puthanakit 3 1 Chiang Mai University, Chiang Mai, Thailand, 2 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand, 3 Chulalongkorn University, Bangkok, Thailand, 4 HIV–NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand Background: Cardio-ankle vascular index(CAVI) was developed to demonstrate arterial stiffness independent of blood pressure(BP). A previous study in HIV-infected Thai adults(mean age 42 years) showed that the prevalence of arterial stiffness(CAVI≥9m/s) was 38%. Yet, data in HIV-infected adolescents is scarce. This study aimed to assess CAVI in HIV-infected Thai adolescents Methods: A multicenter, cross-sectional study was conducted. Perinatally HIV-infected adolescents(10-25years) receiving antiretroviral therapy(ART) for ≥1 year, and age- and sex-matched healthy controls(ratio3:1) were enrolled. CAVI(m/s) was measured by the VaSera(VS-1500) device(Fukuda Denshi, Japan) on both arms and legs. An average value of the two sides represents CAVI for each adolescent. CAVI≥9m/s defines arterial stiffness. Risk for metabolic disorder was assessed, and defined as having either body mass index(BMI)≥30 kg/m2, triglyceride(TG)≥150 mg/dL, LDL-C≥130 mg/dL, HDL-C<40 mg/dL, or homeostasis model assessment of insulin resistance(HOMA-IR)>3.16. Linear regression analysis was performed to identify factors associated with CAVI among HIV-infected adolescents. Results: Of 200 adolescents(150 HIV-infected and 50 healthy) enrolled, half(50%) were male, and median age(IQR) was 18(15-21) years. Among HIV-infected adolescents, 65(43%) currently received protease inhibitor- based regimens, and median ART duration(IQR) was 13(9-14) years. Systemic hypertension(HT) (systolic BP≥130 or diastolic BP≥85 mmHg) was identified in 14(7%) adolescents, and 31(16%) were overweight/obese which were not different between HIV-infected and healthy adolescents(P>0.05). Insulin resistance (HOMA-IR>3.16: 30% vs. 8%; P<0.01) and dyslipidemia (HDL-C<40 mg/dL: 25% vs. 6%, and TG≥150 mg/dL: 26% vs. 8%;P<0.01) were greater in HIV-infected adolescents compared with healthy controls. The median CAVI(IQR) were 5.8(5.2-6.2) and 5.8(5.4-6.3)m/s in HIV-infected and healthy adolescents(P=0.48), respectively. Although there was no adolescent having arterial stiffness (CAVI≥9m/s), those with CAVI ranking ≥95th percentile of our cohort were predominately HIV-infected(n=9), and had ≥1 risk for metabolic disorder(n=8) (Table1). In multivariable analysis, age≥18 years, systemic HT, and ART duration were significantly associated with increased CAVI in HIV- infected adolescents (P<0.05).

Poster Abstracts

CROI 2018 324