CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Background: Numerous studies show a link between visceral adiposity and metabolic disorders. Fatty liver is an established risk factor for cirrhosis and liver cancer and is increasing among aging persons living with HIV (PWH). We investigated the prevalence and correlates of hepatic steatosis, assessed non-invasively by elastography with controlled attenuation parameter (CAP), in a community cohort of HIV+ and HIV- people who inject drugs (PWID) and to determine if these associations varied by HIV infection or antiretroviral therapy (ART) regimen. Methods: Adults from the AIDS Linked to the Intravenous Experience (ALIVE) study with validated liver elastography and CAP measurement from January 2017 to December 2018 were included. CAP >= 270 dB/mwas considered significant steatosis. Multivariable logistic regression estimated odds ratios (OR) for association of steatosis with demographic (age, gender, race), behavioral (at-risk alcohol use, current injection drug use), clinical (liver stiffness, HCV exposure, BMI, waist circumference, blood pressure, blood glucose, serum cholesterol), and HIV related factors (HIV RNA, CD4, ART regimen). Results: Of 1109 participants, 68%were male, 79%were black 40% reported recent drug use, 78%were anti-HCV+ and 35%were HIV infected (75% on ART; 65% had detectable HIV RNA). Median CAP score was 218 dB/m (IQR, 190 – 258) and prevalence of hepatic steatosis was 25%. In multivariable analysis, steatosis was significantly associated with obesity/overweight, [OR= 8.2 (5.1 – 13)] increased waist girth [OR=4.2 (2.8 – 6.2)] and liver fibrosis[OR=1.3 (1.1 – 1.6)]. Among HIV+’s , steatosis was strongly associated with undetectable HIV RNA [OR=1.6 (1.0 – 2.4)] and INSTI based ART [OR=1.8 (1.1 – 2.9)]. In sensitivity analyses, each measure of adiposity (hepatic steatosis, elevated BMI, elevated waist circumference) was individually associated with INSTI use. Conclusion: Classic metabolic risk factors were strongly associated with hepatic steatosis in this community based PWID. While HIV did not independently increase risk, HIV-related factors of viral suppression and INSTI use were associated, contributing partly although not exclusively via adiposity. As HIV- infected PWID age on effective therapy, and with curative treatment for HCV, prevalence and morbidity of hepatic steatosis will likely increase.

and Fisher’s exact tests compared between-group parameters. Multivariate regression assessed the relationship between NAFLD and a FRP controlling for HIV serostatus, study site, age, race, subcutaneous adipose tissue (SAT) density (HU), smoking status, alcohol use, liver fibrosis (FIB-4 >3.25), depression, and physical activity level (by international physical activity questionnaire). The final model included a NAFLD*HIV interaction. Results: HIV- (n=200) and HIV+ (n=292) men had a median age of 55 and 52 years, BMI of 27 and 25 kg/m 2 , and were 32% and 41% non-white, respectively. HIV+men had a median CD4+ T lymphocyte count of 609 cells/mL, and 9.3 years on antiretroviral therapy. NAFLD prevalence was 21% in HIV- men vs 16% in HIV+men; FRP 12% in HIV- vs 17% in HIV+. Among men with NAFLD, FRP was more prevalent in HIV- (21% vs 11% HIV+). In multivariate analysis, NAFLD, smoking, depression, and low physical activity were associated (p<0.05) with a FRP. In stratified adjusted models, HIV- men with NAFLD had 2.6 times higher probability [95% CI: 1.2-5.7] of FRP. This association was not seen in HIV+men. The probability of a FRP was higher among HIV-men with NAFLD (10% vs 27% in men with NAFLD) but lower among HIV+men (18% vs 13% in men with NAFLD). Sarcopenia was not associated with increased risk of NAFLD. Conclusion: NAFLD was more prevalent in HIV- men, and independently associated with a FRP among HIV- men but not men living with HIV despite the latter’s increased prevalence of frailty. The mechanisms of the muscle-liver- adipose tissue axis underlying NAFLD might differ by HIV serostatus. 543 NAFLD AND LIVER FIBROSIS PREDICT HIGH CARDIOVASCULAR RISK IN HIV-MONOINFECTED PATIENT Giovanni Mazzola 1 , Adriana Cervo 1 , Giovanni Guaraldi 2 , Thomas Krahn 3 , Jovana Milic 2 , Annamaria De Luca 4 , Claudia Gioè 4 , Benedetta Romanin 4 , Marcello Trizzino 4 , Sergio Mazzola 4 , Pietro Colletti 4 , Salvatore Petta 4 , Giada Sebastiani 3 , Antonio Cascio 4 1 University Hospital of Palermo, Palermo, Italy, 2 University of Modena and Reggio Emilia, Modena, Italy, 3 McGill University Health Centre, Glen site, Montreal, QC, Canada, 4 University of Palermo, Palermo, Italy Background: Non-alcoholic fatty liver disease (NAFLD) is strongly associated to cardiovascular disease (CVD) in the general population. In people living with HIV (PLWH), this association has not been investigated yet. The aim of this study is to assess the impact of NAFLD and liver fibrosis on cardiovascular risk in PLWH. Methods: 1410 HIV infected patients from three prospective cohorts (LHIVPA in Palermo, LIVEHIV in Montreal, MHMC in Modena) were evaluated with Transient Elastography (TE). Exclusion criteria were: significant alcohol intake, coinfection with hepatitis B or C virus and failure of TE examinations defined as IQR value > 30%. NAFLD and significant liver fibrosis were defined as controlled attenuation parameter (CAP) ≥ 288 dB/m and as liver stiffness measurement (LSM) > 7 kPa, respectively. Cardiovascular risk was assessed with Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator, according to American College of Cardiology, in patients aged 40 – 75 years, and categorized as: low if < 5%, borderline if 5 – 7.4%, intermediate if 7.5 – 19.9% and high if ≥ 20%. Patients with previous cardiovascular events were considered as high risk, regardless of age. Results: 941 HIV mono-infected patients (mean age 53 years, 74%males, 98% on ART) were included. 423 (45%), 128 (13.6%), 260 (27.6%) and 130 (13.8%) patients were categorized as low, borderline, intermediate and high ASCVD risk, respectively. Previous cardiovascular events were found in 8.5%. Prevalence of NAFLD and significant liver fibrosis was 20% and 17%, respectively. The distribution of ASCVD risk classes by NAFLD and fibrosis categories is shown in the Table. Overall, intermediate and high ASCVD risk were more frequent in patients with NAFLD (p < 0.001) and liver fibrosis (p < 0.05). In multivariate logistic regression, NAFLD (OR 2.16, 95% CI 1.44 – 3.26), liver fibrosis (OR 1.75 , 95% CI 1.11 – 2.75) and time to HIV diagnosis (OR 1.04, 95% CI 1.02 – 1.06, p < 0.001) were independently associated with higher ASCVD risk. Conclusion: Both NAFLD and liver fibrosis are predictors of cardiovascular disease in PLHIV. Prevention of CVD, possibly with lifestyle modifications, should be strengthen in PLHIV with NAFLD, in particular in those with longer HIV duration.

Poster Abstracts

542 RELATIONSHIPS BETWEEN HEPATIC STEATOSIS AND FRAILTY DIFFER BY HIV SEROSTATUS Paula Debroy 1 , Benjamin Barrett 2 , Kristine M. Erlandson 3 , Matthew Budoff 4 , Todd T.Brown 2 , Jennifer C. Price 5 , Wendy Post 2 , Valentina Stosor 6 , Carling Lellock 7 , Gypsyamber D'Souza 2 , Jordan E. Lake 1 1 University of Texas at Houston, Houston, TX, USA, 2 Johns Hopkins University, Baltimore, MD, USA, 3 University of Colorado, Aurora, CO, USA, 4 Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, CA, USA, 5 University of California San Francisco, San Francisco, CA, USA, 6 Northwestern University, Chicago, IL, USA, 7 University of Pittsburgh, Pittsburgh, PA, USA Background: Frailty and sarcopenia are associated with abdominal obesity and obesity-related comorbidities but their relationship with non-alcoholic fatty liver disease (NAFLD) in people living with HIV (PLWH) has not been described. We assessed the associations between NAFLD, sarcopenia, and components of a frailty-related phenotype (FRP) in Multicenter AIDS Cohort Study (MACS) participants. Methods: MACS cardiovascular disease sub-study participants (40-70 years old) were included. NAFLD was defined as the ratio of liver/spleen in Hounsfield units (HU) < 1.0 on abdominal CT scans in men without chronic viral hepatitis or heavy alcohol use; FRP as having 3 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity; sarcopenia as an appendicular skeletal muscle index [ASMI (kg)/height (m)²] ≤7.26 kg/m 2 . Wilcoxon rank sum

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