CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

results. Cognizant of sex-specific patterns of HIV-associated immune dysregulation, we compared aPWV among asymptomatic ART-treated women with vs. without HIV. We hypothesized that WHIV would evidence vascular dysfunction in association with monocyte activation. Methods: 20 WHIV and 14 matched women without HIV underwent cardiac MRI, as well as metabolic and immune phenotyping. Women with a history of CVD, diabetes, or significant kidney disease were excluded. Results: Women with vs. without HIV had comparable age (52 vs. 53 years) and BMI (32 vs. 32 kg/m 2 ). WHIV exhibited heightened systemic monocyte activation, reflected by increased levels of sCD163 (1260 vs 938 ng/mL, P=0.005). Among WHIV, duration of HIV was 19±8 years, CD4 count was 773 (526,1202) cells/mm 3 and viral load was 19 (19,19) copies/mL. aPWV was higher among women with vs. without HIV (8.6±1.3 vs 6.5±1.3 m/s), P<0.0001; Fig. 1A). Among the whole group and each sub-group, aPWV did not relate to age, BMI, cigarette smoking burden, or SBP. Among the whole group and among WHIV, aPWV related to sCD163 levels (whole group: R=0.65, P<0.0001; WHIV: R=0.73, P=0.0003; Fig. 1B). Among the whole group and among WHIV, aPWV also related to extracellular volume – a measure of myocardial fibrosis (whole group: R=0.54, P=0.001; WHIV: R=0.47, P=0.04). Both HIV status and sCD163 levels independently predicted aPWV, even after controlling for age, BMI, cigarette smoking status, and SBP (R2=0.63, P=0.0002; HIV status: P=0.02; sCD163: P=0.01). Among WHIV, sCD163 levels independently predicted aPWV after controlling for duration of HIV, CD4 count, and HIV viral load (R2=0.62, P=0.007; sCD163: P=0.0005). Conclusion: Asymptomatic ART-treated WHIV demonstrated increased aPWV. Among WHIV, aPWV related to heightened monocyte activation as well as to downstream CVD pathology. Additional studies are needed to identify targeted immune-modulatory therapies which slow the progression from vascular dysfunction to incident CVD in this at-risk population.

unit/yr increase if baseline CAC=1-100, and ≥10%/yr increase if baseline CAC>100, and analyzed by robust Poisson regression. Progression was defined by the upper tertile of annualized change in total and noncalcified plaque volume, using multinomial logistic regression. Regression models adjusted for demographic, cardiovascular risk, and HIV-related clinical factors, and baseline serum testosterone. Results: Median age among the 300 MWH was 51 years, 48%were white, 41%were in the ASCVD high risk category, 91%were on antiretroviral therapy, and 81% had undetectable HIV viral load (<20 copies/mL). TTh trajectories were: 70% never, 8% former, 7% new, and 15% consistent use. Median total testosterone was 606 ng/dL (IQR=445,808). Adjusting for age, race, testosterone<300 ng/dL, and cardiovascular and HIV cofactors, the risk of significant CAC progression was 2.0 times greater among continuous users (p=0.03) and 2.4 times greater among new users (p=0.01) relative to former users. We observed a similar trend for total and noncalcified plaque volume progression, but these estimates were not statistically significant (Table). Conclusion: MWH who continued or started TTh were twice as likely as former users to experience significant CAC progression over 4 years. To our knowledge, this is the first contemporary study of cardiovascular outcomes associated with TTh use among MWH; additional observational data should be leveraged to further elucidate the potential health implications of TTh use among MWH.

Poster Abstracts

643 POSTDISCHARGE OUTCOMES FOLLOWING ACUTE CORONARY SYNDROME IN HIV Monica Parks 1 , Eric A. Secemsky 2 , Changyu Shen 2 , Robert W. Yeh 2 , Eunhee Choi 2 , Dhruv Kazi 2 , Priscilla Hsue 1 1 University of California San Francisco, San Francisco, CA, USA, 2 Beth Israel Deaconess Medical Center, Boston, MA, USA Background: HIV-infected individuals are at increased risk of cardiovascular death. Most of this risk can be attributed to ischemic heart disease. Differences in the management of HIV-infected patients following hospitalization for acute coronary syndromes (ACS) may contribute to worsened outcomes in this population. We hypothesized that HIV-infected individuals have higher rates of mortality following discharge, and receive sub-optimal medical management compared with uninfected individuals. Methods: This was a retrospective cohort study using data from Symphony Health, a nationwide data warehouse. All adults admitted between January 1st, 2014 and December 31st, 2016 with ACS were included, and their characteristics and outcomes were defined by ICD-9 and 10 diagnostic codes. Results: A total of 1,125,126 patients were included, of whom 6,612 (0.59%) had HIV. The HIV-infected group was younger (57 vs 67 years old, p<0.0001), and had a higher burden of comorbidities such as diabetes, renal disease and substance use (p<0.0001). The type of ACS did not differ significantly between groups. The HIV-infected group had higher adjusted 30-day all-cause readmissions (14.3% vs 9.4%, OR 1.23, 95% CI 1.14-1.33, p<0.0001) and 1-year mortality (5.6% vs 5.1%, OR 1.34, 95% CI 1.2-1.5, p<0.0001). In the 12 month post-discharge period, the HIV+ group filled core cardiac medications such as statins (66.8% vs 73.7%, p<0.0001), beta blockers (67.9% vs 73.9%, p<0.0001), nitrates (31.8% vs 35.9%, p<0.0001) and antiplatelet agents (46.8% vs 51.8%, p<0.0001) at lower rates. Conclusion: Following treatment for ACS, HIV-infected individuals are less likely to be taking guideline-recommended medical therapy and have worsened

642 TESTOSTERONE THERAPY AND SUBCLINICAL ATHEROSCLEROSIS PROGRESSION AMONG MEN WITH HIV

Sabina A. Haberlen 1 , Wendy Post 2 , Matthew Budoff 3 , Jordan E. Lake 4 , Adrian Dobs 2 , Frank J. Palella 5 , Michael Plankey 6 , Anne K. Monroe 7 , Lawrence Kingsley 8 , Todd T. Brown 2 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, CA, USA, 4 University of Texas at Houston, Houston, TX, USA, 5 Northwestern University, Chicago, IL, USA, 6 Georgetown University, Washington, DC, USA, 7 George Washington University, Washington, DC, USA, 8 University of Pittsburgh, Pittsburgh, PA, USA Background: Testosterone therapy (TTh) use is highly prevalent among middle-aged and older men with HIV (MWH) in the United States, but its cardiovascular safety is unclear. We assessed progression of subclinical coronary artery disease by TTh use status among MWH in the Multicenter AIDS Cohort Study (MACS). Methods: MWH in the MACS CVD sub-study in 4 U.S. cities from 2010-17 were included, each of whom underwent two coronary CT angiography (CCTA) measurements 4.5±0.7 years apart. Inclusion criteria were age 40-70 without coronary intervention or kidney dysfunction. TTh use was self-reported semi-annually, and classified as never, prior to baseline CCTA (former), after baseline CCTA (new), or both (consistent). We evaluated associations between TTh and progression of subclinical atherosclerosis, specifically 1)coronary artery calcium (CAC), 2)total plaque volume, and 3)noncalcified plaque volume. CAC progression was defined by incident CAC if baseline CAC=0, ≥10 Agatston

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