CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

clinical outcomes compared to uninfected individuals. Optimizing use of medical therapy and longitudinal care of this high risk group is greatly needed.

1 University of Texas at Houston, Houston, TX, USA, 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 The Ohio State University, Columbus, OH, USA, 4 Asian Pacific AIDS Intervention Team, Los Angeles, CA, USA, 5 Northwestern University, Chicago, IL, USA, 6 University of Pittsburgh, Pittsburgh, PA, USA, 7 Los Angeles LGBT Center, Los Angeles, CA, USA, 8 Georgetown University, Washington, DC, USA, 9 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 10 University of California Los Angeles, Los Angeles, CA, USA Background: Feminizing hormonal therapy (FHT) and HIV potentially alter cardiovascular disease (CVD) risk in transgender women (TW). We assessed serum biomarkers of CVD risk and inflammation among TW by HIV serostatus and FHT use, compared to cis-gender male (CM) controls. Methods: TWwere enrolled from community-based organizations and clinics in Los Angeles, CA and Houston, TX and frequency-matched to Multicenter AIDS Cohort Study CM on age, race, substance use and ART type. Serum biomarker concentrations were assessed via ELISA. Wilcoxon rank sum and Fisher’s exact tests compared groups. Multivariable linear regression analyses assessed factors associated with log 10 -transformed biomarker concentrations. Results: TW (HIV+ n=75, HIV- n=47) and CM (HIV+ n=40, HIV- n=40) had mean age of 43 and 45 years; 90%/91%were non-Hispanic black, Hispanic, or multi-racial, 26%/53% obese, and 34%/24% current smokers, respectively. Persons with HIV (PWH) had current median CD4+ T lymphocyte count 609 cells/uL; 67% of TWwere on FHT (68% HIV+, 66% HIV-). ART use included 29% NNRTIs, 30% PIs, and 37% INSTIs. Among PWH, TW had higher median extracellular newly-identified receptor for advanced glycation end-products (EN-RAGE), lipoprotein-associated phospholipase A2 (LpPLA2), oxidized LDL (oxLDL), soluble TNF receptor type (sTNFR) I/II, interleukin (IL)-8 and plasminogen activator inhibitor (PAI)-1, but lower soluble CD14, von Willebrand factor (vWF) and endothelin (ET)-1 levels than CM, with similar findings for participants without HIV (all p<0.05). In PWH, ENRAGE, oxLDL, and sTNFRI concentrations were higher, and vWF and ET-1 were lower, moving from CM to TW not on FHT (n=24) to TW on FHT (n=51). For persons without HIV, ENRAGE, oxLDL and PAI-1 were higher moving from CM to TW not on FHT (n=16) to TW on FHT (n=31). In multivariate analysis restricted to persons with undetectable HIV-1 RNA and adjusted for HIV serostatus, gender, age, race/ethnicity, BMI, and smoking, being a TW but not HIV status was associated with higher EN-RAGE, IL-6, IL-8, P selectin, PAI-1, oxLDL and sTNFRI/II concentrations, and lower vWF. Both being a TW and a PWH were associated with lower ET-1. Conclusion: Compared to matched CM, TW have altered profiles of biomarkers associated with systemic inflammation and CVD that seem to be influenced by both FHT and HIV, even after adjusting for key risk factors. Clinical data are needed to understand the contributions of FHT and HIV to CVD risk among TW.

644 INSOMNIA AND RISK OF INCIDENT MYOCARDIAL INFARCTION AMONG PEOPLE LIVING WITH HIV Bridget M. Whitney 1 , Robin M. Nance 1 , Joseph Delaney 2 , Stephanie A. Ruderman 1 , Matthew Budoff 3 , W. C. Mathews 4 , Richard D. Moore 5 , Matthew J. Feinstein 6 , Greer Burkholder 7 , Michael J. Mugavero 7 , Joseph J. Eron 8 , Michael Saag 7 , Mari M. Kitahata 1 , Heidi M. Crane 1 , for the CNICS Cohort 1 University of Washington, Seattle, WA, USA, 2 University of Manitoba, Winnipeg, MB, Canada, 3 University of California Los Angeles, Los Angeles, CA, USA, 4 University of California San Diego, San Diego, CA, USA, 5 Johns Hopkins University, Baltimore, MD, USA, 6 Northwestern University, Chicago, IL, USA, 7 University of Alabama at Birmingham, Birmingham, AL, USA, 8 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: Current research suggests that people living with HIV (PLWH) suffer from a substantially higher burden of sleep disturbances, including insomnia, compared to the general population. Insomnia is associated with increased risk of cardiovascular disease (CVD) and may play a role in the increased incidence of myocardial infarctions (MIs) seen among PLWH. Type 1 MIs (T1MI) are due to atherothrombotic coronary plaque rupture, whereas type 2 MIs (T2MI) are from supply-demand mismatch, such as with sepsis or cocaine use; T2MIs are more common in PLWH than in the general population. The disaggregated risk of MI by type due to insomnia in PLWH is unknown. Methods: The multisite Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort includes clinical data, patient-reported outcomes and measures (PROs), and centrally adjudicated MIs with distinction between T1MIs and T2MIs. Using data from PLWH in care at 5 CNICS sites between 2005-2019 we evaluated the relationship between insomnia and first incident MI. Insomnia, defined as having difficulty falling or staying asleep with symptoms that are bothersome, was measured at baseline via PRO as part of the HIV symptom index. The associations between insomnia and incident MI by type were evaluated using separate Cox models adjusted for age, sex, race/ethnicity, CD4 count, viral suppression (VL<400), and traditional CVD risk factors, including treated hypertension, treated dyslipidemia, kidney function (eGFR<30), and smoking. Results: Among 11,189 PLWH there were 241 incident MIs (n=141 T1MIs and n=100 T2MIs) over an average of 4.3 years of follow-up. Sleep disturbance was common, with 6,405 (57%) PLWH reporting some difficulty falling or staying asleep and 5,415 (48%) PLWH reporting their insomnia symptoms were bothersome. In adjusted analyses, PLWH experiencing insomnia were 53%more likely to have an incident T2MI compared to PLWH without insomnia (Hazard Ratio (HR)=1.53, 95% confidence interval (CI): 1.02-2.29; p=0.04). T1MI was not associated with insomnia (HR=0.95, 95%CI: 0.67-1.32; p=0.75). Conclusion: Approximately half of PLWH reported insomnia, an estimate consistent with the 50-70% prevalence reported in the literature. We found that PLWH with insomnia had a substantial increased risk of T2MI, but not T1MI, highlighting the importance of distinguishing MI types. Further investigation into the relationship between insomnia and T2MIs by T2MI cause may elucidate mechanisms underlying this association. 645 HORMONE USE AND HIV ALTER CARDIOVASCULAR BIOMARKER PROFILES IN TRANSGENDER WOMEN Jordan E. Lake 1 , Ruibin Wang 2 , Benjamin Barrett 2 , Nicholas Funderburg 3 , Emily Bowman 3 , Paula Debroy 1 , Jury Candelario 4 , Linda Teplin 5 , Jessica McGuinness 6 , Robert Bolan 7 , Heather McKay 2 , Michael Plankey 8 , Todd T. Brown 9 , Judith S. Currier 10

Poster Abstracts

646 HIV SEVERITY AND INCIDENT HEART FAILURE AMONG PATIENTS IN A LARGE HEALTH CARE SYSTEM Jennifer O. Lam 1 , Wendy Leyden 1 , Kristi J. Reynolds 2 , Michael A.Horberg 3 , William J. Towner 2 , Rulin Hechter 2 , Suma Vupputuri 3 , Thomas K. Leong 1 , Harshith Avula 1 , Teresa J. Harrison 2 , Keane K. Lee 1 , Sue Hee Sung 1 , Romain Neugebauer 1 , Alan S. Go 1 , Michael J. Silverberg 1 1 Kaiser Permanente, Oakland, CA, USA, 2 Kaiser Permanente Southern California, Pasadena, CA, USA, 3 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA

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