CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

652 PREVALENCE OF SUBCLINICAL MYOCARDIAL ABNORMALITIES IN HIV: SMASH STUDY RESULTS Katherine Wu 1 , Sabina A. Haberlen 2 , Michael Plankey 3 , Frank J. Palella 4 , Damani A.Piggott 1 , Gregory D. Kirk 1 , Joseph B. Margolick 2 , Wendy Post 1 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 Georgetown University, Washington, DC, USA, 4 Northwestern University, Chicago, IL, USA Background: It is unknown whether HIV infection remains an independent risk factor for subclinical myocardial disease in the era of combination antiretroviral therapy (cART). We assessed differences in cardiac structure and function by cardiac magnetic resonance (CMR) imaging among people with (HIV+) and without HIV (HIV-) after controlling for potential confounders. Methods: 432 participants (71%men, 63% HIV+) in the Multicenter AIDS Cohort Study, AIDS Linked to the Intravenous Experience study, and Women’s Interagency HIV Study, aged 40-70 years, underwent CMR for biventricular volumes and mass, left atrial (LA) volumes, and left ventricular (LV) and LA strain. CMR with contrast and T1 mapping comprehensively assessed scar patterns and burden. Results: Median participant age was 55 years, 47% smokers, 53% hypertensive, 13% diabetic, and 59% dyslipidemic. Prevalence of stimulant, opioid and marijuana use was 39%, 32%, and 44%. Among HIV+ persons, 89%were on cART, 74% had viral suppression (HIV RNA<50 copies/ml), and most recent median CD4 count was 610/ul (IQR 398-826). For most characteristics, HIV- and HIV+ participants were similar. Median LV ejection fraction (EF) was normal and similar by HIV serostatus (73% for HIV- vs. 72% for HIV+, p=0.53; n=2 with LVEF<40%) as were right ventricular EF, biventricular volumes and masses. Focal myocardial scar prevalence was also similar (32% vs. 37%, p=0.38) with similarly lowmedian scar extents (4.1 vs. 5.0 grams, p=0.46). The pattern of myocardial scar was predominantly non-ischemic. An ischemic scar pattern was found among only 3% of HIV- vs. 5% of HIV+ (p=0.56). Indices of nonischemic diffuse fibrosis did not differ by HIV serostatus. After adjusting for demographics, parent cohort, education, cardiac risk factors, and drug use, LA volumes (maximal, minimal and pre-atrial) were the only CMR parameters that differed significantly by HIV serostatus and were ~10% larger for HIV+(Table). Among HIV+ people, LA volumes did not differ by viral suppression status. Conclusion: Among a comparable group of HIV- and HIV+ people with similar characteristics and patterns of recreational substance use, prevalent ventricular disease was rare and ventricular indices did not differ by HIV serostatus. However, HIV+ serostatus was independently associated with larger LA phasic volumes, possibly reflecting diastolic dysfunction and predisposal to atrial arrhythmias.

651 CONTRIBUTION OF TELOMERE LENGTH AND CLINICAL RISK FACTORS TO CORONARY ARTERY DISEASE Isabella C. Schoepf 1 , Tanja Engel 1 , Marieke Raffenberg 1 , Neeltje A.Kootstra 2 , Peter Reiss 2 , Christian Thorball 3 , Jacques Fellay 3 , Roger Kouyos 4 , Huldrych F. Günthard 4 , Bruno Ledergerber 4 , Philip E. Tarr 1 , for the Swiss HIV Cohort Study 1 University Hospital Basel, Basel, Switzerland, 2 University of Amsterdam, Amsterdam, Netherlands, 3 University of Lausanne, Lausanne, Switzerland, 4 University Hospital Zurich, Zurich, Switzerland Background: In the general population, leukocyte telomere length (TL) shortening, as occurs with advancing age, is associated with coronary artery disease (CAD) events. The relative contribution of TL, HIV-related and traditional risk factors to CAD has not been quantified in HIV-positive persons. Methods: We measured TL in stored peripheral blood mononuclear cells (PBMC) as previously described (Cobos Jimenez J Infect Dis 2016) by quantitative PCR, using the single copy albumin gene as control. Relative TL was estimated using a standard curve prepared from healthy blood donors. Study participants were white Swiss HIV Cohort Study participants. Cases had a 1st CAD event during the study period (1.1.00-31.12.17). We used incidence density sampling and matched 1-3 controls (CAD event-free) on gender, age, and date of registration. We obtained univariable and multivariable odds ratios (OR) for a first CAD event from conditional logistic regression analyses, including as variables TL, age, gender, smoking, family history, hypertension, diabetes, hypercholesterolemia, and HIV-related factors (recent exposure to abacavir, exposure >1 year to indinavir, lopinavir/ritonavir, darunavir; ART discontinuation; on ART but HIV RNA>50 copies/mL). Results: We included 333 cases (median age at CAD event, 54 years; 14% women; 83%with HIV RNA<50) and 745 controls. Median (IQR) time of TL measurement was 9.4 (5.9-13.8) years prior to CAD event. Participants in the 5th (longest) TL quintile, compared to the 1st (shortest) TL quintile had univariable CAD odds ratio of 0.56 (95% confidence interval, 0.35-0.91; p=0.02), and a multivariable OR of 0.47 (0.26-0.86; p=0.01; Figure). In comparison, the OR for current smoking was 2.28 (1.46-3.56), hypercholesterolemia 1.84 (1.33-2.55), diabetes 3.92 (2.26-6.78), on ART/HIV RNA>50 1.80 (0.95-3.42); recent abacavir, cumulative lopinavir, indinavir, darunavir exposure 1.84 (1.28-2.64), 1.87 (1.23–2.84), 3.22 (1.99-5.21), and 1.68 (1.01-2.78), respectively. Conclusion: HIV-positive persons with the longest telomeres (measured >9 years prior to CAD event) had approx. half the odds of developing CAD of those with the shortest telomeres. TL measurement may, in addition to traditional and HIV-related risk factors, provide prognostic information with respect to CAD risk.

Poster Abstracts

653 AORTIC DILATATION IS PRESENT AMONG MEN WITH HIV

Anum S. Minhas 1 , Bin Liu 1 , Henrique Doria De Vasconcellos 1 , Sabina A. Haberlen 1 , Matthew J. Feinstein 2 , Valentina Stosor 2 , Matthew Budoff 3 , Kara W. Chew 3 , Jared Magnani 4 , Todd T. Brown 1 , Sean Altekruse 5 , Wendy Post 1 , Joao Lima 1 , Katherine Wu 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 Northwestern University, Chicago, IL, USA, 3 University of California Los Angeles, Los Angeles, CA, USA, 4 University of Pittsburgh, Pittsburgh, PA, USA, 5 National Heart, Lung, and Blood Institute, Bethesda, MD, USA Background: In the antiretroviral era, cardiovascular disorders have become more prevalent in people living with HIV. However, it is unclear whether HIV

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