CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

656 INPATIENT OUTCOMES FOR HIV-INFECTED PATIENTS HOSPITALIZED FOR ACUTE CORONARY SYNDROME Monica Parks 1 , Eric A. Secemsky 2 , Robert W. Yeh 2 , Changyu Shen 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 adults have excess morbidity and mortality from cardiovascular disease. Differences in the presentation and management of acute coronary syndromes (ACS) in this population may drive these findings. We hypothesized that HIV-infected adults admitted with ACS are less likely to receive percutaneous coronary intervention and have greater adverse outcomes compared with uninfected patients. Methods: This was a retrospective cohort study using inpatient claims data from Symphony Health, a nationwide data warehouse. All adults admitted between January 1st, 2014 and December 31st, 2016 with ACS were included. Patient characteristics and outcomes were defined by ICD-9 or ICD-10 billing codes. Logistic regression adjusted for clinical characteristics was used to evaluate outcomes. 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 medical comorbidities such as diabetes and substance abuse (p<0.0001). Rates of ST-elevation myocardial infarction were similar between groups. In adjusted analysis, HIV-infected individuals were less likely to receive coronary angiogram (31.6% vs 33.4%, OR 0.85, 95% CI 0.80-0.89, p <0.0001) or drug eluting stents (16.5% vs 18.2%, OR 0.88, 95% CI 0.82-0.94, p =0.0001). They also had significantly higher inpatient mortality (5.5% vs 5.3%, OR 1.28, 95% CI 1.15-1.43, p <0.0001) despite having fewer complications such as acute heart failure (19.9% s 23.2%, OR 0.82, 95% CI 0.76-0.88, p <0.0001) or major bleeding (2.8% vs 3.5%, OR 0.82, 95% CI 0.70-0.95, p =0.0074). Conclusion: Among contemporary HIV-infected patients hospitalized with acute coronary syndrome, disparities in treatment persist, with less use of percutaneous coronary interventions. Further attention is needed in order to improve the use of guideline-based therapies with the goal of optimizing the care and outcomes among persons living with HIV.

433 (IQR, 336-559)at enrollment and the median duration of ART was 10 years. The crude prevalence of carotid plaque was 8.4% (13/155) in PLWH and 3.3% (5/150) in HIV-uninfected controls. HIV infection (aOR 1.99; 95% CI, 1.19-3.30), active smoking (aOR 2.11; 95% CI, 1.01-4.38) and untreated hypertension (aOR 4.16; 95% CI, 1.65-10.48) were associated with an increased odds of carotid plaque. Physical activities of moderate intensity (aOR 0.10; 95% CI, 0.01-0.87) and vigorous intensity (aOR 0.21; 95% CI, 0.08-0.52) were associated with lower odds of carotid plaque. Conclusion: The prevalence of carotid plaque was greater among PLWH compared with age- and sex-matched HIV-uninfected comparators in southwestern Uganda. Other correlates of plaque included smoking and untreated hypertension. These data suggest that treated HIV infection might predispose PLWH in rural Africa to increased risk of atherosclerosis. Future work should explore the mechanisms underlying this observation, and whether improved treatment of hypertension and lifestyle modifications might reduce atherosclerotic burden among PLWH in the region.

Poster Abstracts

658 MEASURES OF ADIPOSE-TISSUE REDISTRIBUTION AND ATHEROSCLEROTIC CORONARY PLAQUE IN HIV

Milana Bogorodskaya 1 , Kathleen V. Fitch 2 , Markella V.Zanni 2 , Sara E. Looby 2 , Sanjna Iyengar 2 , Steven K. Grinspoon 2 , Suman Srinivasa 2 , Janet Lo 2 1 Beth Israel Deaconess Medical Center, Boston, MA, USA, 2 Massachusetts General Hospital, Boston, MA, USA Background: People with HIV (PWH) well-treated on antiretroviral therapy (ART) remain at increased risk of cardiovascular disease. Prior studies have not evaluated parallel imaging features using cardiac CT and coronary CTA in relation to specific adipose compartments [visceral and subcutaneous adipose tissue(VAT, SAT)]. We hypothesized abnormal fat redistribution, particularly related to increased VAT and reduced SAT, would be associated with features of atherosclerotic coronary plaque. Methods: 148 PWH and 68 uninfected individuals were previously enrolled. Abdominal VAT and SAT area were measured using CT scan. Coronary artery calcium (CAC) score was derived by non-contrast cardiac CT and coronary plaque composition by coronary CT angiography. We assessed presence of plaque and CAC>0 in relation to body composition parameters using logistic regression. Results: PWH and uninfected individuals were of similar age (47±7 vs. 46±7 yrs), race (55% vs. 53% Caucasian) and sex (65% vs. 60%male). The HIV group (duration HIV 14±6yrs, duration ART 8±5yrs) had good immunological parameters (CD4+ count 549±293cells/ μ l, log 10 viral load 1.82±0.47copies/ mL). VAT (108[61, 209] vs. 103[55, 177]cm 2 ) was similar, whereas SAT (198[125, 287] vs. 241[150, 380]cm 2 , P=.02) was significantly lower among PWH vs. uninfected individuals, resulting in a higher VAT:SAT ratio in the HIV group. Increased VAT was significantly related to increased presence of plaque (OR 1.55 per 100cm 2 , 95% CI[1.10, 2.17],P=.008) and CAC>0 (OR 1.56 per 100cm 2 , 95% CI[1.13, 2.16],P=.006) in the HIV group. In contrast, increased SAT was related to reduced presence of plaque (OR 0.79 per 100cm 2 , 95% CI[0.61, 1.01],P=.057) and reduced CAC>0 (OR 0.69 per 100cm 2 , 95% CI[0.52, 0.92],P=.007) among PWH. VAT, but not SAT, were predictors of plaque and CAC in the uninfected group. BMI did not relate to plaque or CAC score in either group. By plaque composition,

657 PREVALENCE AND CORRELATES OF CAROTID PLAQUE IN A MIXED HIV- SEROSTATUS UGANDAN COHORT Prossy Bibangambah 1 , Linda C. Hemphill 2 , Moses Acan 1 , Alexander C. Tsai 2 , Ruth Sentongo 1 , June-Ho Kim 2 , Mark J. Siedner 2 , Samson Okello 1 1 Mbarara University of Science and Technology, Mbarara, Uganda, 2 Massachusetts General Hospital, Boston, MA, USA Background: The risk of atherosclerotic cardiovascular disease (CVD) is increased amongst people living with HIV in the global north. However, there is scant data on the contributions of HIV infection and its treatment on atherosclerosis in sub-Saharan Africa. Methods: We conducted an analysis of baseline data from the Ugandan Noncommunicable Diseases and Aging Cohort Study, which is a longitudinal cohort consisting of PLWH older than 40 years of age on antiretroviral therapy (ART) for at least 3 years,and a population-based control group of HIV-uninfected persons matched by age and sex. We conducted carotid ultrasonography and collected CVD risk factor data. Our outcome of interest was carotid plaque at enrollment, defined as a thickness of >1.5 mmmeasured from the intima-lumen interface to the media-adventitia interface. We fit multivariable logistic regression models to estimate adjusted correlates of plaque, including HIV infection and traditional cardiovascular risk factors. Results: Carotid ultrasounds were completed among 150 (49%) PLWH and 155 (51%) HIV-uninfected individuals. Among PLWH, median CD4 count was

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