CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

VAT:SAT ratio showed a strong relationship to presence of calcified plaque (OR 3.30, 95% CI[1.12, 9.74],P=.03) in the HIV group and did not relate to non- calcified plaque. Controlling for traditional CVD risk (Framingham Risk Score) and HIV parameters, VAT(P=0.04) and VAT:SAT(P=.02) remained independently related to increased CAC score. Conclusion: Fat redistribution phenotyping by simultaneous quantification of VAT and SAT as independent measures, could help identify those PWH at higher risk of CVD, potentially at an earlier subclinical stage, and inform therapeutic targets for CVD risk reduction. 659 MAJOR VASCULAR EVENTS IN ADULTS ON ART IN A SOUTH AFRICAN HIV MANAGEMENT PROGRAMME Johannes P. Mouton 1 , Renee De Waal 2 , Morna Cornell 2 , Gary Maartens 1 , Karen Cohen 1 1 University of Cape Town, Cape Town, South Africa, 2 Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa Background: Studies from high-income settings found increased risk of major vascular events (MVEs) in people living with HIV (PLWH). Data on MVE incidence in PLWH in Africa are limited. We aimed to describe incidence of MVEs and factors associated with MVEs in PLWH on antiretroviral therapy (ART) in the Aid for AIDS (AfA) private sector cohort. Methods: This was a cohort analysis of adults (≥18 years) starting ART through AfA from 1 January 2011 to 30 September 2018. We defined MVE as hospitalisation claims for stroke, acute coronary syndrome, or coronary revascularization procedure. We excluded hospitalisations with evidence for concomitant infectious or neoplastic diseases that may mimic stroke presentations. We calculated MVE incidence. We explored associations with MVE using Cox regression. We identified hypertension, diabetes, and dyslipidaemia from hospitalisation claims, drug claims, and laboratory results, and included these as time-updated variables. Results: We included 125,978 patients, of whom 75,485 (60%) were women, with total follow-up 320,176 person-years. At entry, median [IQR] age was 38 [33-45] years, CD4 count 276 [140-446] cells/µL, and viral load 4.4 [2.6-5.1] log 10 copies/mL. 5,344 patients (4.2%) died. Hypertension was present in 18%, diabetes in 8%, and dyslipidaemia in 9%. Efavirenz/nevirapine with two nucleoside reverse transcriptase inhibitors (NRTIs) was in use for 89% of person-time. There were 788 first MVEs: 457 (58%) strokes, and 331 (42%) acute coronary syndromes and revascularization procedures. Incidence of MVE was 2.5 per 1,000 person-years follow-up. In the Cox regression model, adjusted for other variables, MVE was associated with older age, male sex, longstanding HIV infection, lower CD4 count at first AfA ART claim, unsuppressed viral load at first AfA ART claim, hypertension, diabetes, and dyslipidaemia. In addition, ART regimens consisting of two NRTIs with a protease inhibitor, or two NRTIs with rilpivirine/etravirine were associated with increased risk of MVE, versus a regimen of two NRTIs with efavirenz/nevirapine. Conclusion: In this young, mostly female, African cohort, MVE incidence was 2.5 per 1,000 person-years. Background incidence data from this setting is lacking. Stroke predominated, in contrast to high-income settings, where coronary disease is more common. The MVE associations with specific ART regimens we identified deserve further study.

660 ASSOCIATION OF HYPERTENSION AND ART USE IN A POPULATION-BASED COHORT, RAKAI, UGANDA Grace Mongo-Bua 1 , Victor Ssempijja 2 , Anthony Ndyanabo 1 , Dorean Nabukalu 1 , Jesca Basiima 1 , Edward Kankaka 1 , Fred Nalugoda 1 , Gertrude Nakigozi 1 , Joseph Kagaayi 1 , Larry W. Chang 3 , Ronald H. Gray 4 , Maria Wawer 4 , Godfrey Kigozi 1 , Steven J. Reynolds 5 1 Rakai Health Sciences Program, Kalisizo, Uganda, 2 Leidos Biomedical Research, Inc, Frederick, MD, USA, 3 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 5 NIAID, Bethesda, MD, USA Background: Antiretroviral therapy (ART) has prolonged survival of people living with HIV (PLHIV). Some studies have reported that HIV and prolonged ART use may result in inflammation, metabolic syndrome and lipodystrophy and that some specific antiretrovirals are associated with development of hypertension. We assessed the association between ART duration and hypertension in a well characterized community cohort. Methods: We conducted a cross-sectional study among HIV infected adults (35-49) years old on ART in the Rakai Community Cohort Study (RCCS) using 18th survey data conducted from August 2016 to May 2018. Systolic and diastolic blood pressure was measured twice, averaged, and classified as: hypertension (stage 1): Systolic blood pressure (BP) ≥ 140mmHg and/or diastolic BP ≥ 90mmHg, and/or taking anti-hypertensive medication; Severe hypertension (stage 2): Systolic BP> 160mmHg and/or diastolic BP > 100mmHg; hypertensive crisis (stage 3): Systolic BP > 180mmHg and/or diastolic BP > 110mmHg. ART duration was categorized as short (< 2 years), moderate (2-5 years), or prolonged (>5 years). Confounding variables included: age, gender and body mass index (BMI). We used logistic regression to estimate adjusted odds ratios (aOR) of hypertension associated with ART duration. Results: A total of 1775 HIV infected adults on ART with documented BP information were identified in the RCCS of whom 265 (14.9%) had hypertension stage 1, 119 (6.7%) had hypertension stage 2 and 64 (3.6%) had hypertension stage 3. The rest of the patients (1351) did not have any hypertension and were included in the study. As shown in Table 1, risk of developing all stages of hypertension significantly increased beyond 5 years of ART treatment (Stage 1 aORs=1.55 (95%CI=1.07-2.26); stage 2 aOR=1.70 (95% CI 0.97- 3.01) and stage 3 at aOR=2.32 (95% CI 1.05-5.16). Conclusion: The risk of developing hypertension significantly increases after 5 consecutive years of ART treatment. Routine screening for hypertension should be incorporated into clinical care of PLHIV. Further studies to elucidate the mechanism for prolonged ART use and hypertension are needed.

Poster Abstracts

CROI 2020 240