CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: HIV serostatus was not associated with prevalent AF/AFL in this cohort of HIV+men with suppressed viral replication. The prevalence of AF/AFL was low, strongly associated with aging, and rare in African-American men 663 MitoQ ATTENUATES EX VIVO PROATHEROGENIC EFFECTS OF HIV PLASMA IN CHRONIC TREATED HIV Background: The mechanisms that drive atherosclerotic cardiovascular disease (CVD) in treated HIV remain unclear. (Pre)clinical studies have shown that the antioxidant MitoQ improves vascular endothelial function by reducing reactive oxygen species production by mitochondria, but its effects in HIV-CVD are unknown. We used an established model of arterial wall to assess ex vivo the impact of MitoQ on early mechanisms of atherogenesis in the presence of plasma from HIV+ individuals on potent antiretroviral therapy (ART). Methods: Human umbilical vein endothelial cells (HUVECs) were pretreated with MitoQ or vehicle control at 200 nM for 24 hours. Peripheral blood mononuclear cells from healthy donors (n=10) were added to HUVEC for 24 hours on type I collagen gels to undergo transendothelial migration (TEM) and form foam cells [monocyte-derived foam cell formation (MDFCF)] in the presence of pooled plasma (PMID: 28926407). Pooled plasma was isolated from healthy (18-40 years old) and HIV+ (40-60 years old) males with no known inflammatory comorbidities other than HIV or risk factors for CVD and on stable potent ART. Flow cytometry assessed MDFCF (BODIPY signal) and TEM. (Un)paired t-tests were used for statistical comparison between and within compared groups. Results: When media containing HIV+ compared to HIV- plasma was added to HUVECs pretreated with vehicle, a significantly increased proportion of monocytes underwent TEM (mean 1.6 fold increase) and CD33+macrophages inside the collagen gel had increased lipid content per cell (mean 2.4 fold increase in ∆MFI BODIPY)(P<0.05). When media containing HIV+ compared to HIV- plasma was added to HUVECs pretreated with MitoQ, a significantly increased proportion of monocytes underwent TEM (mean 1.2 fold increase) and CD33+macrophages inside the collagen gel had a mean 1.3 fold increase in ∆MFI BODIPY(P<0.05). In collagen gels treated with HIV+ plasma, pretreatment of HUVEC with MitoQ attenuated both TEM and MDFCF compared to vehicle control (p<0.05 for all comparisons). Conclusion: MitoQ attenuated proatherogenic effects of HIV-plasma from patients on potent ART with no clinical CVD in ex vivo model of arterial wall. The role of MitoQ in CVD in chronic treated HIV needs to be further studied in vivo. Eleni Ritou 1 , Rachel Heymans 1 , Theodoros Kelesidis 1 1 University of California Los Angeles, Los Angeles, CA, USA

of MI or stroke. To determine whether HIV was a risk factor for mortality following a CVD event, data from an existing national quality registry for coronary care was merged with the Swedish National HIV Registry. As many as 751,889 patients were included for analysis. Results: The incidence of MI and stroke among PLHIV in Sweden was 5.2%. The multivariable Cox regression model revealed that the hazard of MI or stroke among PLHIV increased, compared to patients aged ≤30 years old, by 90% (95% CI: 1.3-2.8, p=0.001) among patients 31-40 years old, 2.9 times (95% CI: 2.0-4.3, p<0.001) among patients 41-50 years old, and almost 9-fold (95% CI: 6.1-12.5, p<0.001) among patients >50 years old. Patients who injected drugs had a double hazard (95% CI: 1.4-2.8, p<0.001) compared to patients infected through heterosexual intercourse, while patients infected in Sweden had a 40% higher hazard (95% CI: 1.0-1.8, p=0.020). A multivariable Cox regression model assessing risk factors for mortality following a CVD event showed that HIV positive patients had a 67% (95% CI: 0.93-3.02, p=0.008) higher risk of mortality than HIV negative patients. Conclusion: The increased incidence of MI in PLHIV compared to the general population of Sweden calls for an increased focus on prevention of CVD in PLHIV. Given that older age is a risk factor for MI among PLHIV, CVD prevention efforts targeting older PLHIV should be scaled up. Moreover, the increased risk of mortality among HIV patients following a CVD event highlights the need for secondary prevention following a CVD event.

Poster Abstracts

665 COST-EFFECTIVENESS OF STATIN USE IN HIV-POSITIVE PERSONS IN THE USA: THE D:A:D STUDY David C. Boettiger 1 , Anthony Newall 2 , Andrew N. Phillips 3 , Lene Ryom 4 , Peter Reiss 5 , Eran Bendavid 6 , Fabrice Bonnet 7 , Rainer Weber 8 , Wafaa M. El-Sadr 9 , Matthew Law 1 , James Kahn 10 , Jens D. Lundgren 4 , Caroline Sabin 3 , Dhruv Kazi 11 , for the D:A:D Study Group 1 Kirby Institute, Sydney, NSW, Australia, 2 University of New South Wales, Sydney, NSW, Australia, 3 University College London, London, UK, 4 CHIP, Department of Infectious Diseases, Copenhagen, Denmark, 5 Academic Medical Center, Amsterdam, Netherlands, 6 Stanford University, Stanford, CA, USA, 7 University of Bordeaux, Bordeaux, France, 8 University Hospital Zurich, Zurich, Switzerland, 9 ICAP at Columbia University, New York, NY, USA, 10 University of California San Francisco, San Francisco, CA, USA, 11 Beth Israel Deaconess Medical Center, Boston, MA, USA Background: People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (CVD) compared to people without HIV. Expanding statin use for the primary prevention of CVD may help alleviate this burden. However, the choice of statin in the context of antiretroviral therapy is challenging. Pravastatin and pitavastatin are preferred agents because they improve cholesterol levels in PLHIV without interacting substantially with antiretroviral therapy. They are also more expensive than most statins. We evaluated the cost-effectiveness of using pravastatin and pitavastatin regardless of cholesterol level for the primary prevention of CVD among PLHIV aged 40-75 years and not currently using lipid-lowering therapy. Methods: We developed a model that randomly selected (with replacement) individuals from the Data-collection on Adverse Effects of Anti-HIV Drugs (D:A:D) study. The model simulated each individual’s probability of experiencing CVD over 20 years. We evaluated: 1) treating no one with statins; 2) treating everyone with pravastatin 40mg/day (drug cost $236/year); and 3) treating everyone with pitavastatin 4mg/day (drug cost $2,828/year). Direct medical costs (in 2019 US dollars) and quality-adjusted life-years (QALYs) were assigned in annual cycles

664 HIV AND AGEING: PRIMARY AND SECONDARY PREVENTION OF CAD AMONG PLHIV Gaetano Marrone 1 , Olof Elvstam 2 , Anders Sönnerborg 1 1 Karolinska University Hospital, Stockholm, Sweden, 2 Lund University, Lund, Sweden Background: With the introduction of combined antiretroviral therapy for HIV patients, the clinical focus has shifted from AIDS-related opportunistic infections to age-related co-morbidities, specifically cardiovascular disease (CVD). As of 2019, there are approximately 7,760 People living with HIV (PLHIV) in Sweden. This study aims to assess the incidence of MI and stroke among PLHIV in Sweden, as well as their the socio-demographic and biological risk factors. Furthermore, this study aims to compare patients with any CVD with and without HIV with regard to baseline and presentation characteristics and mortality. For this retrospective cohort study, a total of 6,987 PLHIV were included from the Swedish National HIV Registry database and linked to the National patient register and the cause of death register to gather information on the incidence

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