CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

alone did not significantly increase the risk [aHR = 1.04 (95%CI 0.3 – 3.7); P=0.96] (Figure). Conclusion: MASLD together with CKD was associated with a significantly increased risk of new-onset CVDs, but MASLD or CKD alone was not. Further studies to understand the mechanisms for the increased risk are warranted for the prevention of CVDs in this group.

carotid plaques (figure 1) both in the discovery and validation cohort. Among these CD8+ T cell subsets, increased proportions of T cell effector memory cells expressing CCR4, CCR6, CXCR3 and CXCR5 were observed (FDR < 0.05 for discovery and p < 0.05 in validation cohort). Furthermore, absolute numbers of CD8+ Tc1 cells expressing the exhaustion marker PD1, were increased in those with carotid plaques as compared with individuals without carotid plaques. Conclusion: In this comprehensive study in PLHIV under suppressive ART, we identified differences within CD8+ T cell populations in individuals with carotid plaques. These alterations span activated and exhausted cell phenotypes. Our findings underscore a role of CD8+ T cells in atherogenesis. Furthermore, the concurrent elevation of CD8+ Tc1 cells expressing the exhaustion marker PD1 provides further insight into the dynamic interplay of immune responses in atherosclerosis.

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The Association of Mild Kidney Disease With Coronary Disease Is Stronger for People With HIV Shradha J Doshi 1 , Barbra Richardson 2 , Rashidah Nazzinda 3 , Henry Mugerwa 3 , Marcio Bittencourt 4 , Geoffrey Erem 5 , Aparna Narendrula 6 , Carey Farquhar 2 , Cissy Kityo 3 , Chris T. Longenecker 2 1 University of Washington, Nairobi, Kenya, 2 University of Washington, Seattle, WA, USA, 3 Joint Clinical Research Centre, Kampala, Uganda, 4 University of Pittsburgh, Pittsburgh, PA, USA, 5 St. Francis Hospital Nsambya, Kampala, Uganda, 6 New York University, New York, NY, USA Background: Chronic kidney disease (CKD)-a common comorbidity for people with HIV (PWH)-is also a risk factor for coronary artery disease (CAD). However, the impact of mildly impaired eGFR and microalbuminuria on CAD risk for PWH is not well defined. Using coronary computed tomography angiography (CCTA), we examined whether the association between mild kidney disease and coronary plaque might be stronger for PWH compared to people without HIV in sub-Saharan Africa. Methods: We conducted a cross-sectional secondary analysis of data from the Ugandan sTudy of HIV effects on the Myocardium and Atherosclerosis (mUTIMA) study. mUTIMA compared 100 PWH on stable antiretroviral therapy (ART) and 100 age- and sex-matched participants without HIV, all aged over 45 with ≥1 cardiovascular disease risk factor. Participants with screening eGFR <60mL/ min/1.73m 2 were excluded due to risk of contrast-induced nephropathy. For 165 of these participants with available CCTA data, we performed multivariable Tobit regression stratified by HIV status to examine the association of CAD with both estimated glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR). CAD was characterized using segment involvement score (SIS; total segments with plaque), segment stenosis score (SSS; segment score weighted by degree of luminal obstruction), and coronary artery calcium (CAC) score. Results: Mean (SD) age was 57.7(6.9) years and 62.4% were female. Mean (SD) systolic blood pressure was 152.2(27.8) mmHg and 31.5% had diabetes. 96% had HIV-1 viral suppression and 47% were on tenofovir (TDF). Among PWH-but not among participants without HIV-mildly impaired eGFR (<90mL/min/1.73 m 2 ) was associated with higher SIS (β 3.31, 95% CI: 0.41 to 6.21, p = 0.03) and SSS (β 5.95, 95% CI: 0.54 to 11.36, p = 0.03). The association with SIS remained significant after adjusting for age, gender, and 10-year ASCVD score (β 2.58, 95% CI: 0.10 to 5.06, p = 0.04). Associations of ACR with coronary plaque were not statistically significant for participants with or without HIV (all p>0.07). Conclusion: Mild to moderately low eGFR is more strongly associated with CAD in PWH compared to those without HIV in Uganda. In addition to assessing traditional risk factors, monitoring renal function may add to cardiovascular risk assessment of PWH in sub-Saharan Africa. The observed association also highlights the need to integrate cardiovascular and renal care into HIV clinics, especially for aging PWH with higher rates of comorbid diabetes and hypertension.

Poster Abstracts

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Co-Occurrence of MASLD and CKD Increased Cardiovascular Incidence Among Thai HIV Population Hay Mar Su Lwin 1 , Tanakorn Apornpong 1 , Win Min Han 2 , Sivaporn Gatechompol 1 , Siwat Thammapiwan 11 , Porntep Amornritvanich 1 , Stephen Kerr 3 , Anchalee Avihingsanon 1 1 Thai Red Cross AIDS Research Center, Bangkok, Thailand, 2 Kirby Institute, Sydney, Australia, 3 Chulalongkorn University, Bangkok, Thailand Background: Combination of Metabolic dysfunction Associated Steatotic Liver Disease (MASLD) and chronic kidney disease (CKD) are associated with cardiovascular diseases (CVDs). However, this importance finding in people living with HIV (PWH) is largely unknown. We therefore investigated the effect of combined diagnosis of MASLD and CKD on the incidence of CVDs among PWH in Thailand. Methods: All PWH starting ART in a prospective cohort with available transient elastography /controlled attenuation parameter (CAP) and serum creatinine during June 2013 to Jul 2023were included. MASLD was defined as steatotic liver disease (CAP ≥248dB/m) plus one of five cardiometabolic criteria: body mass index (BMI) ≥25kg/m 2 or waist circumstance >94cm for males and >80cm for females; fasting glucose ≥100mg/dL or a diagnosis of diabetes melltius; BP ≥130/85mmHg or a diagnosis of hypertension; triglyceride ≥150mg/dL or lipid lowering agents, and HDL ≤40mg/dL in males or ≤50mg/dL for females. CKD was defined as estimated glomerular filtration rate (eGFR) ≤60ml/min/1.73m 2 using the CKD Epidermiology Collaboration. CVDs included coronary diseases, stroke, peripheral arterial disease and aortic disease. Follow-up started at the 1st firbroscan/ eGFR measurement and ended at the first CVDs diagnosis or most recent clinic visit in those without CVDs. Cox regression was used to evaluate factors associated with CVDs development, adjusted for potential cofounders. Results: Totally 1940 PWH (70.8% male, median age 43 [interquartile range (IQR): 32-50] years; BMI 22.5 (IQR: 20.6-24.9); current smoker 18% (n=265); abacavir exposure 7.5% (n=143) were analysed. The prevalence of MASLD+/ CKD+ at baseline was 6.4% (n=125). During a median 4.1 years of follow-up, 20 participants developed new-onset CVDs. Multivariable Cox regression adjusting for age, sex, smoking, ART duration and protease inhibitors use showed that PWH with a combined diagnosis of MAFLD and CKD at baseline was associated with a significantly increased risk of developing CVD (adjusted hazard ratio [aHR] = 7.9 (95%CI 2.5-24.7), p<0.001)), but the presence of either comorbidity

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