CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

CVD risk among WWH and WWoH. CVD risk was dichotomized as low risk versus borderline or higher risk, and two-way interactions were tested by HIV status. Odds ratios [ORs] were not adjusted as age, race, and gender are included as part of the PCE. Results: Data was available for 1,711 women (72% HIV+) with a median age of 53 years (IQR: 46-58). Approximately half (53%) were classified as having low (<5%) risk, while 13%, 24%, and 9% were classified as having borderline (5 7.4%), moderate (7.5-19.9%), or high risk (≥ 20%), respectively. 45.7% of WWH and 51.6% of WWoH were classified as having borderline or higher risk for CVD. Higher annual household income (OR: 0.57, 95% confidence interval [CI]: 0.45 0.72), greater physical activity (OR: 0.63, 95% CI: 0.54-0.73), better diet quality (OR: 1.03, 95% CI: 1.00-1.06), and <7 alcoholic drinks per week (OR: 0.63, 95% CI: 0.51-0.77) were associated with decreased odds of higher CVD risk, while current smoking (OR: 2.22, 95% CI: 1.81-2.70) was associated with increased odds of higher CVD risk. We found effect modification of smoking by HIV status, with an OR for higher risk of 2.54 (95% CI: 2.00-3.21) among WWH versus 1.53 (95% CI:1.07-2.21) among WWoH. There was a lack of modification by HIV-status for all other variables tested. Conclusion: Interventions targeting modifiable lifestyle factors should be considered as a means to reduce CVD risk and improve outcomes among WWH and women behaviorally at risk for acquiring HIV. No Increased Risk for Hypertension With CAB-LA Compared to TDF/FTC for HIV PrEP in HPTN 083 Raphael J Landovitz 1 , Heather J. Ribaudo 2 , Younjung Choi 2 , Kari Chansky 3 , Zoe Wang 3 , Mina Hosseinipour 4 , Sinead Delany-Moretlwe 5 , Lydia Soto-Torres 6 , Sheryl Zwerski 6 , Marybeth McCauley 7 , James F. Rooney 8 , Alex R. Rinehart 9 , Beatriz Grinsztejn 10 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Harvard TH Chan School of Public Health, Boston, MA, USA, 3 Fred Hutchinson Cancer Center, Seattle, WA, USA, 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 University of the Witwatersrand, Johannesburg, South Africa, 6 National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA, 7 FHI 360 , Washington, DC, USA, 8 Gilead Sciences, Inc, Foster City, CA, USA, 9 ViiV Healthcare, Research Triangle Park, NC, USA, 10 Oswaldo Cruz Foundation - Fiocruz, Rio de Janeiro, Brazil Background: Results from some trials of HIV treatment suggest an excess risk of hypertension (HTN) associated with integrase strand transfer inhibitors (INSTIs), independent of changes in weight or BMI. HPTN 083, in HIV-negative MSM and transgender women, compared injectable cabotegravir (CAB) to daily oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) for HIV PrEP. We performed a post-hoc analysis of HPTN 083 to compare incidence rates for HTN in the absence of HIV infection. Methods: Of 4566 participants (ppts) enrolled, the analysis population included 3971 (1993 CAB/1978 TDF-FTC) exposed to study drug and without pre-existing HTN. Incident hypertension was defined as a new diagnosis of HTN, 2 sequential measures of SBP ≥ 140 mm Hg, DBP ≥ 90 mm Hg, or initiation of anti-HTN treatment, through 161 weeks of follow-up. Changes in blood pressure over time by study arm were estimated with mixed effect models. Cox regression models were used to estimate the hazard ratio (HR) for incident HTN between study arms, unadjusted and adjusted for race, age, baseline (BL) BMI, anti-HTN treatment, and time-updated weight change from BL (TUWC). Results: Ppts were well matched between groups; 75% were under age 30; 4% were over age 45. 58% were normal or underweight at baseline. Over 10293 person-years of follow-up, median BMI increased +1.2 (IQR 0.1-2.3) kg/m 2 for CAB and 0.8 (IQR -0.2-2.1) for TDF-FTC. BMI and SBP were weakly correlated. 461 (12%) ppts had incident HTN (246 CAB, 215 TDF-FTC). Mean change per year in SBP was 0.56 mm Hg (95% CI 0.41, 0.71) and DBP was 0.73 (0.62, 0.85) in CAB and 0.30 (0.15, 0.45) and 0.66 (0.55, 0.78) in TDF-FTC. Cumulative incidence of HTN over 3 years was 13.4% for CAB and 11.8% for TDF-FTC (Figure). HTN was more common in US and African ppts and those with higher BMI, older age, and taking anti-HTN meds for non-HTN indications (MFnH). Between arm differences were numerically largest for US ppts, older ppts, and ppts taking MFnH. HR for incident HTN was 1.11 (95% CI 0.92, 1.33, p=0.28) for CAB vs. TDF-FTC in the unadjusted analysis, and 1.00 (95% CI 0.83, 1.21) after adjustment for race, BL age, BL BMI, anti-HTN BL meds, and TUWC. Conclusion: HTN incidence in HPTN 083 was low. Observed HTN incidence was higher in CAB vs. TDF-FTC, but was not statistically significant. Risk factors for HTN included age, BL obesity, and weight gain over time. Over 3 years there was no increase in the hazard of incident HTN in CAB vs. TDF-FTC after adjusting for relevant covariates.

18-64 years of age who newly initiated a stable ART regimen. We excluded people with MACE prior to and within 90 days after ART initiation. Nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens were compared to protease inhibitors (PI) and integrase inhibitors (INSTI) at class-level as well as to individual INSTI drugs. We used propensity score-weighted Kaplan Meier functions to estimate the 6, 12, 18, 24, 36, and 48-months risks and risk differences (RD) for MACE. Secondary analyses including use of tenofovir or abacavir were performed. Results: Among 37,935 new ART initiators, mean age was 40±11 years. The distribution of ART regimens was 45% INSTI- (14% raltegravir, 40% elvitegravir, 30% dolutegravir, and 16% bictegravir), 39% NNRTI-, and 16% PI-based regimen. INSTI initiation increased from 5% in 2008 to 97% in 2020. The median (IQR) follow-up for those starting INSTI-, NNRTI-, and PI-based regimens was 442 (224, 894), 521 (239, 1109), and 429 (212, 932) days, respectively. MACE occurred in 418 individuals (1.1%) over the study period. The highest risk of MACE occurred with PI-based regimens followed by INSTI and NNRTI. Compared to NNRTI initiators, the risk of MACE was higher at 12 months [RD 0.50, 95% CI (0.14, 0.99)], 18 months [RD 0.53, 95% CI (0.11, 1.06)] and 24 months [RD 0.62, 95% CI (0.04, 1.29)] for the PI-group, and at 12 months [RD 0.20, 95% CI (0.03, 0.37)] and 18 months [RD 0.31, 95% CI (0.06, 0.54)] for INSTI initiators; the precision of estimates was limited in later months of follow-up. Risk of MACE did not differ by individual INSTIs, tenofovir, or abacavir use. Conclusion: In this large-scale study using U.S. claims databases, PI-based and INSTI-based regimens were associated with higher risk of MACE compared to NNRTI-based regimens after ART initiation, and the pattern of association between INSTIs and PIs with excess risk of MACE was similar.

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Poster Abstracts

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Modifiable Factors Associated With Cardiovascular Disease Risk Among Women With and Without HIV Jenni Wise 1 , Elizabeth Jackson 1 , Liang Shan 1 , Andrew Edmonds 2 , Deborah Konkle-Parker 3 , Maria L. Alcaide 4 , Gina Wingood 5 , Tracey Wilson 6 , Kathleen Weber 7 , Aruna Chandran 8 , Seble Kassaye 9 , David B. Hanna 10 , Anna Leddy 11 , John Cleveland 1 , Mirjam Colette-Kempf 1 , for the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS) Combined Cohort Study 1 University of Alabama at Birmingham, Birmingham, AL, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 University of Mississippi Medical Center, Jackson, MS, USA, 4 University of Miami, Miami, FL, USA, 5 Emory University, Atlanta, GA, USA, 6 State University of New York Downstate Medical Center Downstate Medical Center, Brooklyn, NY, USA, 7 Cook County Health & Hospitals System, Chicago, IL, USA, 8 The Johns Hopkins University, Baltimore, MD, USA, 9 Georgetown University, Washington, DC, USA, 10 Albert Einstein College of Medicine, Bronx, NY, USA, 11 University of California San Francisco, San Francisco, CA, USA Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among women in the United States. Women living with HIV (WWH) have twice the risk of CVD events compared to women without HIV (WWoH). While increased CVD risk for WWH has been largely attributed to HIV-specific factors, interventions on modifiable factors (e.g., social support, psychological health, physical activity, diet quality, substance use, and HIV viral suppression) may decrease CVD risk among women. Methods: We analyzed data from the Women's Interagency HIV Study (WIHS) to examine relationships between individual-level factors and CVD risk among WWH and WWoH. Women were included if they were 30-79 years of age at the time of their semiannual WIHS study visit (April – September 2019) and had data to calculate the American College of Cardiology and American Heart Association Pooled Cohort Risk Equation (PCE), a 10-year CVD risk score. Descriptive statistics and logistic regression were used to test associations between each factor and

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