CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

811

Sex Differences in Myocardial Steatosis in South African Youth With Perinatally-Acquired HIV Morne Kahts 1 , Mothabisi Nyathi 1 , Lidia S. Szczepaniak 2 , Petronella Samuels 1 , Stephen Jermy 1 , Matthew J. Feinstein 3 , Justine Legbedze 4 , Nana Asafu-Agyei 1 , Emma Carkeek 1 , Nomawethu Jele 1 , Grace A. McComsey 5 , Landon Myer 1 , Heather Zar 1 , Ntobeko Ntusi 6 , Jennifer Jao 3 , for the CTAAC-Heart Study 1 University of Cape Town, Cape Town, South Africa, 2 MRS Consulting in Biomedical Research, Albuquerque, NM, USA, 3 Northwestern University, Chicago, IL, USA, 4 Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA, 5 Case Western Reserve University, Cleveland, OH, USA, 6 South African Medical Research Council, Cape Town, South Africa Background: Despite studies demonstrating an increase in myocardial steatotic burden in adults with HIV on antiretroviral therapy (ART), no studies have evaluated this phenomenon in youth with perinatally-acquired HIV (YPHIV). Methods: The Cape Town Adolescent Antiretroviral Cohort (CTAAC)-Heart study enrolled youth to assess myocardial fibrosis and inflammation using cardiovascular magnetic resonance (CMR). A magnetic resonance proton spectroscopy ( 1 H-MRS) sub-study was conducted among YPHIV to assess myocardial triglyceride (mTG) content. 1 H-MRS was acquired by means of an ECG-triggered, respiratory-gated sequence using a 6x16x18mm voxel placed within the intra-ventricular septum. Fibrosis was assessed using pre-and post contrast T1 mapping with Siemens MyoMaps TM modified Look-Locker inversion recovery sequence and post-contrast T1-weighted phase sensitive inversion recovery sequences with mean extracellular volume fraction (ECV%) calculated. T2 mapping was performed using a T2-prepared fast low angle shot sequence to assess for inflammation. Pathologically elevated mTG content was defined as >0.5%. Logistic regression models were fit to assess the association of sex with mTG content >0.5% adjusting for confounders. Results: Overall, 72 YPHIV [median age (interquartile range (IQR)) 18 years (17-19), 44% females] were included. Females had a higher BMI [24 vs. 20kg/ m 2 , p=0.002] and waist to height ratio [0.48 vs. 0.43, p<0.001] compared to males. There were no differences in serum lipid levels, viral load (VL), CD4 count or current integrase inhibitor (INSTI) use; 28% of participants were on INSTI based ART and 63% had CD4 counts >500 cells/mm 3 with a median VL of 3.91 log10 copies/ml (IQR 3.66-6.02). In addition to higher mean ECV% and native T1, females were noted to have higher mTG content [0.34 vs. 0.13%, p=0.003]. ( Table 1 ) A higher proportion of females had mTG content >0.5% (42 vs. 17%). This relationship persisted even after adjusting for age, BMI, VL, and INSTI based ART use [unadjusted odds ratio (OR)=3.67, 95% confidence interval (CI): 1.14-11.84, p=0.03; adjusted OR=3.78, 95%CI: 0.98-14.63, p=0.05]. Conclusions: In the first study of 1 H-MRS among YPHIV on ART, we report elevated mTG in YPHIV, with females found to have increased myocardial steatosis and fibrosis compared to males. Based on these findings, we propose there is a role for early screening, prevention, and possible intervention in YPHIV, particularly females.

810

Evaluation of Anal Cancer Screening in 18–34-Year-Old Men Who Have Sex With Men Living With HIV Serina S. Applebaum, Elizabeth Chan, Lydia Aoun-Barakat, Michael Virata,

Ritche Hao, Amit C. Achhra Yale University, New Haven, CT, USA

Poster Abstracts

Background: New anal cancer screening guidelines recommend annual anal cytology (PAP) for men who have sex with men (MSM) living with HIV (LWH) aged ≥35 years. Historically our center had offered screening to even younger (>18 years) MSM LWH. There is a growing interest in expanding age-based cancer screening thresholds, including for anal cancer. We assessed the prevalence and outcomes of anal cancer screening among MSM LWH under 35 to better characterize this age threshold. Methods: We performed a retrospective study (2013-2023) of MSM LWH <35 years at our academic HIV center. We recorded the date and result of each anal PAP and high-resolution anoscopy (HRA; referral criteria were any abnormal PAP) performed between ages 18-34, as well as sociodemographic and HIV-related metrics. We compared characteristics between screened and unscreened cohorts and we report prevalence of high-grade dysplasia and anal cancer in the cohort. Results: We identified 216 eligible MSM LWH (median [IQR] age 26.7 [23.9, 30.6] years); 24% were White, 44% non-Hispanic Black, 26% Hispanic; >90% were on antiretroviral therapy and 88% had viral load <1000 copies/mL, and 95% CD4 T-cell count >200 cells/mm 3 at last visit. Of these, 127 (59%) had anal PAP at least once. There were no significant differences between screened and unscreened cohorts, except longer follow-up in the screened group (median 3.8 vs 1.6 years). Of those screened, 58 (46%) had ≥2 PAPs and 58 (46%) had ≥1 HPV vaccine dose. HPV vaccination was not associated with abnormal PAP (p=0.26) or HRA biopsy (p=0.59). Of 246 total PAPs, 19% were unsatisfactory, none showed high-grade dysplasia, and overall 76 (31%) were abnormal, only 23 of which were followed by HRAs of which 11(48%) reported high-grade dysplasia on biopsy ( Table-1 ). In those receiving both PAP and HRA, positive predictive value (PPV) of any PAP abnormality for high-grade dysplasia was 47.8%. We identified 2 cases of anal cancer (diagnosed at ages 29 and 30): both had CD4 nadir <20, were diagnosed symptomatically with local disease and had received screening in the preceding year. Conclusions: Over 10 years, uptake of anal cancer screening among young MSM LWH was variable. Anal PAP had a high rate of ‘unsatisfactory’ samples and poor PPV for high-grade dysplasia. Despite high prevalence of high-grade dysplasia in those undergoing HRA, the rarity of anal cancer, which was diagnosed early due to symptoms, supports excluding younger (<35 years) MSM LWH from asymptomatic screening.

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