CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

respectively. Factors associated with mortality evaluated by multivariate Cox regression. Results: Among 7719 PWH, 358 (4.6%) had a MACE and 39/358 (11%) died within 30 days after BL. Characteristics of the 319 MACE survivors are shown in Table 1. During a median FU of 5.6 years (IQR=2.7-9.3), the overall probability of survival at 5 and 10 years in MACE survivors was 89% (95%CI=0.90-0.96) and 80% (95%CI=0.74-0.86), respectively. Survival probabilities were lower in PWH with diabetes (HR=3.0, 95%CI=1.3 6.8), hypertension (HR=2.7, 95%CI=1.5-4.9), and active smoking (HR=2.0, 95%CI=1.1-3. 6) at BL and in those who had a new MACE diagnosis (HR=4.6, 95%CI=2.3-9.4), used protease inhibitors (HR=4.1, 95%CI=2.0-8.4) or did not use integrase inhibitors (HR=4.8, 95%CI=2.4-9.6) during FU. After adjustment for age, sex, and CD4+ cell count at BL, as well as PI use, LDL cholesterol levels, and last available HIV RNA during FU, diabetes [AHR: 2.4 (95%CI=1.0-5. 5)], hypertension [AHR: 2.5 (95%CI=1.1-5.4)], and smoking at BL [AHR: 3.1 (95%CI=1.4-7.0)] together with lack of use of INSTI during FU [AHR: 4.3 (95%CI=1.9-9.5)] were associated with mortality. Conclusions: Among PWH who survive a MACE, the five-year mortality is 11%. In our cohort, classic cardiovascular risk factors at BL and an antiretroviral regimen without INSTIs during FU were associated with a worse prognosis. For this population, implementation of preventive approaches and careful reassessment of ART are needed.

antiretroviral therapy (ART) was 16 years, with current CD4 and CD4/CD8 ratio at 617 (IQR 477-797) cells/µL and 0.96 (IQR 0.68-1.27), respectively. DD was detected in 40%; Mean (SD) EAT was 101 (40) cm 3 . After adjusting for age, sex, BMI, hypertension and DM, only increased EAT was positively associated with DD (OR 1.49; 95%CI 1.11-1.99 per 1 SD increase; p=0.007). No association was observed between DD and CAC score (OR 0.55-2.71) or sST2 (OR 0.51-1.06). Increasing EAT was significantly associated with increasing left ventricular mass index (LVMI) and average E/e’, and decreasing lateral e’. Although CAC score ≥100 was associated with LAVI after adjusting for age and sex, but the association attenuated after adjustment for BMI, hypertension and DM. (figure). Conclusions: Increased EAT, but not CAC or sST2, is an independent predictor for DD providing enhanced benefit over established echocardiogram parameters. EAT levels also correlated with LVMI and average E/e’ among older PWH. Assessing EAT could be useful for identifying PWH at high risk of DD and prioritizing care delivery.

Poster Abstracts

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Heart Failure Risk and Events in People With HIV in the REPRIEVE Trial Maya Watanabe 1 , Gerald Bloomfield 2 , Sara McCallum 3 , Heather Ribaudo 1 , Judith Aberg 4 , Aya Awwad 3 , Sarah Chu 3 , Judith Currier 5 , Carl Fichtenbaum 6 , Michael T. Lu 3 , Carlos Malvestutto 7 , Sophia Zhao 1 , Markella V. Zanni 3 , Steven Grinspoon 3 , Pamela Douglas 2 , for the REPRIEVE Study 1 Harvard TH Chan School of Public Health, Boston, MA, USA, 2 Duke Clinical Research Institute, Durham, NC, USA, 3 Massachusetts General Hospital, Boston, MA, USA, 4 Icahn School of Medicine at Mount Sinai, New York, NY, USA, 5 University of California Los Angeles, Los Angeles, CA, USA, 6 University of Cincinnati Medical Center, Cincinnati, OH, USA, 7 The Ohio State University, Columbus, OH, USA Background: People with HIV (PWH) have higher risk of heart failure (HF) due to traditional and HIV-related factors. Risk prediction of HF in PWH is not well characterized. Methods: We calculated the PREVENT (Predicting Risk of Cardiovascular Disease Events) 10-year risk of HF for all REPRIEVE participants. HF incidence (events/1000 person years) was described overall and by demographic, HF and HIV-specific factors. Confirmed HF events included adjudicated HF hospitalization and adverse events identified via a standardized Medical Dictionary for Regulatory Archives query. Results: We analyzed 7,769 REPRIEVE participants from five global regions (median 50 years, 31% female, 22% Black of those from high-income region). Median (Q1, Q3) PREVENT HF score was 1.66% (1.01, 2.62). HF incidence was 1.65/1000 person years (95% CI 1.30-2.09) with similar rates by randomized arm. Expected number of HF events by PREVENT HF (73) was similar to observed (67). Median PREVENT HF risk was higher at baseline in those with vs without confirmed HF events (2.22 vs 1.39%). HF incidence was higher in women, among Black or African Americans in high-income regions, participants in sub-Saharan Africa, and among those with pre-existing hypertension and elevated body mass index compared to absence of these factors ( Figure ). Conclusions: In PWH, observed number of HF events aligned with the low estimated PREVENT HF risk rates. Demographics, clinical factors, and global region may contribute to a higher incidence of HF events among PWH.

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Epicardial Fat as a Predictor of Diastolic Dysfunction in Older People With HIV Tanakorn Apornpong 1 , Sarawut Siwamogsatham 2 , Win Min Han 3 , Sudarat Satitthummanid 2 , Monravee Tumkosit 2 , Hay Mar Su Lwin 1 , Sasiwimol Ubolyam 4 , Hein Minn Kyaw 1 , Porntep Amornritvanich 5 , Napon Hiranburana 1 , Stephen Kerr 6 , Pairoj Chattranukulchai 2 , Anchalee Avihingsanon 7 , for the HIV-NAT 006 and 207 Study Teams 1 HIV Netherlands Australia Thailand Research Collaboration, Bangkok, Thailand, 2 King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 3 Kirby Institute, Sydney, Australia, 4 Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 5 Police General Hospital, Bangkok, Thailand, 6 Chulalongkorn University, Bangkok, Thailand, 7 HIV-NAT, Thai Red Cross AIDS and Infectious Disease Research Centre, Bangkok, Thailand Background: Diastolic dysfunction (DD) is increasingly prevalent among people with HIV (PWH) and is associated with a heightened risk of subsequent heart failure (HF). Key mechanisms of HF include left ventricular hypertrophy (LVH), left atrial abnormalities and cardiac fibrosis. Additionally, soluble suppression of tumorigenicity 2 (sST2) has emerged as a potential biomarker for cardiac stress and fibrosis. However, the roles of epicardial fat (EAT), coronary calcium, and sST2 in predicting DD, particularly in older PWH, remain poorly understood. Methods: We conducted a cross-sectional study in Thai PWH aged ≥50 years. Transthoracic echocardiography, and non-contrast cardiac computed tomography were performed to assess diastolic function, coronary calcium (CAC) and epicardial adipose tissue (EAT), respectively. Serum ST2 and other lab parameters including HIV-related parameters were measured. DD was defined using the PWH specific Characterizing Heart Function on Antiretroviral Therapy (CHART) criteria. Multiple linear and logistic regression were used to assess associations between EAT, CAC score, and sST2 level with relevant echocardiographic parameters and DD. Results: Among 283 PWH (male 62%, median [IQR] age 54 years [52-59]) included, 27% had body mass index (BMI) >25 kg/m 2 , while 41 and 17% had hypertension and diabetes mellitus (DM), respectively. Median duration of

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