CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Results: Between July-September 2024 we surveyed 140 clinical providers (66% male): 104 clinical officers (74%), 14 medical assistants (10%), 12 nurses (9%), 4 physicians (3%), and 6 other cadres (4%). Two-thirds of respondents had 5+ years of experience providing hypertension care. Clinical providers had high self-efficacy for hypertension care, with 85% feeling capable of managing antihypertensive medications (Table). However, the average knowledge score was 4.1 (SD 1.6) out of a total possible score of 9. Only half of clinical providers correctly identified the stages of hypertension and only 3% correctly answered all three guideline-based clinical vignette questions about when to start or escalate antihypertensive therapy. Providers reported that the most challenging aspects of delivering hypertension care were antihypertensive medication stock outs; lack of refresher trainings; shortages of lay staff to help with lifestyle counseling; and non-functional blood pressure machines. Conclusions: Clinical providers in our sample had high self-efficacy for delivering hypertension care, but many had low knowledge, including about when to start and escalate antihypertensive medications. Given the high rates of uncontrolled blood pressure among PLHIV at these same sites, interventions that focus on improving clinical provider knowledge and targeting specific barriers, like medication supply and functional equipment, will be important for improving outcomes.

Conclusions: HTN is common among PWH and associated with male sex, Black race, and lower resourced neighborhoods. While most PWH who have a diagnosis of HTN are receiving treatment, monitoring, and control steps in the HTN care cascade need strengthening. Differences along SDH groups appear to mostly disappear after the diagnosis step, except for Black race. Risk of Incident Hypertension With Common Antiretroviral Agent Combinations in the OPERA Cohort Laurence Brunet 1 , Philip C. Lackey 2 , Jennifer S. Fusco 1 , Gerald Pierone Jr 3 , Michael B. Wohlfeiler 4 , Douglas T. Dieterich 5 , Cassidy E. Henegar 6 , Vani Vannappagari 6 , Bryn Jones 7 , Annemiek de Ruiter 7 , Gregory P. Fusco 1 1 Epividian, Inc, Durham, NC, USA, 2 Wake Forest University, Winston-Salem, NC, USA, 3 Whole Family Health Center, Vero Beach, FL, USA, 4 AIDS Healthcare Foundation, Miami, FL, USA, 5 Icahn School of Medicine at Mount Sinai, New York, NY, USA, 6 ViiV Healthcare, Durham, NC, USA, 7 ViiV Healthcare, Brentford, UK Background: The literature on the association between classes of antiretrovirals (ARV) and hypertension (HTN) is conflicting, and very little has been published at the agent level. We compared the rates of incident HTN across combinations of common ARVs among people with HIV in routine clinical care in the US-based OPERA cohort. Methods: Adults with HIV in the OPERA cohort starting a new 2- or 3-drug regimen (DR) between 01JAN2016 and 31DEC2022 were included if they had no evidence of HTN (no HTN diagnosis or prescription for antihypertensive) and either normal blood pressure (BP) (nBP; systolic BP [SBP] <120 mmHg, diastolic BP [DBP] < 80 mmHg) or normal & elevated BP (n+eBP; SBP <140 mmHg; DBP <90 mmHg) at regimen start. Incident HTN was defined as (a) two consecutive SBP ≥140 mmHg or DBP ≥90 mmHg, (b) new HTN diagnosis or (c) new antihypertensive prescription. We estimated adjusted incidence rate ratios (aIRR; multivariate Poisson regression) comparing regimens of dolutegravir (DTG) 3DR with or without tenofovir alafenamide (TAF), DTG/lamivudine (3TC) 2DR, bictegravir/emtricitabine/TAF (B/F/TAF), or boosted darunavir (bDRV) 3DR with or without TAF. Analyses were conducted among those with n+eBP and the subset with nBP, stratified by prior ART experience. Results: There were 7572 ART-naïve people with n+eBP (3220 nBP); 4% aged 55+, 13% female, 53% Black, 14% obese, 83% eGFR ≥90, 6% viral load ≥1M. There were 3428 ART-experienced people with n+eBP (1142 nBP); 14% aged 55+, 18% female, 39% Black, 19% obese, 61% eGFR ≥90, 58% viral load <50. Incidence rates of HTN approximately doubled in those with n+eBBP for both ART-naïve and ART-experienced individuals (Figure). However, there was no statistically significant association between regimen and rate of HTN in ART naïve or ART-experienced individuals, regardless of baseline BP (Figure). Conclusions: In this real-world assessment of people with HIV with either n+eBP or nBP at regimen start, no statistically significant difference was observed between common core ARV agents with or without TAF and the rate of incident HTN in ART-naïve or ART experienced individuals. Among commonly used modern ART regimens, specific antiretroviral combinations do not appear to be a driving factor in the development of HTN in this large and diverse cohort of people with HIV in the US.

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Poster Abstracts

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Social Determinants of Health and the Hypertension Care Cascade in a National HIV Cohort Puja Van Epps 1 , Lewis Musoke 2 , Nadine Harris 3 , Elizabeth Strawbridge 4 , Sandra Woolson 5 , Hayden Bosworth 5 , for the V-Extra CVD Study 1 Case Western Reserve University, Cleveland, OH, USA, 2 Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA, 3 Emory University, Atlanta, GA, USA, 4 Durham VA Medical Center, Durham, NC, USA, 5 Duke University Medical Center, Durham, NC, USA Background: HTN remains a leading modifiable risk factor for cardiovascular, cerebrovascular, and chronic kidney diseases, all disproportionately affecting people with HIV (PWH). Disparities in HTN care have been described in the general population, though such data is limited in PWH. We apply the care cascade framework to HTN to evaluate the association between personal and neighborhood level social determinants of health (SDH) and HTN outcomes in a nationwide cohort of Veterans with HIV. Methods: We queried the Veterans Health Administration (VHA) databases to identify PWH who received care across any VHA facility nationwide during calendar year (CY) 2023. HTN care cascade was defined as: diagnosis - HTN ICD-10 codes associated outpatient encounters; treatment - active prescription of ≥1 antihypertensive drugs; HTN monitoring at least 2 recorded blood pressure (BP) readings at least 90 days apart; control - last BP recording less 140/90 in CY 23. Patient zip codes were used to derive the area deprivation index (ADI) and rurality. Summary statistics are used describe the groups and comparisons were tested using Chi-square statistic and Kruskal-Wallis. Results: Of the 33,569 PWH in care, 42% had a HTN diagnosis in CY 23. HTN diagnosis was more common in birth sex males than females (38% vs. 42%, p=0.0002), Blacks compared with Whites (48% vs. 38%, p<0.0001), and those living in more deprived compared to better resourced neighborhoods (median ADI national rank 57 vs. 52, p<0.0001). Of those with a diagnosis of HTN, 87% of PWH in care were on treatment in CY23, birth sex males more likely to be treatment than females (87% vs. 81%, p=0.0001) and those on treatment being older than those not receiving treatment (65 v 63 p = 0.0001). Of the patients with a diagnosis, 54% were monitored, without significant differences across groups. Of those who were monitored, 64% were controlled, with Blacks having the lowest proportion of control at 58%, Whites highest at 67% (p=0.0086).

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