CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

824

Change in Cardiometabolic Risk Markers Following Switch to Integrase Inhibitors Differs by Sex Cecile D. Lahiri 1 , Cyra C. Mehta 1 , Qian Yang 1 , Julie B. Dumond 2 , Maria L. Alcaide 3 , Frank Palella 4 , Jordan E. Lake 5 , Leah H. Rubin 6 , Audrey L. French 7 , Seble Kassaye 8 , Michael Augenbraun 9 , Anjali Sharma 10 , Ighovwerha Ofotokun 1 , Anandi N. Sheth 1 , Jessica A. Alvarez 1 1 Emory University, Atlanta, GA, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 University of Miami Miller, Miami, FL, USA, 4 Northwestern University, Chicago, IL, USA, 5 University of Texas Health Science Center at Houston, Houston, TX, USA, 6 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 7 Stroger Hospital of Cook County, Chicago, IL, USA, 8 Georgetown University, Washington, DC, USA, 9 SUNY Downstate Medical Center, Brooklyn, NY, USA, 10 Albert Einstein College of Medicine, Bronx, NY, USA Background: Integrase strand-transfer inhibitor (INSTI)-associated weight gain among people with HIV (PWH) is greater in women than men. We assessed sex differences in cardiometabolic markers up to 5 years following INSTI initiation. Methods: We used data collected between 2007-2020 in INSTI-naïve PWH on antiretroviral therapy (ART) for ≥2 years with viral suppression (<200 c/ mL) and persons without HIV (PWOH) enrolled in the MACS/WIHS Combined Cohort Study. We compared PWH who switched/added an INSTI to those who stayed on non-INSTI ART and to PWOH. Follow-up time was years since switch visit or comparable visit in controls. Outcomes included changes in systolic and diastolic blood pressure (SBP, DBP) and fasting lipids (total cholesterol, TC, high density lipoprotein, HDL, low density lipoprotein, LDL, and triglycerides, TG). Linear regression mixed effect models assessed the effects of natal sex, study group, and time on outcomes, adjusted for time-varying age, race/ ethnicity, socioeconomic status, smoking, alcohol, hypertension or cholesterol medications, and body mass index. Results: 3464 participants contributed 3.2 (±1.5) years of data, including 1938 women (411 INSTI, 709 Non-INSTI, 818 PWOH) and 1526 men (223 INSTI, 412 Non-INSTI, 891 PWOH). Pre-switch, women were younger (47 vs 55 years), more likely to be non-Hispanic Black (65 vs 23%) and had higher BMI (32 vs 27 kg/m2), compared to men. Among women, the INSTI group had greater SBP increase versus non-INSTI and PWOH up to 3 years post-switch: +6.7 mm Hg (95% CI +4.7, +8.7) vs +3.0 (+1.3, +4.8) and +3.0 (+1.6, +4.4), and greater DBP increase up to 2 years post-switch: +1.9 mm Hg (+0.9, +3.0) vs -0.4 (-1.2, +0.5) and +0.5 (-0.5, +1.0), respectively, Figure 1A. Women on INSTIs had greater decline in HDL within 1 year of switch versus non-INSTI and PWOH: -2.4 mg/ dL (-4.6, -0.1) vs -0.7 (-1.0, 2.4) and +1.6 (0.1, 3.1), respectively, Figure 1B. Sex and study group modified change over time in HDL (sex*years*study group, p=0.007) but not BP. BMI was significant in BP and HDL models, p<0.001. There were no sex differences in TC, TG, or LDL change by group. Conclusions: INSTI initiation (vs non-initiation) was associated with greater increases in BP and decreases in HDL for women but not for men, possibly consequent to greater INSTI-associated weight gain in women. Research is needed to understand the implications of INSTI-induced changes on cardiovascular outcomes in PWH. Dolutegravir-Based Antiretroviral Therapy and Cardiometabolic Health Risk in Persons With HIV Katuku Aizire 1 , Antonio Bandala-Jacques 1 , Sara K. Nsibirwa 2 , Ponsiano Ocama 2 , Gregory Kirk 3 , for the HIV and Hepatocellular Carcinoma in Uganda (H2U) Consortium 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Makerere University College of Health Sciences, Kampala, Uganda, 3 The Johns Hopkins University, Baltimore, MD, USA Background: Dolutegravir (DTG) based antiretroviral therapy (DTG-ART) is preferred first-line for persons with HIV (PWH), and yet implicated with weight gain. We compared cardiometabolic health risk by DTG-ART. Methods: ART-experienced PWH enrolled via Makerere University IDI-ART clinic in Uganda (2021), cross-sectional comparisons of DTG-ART and age- and sex-matched controls (group A), and pre- and 6-months post-DTG-ART switch comparisons (group B). We used gold-standard measures of liver fat (Fibroscan controlled attenuation parameter (CAP)), and DEXA for body fat composition (group B only). Modified Poisson regression with robust variance estimated adjusted prevalence risk (aPR), and 95% confidence intervals (CI) for cardiometabolic risk, adjusting for age, ART duration, education, viral load and CD4 count, additionally for women, parity and obesogenic contraceptives use. The figure, table, or graphic for this abstract has been removed.

Results: For group A (n=500), 65.2% were women, median age (IQR), 39 (34-46) years compared to men, 45 (38-50) years; 50.2% DTG-ART, 67.1% tenofovir ART backbone, 86.2% virally suppressed (<20 copies/ml). In adjusted analyses stratified by sex, null associations with DTG-ART were observed for anthropometric measures, blood pressure (BP), blood sugar, liver fat CAP >270 dB/m, dyslipidaemia and metabolic syndrome, see figure 1, and similarly in separate analyses stratified by age (≥50 years), DTG-ART duration (>12 months), and ART pre-DTG switch, respectively. Notable exceptions include high BP (≥130/85 mmHg) in men within normal range BMI, aPR (95% CI), 1.98 (1.22, 3.19), pre-DTG ART sans efavirenz, 1.64 (1.10, 2.46); DTG-ART ≥12 months was protective against hypertriglyceridemia ≥150 mg/dl, in women, aPR (95% CI), 0.47 (0.26, 0.83), and men, 0.53 (0.32, 0.87); but associated with HDL<50mg/dl in women (<50 years, 1.44 (1.12, 1.87), overweight/obese, 1.41 (1.10, 1.80) and when compared to NNRTI-ART controls, 1.66 (1.10, 2.56)). For group B (n=50), there were no differences 6 months after DTG-ART switch regarding body fat DEXA measures, liver fat CAP scores, BP, blood sugar, while lipid measures improved significantly in both men and women. Conclusions: Apart from BP in men and HDL in women, DTG-ART use in virally suppressed Ugandan PWH appeared to be lipo-protective or neutral regarding cardiometabolic health risks. Interpretation of these data is complex given concurrent use of potentially weight-attenuating TDF or efavirenz (controls or pre-DTG), considerations for future studies.

Poster Abstracts

826

Changes in Cardiometabolic Parameters After ART Initiated Within 1 Year of HIV Acquisition Nikos Pantazis 1 , Sabin Caroline 2 , Sophie Grabar 3 , Marc van der Valk 4 , Laurence Meyer 5 , Mar Masiá 6 , Christina Carlander 7 , M. John Gill 8 , Fiona Burns 2 , Shema Tariq 2 , Giota Touloumi 1 , Kholoud Porter 2 , for the CASCADE Collaboration 1 National and Kapodistrian University of Athens, Athens, Greece, 2 University College London, London, UK, 3 Sorbonne University, Paris, France, 4 Stichting HIV Monitoring, Amsterdam, Netherlands, 5 Hôpitaux Universitaires Paris-Saclay, Orsay, France, 6 Hospital General Universitario de Elche, Elche, Spain, 7 Karolinska University Hospital, Stockholm, Sweden, 8 University of Calgary, Calgary, Canada Background: Integrase strand transfer inhibitors (INSTIs) have good lipid profiles but some studies have reported increased risk of dyslipidaemia and hypertension, particularly when combined with tenofovir alafenamide (TAF). Studying seroconverters on early antiretroviral therapy (ART) minimizes the potential confounding impact of long-term HIV infection on cardiometabolic parameters. Methods: Included individuals from CASCADE seroconverted 2007-2022, were ≥16 years, initiated ART ≤12 months from seroconversion (SC), had body mass index, CD4 count, and viral load measurements at baseline (ART initiation) and total cholesterol (TCHOL) or triglycerides (TG) or arterial blood pressure (BP) measurements at baseline and post-ART. Evolution of lipid levels was modelled through piecewise linear mixed models with 1 knot at 6 months (based on exploratory analyses) and risk of hyperlipidaemia (TCHOL>240 mg/dL or TG>200 mg/dL or antilipidemic treatment) and hypertension (systolic≥140, or diastolic≥90mmHg or initiation of antihypertensives) using time-to-event methods.

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