CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

833

Prediction of Cardiovascular Risk Among PWH: Comparing the PREVENT and Pooled Cohort Equations Matthew S. Durstenfeld 1 , Megan M. McLaughlin 1 , Monica Gandhi 1 , Alexis Beatty 1 , Priscilla Hsue 2 1 University of California San Francisco, San Francisco, CA, USA, 2 University of California Los Angeles, Los Angeles, CA, USA Background: People with HIV (PWH) are at elevated cardiovascular disease (CVD) risk. Traditional risk prediction tools underestimate CVD risk among PWH and do not predict risk of heart failure (HF). The American Heart Association (AHA) developed new risk prediction equations, Predicting Risk of cardiovascular disease EVENTs (PREVENT), which include risk of HF and has not been studied among PWH. Methods: Using a real-world, electronic health record cohort of PWH over age 40 without known atherosclerotic cardiovascular disease (ASCVD) at two healthcare systems in San Francisco from 2019-2024, we calculated predicted CVD risk using PREVENT, including 10-year ASCVD, heart failure (HF), and total CVD. We compared predicted 10-year ASCVD risk using the pooled cohort equations (PCE) and PREVENT (full equations) both overall and across demographic categories. Results: Among 837 PWH, the median age was 57 years old (IQR 48, 63); 67% were male, 17% were female, and 8% were transgender or nonbinary; 29% identified as Black and 25% as Latino; 88% were on antiretroviral therapy and 89% had virologic suppression. Using PREVENT, the median 10-year predicted risk of ASCVD, HF, and CVD were 2.76% (IQR 1.18, 5.61), 12.80% (9.46, 16.7), and 5.28% (2.76, 8.98), respectively, compared to the PCE predicted risk of ASCVD of 7.55% (3.56, 14.5). Among 574 PWH with complete data to calculate 10-year ASCVD risk using both equations, predicted risk was lower for 95% of individuals using PREVENT (Panel A). Using a 10-year ASCVD risk threshold of 5% for statins, 56% fewer PWH would be strongly recommended for statins with the PREVENT equations compared to the PCE. The difference in predicted risk between the two equations varied across sex and race/ethnicity groups (Panel B). Adjusted for traditional risk factors, the PREVENT equations predicted lower ASCVD risk than the PCE among those with older age (P<0.0001), male sex (p<0.0001), Black race (P<0.002), and Latino ethnicity (P=0.03). Conclusions: The new PREVENT calculator was associated with a lower predicted ASVCD for PWH as compared to the PCE, which was already known to underpredict risk for PWH especially among women and Black individuals. Underprediction of CVD risk, which may translate to lower use of statins and blood pressure treatment, has the potential to increase CVD and worsen healthcare disparities among PWH. The figure, table, or graphic for this abstract has been removed. Lipidomic, Metabolomic, and Immune Profiles Precede Cardiovascular Events in People With HIV Joana Vitalle 1 , Alberto Perez-Gomez 1 , Silvia Chafino-Aixa 2 , Carmen Gasca Capote 3 , Laura Tarancon-Diez 4 , María Reyes Jimenez-Leon 1 , Sara Bachiller 1 , Isabel Gallego 1 , María Angeles Muñoz-Fernandez 5 , Joaquim Peraire 2 , Anna Rull 2 , Francesc Vidal 2 , Luis López-Cortés 6 , Ezequiel Ruiz-Mateos 1 , Adrian Curran 7 1 Institute of Biomedicine of Sevilla, Sevilla, Spain, 2 Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain, 3 Instituto Biomedicina de Sevilla, Sevilla, Spain, 4 Hospital General Universitario Gregorio Marañón, Madrid, Spain, 5 University Hospital Gregorio Marañon, Madrid, Spain, 6 Hospital Universitario Virgen del Rocio, Sevilla, Spain, 7 Hospital Universitari Vall d'Hebron, Barcelona, Spain Background: People with HIV (PWH) have an increased risk of cardiovascular disease (CVD), driven by persistent immune activation and metabolic disturbances, despite successful antiretroviral therapy (ART). Alterations in some immune parameters and metabolites have been associated with the CVD onset. However, specific lipidomic, metabolomic, and immunological biomarkers preceding CVD in PWH are still unknown. Methods: A retrospective case-control study was performed, analyzing 35 PWH on ART 3-18 months before experiencing acute myocardial infarction or acute coronary syndrome and 35 PWH as controls who did not suffer any non-AIDS event, matched by sex, age, active HCV infection, nadir and CD4+ T-cell levels, time since HIV diagnosis, and Framingham Risk Score (FRS), commonly used to predict CVD. 236 lipids and 102 metabolites were detected in plasma by LC-QTOF and GC-qTOF respectively. We performed T cell, monocyte and dendritic cell (DC) deep immunophenotyping by flow cytometry from PBMCs. Mann-Whitney test was used for two group statistic (p>0.05) and ROC curve analysis to determine

of CVD (OR: 1.07, CI: 1.06-1.08). PLR had no significant independent effect on outcomes (OR: 1.00, CI: 1.00-1.00). The full model (HIV status, ASCVD risk, NLR, PLR) demonstrated the strongest predictive ability for combined CVD (OR: 1.28, CI: 1.21-1.35; OR: 1.08 for NLR, CI: 1.06-1.10), with chi-square deviance showing significant improvement compared to the model using HIV status and ASCVD risk alone (p<0.001). Conclusions: Adding NLR and PLR to ASCVD risk scores significantly improves 10-year prediction of combined CVD in PWH, highlighting their potential utility as clinical tools for enhancing risk stratification in this population. Future research should examine the interaction of NLR and PLR and evaluate their contributions to inflammatory mechanisms. Cardiovascular Risk Assessment in Women Living With and Without HIV Using the PREVENT Model Tetiana Povshedna 1 , Renying (Loulou) Cai 1 , Marcela A. P. Silva 2 , Elizabeth King 3 , Shelly Tognazzini 3 , Angela Kaida 3 , Melanie Murray 2 , Helene Cote 1 , for the British Columbia CARMA-CHIWOS Collaboration (BCC3; CIHR CTN 335) 1 University of British Columbia, Vancouver, Canada, 2 BC Children's & Women's Health Centre, Vancouver, Canada, 3 Simon Fraser University, Burnaby, Canada Background: Cardiovascular disease (CVD) risk in women living with HIV (WLWH) is shaped not only by traditional risk factors, but also by HIV specific and women-specific factors. Primary prevention of CVD utilizes risk assessment models that show varying performance in WLWH. Predicting Risk of cardiovascular disease EVENTs (PREVENT) is a novel race/ethnicity-free sex-specific calculator that estimates 10y and 30y atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and composite CVD risks based on cardiovascular-metabolic-kidney disease risk factors and optional incorporation of social deprivation index (SDI, US only). Here, we describe PREVENT-based CVD risk in women living with and without HIV. Methods: British Columbia CARMA-CHIWOS Collaboration (BCC3) is a prospective cohort study enrolling women ≥16y living with and without HIV in British Columbia, Canada since 2020. Participants aged 30-79y with no history of coronary heart disease, stroke, or HF, were included. The base PREVENT model was used (without SDI) to calculate 10y and 30y risks of ASCVD, HF, and CVD, with the 30y risk offering a long-term preventative estimate among women aged 30-59y only. Data were self-reported, or based on the study visit clinical blood tests. Groups were compared by Chi-Squared or Mann-Whitney tests. Results: A total of 164 WLWH and 187 women without HIV were included (25 WLWH and 33 controls excluded due to prior history). WLWH and controls had similar socio-demographic characteristics and shared many risk factors for CVD: age (median [IQR] 49 [43-57] vs 50 [41-58] years, p=0.50), current smoking (40% vs 36%) diabetes (both 8%), antihypertensive medication use (16% vs 12%), current substance use (21% vs 25%), BMI, blood pressure, and total cholesterol (all p>0.05). WLWH were more likely to report a history of hepatitis C (38% vs 15%) and use of lipid-lowering medication (16% vs 5%), but had lower HDL and eGFR compared to women without HIV (all p<0.01). The PREVENT base model revealed no difference in 10y risk of ASCVD, HF, or CVD between the groups, but a higher 30y risk for ASCVD and CVD in WLWH compared to women without HIV (Table 1). Conclusions: Despite similar 10y ASCVD, HF, and CVD risk estimates, WLWH showed higher 30y risk of CVD outcomes. This could reflect long-term implications of HDL/eGFR differences between the groups, or the impact of factors not captured by PREVENT, including higher exposure to adverse life events, chronic immune activation, and non-HIV chronic/latent viruses.

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Poster Abstracts

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CROI 2025 252