CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

841

Markers of Arterial Stiffness in People Living With HIV and Echocardiographic Outcomes Karl Reis 1 , Ponsiano F. Stephano 2 , Salama Fadhil 2 , Megan Willkens 3 , Julie Karand 4 , Eliaz Nyanza 5 , Grace Ruselu 2 , Ayubu Garubindi 5 , Benson Issarow 2 , Myung-Hee Lee 3 , Cody Chicowitz 6 , Rob N. Peck 3 1 University of Washington, Seattle, WA, USA, 2 Mwanza Intervention Trials Unit, Mwanza, Tanzania, 3 Weill Cornell Medicine, New York, NY, USA, 4 University of Delaware, Newark, DE, USA, 5 Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania, 6 University of California San Francisco, San Francisco, CA, USA Background: Cardiovascular disease is a growing cause of morbidity and mortality in people living with HIV (PLWH). Arterial stiffness may be an intermediary between HIV-infection and CVD, necessitating holistic assessment of arterial stiffness and correlation with cardiac outcomes. We conducted a cross-sectional study of PLWH and HIV-uninfected community controls using multimodal assessment of arterial stiffness and echocardiographic outcomes. Methods: We performed ankle-brachial index (ABI) and pulse-wave velocity (PWV) to characterize arterial stiffness in a cohort of PLWH and HIV-uninfected community controls in Mwanza, Tanzania. Simultaneous echocardiograms were performed to define cardiac outcomes including left-ventricular mass index (LVMI), left-ventricular hypertrophy, average e’, and average E:e’. Multivariable logistic regression analysis was used to determine differential risk factors for ABI vs PWV and to determine associations between arterial stiffness and echocardiographic outcomes. Results: We enrolled 848 participants; 398/848 PLWH (46.9%) and 450/848 community controls (53.1%). Age and sex distributions were similar between the two groups. All PLWH were on anti-retroviral therapy (ART) with a mean treatment duration of 2.46 years (SD 0.92). In multivariable models, elevated ABI was associated with HIV infection (3.26 (1.48, 7.16), p=0.003), male sex (3.09 (1.40, 6.82), p=0.005), and BMI (1.08 (1.01, 1.16), p=0.026), whereas elevated PWV was associated with age (1.11 (1.06, 1.17), p<0.001) and systolic blood pressure (1.64 (1.27, 2.10), p<0.001) (Figure 1). After adjusting for confounders, ABI was associated with LVMI (7.06 (0.23, 13.91), p=0.043) and average E:e’ (0.75 (0.19, 1.31), p=0.009), while PWV was associated with LVMI (10.52 (2.47-18.57), p=0.010). No significant interactions with HIV-status were found between arterial stiffness measures and echocardiographic outcomes. Conclusions: Differential associations between HIV and multiple measures of arterial stiffness suggest that HIV is associated with peripheral but not central arterial stiffness. Arterial stiffness was correlated with cardiac hypertrophy and impaired cardiac filling, suggesting a mechanistic pathway for HIV-related CVD that includes peripheral arterial stiffness. Young, male PLWH in similar settings are at risk for sub-clinical and undetected vascular aging.

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Seven-Year Progression of Coronary Artery Calcium Score in Middle-Aged Thai People Living With HIV Napon Hiranburana 1 , Sarawut Siwamogsatham 2 , Pairoj Chattranukulchai 2 , Monravee Tumkosit 2 , Yanisa Jarusyingdumrong 1 , Thanawat Nochaiwong 1 , Tanakorn Apornpong 1 , Stephen Kerr 3 , Porntep Amornritvanich 4 , Anchalee Avihingsanon 5 1 HIV Netherlands Australia Thailand Research Collaboration, Bangkok, Thailand, 2 King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 3 Chulalongkorn University, Bangkok, Thailand, 4 Police General Hospital, Bangkok, Thailand, 5 HIV-NAT, Thai Red Cross AIDS and Infectious Disease Research Centre, Bangkok, Thailand Background: People living with HIV (PLWH) face an elevated risk for atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcium (CAC) scores, a marker of subclinical atherosclerosis, strongly predict ASCVD. Identifying drivers of CAC progression can guide more aggressive preventive strategies for this at risk population. Methods: This cohort study enrolled Thai PLWH aged 50-60 years without established ASCVD from HIV-NAT, Thailand. Baseline data collection included 10-year ASCVD risk, smoking and alcohol consumption status, HIV-related parameters, metabolic profiles, inflammatory markers, and statin use. For this analysis, we included only participants who underwent two CAC assessment: at baseline (2015-2018) and during follow-up (2023-2024) to assess progression across CAC score categories (0, >0-99, 100-399, ≥400). Multivariable logistic regression was used to identify associations with CAC score progression. Results: Of 220 participants, 112 (51%) experienced CAC progression over a median follow-up of 6.9 years (IQR 6.6-7.4). Progressors were more likely to be male (69.6% vs. 45.4%, p<0.001), current smokers (15.2% vs. 7.4%, p<0.001), drink alcohol (25.9% vs. 9.3%, p=0.001), have intermediate to high 10-year ASCVD risk (45.5% vs. 26.6%, p=0.001), high triglycerides (57.1% vs. 41.5%, p=0.02), and were more likely to use protease inhibitors (PI) (43.8% vs. 30.6%, p=0.04). In participants with a baseline CAC score of 0 (n=125), 44% progressed to >0-99, 4.8% to 100-399, and 0.8% to ≥400. Among those with a baseline score of >0-99 (n=73), 43.8% progressed to 100-399, and 11% to ≥400. For participants with baseline CAC 100-399 (n=11), 91% progressed to ≥400. All participants with baseline scores ≥400 (n=11) remained in this category at follow-up. In a multivariable model, BMI ≥25 kg/m² (OR 2.1, 95% CI 1.1-4.2, p=0.03) smoking (OR 2.8, 95% CI 1.6-6.0, p=0.01) and high triglyceride-glucose (TyG) Index (OR 1.8, (95%CI 1.1-3.2), p=0.03) were independently associated with CAC progression. Compared to those taking NNRI, PI or intergrase inhibitor based regimens were not statistically significant but were associated with increased risk ( Figure ). Conclusions: More than 50% of participants showed worsened subclinical atherosclerosis, with greater progression rates in those with higher baseline CAC scores. In addition to statin use, prioritizing smoking cessation and weight management is essential to prevent CAC progression and reduce cardiovascular risk in high-risk PLWH populations.

Poster Abstracts

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CROI 2025 255