CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

visualized as total (TPV) and low attenuated plaque volume (LAPV), and coronary artery calcium (CAC) score by computed tomography angiography. Flow cytometry was used for ALDH activity monitoring on immune cells identified based on the expression of lineage markers as dendritic cells (DC, CD3-HLA-DR+CD1c+), monocytes (CD3-HLA-DR+CD1c-) subdivided in classical (CD14+CD16-), intermediate (CD14+CD16+), and non-classical (CD14-CD16+) monocytes, and CD4+/CD8+ CD3+ T cells. Results: Groups were similar in age, sex, statins, and smoking, but median TPV values were higher in HIV+ART (851 mm 3 ) vs. HIV- (143 mm 3 ). There was an expected decrease in the frequencies of CD4+ T cells and DC, and an expansion of CD8+ T cells and classical monocytes in HIV+ART vs. HIV-. ALDH activity was predominant in cells with high granularity [side scatter high (SSC high ), i.e., DCs, monocytes] compared to SSC low (i.e., CD3+ T, CD3-). The frequency of ALDH+ DC and monocytes was significantly increased in HIV+ART vs. HIV- (Figure 1A), with the highest ALDH activity in intermediate monocytes. ALDH activity was also detected in SSC low CD4+ and CD8+ T-cells, as well as CD3- cells, at levels that were significantly increased in HIV+ART vs. HIV- (Figure 1B). Among HIV+ART with subclinical CVD, the CAC score, and at lower extend TPV and LAPV, positively correlated in a linear regression model with the frequency of ALDH+ SSC High (p=0.02, r 2 =0.24) and SSC Low (p=0.03, r 2 =0.22). Conclusions: The increased ALDH activity in myeloid and lymphoid cells during HIV-1 infection may represent a new functional marker, associated to immune activation and calcified atherosclerotic plaque in ART-treated PWH.

characteristics, ASCVD risk score, cardiovascular/metabolic factors, and HIV related health history. Log-linear models, incorporating interactions between risk factors and treatment group, were used to analyze relative changes from baseline over 24 months. Heterogeneity of treatment effects were identified via interaction tests with P<0.10. All effects described are geometric mean ratio (GMR) between the pitavastatin and placebo groups, adjusting for risk factors and baseline plaque volumes. Results: Participants were median age 52, 90% male, 61% white, 28% black or African American. The relative change from baseline in NCP with pitavastatin was 9% lower, indicating a greater reduction, than with placebo (GMR 0.91, 95% CI[0.82,1.02]). Pitavastatin showed a greater volume-reducing effect on fibro-fatty plaque (0.69 [0.49, 0.96]), with a marginal effect on fibrous plaque (0.92 [0.78, 1.08]) and a trend towards increased volume of calcified plaque (1.29 [0.85, 1.96]). Some heterogeneity in pitavastatin effects on NCP volume was observed. The volume-reducing effect of pitavastatin on NCP was greater among females (0.49[0.25, 0.96]), Hispanic or Latinos (0.55[0.38, 0.79]), those with systolic blood pressure >140 mmHg (0.38[0.20,0.72]), and those using non-statin lipid-lowering therapy (0.50[0.28, 0.92]). HIV-related and other factors did not relate to plaque composition changes. Conclusions: These exploratory results suggest pitavastatin effects on NCP vary by demographic and cardiovascular risk factors; modification of statin effects by HIV risk factors was not apparent. The effect of pitavastatin appears greatest in reducing volume of fibrofatty plaque, which is thought to be the most biologically active component, and may increase plaque density. People With HIV at High Cardiovascular Risk Were Undertreated With Statins Stefan Esser 1 , Lukas Schipper 2 , Sarah Albayrak-Rena 1 , Stefanie Sammet 1 , Felix Maischack 1 , Laven Mavarani 1 , Anja Potthoff 3 , Martin Hower 1 , Boerge Schmidt 1 , Sebastian Dolff 4 , Dirk Schadendorf 1 , Maximilian Platte 4 , for the HIV HEART Aging Cohort Study Group 1 University Hospital Essen, Essen, Germany, 2 University of Duisburg-Essen, Essen, Germany, 3 Ruhr University Bochum, Bochum, Germany, 4 University Hospital of Duisburg-Essen, Essen, Germany Background: Recent studies highlight the importance of statin therapy in people with HIV (PWH), even with moderate overall cardiovascular (CV) risk. Our study aims to assess CV risk management in a cohort of PWH in Germany. Methods: The HIV-HEART Ageing (HIVH) cohort is a prospective study assessing CV risk of PWH in the German Ruhr area since 2004. PWH without prior major adverse CV events were examined at the 10 years follow-up and stratified into four risk groups based on the 2019 German guidelines for dyslipoproteinemia using the SCORE-risk table (very high: ≥10%, high: 5–<10%, medium: 1–<5%, low: <1%). Statin therapy indication was determined by LDL cut-off values for each risk group. PWH with statin therapy indications, those treated, and achievements of therapy goals were assessed. The results were compared using the ASCVD score for risk stratification. Results: 818 PWH were included in the analysis (basic characteristics see table 1). 64 participants had a reported statin therapy. Participants were classified according to SCORE risk groups, with 8.6% in the highest risk group, 19.1% in “high risk”, 49.9% in “medium risk”, and 22.5% in the “low risk” group. Of the 754 participants without statin intake, 179 (23.7%) had an indication for statin therapy according to German guidelines based on SCORE risk groups. In higher risk groups the proportion of PWH with indication for statins was especially high (95.7% in “high risk” and 83.3% in the highest risk group). Among the 64 patients on statins, only 8 (12.5%) achieved the German guidelines recommended, risk adapted LDL therapy targets after 2.5 years. Less than 50% of all PWH with statin use have a sufficient reduction of LDL (by 40% of the baseline values). Using the ASCVD score for risk stratification, even 57.1% of those not treated had an indication for statin therapy. Conclusions: This cohort demonstrates high CV risks and concerning low rates of statin therapies in PWH with elevated CV risk according to SCORE. If the ASCVD score was used for indicating statin therapy, the deficit of statin therapy was even more prevalent. Moreover, LDL therapy targets in those receiving statins were rarely met. Even though LDL targets are often described as idealized, a more consistent therapy of hypercholesterolemia is essential in high-risk patients with regular medical consultations such as PWH.

Poster Abstracts

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Statin Effect Heterogeneity on Plaque Volume & Composition in the REPRIEVE Mechanistic Substudy Borek Foldyna 1 , Xiner Zhou 2 , Thomas Mayrhofer 1 , Julia Karady 1 , Jana Taron 1 , Marton J. Kolossvary 1 , Kayla Paradis 1 , Sara McCallum 1 , Markella V. Zanni 1 , Carl Fichtenbaum 3 , Judith Aberg 4 , Pamela Douglas 5 , Heather Ribaudo 2 , Steven Grinspoon 1 , Michael T. Lu 1 , for the REPRIEVE Study Team 1 Massachusetts General Hospital, Boston, MA, USA, 2 Harvard TH Chan School of Public Health, Boston, MA, USA, 3 University of Cincinnati Medical Center, Cincinnati, OH, USA, 4 Icahn School of Medicine at Mount Sinai, New York, NY, USA, 5 Duke Clinical Research Institute, Durham, NC, USA Background: REPRIEVE and its Mechanistic Substudy established that pitavastatin prevents major adverse cardiovascular events and reduces noncalcified coronary plaque (NCP) on coronary CT angiography (CTA) among PWH with low-to-moderate traditional ASCVD risk. Here we assess heterogeneity of pitavastatin effects on NCP (density <350 HU) volume and plaque composition, categorized by density (<130HU fibrofatty, 130-350 HU fibrous, >350 HU calcified). Methods: In 273 REPRIEVE Substudy participants randomized to pitavastatin calcium 4mg/day (N=140) or placebo (N=133) with preexisting coronary plaque on CTA, we evaluated the effect of pitavastatin on plaque composition, and effect modification by risk factors, including demographic and behavioral

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