CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1068 Characterisation of Cardiac Disease in Adolescents With HIV in the Antiretroviral Therapy Era Edith D. Majonga 1 , Miriam Lacharie 2 , Betty Raman 2 , Hilda A. Mujuru 3 , Kirti Naik 4 , Anoop Shah 5 , Rashida Ferrand 5 , Masliza Mahmod 2 1 Biomedical Research and Training Institute, Harare, Zimbabwe, 2 Oxford University, Oxford, UK, 3 University of Zimbabwe, Harare, Zimbabwe, 4 Baines Imaging Group, Harare, Zimbabwe, 5 London School of Hygiene & Tropical Medicine, London, UK Background: Young people with perinatal HIV (PHIV) have an increased risk of cardiac disease despite effective ART, particularly but not exclusively in those who have had delayed HIV diagnosis and antiretroviral therapy (ART) initiation. The aim of the study is to characterize the myocardial abnormalities in adolescents with PHIV who are established on ART using cardiac magnetic resonance (CMR) imaging and association with biomarkers of inflammation and cardiac stress. Methods: We examined the myocardium in adolescents with PHIV aged 10-19 years taking ART compared to uninfected controls in Zimbabwe. Participants completed a 3-Tesla CMR assessment of cardiac function and myocardial fibrosis using late gadolinium enhancement (LGE). Circulating biomarkers of inflammation (CRP, TNF-α) fibrosis (Gal-3, TIMP-1) and cardiac stress (ST2, GDF-15) were assessed using multiplex bead assay (Luminex). Multivariate linear regression assessed how biomarker levels related to cardiac abnormalities. A p-value of 0.05 or less was considered significant. Results: A total of 120 adolescents were enrolled (60 PHIV; 47% female and 60 HIV-uninfected; 42% female). Participants with HIV were older [median (IQR) 18 (16-19) vs 15 (13-17) years; p<0.001] compared to uninfected controls although both groups had a similar body surface area. In the HIV group, median age at HIV diagnosis was 5.5 (IQR) 4-8 years and 18 (82%) were virally suppressed (<19 copies/ml). 96 participants had CMR scans (49 PHIV and 47 uninfected controls). Both groups had similar myocardial function and no LGE. PHIV group had larger left ventricular (LV) mass index (LVMi) [39.4 (5.9) vs 35.9 (6.0) g/m2; p=0.006] . There was reduced LV ejection fraction [55.2% vs 59.9% ; p=0.005] and right ventricular ejection fraction [55.2% vs 59.2% ml/m2; p=0.026] in those who were not virally suppressed compared those suppressed. Plasma levels of TNF-α, TIMP1 and GDF-15 were higher in the PHIV group compared to uninfected control (p<0.001). CRP and ST2 were higher in those not virally suppressed versus unsuppressed. ST2 was significantly associated with higher LVMi (adjusted β, 1.368 ; p=0.040), LV end diastolic and systolic volume index (3.428 ; p=0.006 and 2.030 ; p=0.027). Conclusions: CMR revealed similar myocardial function between PHIV and controls but mildly increased LVMi in the PHIV group. ST2 biomarker may suggest presence of subclinical myocardial stress. Longitudinal studies to understand the clinical implications of these myocardial alterations are required.

particularly among YPHIV, additional adjustment for lean and adipose body mass (LBM, ABM) may provide more accurate diagnoses. Methods: We evaluated youth (mean age 12.2, range 7.0-18.7 years, 72% nonwhite, 48% male) from the Adolescent Master Protocol (AMP) conducted by the Pediatric HIV/AIDS Cohort Study network. LVM was normalized by BSA or HT, exponentiated to values estimated from both adults and AMP cohorts (via linear regression), and assessing improvement of normalizations including LBM and/or ABM. Normalizations for LVM were computed for YPHIV and youth perinatally exposed but uninfected (YPHEU). Adjusted R 2 (aR 2 ) was used to assess the variation in LVM accounted for by BSA, HT, ABM and/or LBM. Plots of LVM indices by ABM percentage of body mass were used for visual assessments of index suitability. Results: We included 269 AMP youth (171 YPHIV, 98 YPHEU). For LVM indices with BSA or HT alone, estimated exponents among YPHIV for BSA (1.12 (95% CI: 1.03, 1.21) and HT (2.35 (95% CI: 2.11, 2.59) were lower than those among YPHEU [BSA: 1.21 (95% CI: 1.10, 1.32), HT: 2.54 (95% CI: 2.07, 3.00)], and both were lower than standards for adult populations. In HT-based indices, including LBM made major improvements and including ABM further improved normalizations (aR 2 increased 0.11-0.29) for both YPHIV and YPHEU. Mild improvements (aR 2 increased 0.01-0.03) were made in BSA-based indices (Table). YPHEU BSA based and YPHIV indices exhibited no clear patterns. YPHEU HT-based indices without ABM demonstrated a positive linear relationship with ABM%, which disappeared after ABM adjustment. Conclusions: Better fit LVM indices for YPHEU and YPHIV populations were higher than the index based on adults, indicating that adult standards may be over sensitive for LVH diagnoses for YPHEU and YPHIV populations. Adjusting LVM for lean and adipose body mass, in addition to HT or BSA, may provide more accurate LVH diagnoses for pediatric YPHIV and YPHEU. Allometric normalizations including LBM and ABM may not be robust to proportion of adipose in whole body mass.

Poster Abstracts

1070 Distinct Metabolic and Inflammation Signatures in Urban vs Rural Ugandan Youth With HIV Sahera Dirajlal-Fargo 1 , Shan Sun 2 , Kate Ailstock 3 , Rashidah Nazzinda 4 , Christine Karungi 4 , Daisy O. Oryem 4 , Robert Kidega 4 , Victor Musiime 4 , Cissy Kityo 4 , Grace A. McComsey 5 , Nicholas Funderburg 3 1 Northwestern University, Chicago, IL, USA, 2 Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA, 3 Ohio State University, Columbus, OH, USA, 4 Joint Clinical Research Centre, Kampala, Uganda, 5 Case Western Reserve University, Cleveland, OH, USA Background: In Sub-Saharan Africa (SSA), the majority of the inflammatory and metabolic data are from youth living in urban areas. We examined differences between youth with perinatally acquired HIV (YPHIV) in urban vs rural Uganda. Methods: YPHIV (n=100) were enrolled from urban and rural Uganda in an observational cohort study along with age- and sex- matched, population based HIV-seronegative (n=99) comparators. YPHIVs were on ART with HIV-1 RNA level ≤400 copies/mL. We compared fasting lipids, insulin resistance (HOMA-IR), and plasma inflammatory/gut biomarkers between rural and urban sites using Wilcoxon rank-sum tests and chi-square tests. Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA) was conducted to identify key discriminating factors. General linear regression models were used to assess factors associated with metabolic and inflammatory biomarkers, adjusting for HIV status, socioeconomic factors, and other covariates. Results: Median age was 16.2 years, there was more females in rural than urban Uganda (55% vs 48% respectively). Median viral load was 112 copies/mL,

1069 Left Ventricular Mass Adjustment for Body Size in Youth With Perinatal HIV or Perinatal HIV Exposure George W. Sawyer 1 , Tzy-Jyun Yao 1 , Paige Williams 1 , Denise L. Jacobson 1 , Elaine M. Urbina 2 , Steven E. Lipshultz 3 , Steven D. Colan 4 , for the Pediatric HIV/AIDS Cohort Study (PHACS) 1 Harvard TH Chan School of Public Health, Boston, MA, USA, 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, 3 University at Buffalo, Buffalo, NY, USA, 4 Boston Children's Hospital, Boston, MA, USA Background: Cardiac-related complications were one of the most common causes of death in youth living with perinatally-acquired HIV (YPHIV) prior to widespread ART. However, diagnosing Left Ventricular Hypertrophy (LVH) typically relies on indices based on allometric exponents estimated from adults, which normalize Left Ventricular Mass (LVM) by body surface area (BSA) or height (HT) raised to a power (BSA: 1.35, HT: 2.70). In pediatric populations and

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