CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

determine the effect of SDB and hypoxaemia on relevant HIV outcomes such as cognition, systemic inflammation, and immune activation.

663 SEX-SPECIFIC PATTERNS IN HIV-ASSOCIATED CARDIOVASCULAR MORTALITY IN NEW YORK CITY David B. Hanna 1 , Chitra Ramaswamy 2 , Robert C. Kaplan 1 , Jorge R. Kizer 3 , Demetre C. Daskalakis 2 , Kathryn Anastos 1 , Sarah L. Braunstein 2 1 Albert Einstein College of Medicine, Bronx, NY, USA, 2 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 3 University of California San Francisco, San Francisco, CA, USA Background: We previously identified more pronounced associations between HIV status and cardiovascular disease mortality in women than men in New York City. However, because socioeconomic status may confound this relationship and New York City contains both some of the highest and lowest income counties in the nation, we re-analyzed this data restricted to the Bronx, which is both a high HIV prevalence and lower income borough/county. Methods: We included all residents age 13+ reported with HIV to the population-based New York City HIV Surveillance Registry and living between 2007 and 2012. Surveillance data were linked with the city Vital Statistics Registry and National Death Index. Residents without HIV living in each borough, including the Bronx, were enumerated using modified US intercensal estimates after subtracting the surveillance-based counts of those with HIV. We examined sex-specific rates of death due to major cardiovascular diseases (ICD-10 codes I00-I78). Using log-linear models, we determined the association of HIV serostatus with cardiovascular disease mortality rates by sex within each borough, and compared this to the relationship across all New York City residents. Results: There were 1,673 deaths attributed to cardiovascular disease as the underlying cause among HIV+ New Yorkers between 2007 and 2012, with 376 of these occurring among Bronx residents. In the Bronx, the age-adjusted cardiovascular disease mortality rate was 3.33/1,000 person-years (95% confidence interval [CI] 2.45-4.21) among HIV+men and 2.47/1,000 (95% CI 1.42-3.51) among HIV+ women. In analyses of the entire city, the relative rate of cardiovascular disease mortality attributed to HIV serostatus was almost twice as high in women (rate ratio [RR] 2.18, 95% CI 1.96-2.42) than men (RR 1.17, 95% CI 1.08-1.26, P for interaction <0.001) (Figure). A similar disparity was also observed in each of the five boroughs except for the Bronx, where differences by sex were substantially attenuated (RR 1.76, 95% CI 1.44-2.14 in women vs. RR 1.31, 95% CI 1.15-1.48 in men, P for interaction 0.25). Conclusion: After accounting for socioeconomic status through restriction, we found that sex differences in the association of HIV with cardiovascular disease mortality were attenuated. More work is needed to better characterize how socioeconomic and biological factors related to sex may affect cardiovascular disease in people living with HIV.

Poster Abstracts

662LB HIV IS NOT ASSOCIATED WITH SLEEP-DISORDERED BREATHING

Ken M. Kunisaki 1 , Davide De Francesco 2 , Caroline Sabin 2 , Alan Winston 3 , Patrick W. Mallon 4 , Jane Anderson 5 , Marta Boffito 6 , Lewis Haddow 7 , Frank Post 8 , Jaime H. Vera 9 , Wajahat Khalil 1 , Susan Redline 10 , for the Pharmacokinetics and Clinical Observations in People Over Fifty (POPPY) Study Group 1 Minneapolis VA Health Care System, Minneapolis, MN, USA, 2 University College London, London, UK, 3 Imperial College London, London, UK, 4 University College Dublin, Dublin, Ireland, 5 Homerton University Hospital NHS Trust, London, UK, 6 Chelsea and Westminster Hospital, London, UK, 7 Mortimer Market Centre, London, UK, 8 King’s College Hospital, London, UK, 9 Brighton & Sussex University Hospitals NHS Trust, Brighton, UK, 10 Brigham and Women’s Hospital, Boston, MA, USA Background: Sleep-disordered breathing (SDB) and related intermittent hypoxaemia are associated with increased risk of cardiovascular disease, cognitive dysfunction, malignancy, and impaired quality of life. Although high SDB prevalence has been reported in persons living with HIV (PLWH), studies have been small, lacked relevant HIV-negative controls, relied on risk scores or self-reported sleep apnoea rather than objective testing, and/or selectively enrolled PLWH with sleep symptoms potentially biasing findings. We compared overnight oximetry measures in PLWH and HIV-negative persons with similar lifestyles participating in the POPPY study. Methods: We recruited a subset of POPPY participants (PLWH ≥50 y/o, PLWH <50 y/o, and HIV-negative controls ≥50 y/o) without regard to sleep symptoms or sleep apnoea risk. Participants undertook overnight finger pulse oximetry with centralized quality control, with oxygen desaturation index (ODI) defined as number of oxyhaemoglobin desaturation events ≥4% per hour of sleep and SDB as >5 ODI events per hour. Associations between HIV status and ODI were assessed using linear regression; multivariable models included HIV-status/ group, age, race, body mass index (BMI), marital status and hypertension. Results: 453 of 475 (95%) participants provided analysable data: 231 older PLWH (median age 60y), 102 older HIV-negative (60y) and 120 younger PLWH (45y). SDB was present in 42%, 41% and 28% of the groups, respectively. Older PLWH had a median (IQR) ODI of 3.7/h (1.8, 7.5), which was similar to that of the older HIV-negative group (4.2/h [2.1, 7.9]; p=0.76) but higher than that of the younger PLWH (2.7/h [1.5, 5.7]; p=0.02). In multivariable analysis (Table), increased ODI was associated with higher BMI, older age, and marital status, but not HIV status (difference in ODI of -0.02/h [95%CI: -1.4 to +1.4; p=0.97]). Conclusion: SDB is prevalent in older individuals, both with and without HIV. More severe overnight hypoxaemia is associated with expected risk factors such as obesity and older age, but not with HIV status. Further research will

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