CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

666 CARDIOVASCULAR RISK MANAGEMENT AMONG PLWH: DOES PROVIDER SPECIALTY MATTER? Nwora L. Okeke 1 , Katherine R. Schafer 2 , Jan Ostermann 3 , Ansal D. Shah 3 , Susanna Naggie 1 , Hayden B. Bosworth 4 1 Duke University School of Medicine, Durham, NC, USA, 2 Wake Forest University, Winston-Salem, NC, USA, 3 University of South Carolina at Columbia, Columbia, SC, USA, 4 Duke University, Durham, NC, USA Background: Although persons living with HIV (PLWH) are known to be at increased risk for major atherosclerotic cardiovascular disease (ASCVD) events, the impact of provider specialty managing ASCVD risk in this population remains unclear. Methods: We conducted a retrospective analysis of PLWH with a diagnosis of hypertension (HTN) and/or hyperlipidemia (HLD) (by ICD9/10 code) receiving care at 2 major academic health systems in the Southeast between 2013 and 2017. Clinical data were obtained from the Carolinas Collaborative Research Database for all PLWH with HTN and/or HLD and without previous diagnosis of ASCVD (defined as acute coronary syndrome, stroke, coronary artery intervention or peripheral vascular disease) prior to study period. Responsible provider for HTN/HLD management were defined by medication prescription (anti-HTN or statins) and classified into 5 groups: 1) infectious diseases (ID) provider only (≥ 3 prescriptions from ID without evidence of prescription entry by other provider), 2) non-ID primary care provider (PCP) only, 3) co-managed by ID and PCP (≥3 ID prescriptions and ≥1 PCP prescription), 4) medication prescribed by other provider, 5) no prescription found. Cohort members were followed until 1st ASCVD event, death, or end of study period (12/31/17). The primary HTN outcome was meeting 8th Joint National Commission’s (JNC 8) blood pressure (BP) goal of 140/90 at end of observation. The primary HLD outcome was end observation low density lipoprotein (LDL). Risk factors for failure to meet BP goals were defined using logistic regression. Results: Of 1458 PLWH included in the analysis, 1077 (73%) had a diagnosis of HTN and 614 (42%) had HLD (see Table 1). Of persons with HTN (n = 1077), 223 (21%) were managed by ID exclusively, 184 (17%) by PCP only, 37 (3%) by both and 40% had no anti-HTN prescribed. Overall, 616 (57%) met JNC 8 BP goal. Risk factors associated with not meeting JNC 8 goals were Black race (Odds ratio (OR) 0.68, 95% CI 0.50-0.91) and exclusive management by ID (OR 0.66 (95% CI 0.48-0.91), Table 1). Of persons with HLD (n =614), the mean end observation LDL-c was 109.8 mg/dL. On regression analysis, HLD managed exclusively by ID provider was associated with a 11.8 mg/dL (95% CI 1.9-21.3) in end observation LDL-c compared to the rest of the cohort. Conclusion: PLWH with HTN or HLD do not meet evidence-based treatment goals consistently, and provider specialty may play a role in these outcomes. Further study of optimal ASCVD care models in PLWH is needed.

667 INCREASED PREVALENCE OF PROLONGED QTC IN PERSONS LIVING WITH HIV COMPARED TO CONTROLS Andreas D. Knudsen 1 , Jonas B. Nielsen 1 , Marco Gelpi 1 , Jens D. Lundgren 1 , Per E. Sigvardsen 1 , Amanda Mocroft 2 , Jørgen T. Kuhl 1 , Andreas Fuchs 1 , Børge Nordestgaard 1 , Claus Graff 3 , Lars Køber 1 , Thomas Benfield 4 , Klaus F. Kofoed 1 , Susanne D. Nielsen 1 , for the COCOMO study group 1 Rigshospitalet, Copenhagen, Denmark, 2 University College London, London, UK, 3 Aalborg University Hospital, Aalborg, Denmark, 4 Hvidovre Hospital, Hvidovre, Denmark Background: An abnormal electrocardiogram (ECG) is associated with increased risk of arrhythmias and sudden cardiac death (SCD). We aimed to investigate the prevalence and associated risk factors of major ECG abnormalities, prolonged QTc and prior myocardial infarction (MI), in persons living with HIV (PLWH) and uninfected controls. Methods: PLWH aged ≥40 were recruited from the Copenhagen comorbidity in HIV infection (COCOMO) study and matched on sex and 5-year age strata to uninfected controls from the Copenhagen General Population Study. Blood pressure, lipids, glucose and hsCRP were measured. Questionnaires were used to obtain data on smoking history and medication. ECGs were recorded on the same CardioSoft electrocardiograph and categorized according to The Minnesota Code Manual of ECG Findings definition of major abnormalities. A QT interval corrected for heart rate (QTc) >440 ms in males and >460 ms in females was considered prolonged. Prior MI was defined as major Q-wave abnormalities. We calculated binomial proportion confidence intervals (95% CI) and assessed factors associated with ECG abnormalities using a logistic regression model adjusted for age, sex, smoking, dyslipidemia, diabetes, hsCRP and hypertension. Results: An ECG was available for 740 PLWH and 2,955 controls. PLWH were younger (median 52 vs 54), fewer had hypertension (48 % vs 63%), but more were current smokers (26% vs 12%) compared to controls. Prolonged QTc was more prevalent among PLWH (11% [9-13]) than among controls (8% [7-9]), p=.005. Prior MI was also more common in PLWH (6% [5-8]) than in controls (4% [4-5]), p=.04, but there was no difference in prevalence of major ECG abnormalities between PLWH and controls (12% [10-14]) and 12% [11-14], respectively), p=.992 (Table). In adjusted analyses, HIV was independently associated with prolonged QTc (adjusted odds ratio:1.6 [95%CI:1.2-2.1]) but not with other ECG abnormalities. Among PLWH, use of protease inhibitors, previous AIDS, CD4 count, intravenous drug use or methadone treatment were not independently associated with prolonged QTc or major abnormalities. Conclusion: Prevalence of prolonged QTc was higher among PLWH compared to uninfected controls, and HIV remained associated after adjustment for cardiovascular risk factors. Although evidence indicated more ischaemic changes in PLWH, the risk seemed to be associated mainly with an adverse risk profile. These data suggest that continued awareness of QTc may be important in lowering the excess risk of SCD among PLWH.

Poster Abstracts

CROI 2019 254