CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

and increased BMI. Larger cohorts and longitudinal follow-up are needed to better understand the role of HIV in this phenomenon and to pursue strategies targeting associated metabolic risk factors. 642 CARDIOMETABOLIC RISK PROFILES IN HIV AND NONALCOHOLIC FATTY LIVER Alyson Kaplan 1 , Donald Chute 1 , Tracey G. Simon 1 , Samson Okello 2 , Hui Zheng 1 , Raymond T. Chung 1 , Kathleen E. Corey 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 Mbarara University of Science and Technology, Mbarara, Uganda Background: Among the general population, nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for cardiovascular disease (CVD). However, the cardiometabolic risk profiles (CMP) of NAFLD among persons living with HIV (PLWH) are unknown. We sought to determine the CMP of PLWH with NAFLD. Methods: Search of the Partners Research Patient Data Registry identified PLWH with and without NAFLD. NAFLD was defined as fatty infiltration of the liver on imaging or steatosis on biopsy. The absence of NAFLD was defined as normal liver imaging or histology. Those with significant alcohol use or viral hepatitis were excluded. Multivariable logistic regression modelling was used to determine risk factors for an adverse CMP defined as the presence ≥3 of the following: hypertension (HTN), triglycerides ≥ 150 mg/dL, HDL<50 mg/ dL in women and <40 in men mg/dL and diabetes; and for CVD, defined as the presence of coronary artery disease (CAD) or cerebral vascular accidents. As the number of CVD cases was small (N=22) only NAFLD and 1 additional covariate were included in each CVD model. Results: 102 adults with NAFLD and 139 without NAFLD were identified. Adults with NAFLD had significantly higher BMIs than those without NAFLD (31 kg/m2 ± 6.3 vs. 28 kg/m2 ± 5.3, P<0.001). There was no difference by group in age, gender, race, tobacco use or diabetes. NAFLD was associated with an adverse CMP compared to those without NAFLD, with a higher prevalence of HTN (52% vs 35%, p=0.008), lower HDL (40 mg/dL ± 15 vs. 51 mg/dL ± 19, p<0.001), and higher triglyceride levels (255 mg/dl ± 276 vs. 141 mg/dl ± 75, p<0.001). There was no difference in hemoglobin A1C, LDL or total cholesterol levels between groups. CAD and CVD were more common in those with NAFLD (CAD: 9% vs 4%, p=0.089 and CVD: 14% vs. 6%, p=0.034). NAFLD was independently associated with an adverse CMP after adjustment for age, gender, tobacco use and BMI (OR 2.4, p=0.02) and an increased risk of CVD (OR 3.02, p=0.02) after adjustment for BMI and for diabetes. Conclusion: Among PLWH, the presence of NAFLD is independently associated with adverse cardiometabolic risk profiles and CVD. Further evaluation is needed to understand the relationship between HIV, NAFLD and cardiovascular disease.

Poster Abstracts

641 INCREASED RATES OF HEPATIC STEATOSIS IN YOUNG ADULTS WITH LIFE- LONG HIV INFECTION Julia A. Aepfelbacher 1 , Julia Purdy 2 , Aviva Mattingly 1 , Kirsten Zambell 2 , Chloe S. Chaudhury 1 , Colleen Hadigan 1 1 NIAID, Bethesda, MD, USA, 2 NIH, Bethesda, MD, USA Background: Liver disease is a leading cause of morbidity in persons living with HIV (PLWHIV), however little is known about the liver health of adults infected with HIV early in life. Transient elastography permits effective, non- invasive assessment of liver steatosis and fibrosis. As this unique population with life-long HIV ages, concerns over hepatic and metabolic health gain increasing importance. Methods: Young adults who acquired HIV early in life (i.e. perinatal or transfusion) (n=46) and healthy controls (n=9) completed fasting transient elastography and laboratory tests as part of a natural history cohort study. Liver stiffness and controlled attenuation parameter (CAP) measurements were obtained using the Echosens FibroScan 502™. A CAP score >248 dB/mwas used to define hepatic steatosis. Anthropometrics, BMI, lipid panel, glucose, CD4 and HIV viral load were measured. We used non-parametric statistics for between group comparisons. Results: PLWHIV had a median age of 26 years (25/46 male), mean CD4 count 524±370 cells/mm³, 61% HIV VL<40 copies/mL and median ART exposure 19 years. Hepatic steatosis was present in 35% of young adults with HIV and 0% controls (p=0.03), however, fibrosis scores did not differ between groups (HIV 5.8±2.7 vs. controls 6.3±2.5 kPa, p=0.4). Overweight/obesity (BMI > 25kg/ m²) was common in PLWHIV (HIV 54% vs. 22% controls p=0.08). PLWHIV had significantly higher waist to hip ratio compared to controls (p=0.0002). This ratio was not significantly correlated with CAP score within the HIV group, whereas waist circumference was (r=0.42, p=0.01). Among those with HIV, CAP score was also positively correlated with BMI (r=0.33, p<0.05), glucose (r=0.40, p=0.01), and cholesterol (r=0.55, p=0.0004), but not related to CD4 count, viral suppression or ART duration. In a multivariate regression including HIV status, BMI, glucose and cholesterol, cholesterol was a significant independent predictor of CAP score (p=0.007) with a trend (p=0.06) for HIV status. Conclusion: Our study is the first to demonstrate increased rates of hepatic steatosis in young adults with life-long HIV. Hepatic steatosis was noted in association with modifiable metabolic disturbances including dyslipidemia

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