SUN-271 - Cardiac-Kidney-Metabolic-(CKM) Health Outcome Differences between Different HIV Medication Regimens

HIV infection has been proposed to independently promote accelerated atherogenesis, vascular morphologic changes, and endothelial dysfunction(1) [4]. In a systemic review of African Americans with HIV/AIDS in the United States, studies indicated that African Americans with Human immunodeficiency virus (HIV) were at increased CVD risk(2) [3]. The ARTs have raised concerns about metabolic dysfunction such as the protease inhibitors (3-5) [5 – 7]. We hypothesized that, among these HIV regimens there will be differences in the degree of metabolic derangement and progenitor cell function. In this proposal we plan to determine the effect of HIV medications specifically, to assess the impact of INSTIs vs NNRTIs vs (INS+NNRTI) based therapies on Endothelial progenitor cells (EPCs), as an endothelium specific cellular biomarker.

Methods: This is a cross-sectional observational study examining patients with HIV and a history of taking either INSTIs, NNRTIs or INS+NNRTI regimens for at least one year. In this pilot study, 19 subjects were enrolled. Peripheral blood derived CD34+ EPC number, migratory function, mRNA gene expression along with cardiometabolic parameters such as arterial stiffness, biochemistry, resting energy expenditure, and body composition were measured.

Results: We were able to attain a final sample size of n=10 for Group A ( INSTI + TAF/emtricitabine (taf/ftc combination)) Biktarvy; n=4 for Group B( NNRTI + TAF), Odefsey; n= 4 for Group C (TAF free INSTI + 3tc ) Dovato. Since sample size is low, we did not see any significance difference between the groups. However Flowcytometric analysis shows an increase in CXCR4+ (CD184+) cell numbers in Group B and C as compared to Group A. Colony forming units are increased in group C as compared to group A and B. There was no significant difference in migration of cells between the groups. Proteinuria levels are increased in group C compared to groups A and B. Currently we are analyzing the urine exosomes to determine podocyte inflammatory proteins.

Conclusion: Our preliminary results conclude that Odefsey appears to have the best cellular outcomes, however increased proteinuria is a concern

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