Among 14,049 people with HIV in care in 2019-2020, 96% were treated with antiretroviral therapy (ART). Current antiretroviral treatment patterns highlight high uptake of guideline-recommended ART regimens including second-generation integrase strand transfer inhibitors (dolutegravir, bictegravir) and tenofovir alafenamide, especially in ARV-naïve individuals initiating ART.

To assess atrial fibrillation (AF) risk factors in people with HIV, we identified incident AF in a large clinical cohort of people receiving care. Compared with 970 controls without AF, the 97 with adjudicated incident AF were older, less likely Hispanic, and had more coronary disease, heart failure, and chronic obstructive pulmonary disease. In multivariable analysis, non-use of antiretroviral therapy and prescription of antiretroviral regimens with multiple core agents were associated with increased AF risk.

Background: A novel approach to understand the influence of extreme weather events (EWE) on healthcare access (HA) in a population living with HIV (PLWH) demonstrated an increase of up to 13% no-show rate during these events in Miami, Florida. As a coastal city, it is exposed to EWE at increased frequency and intensity. Indirect effects of EWE disrupt comprehensive HA, affecting ART adherence and HIV-treatment retention rates. Method: This study was conducted at the largest academic medical center for South Florida, including a sample of ~87,000 clinic visits retrospectively modelled against EWE. Thirty years of hourly weather data were extracted for Miami, Florida, from the NOAA, and percentiles extrapolated. EWE were defined as >90 th percentile of heat or precipitation. Time series regression analysis was used to link the clinic visits (2015-2019) with percentiles. A survey was distributed to PLWH receiving clinical care and aimed to understand their knowledge, attitudes, and behaviors regarding climate and health, and EWE. These clinics include PLWH who are MSM, pregnant women, homeless, and other marginalized individuals in Miami. Results: There were nearly 10 months with extreme heat and 3 months with extreme precipitation inconsecutively within the five-year study-pe-riod. A 6% reduction in attendance on days with extreme heat (p=.0001), and 3% reduction on days with extreme precipitation (p=.1855) was seen. When asked what PLWH would do if they had a scheduled clinic visit but would be faced with EWE, they were nearly 4x more likely to not attend due to high temperature (p=0.0122) or heavy rain (p=0.0058). Conclusion: As EWE become more prevalent, it is important to develop capacity building within existing healthcare systems and community planning. Climate’s (in)direct influence on health and healthcare access should be integrated in the conversation to build resilient systems offering comprehensive care, ART adherence and increase treatment retention.

OBJECTIVES The relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular disease in people with HIV (PWH) is incompletely understood. We determined whether COPD is associated with risk of myocardial infarction (MI) among PWH, and if this differs for type 1 (T1MI) and type 2 (T2MI). DESIGN We utilized data from 5 sites in the CFAR Network of Integrated Clinical Systems (CNICS) cohort, a multi-site observational study. METHODS Our primary outcome was an adjudicated MI, classified as T1MI or T2MI. We defined COPD based on a validated algorithm requiring COPD diagnosis codes and ≥90-day continuous supply of inhalers. We conducted time-to-event analyses to first MI and used multivariable Cox proportional hazards models to measure associations between COPD and MI. RESULTS Among 12,046 PWH, 945 had COPD. Overall, 309 PWH had an MI: 58% had T1MI (N = 178) and 42% T2MI (N = 131). In adjusted models, COPD was associated with a significantly increased risk of all MI [adjusted hazard ratio (aHR) 2.68 (95%CI 1.99-3.60)] even after including self-reported smoking [aHR 2.40 (95%CI 1.76-3.26)]. COPD was also associated with significantly increased risk of T1MI and T2MI individually, and with sepsis and non-sepsis causes of T2MI. Associations were generally minimally changed adjusting for substance use. CONCLUSION COPD is associated with a substantially increased risk for MI, including both T1MI and T2MI, among PWH. Given the association with both T1MI and T2MI, diverse mechanistic pathways are involved. Future strategies to decrease risk of T1MI and T2MI in PWH who have COPD are needed.

OBJECTIVE Historically, a high burden of resistance to antiretroviral therapy (ART) in heavily treatment experienced (HTE) persons with HIV (PWH) resulted in limited treatment options (LTO). We evaluated the prevalence, risk factors, and virologic control of HTE PWH with LTO throughout the modern ART era. DESIGN We examined all ART-experienced PWH in care between 2000-2017 in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. METHODS We computed the annual prevalence of HTE PWH with LTO defined as having ≤2 available classes with ≤2 active drugs per class based on genotypic data and cumulative antiretroviral resistance. We used multivariable Cox proportional hazards models to examine risk of LTO by 3-year study entry periods adjusting for demographic and clinical characteristics. RESULTS Among 27,133 ART-experienced PWH, 916 were classified as having LTO. The prevalence of PWH with LTO was 5.2-7.5% in 2000-2006, decreased to 1.8% in 2007, and remained < 1% after 2012. Persons entering the study in 2009-2011 had an 80% lower risk of LTO compared with those entering in 2006-2008 (adjusted hazard ratio 0.20; 95% CI: 0.09-0.42). We found a significant increase in undetectable HIV viral loads among PWH ever classified as having LTO from < 30% in 2001 to >80% in 2011, comparable to persons who never had LTO. CONCLUSIONS Results of this large multicenter study show a dramatic decline in the prevalence of PWH with LTO to < 1% with the availability of more potent drugs and a marked increase in virologic suppression in the current ART era.

Stephanie A. Ruderman, MPH, Heidi M. Crane, MD, MPH, Robin M. Nance, MS, Bridget M. Whitney, PhD, MPH, Barbara N. Harding, PhD, MPH, Kenneth H. Mayer, MD, Richard D. Moore, MD, Joseph J. Eron, MD, Elvin Geng, MD, William C Mathews, MD, B Rodriguez, Amanda L. Willig, MD, Greer A. Burkholder, MD, MSPH, Sara Lindström, PhD, MSc, Brian R. Wood, MD, Ann C. Collier, MD, Vani Vannappagari, PhD, Cassidy Henegar, PhD, Jean Van Wyk, MBChB, MFPM, Lloyd Curtis, MA, MRCP, Michael S. Saag, MD, Mari M. Kitahata, MD, MPH, and Joseph A. C. Delaney, PhD