{
  "abstract": "Background The cardiovascular–kidney–metabolic (CKM) framework links cardiometabolic risk, kidney disease, and metabolic health in a patient-centered model. The aim of this study was to determine the prevalence of CKM stages, to characterize stage-to-stage transitions over the period 2005–2025, and to identify clinical and metabolic factors associated with progression and reversion across CKM stages among people with HIV (PWH).Methods This was a longitudinal observational study including PWH attending Modena HIV Metabolic Clinic from 2005 to 2025 divided into three time periods 2005-2015, 2016-2020 and 2021-2025. CKM stages 0-4 criteria are shown in table 1. Transitions across CKM stages and death were modelled using Markov models, accounting for patient age at the time of each transition. Stage 4 CKM and death were considered as irreversible states. Sex, age, duration of HIV infection, physical activity, INSTI, PI and statin use were included as covariates to weight relative risks of progression and reversion across CKM stages.Results Among 31,232 observations, 3,838 PWH had at least two CKM assessments during the study period. Median follow-up was 6.36 years (Q1–Q3: 2.03–12.2), during which 171 deaths occurred. Across CKM stages 0–4 at the last available observation, participants with more advanced stages were older (median age increasing from 42 to 56 years, p<0.001) and more likely to be male (53% to 84%, p<0.001). Sedentary lifestyle and smoking differed significantly across stages (p<0.05). HIV duration increased with higher CKM stage (p<0.001), and nadir CD4 count progressively declined (p<0.001). Figures 1 and 2 summarize population characteristics, prevalence and CKM stage transitions over time. In Markov models of CKM stage transitions, physical activity was associated with regression from stage 1 to stage 0 (HR 1.48, 95% CI 1.06–2.06). From stage 1, male sex and longer HIV duration were consistently associated with progression to stages 2 and 3, while higher physical activity was protective against progression to stage 2 (HR 0.76, 95% CI 0.66–0.88). Older age and longer HIV duration were strong predictors of progression from stage 2 to stage 3. Mortality risk increased with advancing age, particularly from stages 1–4. INSTI use was associated with a lower risk of regression from stage 2 to stage 1 (HR 0.61, 95% CI 0.49–0.76). PI use was associated with a lower risk of regression from stage 3 to stage 2 (HR 0.77, 95% CI 0.63–0.94).Conclusions In a large and well-characterized cohort, PWH show a rising prevalence of advanced CKM stages over time. Both HIV-related and traditional modifiable risk factors were associated with progression and regression across CKM stages. The CKM framework offers a patient-centered model to characterize cardiometabolic and renal disease progression in PWH, enabling longitudinal risk stratification and supporting the development of targeted, integrated strategies to preserve metabolic health.Abstract OC64 Table 1CKM criteriaAbstract OC64 Figure 1–2",
  "authors": [
    {
      "affiliations": [
        "Clinic for Infectious Diseases, University Hospital of Modena, Modena, Italy"
      ],
      "name": "J Milic"
    },
    {
      "affiliations": [
        "Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "C Puzzolante"
    },
    {
      "affiliations": [
        "Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "L Gozzi"
    },
    {
      "affiliations": [
        "Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "M Menozzi"
    },
    {
      "affiliations": [
        "Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy"
      ],
      "name": "F Cinque"
    },
    {
      "affiliations": [
        "Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "G Cuomo"
    },
    {
      "affiliations": [
        "Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "G Mancini"
    },
    {
      "affiliations": [
        "Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy"
      ],
      "name": "R Lombardi"
    },
    {
      "affiliations": [
        "Clinic for Infectious Diseases, University Hospital of Modena, Modena, Italy",
        "Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "C Mussini"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada"
      ],
      "name": "G Sebastiani"
    },
    {
      "affiliations": [
        "Clinic for Infectious Diseases, University Hospital of Modena, Modena, Italy",
        "Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "G Guaraldi"
    }
  ],
  "title": "OC64 Prevalence and long-term transitions of cardiovascular-kidney-metabolic syndrome stages in PWH",
  "uid": "24f598da-56d1-5403-a8d7-5e3a30f050d2"
}