Abstract Body (Do not enter title and authors here): Background: People with HIV (PWH) have elevated cardiovascular risk, but acceptability of cardiovascular prevention strategies among PWH is unknown.

Purpose: To identify preferred strategies to prevent cardiovascular disease among PWH.

Methods: We created a survey to identify preferences for heart disease prevention strategies based on the Acceptability of Intervention Measure (AIM) scale. We surveyed a convenience sample in San Francisco in 2024-2025. We conducted semi-structured interviews among a subset of survey respondents using purposive sampling which we analyzed using rapid qualitative analysis.

Results: We included 102 PWH, with a mean age of 60±11 years old; 86% male, 9% female; and 63% white, 19% Black and 19% Hispanic. Nearly all were on antiretroviral therapy (ART, 95%) with undetectable viral load (94%). Approximately half reported having hypertension, dyslipidemia, and/or family history of heart disease. 15 reported a prior myocardial infarction and 6 a prior stroke. About 2/3 had been prescribed a statin.

Using the AIM scale (Likert 1-5, with 5=high acceptability, Figure), lifestyle interventions had high acceptability (mean ± standard deviation 4.2±0.7), whereas pharmacologic strategies were moderately acceptable: oral polypills combining a statin with ART (3.6±1.0), and long-acting injectable lipid therapies (3.5±1.0), and oral statins (3.3±1.1). The most common first-choice prevention strategy was healthy lifestyle (46%), followed by long-acting injectable lipid therapies (30%), oral polypills (17%), and oral statins (12%). The most important factors in choosing a strategy were efficacy, side effects/risks, tailoring to individualized risk, and personalized recommendation from their care provider.

We interviewed 15 PWH. Key themes are reported in the Table. Findings were consistent with the survey results, with many preferring lifestyle interventions as a first-choice strategy. Most were open to pharmacologic prevention, as long as it was tailored to their individualized risk and preferred delivery strategy (oral statin, oral polypill, or long-acting injectable).

Conclusions: PWH are interested in lifestyle and pharmacologic interventions to prevent heart disease. These findings suggest that an individualized approach to pharmacologic interventions among PWH should be adopted for cardiovascular disease prevention. Future studies will be needed to evaluate the impact of this approach on adherence and prevention of cardiovascular events.