Abstract Body (Do not enter title and authors here): Introduction: People living with Human Immunodeficiency Virus (HIV) have increased cardiovascular disease (CVD) risk, yet the specific contributions of antiretroviral therapy (ART) and immune parameters to CVD phenotypes in marginalized populations are underexplored.

Research Question: This study examined associations between HIV-specific characteristics (e.g., ART regimen, immunologic markers) and traditional cardiovascular risk factors with CVD outcomes, such as coronary artery disease (CAD) progression, myocardial infarction (MI), and in-stent restenosis (ISR).

Methods: A retrospective analysis was performed using electronic health records from individuals with HIV who underwent coronary angiography between 2014 and 2024 at a Houston safety-net hospital. Data included HIV-related factors, demographic, comorbid, and behavioral variables, and CVD outcomes (ejection fraction, MI, ISR, CAD progression - defined as new obstructive lesions or ISR on follow-up angiography). Multivariable logistic regression identified independent predictors, adjusting for relevant confounders.

Results: The cohort included 166 individuals (mean age 55 ± 10 years; 78.9% male; 52.4% Black, 24.1% Hispanic, 16.3% White, 7.2% other). A CD4 nadir ≤200 cells/µL was observed in 54.2%, and 35.5% had detectable viral load. Among 122 patients with follow-up angiography, 36 (29.5%) experienced CAD progression. After adjustment, tenofovir use was associated with decreased CAD progression (aOR 0.14, 95% CI 0.03–0.69, p<0.05), while raltegravir (aOR 49.40, CI 1.84–1326.57, p<0.05), cobicistat (aOR 23.57, CI 1.31–425.58, p<0.05), cocaine use (aOR 13.52, CI 2.09–87.60, p<0.01), male sex (aOR 8.55, CI 1.24–59.12, p<0.05), and obstructive sleep apnea (aOR 25.23, CI 2.15–296.64, p<0.05) were associated with increased risk. Higher CD4 count (per 100 cells/µL) was associated with reduced MI risk (aOR 0.74, CI 0.62–0.89, p<0.01). Darunavir use was associated with increased risk of reduced ejection fraction (aOR 12.30, CI 2.35–64.40, p<0.01), and cobicistat with increased ISR (aOR 23.61, CI 1.92–290.94, p<0.05).

Conclusion: Specific ART agents and CD4 count were independently associated with distinct CVD outcomes alongside traditional cardiovascular risk factors in this cohort. These insights support considering individual ART and immune status for tailored CVD risk assessment in vulnerable populations with HIV.