Higher Risk of Atherosclerosis Not Apparent in HIV-Positive Individuals

A recent study of persons with HIV shows that their HIV infection was not associated with progression of subclinical atherosclerosis (coronary plaque progression) after obtaining results from a follow-up coronary artery calcium scan and coronary CT angiography, reports Open Forum Infectious Diseases.

There was, however, an association between Framingham risk score (FRS) and progression of subclinical atherosclerosis in persons with HIV compared with those who do not have HIV.

The authors from Switzerland looked into how HIV infection, FRS, and progression of subclinical atherosclerosis are related, because of the higher risk of coronary artery disease present in HIV-positive individuals. Plaque progression was evaluated through coronary artery calcium (CAC) score and coronary CT angiography (CCTA).

Data were obtained for baseline CAC and CCTA scans performed between October 2013 and July 2016 and for follow-up scans done between October 2015 and April 2019. A patient cohort of 430 (340, HIV-positive; 90, HIV-negative) had both baseline and follow-up scans and was included in the final analysis. Most of the participants were men, at 85.3% with HIV and 78.9% without HIV, and 94% of the HIV-positive group was virologically suppressed.

Results reveal that the HIV-positive cohort had a 54.5% shorter median (interquartile range [IQR]) follow-up vs the negative patients: 2.2 (2.1-2.4) vs 3.4 (2.7-3.6) years. This group also had a younger median (QR) age, at 52 (49-57) vs 56 (50-62) years; lower median (IQR) BMI, 24.9 (22.8-27.8) vs 26.1 (23.8-28.6) kg/m²; less hypertension, 33.2% vs 64.4%; and less dyslipidemia, 37.9% vs 41.1%.

In addition, no link was found between HIV infection and increase in CAC, segment severity, and segment involvement scores from the baseline to the follow-up scans. Compared with HIV-negative participants, no associations were found between HIV infection and the following measures after univariable analysis for subclinical atherosclerosis at the follow-up CAC/CCTA:

• Any plaque (annualized incidence rate ratio [aIRR], 0.97; 95% CI, 0.46-2.05)
• Calcified plaque (aIRR, 1.03; 95% CI, 0.55-1.94)
• Noncalcified/mixed plaque (aIRR, 1.22; 95% CI, 0.68-2.17)
• High-risk plaque (aIRR, 1.41 (95% CI, 0.64-3.10)
• Any coronary stenosis (aIRR, 1.14; 95% CI, 0.59-2.22)
• Stenosis of 50% or greater (aIRR, 1.16; 95% CI, 0.52-2.59)
• Stenosis of 70% or greater (aIRR, 0.97; 95% CI, 0.30-3.10)

However, despite the 10-year FRS being almost equal between the groups, at 8.9% for the HIV-positive and 9.0% for the HIV-negative participants (P = .82), following multivariable analysis, a per-point increase in FRS was linked to the following regarding new subclinical atherosclerosis at the follow-up CAC/CCTA:

• Any plaque (aIRR, 1.48; 95% CI, 01.03-2.13)
• Calcified plaque (aIRR, 1.70; 95% CI, 1.30-2.23)
• Noncalcified/mixed plaque (aIRR, 1.66; 95% CI, 1.27-2.17)
• High-risk plaque (aIRR, 1.78; 95% CI, 1.24-2.54)
• Any coronary stenosis (aIRR, 1.66; 95% CI, 1.27-2.17)
• Stenosis of 50% or greater (aIRR, 2.14; 95% CI, 1.51-3.03)
• Stenosis of 70% or greater (aIRR, 2.44; 95% CI, 1.50-3.99)

In contrast, HIV infection was not associated with the following measures after multivariable analysis:

• Any plaque (aIRR, 1.21; 95% CI, 0.62-2.35)
• Calcified plaque (aIRR, 1.06; 95% CI, 0.56-2)
• Noncalcified/mixed plaque (aIRR, 1.24; 95% CI, 0.69-2.21)
• High-risk plaque (aIRR, 1.46; 95% CI, 0.66-3.20)
• Stenosis of 50% or greater (aIRR, 1.17; 95% CI, 0.53-2.62)
• Stenosis of 70% or greater (aIRR, 0.95; 95% CI, 0.30-3.03)

The authors hope their findings reassure HIV-positive persons, their families, and their treating physicians who may be concerned about accelerated atherosclerosis or accelerated aging, despite being on effective antiretroviral treatment.

“Our longitudinal CAC/CCTA study reassuringly finds no significant differences in coronary plaque progression in HIV+ persons compared to HIV- persons in Switzerland,” the authors concluded. “In aggregate, these data serve to further attenuate concerns about accelerated atherosclerosis in persons with well controlled HIV infection.”

Reference

Tarr PE, Ledergerber B, Calmy A, et al. Longitudinal progression of subclinical coronary atherosclerosis in Swiss HIV-positive compared to HIV-negative persons undergoing coronary calcium score scan and CT angiography. Open Forum Infect Dis. Published September 16, 2020. doi:10.1093/ofid/ofaa438