Carotid Artery Atherosclerosis Is Associated With Mortality in Adults With HIV

Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.

Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus, according to a study recently published in AIDS.

B-mode ultrasound-based measures of the carotid artery predict future risk for cardiovascular disease (CVD) and all-cause mortality in the general population. Carotid artery ultrasound can be used to image various stages of arteriosclerosis, including arterial stiffening, wall thickening, plaque formation, and luminal narrowing before CVD manifests clinically. These measures are also used to characterize subclinical CVD burden in people living with HIV, where there are increased risks for myocardial infarction, stroke, heart failure, and CVD mortality. 

Different features of subclinical CVD have been found to have variable correlations in different populations and also have independent associations with CVD mortality risk. Among people living with HIV, there are few long-term studies of noninvasive ultrasound-based measurements of the carotid artery predicting major health events. Therefore, this nested cohort study hypothesized that such measurements are associated with 10-year mortality in the Women’s Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS), and that associations differ by HIV serostatus.

Each cohort (WIHS and MACS) involved semiannual follow-up visits with detailed examinations, specimen collection, and structured interviews. A total of 1722 women (median age, 40 years; 90% non-white, 71% HIV-positive) were included from WIHS; a total of 1304 men (median age, 50 years; 39% non-white, 62% HIV-positive) were included from MACS. Participants without coronary heart disease underwent B-mode carotid artery ultrasound, with measurement of common carotid artery intima-media thickness (CCA-IMT), carotid artery plaque (focal IMT >1.5 mm) at 6 locations, and Young’s modulus of elasticity (a measure of arterial stiffness). All-cause mortality was examined using Cox models that were controlled for demographic, behavioral, cardiometabolic, and HIV-related factors.

Associations between carotid plaque and mortality were reproduced across 2 HIV-positive cohorts that are demographically different, although studied using nearly identical methods. Mortality was higher among women with HIV (19.9 deaths/1000 person-years) than in men with HIV (15.1/1000 person-years). In adjusted analyses, plaque was associated with mortality regardless of HIV serostatus, and varied by sex, with plaque observed in 28% of men compared with 8% of women (P <.001). Subgroup analyses suggested that this association was stronger among the primarily white, highly educated male MACS cohort than the poorer, largely minority female WIHS cohort. Further, the association of plaque with mortality was more pronounced among HIV-negative than HIV-positive participants.

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Arterial stiffness was also associated with mortality and varied by sex, with a significantly greater amount of men compared with women showing arterial stiffness (P <.001). Greater CCA-IMT was not associated with mortality, although that greater CCA-IMT seemed to be associated with lower mortality risk, which was observed consistently in men and women with HIV.

Overall, the study authors concluded that, “Our study supports the validity of subclinical CVD markers to assess future health risks in HIV-positive adults.”


Haana DB, Moon JY, Haberlen SA, et al. Carotid artery atherosclerosis is associated with mortality in HIV-positive women and men [published online August 9, 2018]. AIDS. doi: 10.1097/QAD.0000000000001972