Results of a systematic review published in JAMA found that reporting on the relationship between HIV and cardiovascular pathologies has not led to concise conclusions, and published data may not be representative of all individuals living with HIV infection worldwide.
Researchers at the London School of Hygiene and Tropical Medicine in the United Kingdom searched publication databases through February 2022 for studies that assessed advanced cardiovascular imaging in the setting of HIV infection. The primary outcomes included moderate to severe coronary stenosis, determined via computed tomography coronary angiography; myocardial fibrosis identified by late gadolinium enhancement, determined via cardiac magnetic resonance imaging; and vascular and myocardial target to background ratio, determined via positron emission tomography.
A total of 45 studies were included in the review, comprising 5218 patients with HIV infection and 2414 without HIV infection. Of patients with HIV infection, the mean age was 48.5 (range, 22-63) years, 24% were women, and 88% were receiving antiretroviral therapy. In 26 studies,
Of the included studies, most (n=38) were conducted in high-income countries and 85% had a cross-sectional design (85%). None of the studies were conducted in low-income countries.
The prevalence of moderate (50%-69% luminal stenosis) to severe (≥70% luminal stenosis) coronary stenosis in studies that included only HIV-positive patients ranged from 0% to 52% at the individual level and from 0% to 37% at the study level.
In 11 studies that compared HIV-positive patients with HIV-negative patients, the estimated individual-level stenosis rates were between 0% and 52% and 0% to 27% for those in the positive and negative HIV cohorts, respectively. The estimated prevalence ratios for the association between HIV and moderate to severe coronary disease ranged from 0.33 (95% CI, 0.01-15.90) to 5.19 (95% CI, 1.26-21.42).
In 15 studies conducted among patients with HIV infection, the prevalence of late gadolinium enhancement ranged from 5% to 84%. For studies conducted in upper middle- and high-income countries, the prevalence of late gadolinium enhancement ranged from 24% to 84% and 5% to 82%, respectively. Metaregression analyses performed at the study level showed significant correlation between an increased prevalence of late gadolinium enhancement and decreased mean CD4 cell counts (R2 =58; P =.002).
In 9 studies conducted among patients with (n=751) and without (n=482) HIV infection, the comparative prevalence of late gadolinium enhancement ranged from 5% to 84% and 0% to 68%, respectively. The prevalence ratios for the association between HIV infection and late gadolinium enhancement ranged from 1.01 (95% CI, 0.85-1.21) to 17.35 (95% CI, 1.10-274.28), with significant heterogeneity noted (I2 =88%; P <.005).
For vascular inflammation, the differences in the vascular target to background ratio between patients with and without HIV infection ranged from 0.06 (95% CI, 0.01-0.11) to 0.37 (95% CI, 0.02-0.72), with moderate heterogeneity noted (I2 =64%; P =.07).
Limitations include significant heterogeneity, potential variations in primary outcomes and their definitions, and the inability to access individual patient-level data.
“This systematic review provides a summary of the available data about imaging-based cardiovascular pathologies among persons living with HIV,” the researchers concluded.
Disclosure: One author reported affiliations with industry. Please see the reference for a full list of disclosures.
Hudson JA, Majonga ED, Ferrand RA, Perel P, Alam SR, Shah ASV. Association of HIV infection with cardiovascular pathology based on advanced cardiovascular imaging: a systematic review. JAMA. 2022;328(10):951-962. doi:10.1001/jama.2022.15078