Well-Controlled HIV Infection Not Associated With Progression of Subclinical Atherosclerosis

There were no significant differences in coronary plaque progression in people with HIV compared to people without HIV, further attenuating concerns about accelerated atherosclerosis in persons with well-controlled HIV infection, according to results from a longitudinal Swiss study published in the Open Forum Infectious Diseases.

Researchers investigated the associations of atherosclerosis progression with Framingham risk score (FRS) and HIV infection, and whether subclinical atherosclerosis progresses more rapidly over a follow-up period of more than 2 years in people with HIV compared with people without HIV using coronary artery calcium (CAC) scan and coronary computerized tomography angiography (CCTA). The primary endpoint was the FRS-adjusted incidence rate ratio (IRR) for non-calcified/mixed plaque when comparing participants with and without HIV.

Baseline CAC/CCTA scans were obtained from October 2013 to July 2016 and follow-up CAC/CCTA scans were performed from October 2015 to April 2019. Data for people with HIV were obtained from the Swiss HIV Cohort Study, and follow-up for people without HIV was performed at the University Hospital in Zurich.

Within the 430 participants with follow-up CAC/CCTA completed, the median interval between baseline and follow-up scans of 2.2 years (interquartile range [IQR], 2.1-2.4) in the HIV+ group (n=340) and 3.4 years (IQR, 2.7-3.6) in the HIV- group (n=90). Participants in both groups were mostly men (85.3% in HIV+ group and 78.9% in HIV- group) and 94% in HIV+ group had suppressed HIV viral load.

Compared with participants without HIV, participants with HIV:

• Were younger (median age, 52 vs 56 years; P <.01)
• Had lower body mass index (24.9 vs 26.1 kg/m²; P <.01)
• Had lower prevalence of hypertension (33.2% vs 64.4%; P <.01)
• Had lower high-density lipoprotein cholesterol (1.3 vs 1.4 mmol/L; P <.01)
• Were more likely to smoke (36.2% vs 12.2%; P <.01)
• And were more likely to use illicit drugs (3.2% vs 0%; P =.08). 

However, median 10-year FRS was similar between the 2 groups (8.9% vs 9.0%; P =.82), as were percentages of participants in the low-, intermediate-, and high-risk FRS categories (P =1.00).

Progression of CAC score between baseline and follow-up CAC/CCTA was similar in the HIV+ and HIV- groups (median annualized change, 0.41 [IQR, 0-10.19] vs 2.38 [IQR, 0-16.29], respectively; P =.11), as was progression of coronary segment severity score (median annualized change, 0 [IQR, 0-0.47] vs 0 [IQR, 0-0.52], respectively; P =.10), and coronary segment involvement score (median annualized change, 0 [IQR, 0-0.45] vs 0 [IQR, 0-0.41], respectively; P =.25).

In univariable and multivariable analyses, FRS was associated with IRR of new subclinical atherosclerosis at the follow-up CAC/CCTA but HIV infection was not associated with:

• Any plaque (annualized IRR, 1.21; 95% CI, 0.62-2.35)
• Calcified plaque (annualized IRR, 1.06; 95% CI, 0.56-2)
• Non-calcified/mixed plaque (annualized IRR, 1.24; 95% CI, 0.69-2.21)
• High-risk plaque (annualized IRR, 1.46; 95% CI, 0.66-3.20)
• Stenosis of at least 50% (annualized IRR, 1.17; 95% CI, 0.53-2.62)
• Stenosis of at least 70% (annualized IRR, 0.95; 95% CI, 0.30-3.03).

Age and FRS were significantly associated with atherosclerosis progression, but researchers found no evidence of accelerated progression of subclinical coronary artery disease (including calcified, non-calcified, and high-risk plaque) in a Swiss population with HIV.

The study was limited by the low number of HIV- participants for follow-up. Investigators added, “[S]uccessful HIV treatment in our study may have prevented us from detecting any atherosclerosis-promoting effects of suboptimal HIV control.” Since participants were more than 65 years of age and only 16% were women, results should be interpreted with caution in these populations.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

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