Longitudinal progression of subclinical coronary atherosclerosis in Swiss HIV-positive compared with HIV-negative persons undergoing coronary calcium score scan and CT angiography. Open Forum Infectious Diseases
Tarr et al. investigated whether HIV infection accelerates the progression of atherosclerosis over time comparing coronary computed tomography angiography (CCTA) of people with and without HIV infection.
Changes in coronary artery calcium scores over time were compared between asymptomatic people with HIV of the Metabolism and Aging Core Project from the SHCS and HIV-negative individuals who were referred for clinically indicated CCTA.
The study included 340 people with HIV, and 90 HIV negative controls. Compared to individuals without HIV, those with HIV were more likely to be male (85% vs. 79%), to smoke (36% vs. 12%) and to report illicit drug use (3% vs. 0), but had a similar 10-year Framingham risk score (8.9% vs. 9.0%, p-value 0.82). The majority of people with HIV had a suppressed HIV viral load during follow-up (94%).
Overall, increases in coronary artery calcium score were larger among individuals with a higher calcium score and a higher Framingham risk score at baseline, but did not differ substantially between people with and without HIV infection. After taking the Framingham risk score into account, there was no significant association between HIV infection and the development of any new plaques (incidence rate ratio [IRR] 1.21, 95% CI 0.62-2.35), calcified plaques (IRR 1.06, CI 0.56-2.00), mixed plaques (IRR 1.24, CI 0.69-2.21), high-risk plaques (1.46, CI 0.66-3.20) and coronary artery stenosis ≥70% (IRR 0.95, CI 0.30-3.03).
In conclusion, the present study found no accelerated coronary atherosclerosis progression in people with well-controlled HIV infection. The study findings underline once again the importance of conventional cardiovascular risk factors for the development of coronary artery disease in people with HIV.