Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons. European Heart Journal
Tarr et al. aimed to compare the prevalence of subclinical atherosclerosis in HIV-positive and HIV-negative persons in Switzerland using coronary artery calcium (CAC)/computed tomography angiography (CCTA), and to assess associations between cardiovascular risk factors, HIV infection, and subclinical coronary artery disease. They enrolled 428 HIV-positive participants of the Swiss HIV Cohort Study and 276 HIV-negative controls concurrently referred for clinically indicated CCTA.
HIV-positive participants were younger than HIV-negative participants (median age 52 vs. 56 years; P < 0.01) but had similar median 10-year Framingham risk scores (9.0% vs. 9.7%; P = 0.40). The prevalence of CAC score > 0 (53% vs. 56.2%; P = 0.42) and median CAC scores (47 vs. 47; P = 0.80) were similar, as was the prevalence of any, non-calcified/ mixed, and high-risk plaque. In multivariable adjusted analysis, HIV-positive participants had a lower prevalence of calcified plaque than HIV-negative participants [36.9% vs. 48.6%, P < 0.01; adjusted odds ratio (aOR) 0.57; P < 0.01], lower coronary segment severity score (aOR 0.72; P = 0.04), and lower segment involvement score (aOR 0.71; P = 0.03). Advanced immunosuppression was associated with non-calcified/mixed plaque (aOR 1.97; P = 0.02).
In conclusion, in this study HIV infection was not associated with more subclinical atherosclerosis. On the contrary, HIV was associated with less calcified coronary plaques and lower coronary atherosclerosis involvement and severity scores than HIV-negative persons with similar Framingham risk scores. In addition, the study found no evidence of advanced coronary age in HIV-positive patients, and thus was unable to confirm previous reports. Taken together, these reports somewhat attenuate concerns about accelerated subclinical atherosclerosis in HIV-positive persons.