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HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)
P Elliott Miller1, Sabina A Haberlen2, Thomas Metkus1
1Johns Hopkins University School of Medicine, Baltimore MD, USA.
Insights
HIV-infected men show a higher prevalence of positive remodeling in coronary arteries, a characteristic linked to myocardial infarction risk. This finding suggests potential cardiovascular implications for HIV+ individuals, warranting further investigation into associated risk factors and outcomes.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Radiology
Background:
- Positive remodeling (PR) is a coronary artery characteristic associated with increased risk of myocardial infarction (MI).
- HIV infection may be associated with a higher prevalence of PR, but this has not been extensively studied.
Purpose of the Study:
- To evaluate the prevalence of PR using coronary CT angiography (CCTA) in HIV-infected (HIV+) and HIV-uninfected (HIV-) men.
- To determine if HIV serostatus is independently associated with PR after adjusting for demographics and cardiovascular disease risk factors.
Main Methods:
- Men aged 40-70 from the Multicenter AIDS Cohort Study with normal kidney function and no prior coronary revascularization underwent CCTA.
- Multivariable logistic regression models were used to assess the odds ratio (OR) of PR by HIV serostatus, adjusting for covariates.
- Analysis was further stratified by plaque characteristics and stenosis severity within atherosclerotic segments.
Main Results:
- The prevalence of PR was 12.1% in HIV+ men versus 8.4% in HIV- men (p=0.10).
- After demographic adjustment, HIV+ men had double the odds of PR (OR 2.01), which persisted after CAD risk factor adjustment (OR 1.76).
- Factors associated with increased PR odds included higher systolic blood pressure, total cholesterol, diabetes medication use, older age, plaque presence, non-calcified plaque, and stenosis >50%; higher HDL cholesterol, nadir CD4 count, and Black race were associated with lower PR odds.
Conclusions:
- HIV+ men exhibit a greater number of positively remodeled coronary arterial segments, potentially linked to increased atherosclerosis or HIV-related immunosuppression.
- Further research is necessary to ascertain if PR contributes to elevated MI rates in HIV+ individuals.
Objective:
Positive remodeling (PR), a coronary artery characteristic associated with risk for myocardial infarction (MI), may be more prevalent in HIV-infected (HIV+) people. We evaluated the prevalence of PR using coronary CT angiography (CCTA) in HIV+ and HIV-uninfected (HIV-) men.
Methods:
Men enrolled in the Multicenter AIDS Cohort Study underwent CCTA if they were 40-70 years, had normal kidney function and no history of coronary revascularization. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PR by HIV serostatus, adjusting for demographics and coronary artery disease (CAD) risk factors. Analysis of PR among atherosclerotic segments further adjusted for plaque type and stenosis.
Results:
The prevalence of PR was 8.4% versus 12.1% (p = 0.10) for HIV- and HIV + men, respectively. After demographic adjustment, HIV + men had twice the odds of PR [OR 2.01(95% CI 1.20-3.38)], which persisted after CAD risk factor adjustment [1.76(1.00-3.10)]. Higher systolic blood pressure, total cholesterol, diabetes medication use, older age, segment number with plaque present, mixed and non-calcified plaque, and stenosis>50%, were associated with increased odds of PR, while higher HDL cholesterol, higher nadir CD4 count, and black race were associated with lower PR odds. Among atherosclerotic segments, the association between HIV infection and PR persisted, but was not statistically significantly.
Conclusion:
HIV+ men have more positively remodeled arterial segments, which may be due to more coronary segments with atherosclerosis or HIV-related immunosuppression. Further studies are needed to evaluate whether PR contributes to higher rates of MI in HIV+ individuals.