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Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons

Philip E Tarr1, Bruno Ledergerber2, Alexandra Calmy3

  • 1University Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland.

European Heart Journal
|March 29, 2018
PubMed

Insights

HIV-positive individuals had less calcified plaque and coronary atherosclerosis compared to HIV-negative individuals, despite similar cardiovascular risk scores. This suggests HIV infection may influence plaque characteristics differently than traditional risk factors.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • HIV infection is linked to increased cardiovascular event rates.
  • Data on subclinical atherosclerosis prevalence in HIV-positive versus HIV-negative individuals are inconsistent.
  • Subclinical atherosclerosis assessment is crucial for understanding cardiovascular risk in HIV.

Purpose of the Study:

  • To compare subclinical atherosclerosis using coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) in HIV-positive and HIV-negative individuals.
  • To assess the association of HIV infection and related factors with subclinical atherosclerosis.
  • To investigate differences in plaque characteristics and severity between the two groups.

Main Methods:

  • Utilized CAC scoring and CCTA in 428 HIV-positive participants (Swiss HIV Cohort Study) and 276 HIV-negative controls.
  • Performed univariable and multivariable analyses to assess associations.
  • Compared prevalence of CAC score >0, median CAC scores, and plaque types (calcified, non-calcified/mixed, high-risk).

Main Results:

  • HIV-positive participants were younger but had similar 10-year Framingham risk scores compared to controls.
  • Prevalence of CAC score >0 and median CAC scores were similar between groups.
  • HIV-positive participants showed a lower prevalence of calcified plaque (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).

Conclusions:

  • HIV-positive individuals in Switzerland exhibited less calcified coronary plaque and lower atherosclerosis burden compared to HIV-negative individuals with similar cardiovascular risk.
  • Non-calcified/mixed plaque and high-risk plaque prevalence were similar between groups.
  • Findings suggest HIV infection may be associated with a different pattern of coronary atherosclerosis development.
Abstract

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