Coronary Artery Disease in Persons With Human Immunodeficiency Virus Without Detectable Viral Replication
Andreas D Knudsen1,2, Andreas Fuchs2, Thomas Benfield3
1Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Insights
Nearly half of people with HIV (PWH) without viral replication had coronary artery disease (CAD). Inflammatory markers like IL-6 and hsCRP were linked to CAD, but this association weakened after considering traditional risk factors.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Coronary artery disease (CAD) is a significant concern in people with human immunodeficiency virus (HIV).
- Understanding the role of inflammation in CAD development among PWH is crucial for risk stratification and management.
- Previous research suggests a potential link between inflammatory markers and cardiovascular complications in HIV-infected individuals.
Purpose of the Study:
- To determine the prevalence of CAD in virologically suppressed people with HIV (PWH).
- To investigate the association between inflammatory markers (IL-6, IL-1β, hsCRP) and CAD in PWH.
- To explore the role of inflammation in mediating the relationship between traditional cardiovascular risk factors and CAD in this population.
Main Methods:
- The study analyzed data from the Copenhagen Comorbidity in HIV Infection (COCOMO) study.
- Participants included virologically suppressed PWH who underwent coronary computed tomographic (CT) angiography.
- Atherosclerosis was defined as >0% stenosis, and obstructive CAD as ≥50% stenosis. Inflammatory markers and traditional risk factors were assessed.
Main Results:
- Among 669 PWH (mean age 51 years, 89% male), 45% had atherosclerosis and 18% had obstructive CAD.
- Traditional risk factors (age, male sex, hypertension, diabetes, smoking, dyslipidemia, time with HIV, protease inhibitor use) were associated with CAD.
- Elevated IL-6 and hsCRP levels showed an association with CAD in univariable analyses, but this was not significant after adjusting for traditional risk factors.
Conclusions:
- A substantial proportion of virologically suppressed PWH exhibit angiographically verified atherosclerosis.
- While inflammatory markers IL-6 and hsCRP were associated with CAD in initial analyses, this link was diminished when accounting for established cardiovascular risk factors.
- Inflammation may play a mediating role in the development of CAD driven by traditional risk factors in the PWH population.
Background:
We aimed to determine the prevalence of coronary artery disease (CAD) in persons with human immunodeficiency virus (HIV; PWH) and investigate whether inflammatory markers, including interleukin 6, IL-1β, and high-sensitivity C-reactive protein (hsCRP), were associated with CAD.
Methods:
From the Copenhagen Comorbidity in HIV Infection (COCOMO) study, we included virologically suppressed PWH who underwent coronary computed tomographic (CT) angiography. Any atherosclerosis was defined as >0% stenosis, and obstructive CAD as ≥50% stenosis.
Results:
Among 669 participants (mean age [standard deviation], 51 [11] years; 89% male), 300 (45%) had atherosclerosis, and 119 (18%) had obstructive CAD. The following risk factors were associated with any atherosclerosis and with obstructive CAD: age, male sex, hypertension, diabetes, smoking, dyslipidemia, time with HIV, and current protease inhibitor use. Interleukin 6 (IL-6) and hsCRP levels >2 mg/L were associated with any atherosclerosis and with obstructive CAD in univariable analyses but not after adjustment for traditional risk factors. IL-1β was not associated with CAD.
Conclusions:
In a large population of PWH without viral replication, almost half had angiographically verified atherosclerosis. High concentrations of IL-6 and hsCRP were associated with CAD in univariable analyses, but adjustment for cardiovascular risk factors attenuated the association, suggesting that inflammation may mediate the association between traditional risk factors and CAD.
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