Progression of subclinical cardiovascular disease in patients with HIV

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• Individuals with Human Immunodeficiency Virus (HIV) infection face an elevated risk of cardiovascular disease (CVD).
• Subclinical atherosclerosis and CVD progression are significant concerns in this population.
• Multidetector computed tomography (MDCT) can assess cardiovascular risk in asymptomatic individuals.

Purpose of the Study:

• To evaluate the ability of MDCT, alongside clinical and laboratory parameters, to assess subclinical CVD progression in HIV-infected patients.
• To determine changes in cardiovascular risk scores and imaging markers over a six-year period.

Main Methods:

• A prospective longitudinal cohort study involving HIV patients with at least 10 years of infection and 5 years of antiretroviral therapy.
• Patients with initially low cardiovascular risk were monitored for six years (2015-2021).
• Data collected included clinical assessments, blood analysis, carotid ultrasound, and gated MDCT at baseline and follow-up.

Main Results:

• Over six years, the Systematic Coronary Risk Estimation-2 (SCORE2) increased from 2.9% to 4.4%, and the Multi-Ethnic Study of Atherosclerosis (MESA) risk score rose from 3.4 to 6.0.
• Coronary artery calcification (CAC) scores >100 increased from 11.1% to 25.4% (P < 0.05).
• The prevalence of carotid plaques increased from 11% to 27% (P = 0.03).

Conclusions:

• A significant progression of subclinical CVD was observed in HIV patients over six years.
• Increases in SCORE2, MESA risk, CAC scoring, and carotid plaque prevalence indicate worsening cardiovascular health.
• MDCT findings, combined with clinical and laboratory data, are valuable for monitoring CVD progression in at-risk HIV patients.