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Published on: January 15, 2022
Associations between HIV serostatus and coronary artery plaque volume progression
Seamus P Whelton1, Sabina A Haberlen2, Long Zhang2
1Johns Hopkins University School of Medicine.
Insights
Men with HIV show increased coronary plaque progression, particularly calcified plaque. This finding may explain the higher rates of coronary heart disease in this population, especially among non-Black individuals.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Men with HIV exhibit higher prevalence of coronary atherosclerosis compared to HIV-negative men.
- Understanding plaque progression dynamics is crucial for managing cardiovascular risk in HIV-positive individuals.
Purpose of the Study:
- To investigate differences in coronary plaque progression between men with and without HIV.
- To identify specific plaque types that exhibit differential progression based on HIV serostatus.
Main Methods:
- Coronary CT angiography was used to assess plaque progression over a median of 4.5 years in 548 men from the Multicenter AIDS Cohort Study.
- Change in total, calcified, noncalcified, and low attenuation plaque volume was quantified.
- Multinomial logistic regression analyzed the association between HIV status and plaque progression.
Main Results:
- 78% of participants showed plaque progression, with a median increase of 34 mm³.
- Men with HIV had significantly higher odds of calcified plaque progression (OR 1.99).
- Elevated, though not statistically significant, odds for total and noncalcified plaque progression were observed in men with HIV.
- HIV was associated with increased plaque progression in non-Black participants, but not in Black participants.
Conclusions:
- Men with HIV experience accelerated coronary plaque progression, contributing to their elevated risk of coronary heart disease.
- Calcified plaque progression is a key differentiator observed in HIV-positive men.
- Further research into HIV-specific cardiovascular risk factors and targeted interventions is warranted.
Objective:
Men with HIV have more coronary atherosclerosis than men without HIV. We examined whether plaque progression differed based on HIV serostatus.
Design:
We examined plaque progression over a median of 4.5 years [interquartile range (IQR) 3.9-4.9] among 548 men with ( n = 313) or without ( n = 235) HIV from the Multicenter AIDS Cohort Study using coronary CT angiography.
Methods:
Change in coronary plaque volume was calculated for total, calcified, noncalcified, and low attenuation plaque and categorized by tertile. Multinomial logistic regression models estimated the association between HIV and coronary plaque progression.
Results:
The median age was 53 years and 30% were Black. Total plaque volume regressed among 2 and 20% remained without plaque, and 78% had progression with a median progression of 34 mm 3 (IQR 3-106). Compared to men without HIV, men with HIV had a statistically significant 1.99 higher odds of calcified plaque progression [95% confidence interval (CI) 1.16-3.44, P = 0.01] and elevated odds for progression in total plaque [odds ratio (OR) 1.62, 95% CI: 0.94-2.77, P = 0.08] and noncalcified plaque volume (OR 1.64, 95% CI 0.97-2.79, P = 0.07], although the latter findings did not meet the cutpoint for statistical significance. The progression of low attenuation plaque did not significantly differ by HIV serostatus (OR 1.34, 95% CI: 0.88-2.05, P = 0.18). HIV was significantly associated with the progression of total, calcified, and noncalcified plaque among non-Black participants, but not Black participants.
Conclusion:
These results suggest that men with HIV may have greater plaque progression, which may contribute to the observed higher incidence of coronary heart disease among men with HIV.
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