HIV infection is independently associated with carotid plaque burden and echogenic characteristics

People living with HIV (PWH) are at increased risk of cardiovascular disease; however, evidence from Asian populations remains limited. We evaluated the prevalence and characteristics of carotid plaques among PWH and people without HIV (PWoH) in China to examine the impact of HIV infection on subclinical atherosclerosis.

In this cross-sectional study conducted at the Shanghai Public Health Clinical Center, China, we enrolled 1390 PWH and 1390 age-frequency and sex-frequency matched PWoH aged 40 years or older. Carotid ultrasonography was used to assess the presence, number and echogenicity of carotid plaques.

The prevalence of carotid plaques was significantly higher in PWH than in PWoH (45.3% vs 37.5%, p<0.001), and the prevalence of echo-lucent plaques was also higher (21.1% vs 18.0%, p=0.045). Among participants with carotid plaques, PWH were more likely to have three or more plaques (35.8% vs 21.2%, p<0.001) and a greater maximum plaque thickness (2.0 mm vs 1.9 mm; p=0.026). After adjustment for age, sex and dyslipidaemia, HIV infection remained independently associated with increased odds of carotid plaques (adjusted OR (aOR)=1.45; 95% CI 1.23 to 1.70) and echo-lucent plaques (aOR=1.24; 95% CI 1.02 to 1.50). Associations were strongest among men and younger participants. No HIV-related clinical factors were significantly associated with carotid plaque presence.

HIV infection is independently associated with an increased carotid plaque burden and echo-lucent plaque features, suggesting accelerated atherosclerosis beyond traditional risk factors. These findings support routine cardiovascular risk assessment and early preventive strategies in PWH.