Lipoprotein(a) is associated with coronary inflammation in people with HIV and undetectable HIV RNA

People with HIV (PWH) and undetectable virus experience elevated cardiovascular risk independent of traditional risk factors. Vascular inflammation may contribute to this residual risk. The perivascular fat attenuation index (FAI), derived from coronary computed tomography angiography (CCTA), is a biomarker of coronary inflammation. Lipoprotein(a) [Lp(a)] carries oxidized phospholipids that may promote inflammation. Statins have demonstrated cardiovascular benefit in PWH, including pleiotropic anti-inflammatory effects. This study assessed the associations of Lp(a) and of statin use with coronary inflammation (FAI) in men with HIV (MWH).

We analysed FAI of the left anterior descending (LAD) and the right coronary arteries (RCA) in 583 men from the Multicenter AIDS Cohort Study, a prospective, multicentre cohort study, including 280 with undetectable HIV RNA, <50 copies/ml. Associations between log₁₀[Lp(a)] and LAD and RCA FAI were assessed using linear regression, adjusting for demographic and cardiovascular risk factors. Log₁₀[Lp(a)] was associated with LAD FAI in MWH with undetectable HIV in adjusted analysis [+1.99 HU (0.38, 3.59); P = 0.02] but not among men without HIV (MWoH) or MWH with detectable HIV. Associations with RCA FAI were only significant in the unadjusted analysis. Statin use was associated with lower FAI, less inflammation in the LAD in MWH with undetectable virus, but did not modify the association between Lp(a) and coronary inflammation.

Lp(a) was associated with increased coronary inflammation, independent of traditional cardiovascular risk factors, in MWH with undetectable virus. Statin therapy did not modify the relationship between coronary inflammation and Lp(a).