Risk of Cardiovascular Disease Among People Living With HIV With Immunological Nonresponse

Area of Science:

• Cardiology
• Infectious Diseases
• Immunology

Background:

• Cardiovascular disease (CVD) is a significant concern for people living with HIV (PLWH).
• Immunological non-response (INR) may impact CVD risk and cardiac health in PLWH.
• Subclinical cardiac abnormalities are increasingly recognized in PLWH.

Purpose of the Study:

• To compare 10-year CVD risk and echocardiographic abnormalities between PLWH with INR and those with immunological response (IR).
• To identify factors associated with increased CVD risk and cardiac abnormalities in PLWH.

Main Methods:

• Cross-sectional study involving 520 PLWH (260 INR, 260 IR matched for age and gender).
• Echocardiography performed for all participants.
• Cardiovascular risk assessed using the Framingham Risk Score (FRS).

Main Results:

• PLWH with INR had significantly higher 10-year CVD risk (11.86% vs 9.51%) and more echocardiographic abnormalities (83.5% vs 74.2%) compared to IR controls.
• Factors associated with increased CVD risk included longer treatment duration, larger waist circumference, prolonged prothrombin time, lower education, and carotid plaque.
• Within the INR group, age and lower CD19+ levels correlated with echocardiographic abnormalities. An interaction between age and immune reconstitution status on CVD risk was observed.

Conclusions:

• Poor immune reconstitution is linked to elevated CVD risk and subclinical cardiac abnormalities in PLWH.
• Older PLWH with poor immune reconstitution are particularly vulnerable.
• Findings highlight the need for tailored cardiovascular screening strategies in this population.