Atherosclerosis common among middle-aged adults with well-controlled HIV

Nearly half of adults with HIV infection without viral replication were found to have angiography-confirmed atherosclerosis, according to results from a recent study published in Open Forum Infectious Diseases.

Between March 2015 and December 2016, researchers enrolled 1099 patients from the Copenhagen Co-morbidity in HIV Infection study (Clinicaltrials.gov Identifier: NCT02382822). The researchers aimed to determine if there was a correlation between increased levels of inflammatory markers, including high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, and IL-1β, and the occurrence and severity of coronary artery disease (CAD). Patients who were positive for HIV infection and older than 18 years were enrolled. Coronary computed tomography angiography was performed among 724 patients, and 686 were virologically suppressed. Multivariable logistic regression was used to assess risk factors associated with the presence of any atherosclerosis and obstructive CAD.

Among 669 patients included in the final analysis, the mean (SD) age was 51 (11) years, and 89% were men. Evidence for atherosclerosis was present in 300 (45%) patients, and 84 (13%) and 97 (14%) had minimal and mild atherosclerosis, respectively. In addition, 119 (18%) patients had obstructive CAD, of whom 44% had moderate stenosis, 25% had severe stenosis, 10% had at least 1 occluded coronary artery segment, and 20% previously underwent coronary angioplasty.

Multivariable analyses were performed with adjustments for traditional risk factors for CAD, including age, sex, smoking status, diabetes, and hypertension. Results showed that the presence of any atherosclerosis was significantly associated with age, male sex, hypertension, active smoking status, dyslipidemia, and BMIs greater than 30 kg/m². Factors associated with obstructive CAD were similar, with the exception of male sex and BMI. Further, patients with high vs low Framingham risk scores were at increased risk for both any atherosclerosis (odds ratio [OR], 13.51; 95% CI, 8.12-22.49) and obstructive CAD (OR, 11.47; 95% CI, 6.34-20.75)

In regard to HIV-related risk factors, time since HIV diagnosis and protease inhibitor use were associated with obstructive CAD. Of note, the risk for any atherosclerosis was decreased among patients with high CD4 counts (500 cells/µL).

In the univariable analysis, IL-6 and high-sensitivity CRP levels greater than 2 mg/L were associated with any atherosclerosis, whereas only high IL-6 levels were associated with obstructive CAD. However, after adjustment for age and sex, high IL-6 levels remained associated with obstructive CAD (adjusted OR, 1.86; 9% CI, 1.13-3.08; P =.016) but not with any atherosclerosis. Neither IL-1β levels nor high-sensitivity CRP levels were associated with coronary atherosclerosis.

Study limitations include the predominance of men of Scandinavian descent and the cross-sectional design.

According to the researchers, “The pathogenesis of CAD in PWH [people with HIV] likely reflects an intricate interplay between both traditional and HIV-related factors that may accelerate the development of atherosclerosis.”

By Lisa Kuhns, PhD

References:

Knudsen AD, Fuchs A, Benfield T, et al. Coronary artery disease in persons with HIV without detectable viral replication. Open Forum Infect Dis. Published online May 31, 2023. doi:10.1093/ofid/ofad298