New Study Highlights Importance of Cardiac Health in Persons Living With HIV

April 20, 2021
Maggie L. Shaw

With persons living with HIV increasingly succumbing to age-related diseases, a group of investigators looked into the greater risk of coronary artery disease among these individuals.

Elevated levels of noncalcified coronary plaque, absent known cardiovascular disease, were seen in a recent Canadian study among persons living with HIV vs those without the disease.

With persons living with HIV increasingly succumbing to age-related diseases, such as cardiac disease, the investigators note extra attention must be paid to ensuring a healthy lifestyle. Their findings were published online today in Radiology.

“People living with HIV should be aware of their cardiovascular risk factors such as smoking, diabetes, high blood pressure, obesity, and lack of physical exercise,” the authors said in a statement. “They should also discuss with their physicians the best ways to prevent cardiovascular disease.”

An accompanying editorial underscores that an interest in the link between coronary artery disease (CAD) and HIV stems from evidence pointing to a greater risk of clinical CAD from HIV infection, “in particular, an assessment of the extent to which HIV infection impacts the risk of CAD,” wrote Shenghan Lai, MD, MPH, of the Institute of Human Virology at the University of Maryland School of Medicine.

The present prospective study is a subanalysis of data from the Canadian HIV and Aging Cohort Study (CHACS) and includes 181 individuals living with HIV (mean [SD] age, 56 [7] years) and 84 HIV-negative persons (mean age, 57 [8] years). Men made up a majority of these trial participants, at 92% and 77%, respectively, and all participants underwent coronary artery calcium (CAC) scoring via CT. Among them, 155 in the HIV-positive group and 78 in the HIV-negative groups also had CT angiography, after which their plaques were classified as calcified, noncalcified, or mixed.

Several results were similar between the participants living with HIV and the healthy controls:

  • Median 10-year Framingham Risk Score: 10% vs 9%, respectively (P = .45)
  • CAC score (odds ration [OR], 1.06; 95% CI, 0.58-1.94; P = .85)
  • Overall plaque (prevalence ratio, 1.07; 95% CI, 0.86-1.32; P = .55)

Study participants with HIV were recruited from the HIV clinic at the University of Montreal Hospital and the healthy controls, from the hospital’s internal medicine clinics.

Distinct differences were seen when the authors analyzed their findings by plaque type and when CAC prevalence and scores were compared between the groups. For example, noncalcified plaque carried with it a 1.5-times greater risk by prevalence and a 1.8-times greater cardiovascular risk by volume:

  • Plaque prevalence (prevalence ratio, 2.5; 95% CI, 1.07-5.67; P = .03)
  • Plaque volume (OR, 2.8; 95% CI, 1.05-7.40; P = .04)
  • CAC prevalence: 65.7% in the HIV cohort vs 58% in the healthy controls
  • Median (interquartile range [IQR]), CAC scores: 14 (IQR, 0-128.5) in the HIV cohort vs 8.5 (0-71.7) in the healthy controls

Analyses also revealed 10-year exposure to antiretroviral treatment, especially that with protease inhibitors, resulted in overall elevated plaque volume and mixed plaque in the HIV cohort:

  • Overall volume (OR, 1.8; 95% CI, 1.09-2.85; P = .02)
  • Mixed plaque (OR, 1.6; 95% CI, 1.04-2.45; P = .03)

Even after adjusting for cardiovascular risk, this association remained.

However, there were fewer cases of calcified plaque in the HIV cohort (OR, 0.6; 95% CI, 0.40-0.91; P = .02), and this group also had a lower overall mean body mass index compared with the HIV-negative controls: 25.3 (4.2) vs 27.3 (4.7) kg/m2 (P = .001). But more of the HIV cohort also were smokers, with exposure measured in pack-years: median (IQR), 6 pack-years (IQR, 0-25.8) vs 0 pack-years (IQR, 0-8.2) (P < .001).

The authors noted that their findings mirror those seen in previous studies, which show higher HRs for all-cause mortality from noncalcified plaque (HR, 7.4; P < .001) compared with mixed plaques (HR, 3.2; P = .001), and confirm that CT angiography among persons with HIV needs to include subtyping of coronary plaque “for better cardiovascular risk stratification.”

“Our results suggest that noncalcified plaque is involved as an anatomic substrate in the higher risk of cardiovascular disease in people living with HIV,” the authors concluded, “and CT should be considered a noninvasive imaging option of choice in further clinical, prognostic, and mechanistic studies of HIV-associated atherosclerosis.”

Reference

Boldeanu I, Sadouni M, Mansour S, et al. Prevalence and characterization of subclinical coronary atherosclerotic plaque with CT among individuals with HIV: results from the Canadian HIV and Aging Cohort Study. Radiol. Published online April 20, 2021. doi:10.1148/radiol.2021203297