Prevalence and Characterization of Subclinical Coronary Atherosclerotic Plaque with CT among Individuals with HIV: Results from the Canadian HIV and Aging Cohort Study

Abstract

P eople with HIV infection now live longer and increasingly experience age-related diseases such as coronary artery disease. Studies from North America and Europe showed a greater myocardial infarction risk ratio varying from 1.5 to 2.1 in people living with HIV (PLWH) compared with the general population (1-3). Other than age, overrepresentation of traditional cardiovascular risk factors such as smoking, dyslipidemia, hypertension, and diabetes (1,4) probably also contributes to the increased incidence of cardiovascular disease in PLWH, although this increased incidence persists after adjustment for these risk factors (1,2). An impact of antiretroviral therapy on coronary artery disease has been discussed in multiple studies (5,6). Mechanisms such as inflammation and immune dysfunction seem to have a role along the pathways to this higher risk of cardiovascular disease (7,8).Coronary CT angiography is a noninvasive imaging option of choice for the characterization, quantification, and monitoring of coronary HIV-related atherosclerosis in clinical studies and may provide robust anatomic substrates suitable for correlative assessment in mechanistic studies. Controversial findings exist regarding the higher rates of noncalcified coronary plaque in PLWH compared with healthy volunteers without HIV (9-13). In our prospective study nested in a large cohort, we aimed to compare the burden and CT characteristics of subclinical coronary atherosclerotic plaque in asymptomatic PLWH without known cardiovascular disease compared with healthy volunteers without HIV. We hypothesized Background: People living with HIV (PLWH) have a higher risk of myocardial infarction. Coronary atherosclerotic plaque CT characterization helps to predict cardiovascular risk.Purpose: To measure CT characteristics of coronary plaque in PLWH without known cardiovascular disease and healthy volunteers without HIV. Materials and Methods:In this prospective study, noncontrast CT (all participants, n = 265) was used for coronary artery calcium (CAC) scoring in asymptomatic PLWH and healthy volunteers without HIV, without known cardiovascular disease, from 2012 to 2019. At coronary CT angiography (n = 233), prevalence, frequency, and volume of calcified, mixed, and noncalcified plaque were measured. Poisson regressions were used with adjustment for cardiovascular risk factors.Results: There were 181 PLWH (mean age, 56 years 6 7; 167 men) and 84 healthy volunteers (mean age, 57 years 6 8; 65 men) evaluated by using noncontrast CT. CT angiography was performed in 155 PLWH and 78 healthy volunteers. Median 10-year Framingham risk score was not different between PLWH and healthy volunteers (10% vs 9%, respectively;

Subclinical Atherosclerosis is Associated with Discrepancies in BAFF and APRIL Levels and Altered Breg Potential of Precursor-like Marginal Zone B-Cells in HIV Treated Individuals

“…No differences were found between the HIV+ CVD- and HIV+ CVD+ groups. Importantly, statin usage is not controlled in the CHACS, and its usage seems to be augmented in PLHIV [31]. However, we did not see any significant difference for statin usage among the study groups.…”

“…Controls are recruited at the same clinics as the PLHIV participants, and the full study protocol and data collection forms have been published [6]. Participants from the CHACS cohort who were free of overt cardiovascular disease (had never suffered a myocardial infarction, coronary revascularization, angina, stroke of peripheral vascular revascularization) and had a 10-year Framingham risk score (the probability of developing CVD in the near future) ranging from 5 to 20% were invited to participate in the cardiovascular imaging substudy [31]. Data on all traditional cardiovascular risk factors was collected prospectively as part of the CHACS visits.…”

“…Coronary plaques were measured as previously described [31, 32]. Briefly, individuals recruited from the CHACS were administered 50-75 mg metoprolol (a beta blocker used to lower heart rate) orally when heart rate was higher than 60 beats per minute.…”

High frequencies of adaptive NK cells are associated with absence of coronary plaque in cytomegalovirus infected people living with HIV

“…Consecutive participants from CHACS who were free of clinically overt CVD at baseline and presented a Framingham risk score ranging between 5% and 20% were invited to participate in the cardiovascular imaging sub-study. [ 24 ] Of the 219 participants in the imaging sub-study, the 194 participants with complete data and available blood samples were included in our analyses. Of these, 128 were CMV + PLWH, 8 were CMV − PLWH, 37 were CMV mono-infected and 21 individuals were negative for both HIV and CMV infection.…”

“…For this analysis, TPV was dichotomized as 0 (absence of subclinical coronary atherosclerosis) or greater than 0 (presence of coronary atherosclerosis). [24] All imaging studies were performed at the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada, and interpreted by a board-certified cardiothoracic radiologist (CC-L). All radiology personnel performing image interpretation and postprocessing were blinded to HIV and CMV status.…”