<scp>HIV</scp> infection is associated with an increased prevalence of coronary noncalcified plaque among participants with a coronary artery calcium score of zero: <scp>M</scp>ulticenter <scp>AIDS C</scp>ohort <scp>S</scp>tudy (<scp>MACS</scp>)

Metkus, TS; Brown, Todd T.; Budoff, Matthew J.; Kingsley, Lawrence A.; Palella, FJ; Witt,; Li, X; George, R.B.P. Terry; Jacobson, Lisa P.; Post, WS

doi:10.1111/hiv.12262

Cited by 32 publications

(20 citation statements)

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“…By 2016, the numbers of health care visits by HIV status were similar. In analyses restricted to HIV-positive participants, we found that having a detectable viral load, CD4 less than 500, and ART adherence were not associated with a greater likelihood of polypharmacy, while ART use was associated with polypharmacy; this finding could be related to increased dyslipidemia and cardiovascular disease reported in association with ART use among HIV-positive persons [ 25 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016

et al. 2018

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Rates of aging-related comorbidities, which require targeted medications to treat, have been shown to be increased among persons living with HIV compared with uninfected counterparts. Polypharmacy is generally defined as the concurrent use of 5 or more medications. We investigated polypharmacy prevalence for non-HIV medications over a 12-year period among HIV-positive and -negative participants in the Multicenter AIDS Cohort Study. Information regarding non-HIV medication use, HIV status, age, race/ethnicity, enrollment period, and medication insurance was obtained on 3,160 participants from semiannual visits between 2004 and 2016. Polypharmacy was defined as taking 5 or more non-HIV medications since the last health care visit. Generalized estimating equation models with repeated measures were produced overall and by HIV status to examine polypharmacy. The unadjusted prevalence of polypharmacy across all study visits was 18.6% and was higher among HIV-positive participants (24.4%) compared with HIV-negative participants (11.6%) (P < .0001). Among the 50 years and older age group, HIV-positive and HIV-negative participants had increases in polypharmacy over the observation period, from 38.4% to 46.8% (P = .0081) and from 16.7% to 46.0% (P < .0001), respectively. Among participants younger than 50, polypharmacy among HIV-positive participants remained stable (18.9% in 2004 to 17.3% in 2016; P = .5374) but increased among HIV-negative men (5.6% to 20.4%; P < .0001). After adjusting for age, race/ethnicity, and medication insurance, HIV-positive participants had a higher prevalence of polypharmacy than HIV-negative participants (25.3% vs 18.7%; P < .0001). Older age, white race, and having medication insurance coverage were also associated with greater polypharmacy. A convergence of polypharmacy prevalence was observed between HIV-positive and -negative participants at the end of observation. HIV-positive status was associated with an increased likelihood of polypharmacy, after adjusting for age, race/ethnicity, enrollment period, medication insurance, and study visit. Over time, polypharmacy prevalence increased among all participants, with converging rates between HIV-positive and -negative participants by the end of the observation period.

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Section: Discussionmentioning

confidence: 99%

Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016

et al. 2018

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“…Previous work from MACS revealed HIV-infected men were more likely to have non-calcified plaque than HIV-uninfected men. 18, 40 . However, we did not find any association of frailty with NCPS regardless of HIV-serostatus.…”

Section: Discussionmentioning

confidence: 99%

Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS)

et al. 2017

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Background and aims Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. Methods We studied 976 [62% HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having ≥3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. Results Mean (SD) age of participants was 54 (7) years; 31% were black. Frailty existed in 7.5% and 14.3% of HIV-uninfected and HIV-infected men, respectively. After adjustment for demographics, frailty was significantly associated with prevalence of any CAC (CAC>0), any plaque (TPS>0), and mixed plaque (MPS>0) in HIV-uninfected but not in HIV-infected men (p-interaction_HIV<0.05 for all). Among HIV-uninfected men, after adjustment for cardiovascular risk factors, frailty was significantly associated only with CAC>0 [Prevalence Ratio 1.27 (95%CI 1.02, 1.59)] and TPS>0 [1.19 (1.06, 1.35)]. No association was found for NCPS. Conclusions Frailty was independently associated with subclinical coronary atherosclerosis among HIV-uninfected men, but not among HIV-infected men. Further work is needed to ascertain mechanisms underlying these differences and whether interventions that improve frailty (i.e. strength training) can improve cardiovascular outcomes.

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“…The CAC score though may underestimate atherosclerotic burden in patients with HIV, especially compared to other imaging modalities. Among patients with undetectable CAC, more patients with HIV have increased CIMT [24] and non-calcified plaque on cardiac computed tomography angiography (CCTA) [25] compared to patients without HIV. In addition to non-calcified plaque, CCTA can also detect high-risk morphologic features of coronary atherosclerosis such as plaque volume, low attenuation, positive remodeling, spotty calcification, and the napkin ring sign, which in the general population have been associated with culprit lesions in acute coronary syndrome [26].…”

Section: Insights From Cardiac Imaging Into the Unique Pathophysiologmentioning

confidence: 99%

Inflammation, immune activation, and cardiovascular disease in HIV

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Lo²,

Grinspoon³

2016

Aids

165

130

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HIV infection is associated with an increased prevalence of coronary noncalcified plaque among participants with a coronary artery calcium score of zero: Multicenter AIDS Cohort Study (MACS)

Cited by 32 publications

References 20 publications

Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016

Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016

Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS)

Inflammation, immune activation, and cardiovascular disease in HIV

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