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;