Two studies presented at the annual Conference on Retroviruses and Opportunistic Infections showed elevated CV risk among men with HIV and suggest avenues for future study.
The two studies focused on narrowing the knowledge gap that exists in prevalence and CV risk factors among this patient population.
“HIV-infected individuals are surviving longer due to effective antiretroviral therapy, and CVD has emerged as a leading cause of morbidity and mortality. However, the mechanisms for increased risk are incompletely understood,” Wendy S. Post, MD, MS, professor of medicine and cardiovascular fellowship research director at Johns Hopkins University, said in her presentation.
PAD prevalence in HIV
According to research presented by Andreas D. Knudsen, MD, PhD, from Rigshospitalet in Copenhagen, Denmark, adults living with HIV had an increased rate of peripheral artery disease compared with healthy controls.
“It is well-known that persons living with HIV have increased risk of CVD, but less is known about PAD,” Knudsen said. “The aims of this study were to characterize the prevalence and risk factors of PAD among persons living with HIV.”
Knudsen and colleagues studied 908 adults living with HIV (median age, 52 years) and 11,106 controls without HIV (median age, 53 years). Using questionnaires, researchers obtained data on smoking history and medication. Ankle-brachial index was used to diagnose PAD. Logistic regression models were adjusted for age, sex, smoking status, dyslipidemia, diabetes, high-sensitivity C-reactive protein and hypertension to assess PAD predictors.
Among adults living with HIV, there was a lower prevalence of hypertension (P < .0001), but higher rates of current smoking and intermittent claudication compared with the control group (P < .0001 for both).
Knudsen and colleagues found that PAD was prevalent in 12% of adults living with HIV vs. 6% of control patients (adjusted OR = 2.4; 95% CI, 1.9-2.9).
Irrespective of HIV status, age, female sex, smoking status, hypertension, intermittent claudication and kidney function were independently associated with PAD, according to the researchers.
“PAD is more prevalent among persons living with HIV, and HIV is independently associated with disease,” Knudsen said. “More studies are needed to investigate the mechanisms of the atherosclerotic process in HIV.”
Coronary plaque risk
In the second study presented at CROI 2018, Post and colleagues aimed to define the relationship between HIV infection and progression and composition of coronary atherosclerotic plaque among men in the Multicenter AIDS Cohort Study (MACS). MACS is a prospective, observational cohort study that currently consists of 2,283 gay or bisexual adult men with and without HIV, all located in the Baltimore/Washington, D.C., Chicago, Pittsburgh and Los Angeles regions. Participants were enrolled in MACS in 1984-1985, 1987-1991 and 2001-2003.
Post presented follow-up data from participants with no history of coronary revascularization and normal kidney function who participated in a MACS cardiovascular substudy. In total, 765 men underwent baseline coronary CT angiography, of whom 59% had HIV. At follow-up in 2015-2017, the researchers analyzed data on 313 patients with HIV (mean age, 51 years; one-third black) and 235 without HIV (mean age, 56 years; one-quarter black) who underwent a second CT with contrast. About one-quarter of patients were current smokers, mean systolic BP was 127 to 129 mm Hg, 40% were using antihypertension medication, fasting glucose was 94 mg/dL to 96 mg/dL and mean HDL was slightly lower in the group with HIV (46 mg/dL vs. 53 mg/dL).
Overall, 78% of patients exhibited plaque progression, 20% exhibited no change and 2% exhibited plaque regression from baseline. The median unadjusted change in total plaque volume by HIV serostatus was 36.16 mm3 among men with HIV vs. 30.75 mm3 among men without HIV.
“We found that the progression of coronary atherosclerotic plaque volume was greater in HIV-infected than uninfected men, even after adjusting for differences in demographics and CVD risk factors,” Post said. “This faster progression was mostly confined to non-black HIV-infected men, who had a twofold increase in the odds of being in the top third tertile of plaque progression, relative to the first [tertile], compared with HIV-uninfected men. In contrast, black men had no significant associations between HIV and plaque progression.”
HIV suppression by use of antiretroviral therapy did not reduce the elevated risk for plaque progression in non-black men, according to the researchers.
“To our knowledge, this is the first study to document and quantify progressions of coronary plaque in people living with HIV in a large longitudinal study,” Post said.
Strengths of this study are its comparison of men with HIV vs. men without HIV from the same population as well as a detailed characterization of traditional CV risk factors.
“It will be important now to focus on possible mechanisms of why coronary plaque progresses faster in HIV-infected men than in similar uninfected men, such as coinfections or greater immune activation and inflammation and on mechanisms for racial differences in HIV-related plaque progression,” she said. – by Dave Quaile
Knudsen AD, et al. Abstract 76.
Post W, et al. Abstract 77. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2018; Boston.
Disclosures: Post reports no relevant financial disclosures. Cardiology Today could not confirm relevant financial disclosures for Knudsen at the time of publication.
Editor’s note: This article was updated on March 7, 2018, to incorporate updated information provided by Wendy S. Post, MD, MS.