Cytomegalovirus immunoglobulin G antibody is associated with subclinical carotid artery disease among HIV-infected women

Abstract

Background: Cytomegalovirus (CMV) infection has been implicated in immune activation and accelerated progression of immunodeficiency from human immunodeficiency virus (HIV) coinfection. We hypothesized that CMV is associated with vascular disease in HIV-infected adults.

Methods: In the Women's Interagency HIV Study, we studied 601 HIV-infected and 90 HIV-uninfected participants. We assessed the association of CMV immunoglobulin G (IgG) level with carotid artery intima-media thickness, carotid artery distensibility, Young's elastic modulus, and blood pressures. Multivariable models adjusted for age, race/ethnicity, smoking, diabetes, and body mass index.

Results: Mean CMV IgG levels were higher in HIV-infected women compared with HIV-uninfected women (P < .01). Among HIV-infected women, higher CMV IgG level was associated with decreased carotid artery distensibility (P < .01) and increased Young's modulus (P = .02). Higher CMV IgG antibody level was associated with increased prevalence of carotid artery lesions among HIV-infected women who achieved HIV suppression on antiretroviral therapy, but not among viremic or untreated HIV-infected women. Adjustment for Epstein-Barr virus antibody levels and C-reactive protein levels had no effect on the associations between CMV IgG levels and vascular parameters.

Conclusions: Cytomegalovirus antibody titers are increased in HIV-infected women and associated with subclinical cardiovascular disease. Host responses to CMV may be abnormal in HIV infection and associated with clinical disease.

Figure 1.

Association of cytomegalovirus (CMV) immunoglobulin G (IgG) with presence of lesions among human immunodeficiency virus (HIV)–infected women by treatment and viremia status. Mean CMV IgG levels and 95% confidence intervals (CIs) are presented. Prevalence ratios and 95% CIs associated with each 10-IU/mL increase in CMV IgG, after adjustment for age, race, and smoking were: 1.58 (1.09–2.30) in treated/aviremic women, 0.76 (.49–1.20) in treated/viremic women, and 0.93 (.58–1.48) in untreated women. Interaction term P < .05 after adjustment for age, race, and smoking, and interaction term not significant (NS) after further multivariable adjustment.