Associations between antiretroviral use and subclinical coronary atherosclerosis

Abstract

Objectives: HIV infection is associated with increased prevalence of subclinical coronary plaque. The extent to which such plaque reflects effects of HIV infection or effects of long-term antiretroviral therapy (ART) use remains unclear and was the goal of this analysis.

Design and methods: We compared the prevalence and extent of coronary plaque and stenosis between users of specific ART drugs or drug classes using coronary computed tomography (CT) among HIV-infected men in the Multicenter AIDS Cohort Study. To account for time-dependent confounders, including cardiovascular disease risk factors and time-varying reasons for using specific treatments, we conducted fully adjusted logistic and linear models with inverse probability of treatment weighting.

Results: There were 618 men who underwent noncontrast coronary CT; 450 also underwent coronary CT angiography. At the time of scanning, 81% had undetectable plasma HIV RNA. In fully adjusted models, cumulative use of zidovudine, abacavir, darunavir, and protease inhibitors as a drug class were inconsistently associated with specific forms of plaque presence or extent.

Conclusion: Among virally suppressed HIV-infected men with extensive ART exposure, no consistent associations between use of specific ART drugs and both subclinical coronary plaque presence and extent were apparent. Our findings support the hypothesis that, among virally suppressed persons, type of ART used is not in general a major determinant of subclinical coronary plaque risk.

Figure 1. Prevalence of plaque by antiretroviral drug use stratified by duration of exposure and adjusted for age and race

The points represent the plaque prevalence and the bars represent the 95% confidence interval. CAC = coronary artery calcium, PI = protease inhibitor, RTV = ritonavir, LPV = lopinavir, DRV = darunavir, ATZ = atazanavir, D4T = stavudine, AZT = zidovudine, ABC = abacavir