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. 2020 Sep 16;7(10):ofaa438.
doi: 10.1093/ofid/ofaa438. eCollection 2020 Oct.

Longitudinal Progression of Subclinical Coronary Atherosclerosis in Swiss HIV-Positive Compared With HIV-Negative Persons Undergoing Coronary Calcium Score Scan and CT Angiography

Philip E Tarr  1 , Bruno Ledergerber  2 , Alexandra Calmy  3 , Thanh Doco-Lecompte  3 , Isabella C Schoepf  1 , Alex Marzel  2 , Rainer Weber  2 , Philipp A Kaufmann  4 , René Nkoulou  5 , Ronny R Buechel  4 , Helen Kovari  2 ; Swiss HIV Cohort Study
Collaborators, Affiliations

Longitudinal Progression of Subclinical Coronary Atherosclerosis in Swiss HIV-Positive Compared With HIV-Negative Persons Undergoing Coronary Calcium Score Scan and CT Angiography

Philip E Tarr et al. Open Forum Infect Dis. .

Abstract

Background: People with HIV (HIV+) may have increased cardiovascular event rates compared with HIV-negative (HIV-) persons. Cross-sectional data from the United States and Switzerland, based on coronary artery calcium scan (CAC) and coronary computed tomography angiography (CCTA), suggest, respectively, increased and similar prevalence of subclinical atherosclerosis in HIV+ vs HIV- persons.

Methods: We repeated CAC/CCTA in 340 HIV+ and 90 HIV- study participants >2 years after baseline CAC/CCTA. We assessed the association of HIV infection, Framingham risk score (FRS), and HIV-related factors with the progression of subclinical atherosclerosis.

Results: HIV+ were younger than HIV- participants (median age, 52 vs 56 years; P < .01) but had similar median 10-year FRS (8.9% vs 9.0%; P = .82); 94% had suppressed HIV viral load. In univariable and multivariable analyses, FRS was associated with the incidence rate ratio (IRR) of new subclinical atherosclerosis at the follow-up CAC/CCTA, but HIV infection was not: any plaque (adjusted IRR for HIV+ vs HIV- participants, 1.21; 95% CI, 0.62-2.35), calcified plaque (adjusted IRR for HIV+ vs HIV- participants, 1.06; 95% CI, 0.56-2), noncalcified/mixed plaque (adjusted IRR for HIV+ vs HIV- participants, 1.24; 95% CI, 0.69-2.21), and high-risk plaque (adjusted IRR for HIV+ vs HIV- participants, 1.46; 95% CI, 0.66-3.20). Progression of CAC score between baseline and follow-up CAC/CCTA was similar in HIV+ (median annualized change [interquartile range {IQR}], 0.41 [0-10.19]) and HIV- participants (median annualized change [IQR], 2.38 [0-16.29]; P = .11), as was progression of coronary segment severity score (HIV+: median annualized change [IQR], 0 [0-0.47]; HIV-: median annualized change [IQR], 0 [0-0.52]; P = .10) and coronary segment involvement score (HIV+: median annualized change [IQR], 0 [0-0.45]; HIV-: median annualized change [IQR], 0 [0-0.41]; P = .25).

Conclusions: In this longitudinal CAC/CCTA study from Switzerland, Framingham risk score was associated with progression of subclinical atherosclerosis, but HIV infection was not.

Keywords: HIV; cardiovascular disease; coronary CT angiography; longitudinal study; subclinical atherosclerosis.

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Figures

Figure 1.
Figure 1.
Association of baseline CAC score, FRS, SSS, and SIS with measurements at follow-up CAC/CCTA in HIV+ and HIV- study participants. A, Relationship between CAC at baseline and follow-up scans. B, Regression analysis of annualized CAC increase from baseline to follow-up CAC determination. Marginal effects from robust regression analysis with interaction terms of CAC at visit 1, 1-year Framingham risk at visit 1, and HIV status. C, Probability of SSS increase from baseline to follow-up CCTA. Marginal effects from logistic regression analysis with interaction terms of SSS at baseline CCTA, 1-year Framingham risk at baseline CCTA, and HIV status. For visual clarity, no 95% CIs are shown. For figures with 95% CI, see Supplementary Figure 1C. D, Probability of SIS increase from baseline to follow-up CCTA. Marginal effects from logistic regression analysis with interaction terms of SIS at visit 1, 1-year Framingham risk at visit 1, and HIV status. For visual clarity, no 95% confidence intervals are shown. For figures with 95% CIs, see Supplementary Figure 1D. Abbreviations: CAC, coronary artery calcium scan; CCTA, coronary computed tomography angiography; FRS, Framingham risk score; SIS, segment involvement score; SSS, segment severity score.
Figure 2.
Figure 2.
Incidence rates of new subclinical CAD (upper panel) and mean annual increase of coronary CAC, SSS, and SIS scores (lower panel) in HIV+ and HIV- study participants, univariable analysis. The incidence rates (upper panel) shown here are tabulated in Supplementary Table 1. Abbreviations: CAC, coronary artery calcium scan; CCTA, coronary computed tomography angiography; SIS, segment involvement score; SSS, segment severity score.
Figure 3.
Figure 3.
Adjusted incidence rate ratio of new subclinical CAD in HIV+ and HIV- study participants. Abbreviation: CAC, coronary artery calcium scan.
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