Suboptimal HIV suppression is associated with progression of coronary artery stenosis: The Multicenter AIDS Cohort Study (MACS) longitudinal coronary CT angiography study

Abstract

Background and aims: People living with HIV (HIV+) are surviving longer due to effective antiretroviral therapy. Cardiovascular disease is a leading cause of non-AIDS related clinical events. We determined HIV-related factors associated with coronary artery stenosis progression.

Methods: We performed serial coronary CT angiography among HIV+ and HIV-uninfected (HIV-) men in the Multicenter AIDS Cohort Study. The median inter-scan interval was 4.5 years. Stenosis was graded as 0, 1-29, 30-49, 50-69 or ≥70%. Progression was defined as an increase ≥2 categories. Suppressed HIV infection was consistent viral loads <50 copies/mL allowing 1 "blip" <500 copies/mL, otherwise considered viremic. Multivariable Poisson regression analysis assessed adjusted associations between HIV serostatus and viremia with coronary stenosis progression.

Results: The sample included 310 HIV+ (31% viremic) and 234 HIV- men. The median age was 53 years, 30% Black and 23% current smokers. Viremic men were 2.3 times more likely to develop coronary stenosis progression than HIV- men (adjusted RR 2.30; 95% CI, 1.32-4.00, p = 0.003), with no difference in progression between HIV+ suppressed and HIV- men (RR 1.10; 95% CI, 0.70-1.74, p = 0.67). There was a progressive increase in adjusted relative risk with greater viremia (p = 0.03). Men with >1 viral load >500 copies/ml demonstrated greatest stenosis progression (RR 3.01; 95% CI, 1.53-4.92, p = 0.001 compared with HIV- men). Suppressed HIV+ men with suboptimal antiretroviral adherence had greater stenosis progression (RR 1.91; 95% CI 1.12-3.24, p = 0.02) than HIV + suppressed men with optimal adherence.

Conclusions: Coronary artery stenosis progression was associated with suboptimal HIV RNA suppression and antiretroviral therapy adherence. Effective ongoing HIV virologic suppression and antiretroviral therapy adherence may mitigate risk for coronary disease events among people living with HIV.

Keywords: Atherosclerosis; Coronary CT angiography; Coronary artery disease; Epidemiology; HIV.

Figure 1.. Participant flow diagram.

The participant flow diagram is displayed. eGFR=estimate glomerular filtration rate; ^aparticipant excluded due to low eGFR documented between baseline CTA and enrollment screening for the follow-up CTA scan; ^bparticipant was enrolled for follow-up scan, but did not receive contrast CTA due to low eGFR at the study visit.

Figure 2.. Adjusted relative risk of stenosis progression by HIV viremic group.

The adjusted relative risks for coronary artery stenosis progression are presented. Relative risks are adjusted for age, race, education, study site, cohort enrollment date, interval scan time, CVD risk factors and cocaine use. Upper panel (A) sample sizes by outcome: 1) segment-level stenosis, HIV+ Viremic=1,299 segments/98 ids, HIV+ suppressed=2,793 segments/212 ids, and HIV−=3,104 segments/234 ids, 2) incident stenosis, HIV+ Viremic=85, HIV+ Suppressed=180, and HIV−=203, and 3) vessel-involvement progression, HIV+ Viremic=97, HIV+ Suppressed=211, and HIV−=230. HIV=human immunodeficiency virus, RR=relative risk, VL=viral load.