Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 31;10(7):ofad298.
doi: 10.1093/ofid/ofad298. eCollection 2023 Jul.

Coronary Artery Disease in Persons With Human Immunodeficiency Virus Without Detectable Viral Replication

Andreas D Knudsen  1   2 , Andreas Fuchs  2 , Thomas Benfield  3 , Jan Gerstoft  1 , Lars Køber  2 , Marius Trøseid  4 , Klaus F Kofoed  2   5 , Susanne D Nielsen  1
Affiliations

Coronary Artery Disease in Persons With Human Immunodeficiency Virus Without Detectable Viral Replication

Andreas D Knudsen et al. Open Forum Infect Dis. .

Abstract

Background: We aimed to determine the prevalence of coronary artery disease (CAD) in persons with human immunodeficiency virus (HIV; PWH) and investigate whether inflammatory markers, including interleukin 6, IL-1β, and high-sensitivity C-reactive protein (hsCRP), were associated with CAD.

Methods: From the Copenhagen Comorbidity in HIV Infection (COCOMO) study, we included virologically suppressed PWH who underwent coronary computed tomographic (CT) angiography. Any atherosclerosis was defined as >0% stenosis, and obstructive CAD as ≥50% stenosis.

Results: Among 669 participants (mean age [standard deviation], 51 [11] years; 89% male), 300 (45%) had atherosclerosis, and 119 (18%) had obstructive CAD. The following risk factors were associated with any atherosclerosis and with obstructive CAD: age, male sex, hypertension, diabetes, smoking, dyslipidemia, time with HIV, and current protease inhibitor use. Interleukin 6 (IL-6) and hsCRP levels >2 mg/L were associated with any atherosclerosis and with obstructive CAD in univariable analyses but not after adjustment for traditional risk factors. IL-1β was not associated with CAD.

Conclusions: In a large population of PWH without viral replication, almost half had angiographically verified atherosclerosis. High concentrations of IL-6 and hsCRP were associated with CAD in univariable analyses, but adjustment for cardiovascular risk factors attenuated the association, suggesting that inflammation may mediate the association between traditional risk factors and CAD.

Keywords: CCTA; HIV; comorbidity; coronary artery disease; inflammation.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. A. D. K has received grants from the Danish Heart Foundation and the European Commission (the European Union’s Seventh Framework Programme; grant 603266). T. B reports grants from the Novo Nordisk Foundation, the Lundbeck Foundation, the Simonsen Foundation, GSK, Pfizer, Gilead, the Kai Hansen Foundation, and Erik and Susanna Olesen's Charitable Fund and personal fees from GSK, Pfizer, Boehringer Ingelheim, Gilead, MSD, Pentabase, Becton Dickinson, Janssen, and Astra Zeneca, all outside the submitted work. L. K. has received speaker honoraria from Novo, Novartis, AstraZeneca, Boehringer, and Bayer, unrelated to the current work. K. F. K. has received research grants from AP Møller og Hustru Chastine McKinney Møllers Fond, the Research Council of Rigshopitalet, the University of Copenhagen, the Danish Heart Foundation, the Danish Agency for Science, Technology and Innovation of the Danish Council for Strategic Research, the Novo Nordisk Foundation, Canon Medical Systems, and GE Healthcare. S. D. N. has received unrestricted research grants from the Novo Nordisk Foundation, the Lundbeck Foundation, the Augustinus Foundation, and the Rigshospitalet Research Council and reports advisory board activity for Gilead and GSK/ViiV, all unrelated to the current work. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Coronary Artery Disease Reporting and Data System (CAD-RADS) assessment category definitions with examples [13]. The CAD-RADS category is based on the maximum diameter stenosis in coronary segments with diameter ≥ 1.5 mm. Segments were defined according to the segmental anatomy of the coronary arteries outlined by the Society of Cardiovascular Computed Tomography. Abbreviations CAD, coronary artery disease: LM: Left main,.
Figure 2.
Figure 2.
Distribution of coronary artery disease (CAD) among well-treated persons with human immunodeficiency virus. A, Coronary Artery Disease Reporting and Data System (CAD-RADS) categories for each of the 669 study participants. B, Histogram showing the number of coronary segments with atherosclerosis among participants with atherosclerosis irrespective of stenosis grade (segment involvement score). Segments were defined according to the segmental anatomy of the coronary arteries outlined by the Society of Cardiovascular Computed Tomography [13]. Abbreviation: CABG, coronary artery bypass graft.
Figure 3.
Figure 3.
Coronary artery disease (CAD) stratified by Framingham risk scores. Any atherosclerosis was defined as ≥1% coronary artery stenosis; obstructive CAD, as ≥50% coronary artery stenosis. Low risk was defined as <10%, intermediate risk as ≥10% and <20%, and high risk as ≥20%.
See this image and copyright information in PMC

References

    1. Feinstein MJ, Hsue PY, Benjamin LA, et al. . Characteristics, prevention, and management of cardiovascular disease in people living with HIV: a scientific statement from the American Heart Association. Circulation 2019; 140:e98–e124. - PMC - PubMed
    1. Nou E, Lo J, Grinspoon SK. Inflammation, immune activation, and cardiovascular disease in HIV. AIDS 2016; 30:1495–509. - PMC - PubMed
    1. Duprez DA, Neuhaus J, Kuller LH, et al. . Inflammation, coagulation and cardiovascular disease in HIV-infected individuals. PLoS One 2012; 7:e44454. - PMC - PubMed
    1. Subramanian S, Tawakol A, Burdo TH, et al. . Arterial inflammation in patients with HIV. JAMA 2012; 308:379–86. - PMC - PubMed
    1. Knudsen A, Hag AM, Loft A, et al. . HIV Infection and arterial inflammation assessed by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET): a prospective cross-sectional study. J Nucl Cardiol 2015; 22:372–80. - PMC - PubMed