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Clinical Trial
. 2024 Apr 26;11(5):ofae234.
doi: 10.1093/ofid/ofae234. eCollection 2024 May.

Coronary Microvascular Dysfunction Is Present Among Well-Treated Asymptomatic Persons With HIV and Similar to Those With Diabetes

Suman Srinivasa  1 , Allie R Walpert  1 , Daniel Huck  2   3 , Teressa S Thomas  1 , Carolyn N Dunderdale  1 , Hang Lee  4 , Marcelo F Dicarli  2 , Gail K Adler  5 , Steven K Grinspoon  1
Affiliations
Clinical Trial

Coronary Microvascular Dysfunction Is Present Among Well-Treated Asymptomatic Persons With HIV and Similar to Those With Diabetes

Suman Srinivasa et al. Open Forum Infect Dis. .

Abstract

Background: Coronary microvascular dysfunction (CMD) could be a potential underlying mechanism for myocardial disease in HIV.

Methods: Comparisons of coronary flow reserve corrected for heart rate-blood pressure product (CFRCOR) were made among people with HIV (PWH) with no known history of cardiovascular disease (CVD) or diabetes mellitus, persons without HIV (PWOH), and persons with diabetes (PWDM) and no known history of CVD or HIV.

Results: PWH (n = 39, 74% male, age 55 [7] years, body mass index [BMI] 32.3 (26.8-34.9) kg/m2, duration of antiretroviral therapy 13 [5] years, CD4+ count 754 [598-961] cells/μL) were similar to PWOH (n = 69, 74% male, age 55 [8] years, BMI 32.2[25.6-36.5] kg/m2) and PWDM (n = 63, 63% male, age 55 [8] years, BMI 31.5 [28.6-35.6] kg/m2). CFRCOR was different among groups: PWOH 2.76 (2.37-3.36), PWH 2.47 (1.92-2.93), and PWDM 2.31 (1.98-2.84); overall P = .003. CFRCOR was reduced comparing PWH to PWOH (P = .04) and PWDM to PWOH (P = .007) but did not differ when comparing PWH to PWDM (P = .98). A total 31% of PWH had CFRCOR < 2.0, a critical cutoff for CMD, compared to 14% of PWOH and 27% with PWDM. A total 40% of women with HIV had a CFRCOR < 2.0 compared to 6% of women without HIV (P = .02).

Conclusions: Subclinical CMD is present among chronically infected and well-treated, asymptomatic PWH who are immunologically controlled. This study demonstrates CFR is reduced in PWH compared to PWOH and comparable to PWDM, further highlighting that well-treated HIV infection is a CVD-risk enhancing factor for CMD similar to diabetes. Clinical Trials Registration: NCT02740179.

Keywords: HIV; coronary flow reserve; myocardial blood flow; myocardial dysfunction.

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Conflict of interest statement

Potential conflicts of interest. S. S. was the recipient of a Gilead Sciences Research Scholars award. S K. G. has received research funding from KOWA, Gilead, ViiV, and Theratechnologies, received consulting fees from Theratechnologies and ViiV, and is a member of the Scientific Advisory Board of Marathon Asset Management. All disclosures are unrelated to this manuscript. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Coronary microvascular dysfunction among persons with HIV. Global CFR corrected for heart rate-blood pressure product (CFRCOR) as assessed on coronary PET among persons without HIV/DM, persons with HIV, and persons with DM. Box plot represents the 25th and 75th percentile and line within the box represents the median. Dots represent data for each participant. Overall group comparison was made using the Kruskal-Wallis Test. Paired comparisons are made using Tukey-Kramer. *P < .05.
See this image and copyright information in PMC

References

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