. 2024 May 3;3(6):100968.

doi: 10.1016/j.jacadv.2024.100968. eCollection 2024 Jun.

Coronary Plaque in People With HIV vs Non-HIV Asymptomatic Community and Symptomatic Higher-Risk Populations

Julia Karady^{1

2}, Michael T Lu¹, Göran Bergström^{3

4}, Thomas Mayrhofer^{1

5}, Jana Taron^{1

6}, Borek Foldyna¹, Kayla Paradis¹, Sara McCallum⁷, Judith A Aberg⁸, Judith S Currier⁹, Kathleen V Fitch⁷, Evelynne S Fulda⁷, Gerald S Bloomfield¹⁰, Edgar T Overton¹¹, Lars Lind¹², Carl Johan Östgren^{13

14}, Olof Elvstam^{15

16}, Stefan Söderberg¹⁷, Tomas Jernberg¹⁸, Rosalie Pepe¹⁹, Michael P Dubé²⁰, David Mushatt²¹, Carl J Fichtenbaum²², Carlos Malvestutto²³, Markella V Zanni⁷, Udo Hoffmann^{1

24}, Heather Ribaudo²⁵, Steven K Grinspoon⁷, Pamela S Douglas¹⁰

Affiliations

¹ Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA.
² Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
³ Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁴ Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
⁶ Faculty of Medicine, Department of Radiology, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany.
⁷ Metabolism Unit, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA.
⁸ Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁹ Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
¹⁰ Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
¹¹ Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹² Division of Clinical Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
¹³ Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
¹⁴ Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
¹⁵ Department of Translational Medicine, Lund University, Malmö, Sweden.
¹⁶ Department of Infectious Diseases, Växjö Central Hospital, Växjö, Sweden.
¹⁷ Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁸ Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
¹⁹ Cooper University Hospital, Camden, New Jersey, USA.
²⁰ Division of Infectious Diseases, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
²¹ Section of Infectious Disease, Tulane School of Medicine, New Orleans, Louisiana, USA.
²² Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA.
²³ Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
²⁴ Innovative Imaging Consulting LLC, Boston, Massachusetts, USA.
²⁵ Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

PMID: 38938873
PMCID: PMC11198107
DOI: 10.1016/j.jacadv.2024.100968

Coronary Plaque in People With HIV vs Non-HIV Asymptomatic Community and Symptomatic Higher-Risk Populations

Julia Karady et al. JACC Adv. 2024.

. 2024 May 3;3(6):100968.

doi: 10.1016/j.jacadv.2024.100968. eCollection 2024 Jun.

Authors

Affiliations

¹ Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA.
² Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
³ Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁴ Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
⁶ Faculty of Medicine, Department of Radiology, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany.
⁷ Metabolism Unit, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA.
⁸ Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁹ Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
¹⁰ Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
¹¹ Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹² Division of Clinical Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
¹³ Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
¹⁴ Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
¹⁵ Department of Translational Medicine, Lund University, Malmö, Sweden.
¹⁶ Department of Infectious Diseases, Växjö Central Hospital, Växjö, Sweden.
¹⁷ Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁸ Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
¹⁹ Cooper University Hospital, Camden, New Jersey, USA.
²⁰ Division of Infectious Diseases, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
²¹ Section of Infectious Disease, Tulane School of Medicine, New Orleans, Louisiana, USA.
²² Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA.
²³ Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
²⁴ Innovative Imaging Consulting LLC, Boston, Massachusetts, USA.
²⁵ Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

PMID: 38938873
PMCID: PMC11198107
DOI: 10.1016/j.jacadv.2024.100968

Abstract

Background: People with HIV (PWH) have a high burden of coronary plaques; however, the comparison to people without known HIV (PwoH) needs clarification.

Objectives: The purpose of this study was to determine coronary plaque burden/phenotype in PWH vs PwoH.

Methods: Nonstatin using participants from 3 contemporary populations without known coronary plaques with coronary CT were compared: the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) studying PWH without cardiovascular symptoms at low-to-moderate risk (n = 755); the SCAPIS (Swedish Cardiopulmonary Bioimage Study) of asymptomatic community PwoH at low-to-intermediate cardiovascular risk (n = 23,558); and the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) of stable chest pain PwoH (n = 2,291). The coronary plaque prevalence on coronary CT was compared, and comparisons were stratified by 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and coronary artery calcium (CAC) presence.

Results: Compared to SCAPIS and PROMISE PwoH, REPRIEVE PWH were younger (50.8 ± 5.8 vs 57.3 ± 4.3 and 60.0 ± 8.0 years; P < 0.001) and had lower ASCVD risk (5.0% ± 3.2% vs 6.0% ± 5.3% and 13.5% ± 11.0%; P < 0.001). More PWH had plaque compared to the asymptomatic cohort (48.5% vs 40.3%; P < 0.001). When stratified by ASCVD risk, PWH had more plaque compared to SCAPIS and a similar prevalence of plaque compared to PROMISE. CAC = 0 was more prevalent in PWH (REPRIEVE 65.2%; SCAPIS 61.6%; PROMISE 49.6%); among CAC = 0, plaque was more prevalent in PWH compared to the PwoH cohorts (REPRIEVE 20.8%; SCAPIS 5.4%; PROMISE 12.3%, P < 0.001).

Conclusions: Asymptomatic PWH in REPRIEVE had more plaque than asymptomatic PwoH in SCAPIS but had similar prevalence to a higher-risk stable chest pain cohort in PROMISE. In PWH, CAC = 0 does not reliably exclude plaque.

Keywords: asymptomatic community cohort; cardiovascular disease; coronary CT angiography; coronary plaque; people with HIV; stable chest pain.

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Conflict of interest statement

10.13039/100000002This paper received NIH grants U01HL123336 to the REPRIEVE Clinical Coordinating Center and U01HL123339 to the REPRIEVE Data Coordinating Center, as well as funding from Kowa Pharmaceuticals, Gilead Sciences, and ViiV Healthcare. The 10.13039/100000060National Institute of Allergy and Infectious Diseases (NIAID) supported this study through grants UM1 AI068636, which supports the AIDS Clinical Trials Group (ACTG) Leadership and Operations Center, and UM1 AI106701, which supports the ACTG Laboratory Center. The PROMISE trial was supported by the 10.13039/100000050National Heart, Lung, and Blood Institute (R01HL098237, R01HL098236, R01HL98305, and R01HL098235). The SCAPIS trial received funding from the Swedish Heart-Lung Foundation, Knut and Alice Wallenberg Foundation, Swedish Research Council and Vinnova (Sweden’s Innovation Agency), University of Gothenburg and Sahlgrenska University Hospital, Karolinska Institutet and Stockholm County Council, Linköping University and University Hospital, Lund University and Skåne University Hospital, Umeå University and University Hospital, and Uppsala University and University Hospital. The content of this manuscript is solely the responsibility of the authors and does not necessarily reflect the views of any of the funding agencies. Dr Lu has received funding to his institution from Kowa, AstraZeneca/MedImmune, Johnson & Johnson Innovation, Ionis, and the American Heart Association unrelated to this research. Dr Taron has received funding by Deutsche Forschungsgesellschaft (DFG, German Research Foundation) (TA 1438/1-2); is on Speakers Bureau for Siemens Healthcare GmbH and Bayer AG; and has received consulting fees from Universimed Cross Media Content GmbH and Core Lab Black Forrest GmbH, unrelated to this work. Dr Foldyna has received funding to his institution from AstraZeneca/MedImmune, MedTrace, and Eli Lilly unrelated to this research. Dr Currier served as an advisor to Merck. Dr Elvstam has received grants to his institution from Pfizer; and has received honoraria as a speaker from Gilead Sciences, unrelated to this research. Dr Dubé has received funding to his institution from Gilead Sciences unrelated to this research. Dr Fichtenbaum has received funding to the institution from ViiV Healthcare, Gilead Sciences, Merck, Cytodyn, and Moderna unrelated to this work and serves on the advisory board for ViiV Healthcare. Dr Malvestutto has received funding to his institution from Lilly; and has received consulting fees from Viiv Healthcare and Gilead Sciences unrelated to this work. Dr Zanni reports being PI on research grants from the NIH (NHLBI and NIAID) and Gilead Sciences to her institution. Dr Ribaudo has received grants from Kowa Pharmaceuticals during the conduct of the study, as well as grants from NIH/NIAID, NIH/NHLBI, NIH/NIDDK, and NIH/NIA, outside the submitted work. Dr Grinspoon reports being a part of the Scientific Advisory Board for Marathon Asset Management and consultant Theratechnologies is unrelated to this report; research funds come from Gilead, Viiv, and Kowa through his institution. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Figure 1**
Presence of Any Coronary Atherosclerotic Plaque in REPRIEVE vs SCAPIS vs PROMISE Participants Without Established Coronary Heart Disease as Stratified by Age (A) Total population. (B) Men. (C) Women. PROMISE = Prospective Multicenter Imaging Study for Evaluation of Chest Pain; REPRIEVE = Randomized Trial to Prevent Vascular Events in HIV; SCAPIS = Swedish Cardiopulmonary Bioimage Study.

**Figure 2**
**Presence of Any Noncalcified Coronary Atherosclerotic Plaque of REPRIEVE vs SCAPIS vs PROMISE Participants Without Established Coronary Heart Disease as Stratified by Age** ASCVD = atherosclerotic cardiovascular disease; CAD = coronary artery disease; PROMISE = Prospective Multicenter Imaging Study for Evaluation of Chest Pain; REPRIEVE = Randomized Trial to Prevent Vascular Events in HIV; SCAPIS = Swedish Cardiopulmonary Bioimage Study.

**Figure 3**
Presence of Any Coronary Atherosclerotic Plaque of REPRIEVE vs SCAPIS vs PROMISE Participants Without Established Coronary Heart Disease as Stratified by 10-Year Risk for Atherosclerotic Cardiovascular Disease PROMISE = Prospective Multicenter Imaging Study for Evaluation of Chest Pain; REPRIEVE = Randomized Trial to Prevent Vascular Events in HIV; SCAPIS = Swedish Cardiopulmonary Bioimage Study.

**Figure 4**
Prevalence of Any Atherosclerotic Plaque in the Subgroup with CAC = 0 (A) Stratified by Age. (B) Stratified by 10-year risk for atherosclerotic cardiovascular disease. ASCVD = atherosclerotic cardiovascular disease; CAC = coronary artery calcium score; CAD = coronary artery disease.

**Central Illustration**
Coronary Plaque in PWH vs PwoH Asymptomatic REPRIEVE PWH at low-to-intermediate cardiovascular risk had more prevalent coronary artery plaque compared to an asymptomatic community PwoH SCAPIS cohort at low cardiovascular risk, and similar prevalence of plaque When compared to an older, higher-risk stable chest pain PwoH PROMISE cohort. PROMISE = Prospective Multicenter Imaging Study for Evaluation of Chest Pain; PWH = people with HIV; PwoH = people without known HIV; REPRIEVE = Randomized Trial to Prevent Vascular Events in HIV; SCAPIS = Swedish Cardiopulmonary Bioimage Study.

See this image and copyright information in PMC

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Coronary Plaque in People With HIV vs Non-HIV Asymptomatic Community and Symptomatic Higher-Risk Populations

Affiliations

Coronary Plaque in People With HIV vs Non-HIV Asymptomatic Community and Symptomatic Higher-Risk Populations

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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