Cardiovascular Risk Factors and Illicit Drug Use May Have a More Profound Effect on Coronary Atherosclerosis Progression in People Living with HIV

Objectives: To assess whether HIV infection directly or indirectly promotes coronary artery disease (CAD) volume progression in a longitudinal study of African Americans.

Methods: We randomly selected 300 individuals with subclinical CAD (210 male; age: 48.0 ± 7.2 years; 226 HIV infected, 174 cocaine users) from 1429 cardiovascularly asymptomatic participants of a prospective epidemiological study between May 2004 and August 2015. Individuals underwent coronary CT angiography at two time points (mean follow-up: 4.0 ± 2.3 years). We quantified noncalcified (NCP: -100-350HU), low-attenuation noncalcified (LA-NCP: -100-30HU), and calcified (CP: ≥ 351 HU) plaque volumes. Linear mixed models were used to assess the effects of HIV infection, atherosclerotic cardiovascular disease (ASCVD) risk, and years of cocaine use on plaque volumes.

Results: There was no significant difference in annual progression rates between HIV-infected and HIV-uninfected regarding NCP (8.7 [IQR: 3.0-19.4] mm/year vs. 4.9 [IQR: 1.5-18.3] mm/year, p = 0.14), LA-NCP (0.2 [IQR: 0.0-1.6] mm/year vs. 0.2 [IQR: 0.0-0.9] mm/year, p = 0.07) or CP volumes (0.3 [IQR: 0.0-3.4] mm/year vs. 0.1 [IQR: 0.0-3.2] mm/year, p = 0.30). Multivariately, HIV infection was not associated with NCP (-6.9mm, CI: [-32.8-19.0], p = 0.60), LA-NCP (-0.1mm, CI: [-2.6-2.4], p = 0.92), or CP volumes (-0.3mm, CI: [-9.3-8.6], p = 0.96). However, each percentage of ASCVD and each year of cocaine use significantly increased total, NCP, and CP volumes among HIV-infected individuals, but not among HIV-uninfected. Importantly, none of the HIV-associated medications had any effect on plaque volumes (p > 0.05 for all).

Conclusions: The more profound adverse effect of risk factors in HIV-infected individuals may explain the accelerated progression of CAD in these people, as HIV infection was not independently associated with any coronary plaque volume.

Key Points: • Human immunodeficiency virus-infected individuals may have similar subclinical coronary artery disease, as the infection is not independently associated with coronary plaque volumes. • However, cardiovascular risk factors and illicit drug use may have a more profound effect on atherosclerosis progression in those with human immunodeficiency virus infection, which may explain the accelerated progression of CAD in these people. • Nevertheless, through rigorous prevention and abstinence from illicit drugs, these individuals may experience similar cardiovascular outcomes as -uninfected individuals.