Introduction: HIV infected (HIV+) persons are surviving longer due to effective antiretroviral therapy (ART). CVD has emerged as a leading cause of non-AIDS related events. The purpose of this study was to determine factors associated with progression of coronary stenosis.
Methods: We performed serial coronary CT angiography among men in the Multicenter AIDS Cohort Study (MACS); median inter-scan interval was 4.5 yrs. Extent of stenosis was graded visually in each coronary segment as 0, 1-29, 30-49, 50-69 or ≥70%. Progression was defined as an increase ≥ 2 stenosis categories among segments with baseline stenosis <50%. Suppressed HIV infection (SUP) was defined as consistent viral load <50 copies/mL between CT scans allowing 1 “blip” <500 copies/mL, otherwise categorized as viremic HIV infection (VIR). Multilevel Poisson regression analysis was used to determine the association between HIV and progression of coronary stenosis within coronary segments, adjusting for demographics, medication use, and CVD risk factors.
Results: The sample included 6505 coronary segments from 302 HIV+ (70% SUP, 30% VIR) and 229 HIV uninfected (HIV-) men. Mean baseline age was 54 yrs (53 SUP, 51 VIR, 56 HIV-), 30% were black (26% SUP, 53% VIR, 24% HIV-) and 26% current smokers (27% SUP, 41% VIR, 19% HIV-). VIR men reported ART use during 82% of semi-annual visits between CT scans vs 95% for SUP men. The incidence of stenosis progression was 0.5 per 100 segment-years in SUP, 0.8 in VIR, and 0.4 in HIV-. There was no difference in coronary stenosis progression among SUP men compared with HIV- men [incidence ratio (IR) 1.2, p=0.37]. However, there was a three-fold increase in progression of coronary stenosis among VIR men compared with HIV- men (IR 3.1, p<0.001). Progression was also independently associated with older age, white race, cigarette smoking, higher total and lower HDL cholesterol, and statin use (all p< 0.05).
Conclusions: These results demonstrate that progression of coronary atherosclerosis correlates with suboptimal HIV suppression as well as traditional CVD risk factors and emphasizes the importance of aggressive CVD risk factor modification. These data also suggest a need to achieve effective viremia suppression to mitigate this increase in risk among HIV+ persons.