Higher Prevalence of Noncalcified Coronary Plaque Found in People Living with HIV

1. Compared to HIV-negative individuals, people living with HIV (PLHIV) had a greater prevalence of noncalcified coronary plaque, but comparable prevalence of coronary artery calcium (CAC).

Evidence Rating Level: 2 (Good)

The lifespan of people living with HIV infection (PLHIV) is increasing due to the effectiveness of antiretroviral therapy (ART). As a result, cardiovascular disease (CVD) is now emerging as a leading health concern for PLHIV, due to CVD risk factors such as chronic HIV infection, inflammation, and ART’s effects on cardiometabolic disease. Previous research has not established a conclusive association between HIV status and coronary artery calcium (CAC) or noncalcified coronary plaque. Therefore, the current systematic review and meta-analysis aimed to examine the evidence on the burden of CAC and coronary plaque in PLHIV compared to HIV-negative individuals. The study included 27 observational studies, 15 of which recruited both HIV-positive and HIV-negative patients, with the mean age of the PLHIV patients being 6 years younger. Overall, the study found no significant difference between the groups for prevalence of CAC, after adjusting for Framingham Risk Score. Contrastingly, the prevalence of noncalcified plaque was 29% greater in PLHIV. Because noncalcified plaque is considered to be at greater risk for rupture, these findings have implications for screening PLHIV for CVD at younger ages, considering that the PLHIV cohort was younger than the control patients on average. However, this study was limited in that there were no data on outcomes, such as prevalence of heart attacks or death from CVD.

Click here to read the article in the Journal of the American Heart Association

Relevant Reading: Subclinical coronary atherosclerosis, HIV infection and antiretroviral therapy: Multicenter AIDS Cohort Study

In-Depth [systematic review and meta-analysis]: In total, there were 10,867 patients (6699 HIV-positive and 4168 HIV-negative). The mean±SD age was 49±5 years and 57±5 years for the HIV-positive and HIV-negative groups respectively. The prevalence of diabetes mellitus and hypertension were similar between HIV-positive and negative groups (9±4% versus 13±3% for diabetes and 30±13% versus 43±15% for hypertension), although the prevalence of smoking was higher in the HIV-positive group (45±18% versus 20±14%). As well, the mean Framingham Risk Score (FRS) was significantly lower in the HIV-positive group (6±3 versus 18±5, p < 0.001). In terms of CAC, the percentage of patients with any presence of CAC was 45% (95% CI 43-47%) and 52% (95% CI 50-53%) in HIV-positive and negative patients respectively. There was no difference after adjusting for FRS score (p = 0.23). In terms of noncalcified coronary plaque, the pooled estimate for prevalence of plaque was higher for HIV-positive patients, at 49% (95% CI 47-52%) versus 20% (95% CI 17-23%), with an odds ratio of 1.23 (95% CI 1.08-1.38). In conclusion, people living with HIV had a greater prevalence of noncalcified coronary plaque, but comparable prevalence of coronary artery calcium.

Image: PD

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