@article{99a3458ed5354be78b6f28a7210911f7,
title = "Suboptimal HIV suppression is associated with progression of coronary artery stenosis: The Multicenter AIDS Cohort Study (MACS) longitudinal coronary CT angiography study",
abstract = "Background and aims: People living with HIV (HIV+) are surviving longer due to effective antiretroviral therapy. Cardiovascular disease is a leading cause of non-AIDS related clinical events. We determined HIV-related factors associated with coronary artery stenosis progression. Methods: We performed serial coronary CT angiography among HIV+ and HIV-uninfected (HIV-) men in the Multicenter AIDS Cohort Study. The median inter-scan interval was 4.5 years. Stenosis was graded as 0, 1–29, 30-49, 50–69 or ≥70%. Progression was defined as an increase ≥2 categories. Suppressed HIV infection was consistent viral loads <50 copies/mL allowing 1 “blip” <500 copies/mL, otherwise considered viremic. Multivariable Poisson regression analysis assessed adjusted associations between HIV serostatus and viremia with coronary stenosis progression. Results: The sample included 310 HIV+ (31% viremic) and 234 HIV- men. The median age was 53 years, 30% Black and 23% current smokers. Viremic men were 2.3 times more likely to develop coronary stenosis progression than HIV- men (adjusted RR 2.30; 95% CI, 1.32–4.00, p = 0.003), with no difference in progression between HIV+ suppressed and HIV- men (RR 1.10; 95% CI, 0.70–1.74, p = 0.67). There was a progressive increase in adjusted relative risk with greater viremia (p = 0.03). Men with >1 viral load >500 copies/ml demonstrated greatest stenosis progression (RR 3.01; 95% CI, 1.53–4.92, p = 0.001 compared with HIV- men). Suppressed HIV+ men with suboptimal antiretroviral adherence had greater stenosis progression (RR 1.91; 95% CI 1.12–3.24, p = 0.02) than HIV + suppressed men with optimal adherence. Conclusions: Coronary artery stenosis progression was associated with suboptimal HIV RNA suppression and antiretroviral therapy adherence. Effective ongoing HIV virologic suppression and antiretroviral therapy adherence may mitigate risk for coronary disease events among people living with HIV.",
keywords = "Atherosclerosis, Coronary CT angiography, Coronary artery disease, Epidemiology, HIV",
author = "Post, {Wendy S.} and Haberlen, {Sabina A.} and Witt, {Mallory D.} and Long Zhang and Jacobson, {Lisa P.} and Brown, {Todd T.} and Margolick, {Joseph B.} and Lawrence Kingsley and Palella, {Frank J.} and Matthew Budoff",
note = "Funding Information: The risk for CVD events in people living with HIV is likely multifactorial, including 1) a high prevalence of traditional CVD risk factors, 2) heightened inflammatory response and immune dysregulation, and 3) metabolic side effects of some older ART agents [3]. People living with HIV were randomized to ART treatment interruption compared with continuous ART in the SMART study, which demonstrated the association between ART disruption and viremia, the association between inflammation and CVD events [20], and the increased risk for CVD events with viremia and treatment interruption [ 5,21]. The START study randomized people living with HIV to immediate versus deferred ART based on CD4+ T cell counts. Immediate therapy led to a lower risk of AIDS and non-AIDS serious events and mortality; however, there was no association with CVD events, likely due to limited power [22]. The heightened immune activation and inflammation present in the setting of HIV viremia demonstrated in these studies and others [23,24], are likely drivers contributing to coronary plaque progression and coronary artery stenosis. In addition, in vitro and animal studies suggest that specific viral proteins may have effects on endothelial function and contribute to the pathogenesis of coronary atherosclerosis [25,26]. The present study results support early and uninterrupted ART for people living with HIV to achieve durable viral suppression, which may reduce the risk of coronary artery stenosis progression, with vigilance required to address occurrences of suboptimal viral suppression and less than optimal adherence to cART. Although the number of people living with HIV who are prescribed ART and are virally suppressed has increased in recent years, there are still significant age and racial disparities, which need to be addressed [ 27–29]. It is also possible that men with viral suppression had better cardiovascular outcomes in part due to access and behaviors related to other predictors of slower atherosclerosis progression, such as diet, exercise, avoidance of unhealthy behaviors, and health care utilization that were not evaluated in our study. For example, men with viral suppression and adherence to cART, were more likely to receive lipid lowering medications than men less adherent to cART. Systemic factors that limit the ability to optimally address CVD risk factor modification and healthy behaviors need to be addressed.The MACS coronary CT angiography studies are funded by National Heart Lung and Blood Institute (NHLBI) RO1 HL095129 (Post) and R01 HL125053 (Post). Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS), now the MACS/WIHS Combined Cohort Study (MWCCS). U01-HL146201, U01-HL146193, U01-HL146245, U01-HL146240, U01-HL146333, U01-HL146208. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding NICHD, NIDCR, NIAID, NINDS, NIMH, NIDA, NINR, NCI, NIAAA, NIDCD, NIDDK, NIMHD. MWCCS data collection is also supported by UL1TR003098 (JHU ICTR), UL1- TR001881 (UCLA-CTSI). Funding Information: The MACS coronary CT angiography studies are funded by National Heart Lung and Blood Institute (NHLBI) RO1 HL095129 (Post) and R01 HL125053 (Post). Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS), now the MACS/WIHS Combined Cohort Study (MWCCS). U01-HL146201 , U01-HL146193 , U01-HL146245 , U01-HL146240 , U01-HL146333 , U01-HL146208 . The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute ( NHLBI ), with additional co-funding NICHD , NIDCR , NIAID , NINDS , NIMH , NIDA , NINR , NCI , NIAAA , NIDCD , NIDDK , NIMHD . MWCCS data collection is also supported by UL1TR003098 ( JHU ICTR ), UL1- TR001881 (UCLA- CTSI ). Publisher Copyright: {\textcopyright} 2022 Elsevier B.V.",
year = "2022",
month = jul,
doi = "10.1016/j.atherosclerosis.2022.04.019",
language = "English (US)",
volume = "353",
pages = "33--40",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",
}