Longitudinal progression of subclinical coronary atherosclerosis in Swiss HIV-positive compared to HIV-negative persons undergoing coronary calcium score scan and CT angiography.

Background People living with HIV (HIV+) may have increased cardiovascular event rates compared to HIV-negative (HIV-) persons. Cross-sectional data from the US and Switzerland, based on coronary artery calcium scan (CAC) and coronary CT angiography (CCTA) suggest, respectively, increased and similar prevalence of subclinical atherosclerosis in HIV+ vs. HIV- persons. Methods We repeated CAC/CCTA in 340 HIV+ and 90 HIV- study participants >2 years after baseline CAC/CCTA. We assessed the association of HIV infection, Framingham risk score (FRS), and HIV-related factors with the progression of subclinical atherosclerosis. Results HIV+ were younger than HIV- participants (median age, 52 vs. 56 years; p<0.01), but had similar median 10-year FRS (8.9% vs. 9.0%; p=0.82); 94% had suppressed HIV viral load. In univariable and multivariable analyses, FRS was associated with the incidence rate ratio (IRR) of new subclinical atherosclerosis at the follow-up CAC/CCTA, but HIV infection was not: any plaque (adjusted IRR for HIV+ vs. HIV- participants, 1.21; 95% confidence interval, 0.62-2.35), calcified plaque (1.06; 0.56-2), non-calcified/mixed plaque (1.24; 0.69-2.21), and high-risk plaque (1.46; 0.66-3.20). Progression of CAC score between baseline and follow-up CAC/CCTA was similar in HIV+ (median annualized change [interquartile range], 0.41 [0-10.19]) and HIV- participants (2.38 [0-16.29]; p=0.11), as was progression of coronary segment severity score (HIV+, 0 [0-0.47]; HIV-, 0 [0-0.52]; p=0.10), and coronary segment involvement score (HIV+, 0 [0-0.45]; HIV-, 0 [0-0.41]; p=0.25). Conclusions In this longitudinal CAC/CCTA study from Switzerland, Framingham risk score was associated with progression of subclinical atherosclerosis, but HIV infection was not.