HIV Infection Tied to Early Subclinical Atherosclerosis

By Will Boggs MD

December 03, 2019

NEW YORK (Reuters Health) - HIV infection is associated with an increased prevalence of subclinical atherosclerosis, especially in younger age groups, according to data from an ongoing study in China.

"The early initiation of atherosclerosis owing to HIV infection among young adults strongly underscores the need for early screening of atherosclerosis and interventions for people with HIV," Dr. Na He of Fudan University, in Shanghai, told Reuters Health by email.

With the increasing life expectancy of people with HIV, cardiovascular disease has emerged as a leading cause of morbidity and mortality. HIV infection and the drugs used to treat it have adverse effects on the metabolic mechanisms that contribute to atherosclerosis, but studies on the relationship between HIV infection and subclinical atherosclerosis have yielded conflicting results.

Dr. He's team used data from the Comparative HIV and Aging Research in Taizhou (CHART) cohort to evaluate the association of HIV infection with subclinical atherosclerosis, as defined by carotid intima-media thickness (cIMT) of at least 780 um.

The prevalence of subclinical atherosclerosis was significantly higher among the 1,425 HIV-positive individuals than among the 2,850 HIV-negative individuals (36.1% vs. 27.5%, P<0.0001), the team reports in The Lancet HIV, online October 18.

The prevalence of subclinical atherosclerosis was significantly higher in HIV-positive than in HIV-negative individuals in age groups 18-29 years (16.0% vs. 2.5%), 30-44 years (24.0% vs. 14.4%) and 45-59 years (46.6% vs. 37.6%), but not in the age group 60-75 years (66.5% vs. 66.1%).

Independent of sex and Framingham risk score, HIV infection was associated with 8.84-fold higher odds of subclinical atherosclerosis in the 18-29-years age group, 2.09-fold higher odds in the 30-44-years age group, and 54% higher odds in the 45-59-years age group. The odds were not significantly increased in the 60-75-years age group.

Among HIV-positive individuals, cIMT was not significantly associated with transmission route, years since HIV diagnosis, nadir or current CD4 cell count, treatment status, or HIV RNA less than 200 copies per mL.

"More longitudinal studies and clinical trials are needed to inform updates of current clinical guidelines for atherosclerosis and/or atherosclerotic cardiovascular disease treatment and care," Dr. He said.

"Recommending standard preventive measures for people with HIV, which are outlined in major guidelines and recommended for the general population, intuitively makes sense, but it seems necessary that people with HIV should have earlier and more aggressive interventions to reduce HIV-related cardiovascular disease risk beyond suppressive antiretroviral therapy (ART)," writes Dr. Esteban Martinez of Hospital Clinic and the University of Barcelona, Spain, in a linked editorial.

"The well-powered REPRIEVE study, the largest clinical trial ever done in HIV-positive patients, will test whether administration of a statin (pitavastatin) to people with HIV with a low cardiovascular risk will have an effect on major cardiovascular events, subclinical atherosclerosis, inflammatory biomarkers, non-AIDS comorbidities other than cardiovascular disease, and death," he notes. "If the results of the REPRIEVE study are favorable, they will dramatically affect the prevention of cardiovascular disease in people with HIV and establish a new standard in the clinical care of this population."

Dr. David B. Hanna of Albert Einstein College of Medicine, in New York City, who has studied cardiovascular disease among people with HIV, told Reuters Health by email, "The study adds to the growing evidence that HIV plays a major role in the development of atherosclerotic cardiovascular disease that is independent of the effects of traditional cardiovascular disease risk factors that are often common in people living with HIV and that manifest in the course of aging."

"Physicians should recognize that HIV-positive patients are at increased risk of cardiovascular disease," said Dr. Hanna, who was not involved in the new work. "This cross-sectional study suggests that this increased risk may extend even to young adults. However, longitudinal studies of clinical cardiovascular disease outcomes are needed to confirm this."

The study had no commercial funding.


Lancet HIV 2019.