Early Identification of Atherosclerosis in People Living with HIV by Coronary Computed Tomography Angiography

TL;DR

People with HIV are more likely to develop early heart disease, and checking blood sugar and age can help detect it sooner.

Contribution

This study identifies early coronary artery disease in HIV-positive individuals using CTA and highlights age, HbA1c, and fasting blood sugar as key predictors.

Findings

20% of HIV-positive individuals showed coronary plaque compared to 7% in controls.

Age was the strongest predictor of plaque presence with an AUC of 0.899.

HbA1c and fasting blood sugar also predicted plaque, with cutoff values of 5.5 and 92.4 respectively.

Abstract

Background: The advancements in antiretroviral treatment (ART) have led to a 69% reduction in AIDS-related deaths. However, people living with HIV (PLWH) face age-related comorbitidies like coronary artery disease (CAD), which can be 50% higher compared to HIV-negative individuals. This study explores the prevalence and extent of early CAD in PLWH without a history of cardiovascular disease using computed tomography angiography (CTA). Methods: A 320-detector row CTA (Aquilion ONE, Canon Medical Systems) was utilized to determine prevalence of coronary atherosclerosis. Logistic regression analysis and ROC analysis were performed to predict risk factors for the presence of atherosclerosis. Results: A total of 186 individuals participated in this study, including 74 PLWH and 112 HIV-seronegative controls. A notable disparity in the occurrence of coronary atherosclerosis was observed between the two groups, with 20% of individuals in PLWH showing plaque in the coronary arteries as detected by CTA, compared to 7% in the control group (p = 0.015). In the plaque group, a significant increase in age was observed (p = 0.001) along with elevated levels of fasting blood glucose and hemoglobin A1c (p < 0.001 and p = 0.017 respectively). HIV seropositivity and age were significantly associated with the presence of plaque (aOR, 5.5 [95% CI, 1.7–25.8] and 21.7 [95% CI, 5.5–88] respectively). When evaluating age, fasting blood sugar and HbA1c through ROC analysis to predict plaque presence, age is the strongest predictor, with an AUC of 0.899 (p < 0.001, 95% CI: 0.847–0.939) and a cutoff value of 35 years. Additionally, HbA1c and fasting blood sugar had an AUC of 0.664 (p = 0.0047, 95% CI: 0.574–0.746) and 0.759 (p < 0.001, 95% CI: 0.688–0.822) respectively. Youden cutoff values were 5.5 for HbA1c and 92.4 for fasting blood sugar. Conclusions: The higher prevalence of CAD in PLWH may indicate that inflammation is a substantial risk. It is important to remember that CAD can develop early in PLWH. Moreover, including HbA1c and fasting blood sugar measurements in routine follow-up may help facilitate earlier detection of atherosclerosis.

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