Coronary artery plaque progression and cardiovascular risk scores in men with and without HIV-infection.

OBJECTIVE: To assess the association of cardiovascular disease (CVD) risk scores and coronary artery plaque (CAP) progression in HIV-infected participants.

METHODS: We studied men with and without HIV-infection enrolled in the Multicenter AIDS Cohort Study (MACS) CVD study. Coronary artery plaque (CAP) at baseline and follow-up was assessed with cardiac computed tomography angiography (CCTA). We examined the association between baseline risk scores including pooled cohort equation (PCE), Framingham risk score (FRS) and Data collect of Adverse effects of anti-HIV drugs equation (D:A:D) and CAP progression.

RESULTS: We studied 495 men (211 HIV-uninfected, 284 HIV-infected). The adjusted odds ratio (aOR) of total plaque volume (TPV) and non-calcified plaque volume (NCPV) progression in the highest relative to lowest tertile was 9.4 (95% CI 2.4, 12.1, p < 0.001) and 7.7 (3.1,19.1, p < 0.001) times greater, respectively, among HIV-uninfected men in the PCE atherosclerotic cardiovascular disease (ASCVD) high vs. low risk category. Among HIV-infected men, the association for TPV and NCPV progression for the same PCE risk categories, OR 2.8 (1.4, 5.8, p < 0.01) and OR 2.4 (1.2, 4.8, p < 0.05) respectively (p-values for interaction by HIV = 0.02 and 0.08, respectively). Similar results were seen for the FRS risk scores. Among HIV-uninfected men, PCE high risk category identified the highest proportion of men with plaque progression in the highest tertile. While, in HIV-infected men, high risk category by D:A:D identified the greatest percentage of men with plaque progression albeit with lower specificity than FRS and PCE.

CONCLUSIONS: PCE and FRS categories predict CAP progression better in HIV-uninfected compared to HIV-infected men. Improved CVD risk scores are needed to identify high risk HIV-infected men for more aggressive CVD risk prevention strategies.