Short Communication: Predictive Value of HIV-Related Versus Traditional Risk Factors for Coronary Atherosclerosis in People Aging with HIV

BACKGROUND Cardiovascular disease (CVD) is an important cause of morbidity in people living with HIV (PLWH). We compared the predictive value of HIV-related and traditional CVD risk factors to assess which factors best predict the presence of subclinical coronary atherosclerosis in PLWH. METHODS Cross-sectional study in PLWH over 50 years of age who performed CT coronary artery calcium (CAC) scoring between 2009-2019 at Chelsea and Westminster Hospital. The following outcomes were analyzed: CAC=0 (no calcification), CAC >0 (any calcification), CAC >100 (moderate calcification) and CAC >400 (severe calcification). Univariate and multivariate logistic regression analyses were performed to assess predictors of coronary calcification. RESULTS A total of 744 patients were included (mean age 56 ± 5.7 years, 94.8% male, 84% white). A CAC >0 was found in 392 (52.7%), CAC >100 in 90 (12.1%) and CAC >400 in 42 (5.6%) subjects. CAC >100 was strongly associated with hypertension [odds ratio OR: 2.91, (95% confidence interval CI: 1.93-4.36), P 6 years) to protease inhibitors [1.67 (1.06-2.61), P =0.05] whereas exposure to tenofovir (> 8 years) was negatively associated with CAC >100 [0.54 (0.30-0.98), P =0.05]. Despite the high prevalence of hypertension (45.4%), only 21.5% were on anti-hypertensives whereas only 29.2% of eligible candidates were receiving lipid lowering drugs for primary prevention of CVD. CONCLUSIONS Traditional cardio-metabolic risk factors remain the strongest predictors of coronary atherosclerosis in PLWH as in the general population. These results underscore the importance of optimizing treatment of hypertension and promoting primary prevention strategies that may be underused in PLWH.