Cardiovascular risk factors and illicit drug use may have a more profound effect on coronary atherosclerosis progression in people living with HIV

To assess whether HIV infection directly or indirectly promotes coronary artery disease (CAD) volume progression in a longitudinal study of African Americans. We randomly selected 300 individuals with subclinical CAD (210 male; age: 48.0 ± 7.2 years; 226 HIV infected, 174 cocaine users) from 1429 cardiovascularly asymptomatic participants of a prospective epidemiological study between May 2004 and August 2015. Individuals underwent coronary CT angiography at two time points (mean follow-up: 4.0 ± 2.3 years). We quantified noncalcified (NCP: -100-350 HU), low-attenuation noncalcified (LA-NCP: -100-30 HU), and calcified (CP: ≥ 351 HU) plaque volumes. Linear mixed models were used to assess the effects of HIV infection, atherosclerotic cardiovascular disease (ASCVD) risk, and years of cocaine use on plaque volumes. There was no significant difference in annual progression rates between HIV-infected and HIV-uninfected regarding NCP (8.7 [IQR: 3.0-19.4] mm${}^3$/year vs. 4.9 [IQR: 1.5-18.3] mm${}^3$/year, p = 0.14), LA-NCP (0.2 [IQR: 0.0-1.6] mm${}^3$/year vs. 0.2 [IQR: 0.0-0.9] mm${}^3$/year, p = 0.07) or CP volumes (0.3 [IQR: 0.0-3.4] mm${}^3$/year vs. 0.1 [IQR: 0.0-3.2] mm${}^3$/year, p = 0.30). Multivariately, HIV infection was not associated with NCP (- 6.9mm${}^3$, CI: [-32.8-19.0], p = 0.60), LA-NCP (- 0.1mm${}^3$, CI: [-2.6-2.4], p = 0.92), or CP volumes (- 0.3mm${}^3$, CI: [-9.3-8.6], p = 0.96). However, each percentage of ASCVD and each year of cocaine use significantly increased total, NCP, and CP volumes among HIV-infected individuals, but not among HIV-uninfected. Importantly, none of the HIV-associated medications had any effect on plaque volumes (p > 0.05 for all). The more profound adverse effect of risk factors in HIV-infected individuals may explain the accelerated progression of CAD in these people, as HIV infection was not independently associated with any coronary plaque volume.