HIV Is Associated With Subclinical Coronary Atherosclerosis: A Prospective Matched Cohort Study

Background. Persons with HIV (PWH) have an elevated risk of myocardial infarction compared to the general population. However, the underlying mechanisms linking HIV with this increased risk remain unclear. We aimed to compare the prevalence and characteristics of subclinical coronary atherosclerosis in PWH with population controls. Methods. Participants were included from the Copenhagen Comorbidity in HIV Infection study and the Copenhagen General Population Study. Presence of any and obstructive subclinical coronary atherosclerosis (≥50% stenosis) were assessed using coronary computed tomography angiography. Analyses were adjusted for cardiovascular risk factors including age, sex, hypertension, dyslipidemia, current smoking, overweight or obesity, and diabetes. Results. We included 519 PWH and 1114 age and sex-matched population controls. The median age was 52 years, and 89% of participants were men. The cardiovascular risk, evaluated by the Systematic COronary Risk Evaluation 2 prediction algorithm, was similar in PWH and population controls. PWH exhibited a higher prevalence of both any (54% vs 42%, P < .001) and obstructive coronary atherosclerosis (16% vs 8%, P < .001) than population controls. After adjusting for cardiovascular risk factors, HIV was associated with an odds ratio of 1.98 [95% confidence interval, 1.52–2.58] of any coronary atherosclerosis, and odds ratio of 3.21 [2.00–5.17] of obstructive atherosclerosis. Conclusions. HIV is independently associated with a three-fold higher risk of subclinical obstructive coronary atherosclerosis. Our results offer a possible explanation for the higher risk of myocardial infarction observed in PWH.