HIV is independently associated with a significantly increased risk of subclinical coronary atherosclerosis, including obstructive plaque, even after controlling for traditional cardiovascular risk factors, according to a new prospective cohort study.
In a matched analysis from two large Danish cohorts, researchers evaluated 519 persons with HIV (PWH) and 1,114 age- and sex-matched controls from the general population. Using coronary computed tomography angiography, the study examined both the presence and severity of coronary atherosclerosis in participants without known cardiovascular disease.
Despite having a similar overall cardiovascular risk profile, based on the Systematic Coronary Risk Evaluation 2 algorithm, PWH demonstrated a notably higher prevalence of any coronary atherosclerosis (54% vs 42%), and obstructive lesions defined as ≥50% stenosis (16% vs 8%) compared with controls. Both differences were statistically significant (P <0.001). Importantly, after adjustment for age, sex, hypertension, dyslipidemia, smoking, overweight or obesity, and diabetes, HIV infection remained strongly associated with coronary disease. The adjusted odds ratio (OR) for any atherosclerosis was 1.98 (95% CI, 1.52–2.58), and for obstructive atherosclerosis, the OR rose to 3.21 (95% CI, 2.00–5.17), suggesting that HIV infection may act as an independent risk enhancer. These findings provide critical insights into the potential mechanisms behind the increased rate of myocardial infarction observed in people living with HIV, and they support early and more intensive cardiovascular screening in this population. As antiretroviral therapy continues to improve long-term survival, cardiovascular health has become a growing concern for aging PWH, underscoring the importance of understanding and addressing non-infectious comorbidities. Further research is warranted to explore the role of inflammation, immune activation, and antiretroviral therapy in the pathogenesis of coronary plaque development in this group. Reference: Knudsen AD et al. HIV Is Associated With Subclinical Coronary Atherosclerosis: A Prospective Matched Cohort Study. Clin Infect Dis. 2025:ciae609. doi: 10.1093/cid/ciae609. [Online ahead of print]
