Background
HIV is an established risk factor for coronary atherosclerotic disease (CAD) in the United States and Europe. However, data linking HIV infection with coronary atherosclerosis in the African region are lacking.
Methods
We enrolled people living with HIV (PWH) over 40 and on antiretroviral therapy (ART) for a minimum of three years from public-sector HIV clinics in Uganda. We then used population census data to recruit age- and sex-similar comparators without HIV (PWoH) from the same resident communities. Participants underwent cardiovascular disease (CVD) risk profiling and computed tomography (CT), including coronary artery calcium (CAC) scoring and coronary CT angiography (CCTA) for detection of CAD. Our primary outcome of interest was CAD, defined by presence of calcified or non-calcified plaque. Prespecified secondary outcomes were prevalence of non-calcified plaque, coronary artery segment involvement score, Agatston calcium score, and Coronary Artery Disease Reporting and Data System (CAD-RADS) Score. We fit multivariable regression models with HIV as the primary exposure of interest before and after adjustment for CVD risk factors or the atherosclerotic cardiovascular disease (ASCVD) risk score.
Results
Out of 627 eligible individuals recruited, 586 met inclusion criteria and had evaluable images for interpretation. 287 (49.0%) were PWH, of whom over half (52%) had a CD4 count >500 cells/uL and most of whom (272/287, 95%) were virologically suppressed. PWH and PWoH were similar in age (57 years), proportion female (49%) and median ASCVD 10-year risk scores (3.4 vs. 4.1, P=0.30). Prevalence of CAD was low overall (54/586, 7.7%) and similar between PWH (26/287, 9.1%) and PWoH (19/299, 6.4%; absolute difference 2.7%, 95%CI -1.6, 7.0%). Findings were similar in multivariable regression models adjusted for CVD risk factors (adjusted prevalence ratio for PWH vs. PWoH 1.57, 95%CI 0.90, 2.74, P=0.11). Among those with plaque, prevalence of non-calcified plaque was similar between groups (8/26, 30.8% vs 5/19, 26.3%, P=0.60). Only 3 (0.5%) participants had an Agatston calcium score >100. No participants had a CAD-RADS score >2.
Conclusions
We found no difference in the prevalence of CAD or non-calcified plaque between PWH and PWoH in Uganda in the ART era. Our observations confirm smaller hospital-based studies demonstrating extremely low of CAD compared to populations in the Global North and suggest that CAD may not be a major cause of morbidity in PWH in Uganda.
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