A recent prospective matched cohort study has revealed that individuals living with HIV (PWH) face a significantly higher risk of developing subclinical coronary atherosclerosis compared to the general population. This finding underscores the importance of proactive cardiovascular assessment and management in this demographic.
The study included 519 PWH and 1,114 age- and sex-matched controls from the Copenhagen Comorbidity in HIV Infection study and the Copenhagen General Population Study, respectively. Participants had a median age of 52 years, with males constituting 89% of the cohort. Notably, both groups exhibited similar cardiovascular risk profiles as determined by the Systematic COronary Risk Evaluation 2 (SCORE2) algorithm.
Utilizing coronary computed tomography angiography, researchers assessed the presence of any coronary atherosclerosis and specifically obstructive coronary atherosclerosis, defined as stenosis of 50% or greater. The findings were striking: 54% of PWH had some form of coronary atherosclerosis compared to 42% of controls (P < .001). More concerningly, 16% of PWH exhibited obstructive coronary atherosclerosis, double the 8% observed in the control group (P < .001). After adjusting for traditional cardiovascular risk factors—including age, sex, hypertension, dyslipidemia, current smoking status, overweight or obesity, and diabetes—HIV infection remained a significant independent predictor. PWH had an odds ratio of 1.98 (95% confidence interval [CI], 1.52–2.58) for any coronary atherosclerosis and an odds ratio of 3.21 (95% CI, 2.00–5.17) for obstructive atherosclerosis. These results suggest that HIV infection is independently associated with a nearly twofold increase in the risk of any coronary atherosclerosis and a threefold increase in the risk of obstructive coronary atherosclerosis. This elevated risk may contribute to the higher incidence of myocardial infarction observed among PWH. For healthcare professionals, these findings highlight the critical need for heightened cardiovascular vigilance in patients with HIV. Reference: Knudsen AD et al. HIV Is Associated With Subclinical Coronary Atherosclerosis: A Prospective Matched Cohort Study. Clin Infect Dis. 2025;ciae609. Anaya Malik | AMJ
