Factors associated with the development of coronary artery disease in people with HIV

Background: People living with HIV (PLHIV) are at increased risk for coronary artery disease (CAD). This study aimed to describe the features associated with CAD in PLHIV. Methods: A case ([n = 160] PLHIV with CAD) control ([n = 317] PLHIV matched by age and sex without CAD) study was performed at the Alfred Hospital, Melbourne, Australia (January 1996 and December 2018). Data collected included CAD risk factors, duration of HIV infection, nadir and at-event CD4+ T-cell counts, CD4:CD8 ratio, HIV viral load, and antiretroviral therapy exposure. Results: Participants were predominantly male (n = 465 [97.4%]), with a mean age of 53 years. Traditional risk factors associated with CAD in univariate analysis included hypertension (OR 11.4 [95%CI 5.01, 26.33], P < 0.001), current cigarette smoking (OR 2.5 [95% CI 1.22, 5.09], P = 0.012), and lower high-density lipoprotein cholesterol (OR 0.14 [95%CI 0.05, 0.37], P < 0.001). There was no association between duration of HIV infection, nadir or current CD4 cell count. However, current and ever exposure to abacavir (cases: 55 [34.4%]; controls: 79 [24.9%], P = 0.023 and cases: 92 [57.5%]; controls: 154 [48.6%], P = 0.048, respectively) was associated with CAD. In conditional logistic regression analysis, current abacavir use, current smoking, and hypertension remained significantly associated (aOR = 1.87 [CI = 1.14, 3.07], aOR = 2.31 [1.32, 4.04], and aOR = 10.30 [5.25, 20.20] respectively). Conclusion: Traditional cardiovascular risk factors and exposure to abacavir were associated with CAD in PLHIV. This study highlights that aggressive management of cardiovascular risk factors remains critical for reducing risk in PLHIV.