Treated HIV infection is not associated with carotid vascular inflammation or plaque progression as assessed by dynamic contrast magnetic resonance imaging.

BACKGROUND: Inflammation and immune dysregulation are thought to drive residual cardiovascular disease risk among persons living with human immunodeficiency virus (HIV) (PLWH) despite effective viral suppression with antiretroviral therapy (ART).

METHODS: We investigated differences in carotid inflammation and atherosclerosis in a longitudinal cohort of virally suppressed PLWH (N = 50; on stable ART with CD4 > 250 cells/mm3, viral load < 200 copies/mL for > 6 months) and HIV-uninfected controls (N = 51) matched for age, sex, hypertension, diabetes, smoking, hyperlipidemia, and family history of premature coronary artery disease (CAD). Participants were ≥ 40 years old at enrollment. Measures of carotid vascular inflammation (Ktrans), neovascularization (Vp), and wall thickness were assessed at baseline, 1 year, and change over 1 year by dynamic contrast-enhanced magnetic resonance imaging (MRI).

RESULTS: Among 101 participants, 8% were women, 42% had hypertension, 52% had hyperlipidemia, 16% had diabetes, and 48% had a family history of CAD. Both PLWH and control participants demonstrated a reduction in systolic and diastolic blood pressures and total cholesterol over 1 year; however, the difference was not significant by HIV status. PLWH had a significant reduction in triglycerides compared with controls (-48.8 vs 12.8 mg/dL, p = 0.026). HIV was not associated with baseline, follow up, or change in markers of systemic inflammation assessed by plasma cytokines, nor vascular inflammation as assessed by Ktrans, Vp, carotid wall thickness, or percent wall volume (a measure of plaque burden).

CONCLUSION: In contrast to other studies of treated and virally suppressed PLWH, HIV infection was not associated with carotid inflammation or plaque in our hypothesis-generating study.