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Rosuvastatin slows progression of subclinical atherosclerosis in patients with treated HIV infection

Antiretroviral therapy for the prevention of HIV-1 transmission

HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy

Review of the Efficacy, Safety, and Pharmacokinetics of Raltegravir in Pregnancy

Use of Abacavir and Risk of Cardiovascular Disease Among HIV-Infected Individuals

Rosuvastatin Is Effective to Decrease CD8 T-Cell Activation Only in HIV-Infected Patients With High Residual T-Cell Activation Under Antiretroviral Therapy

Botswana's progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: a population-based survey

Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial

Feasibility and efficacy of early lung cancer diagnosis with chest computed tomography in HIV-infected smokers

Patterns of Cardiovascular Mortality for HIV-Infected Adults in the United States: 1999 to 2013

Adjunctive Dexamethasone in HIV-Associated Cryptococcal Meningitis

Outcomes of HIV-associated Hodgkin lymphoma in the era of antiretroviral therapy

CD4+ and CD8+ T-cell kinetics in aviremic HIV-infected patients developing Hodgkin or non-Hodgkin lymphoma

CD8 T-Cell Expansion and Inflammation Linked to CMV Coinfection in ART-treated HIV Infection

Human Immunodeficiency Virus Infection Does Not Worsen Prognosis of Liver Transplantation for Hepatocellular Carcinoma

Ongoing HIV Replication Replenishes Viral Reservoirs During Therapy

Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men

Transient elastography for the detection of hepatic fibrosis in HIV-monoinfected adults with elevated aminotransferases on antiretroviral therapy

Association of immune-activation and senescence markers with non-AIDS-defining comorbidities in HIV-suppressed patients

Effects of randomized rosuvastatin compared with placebo on bone and body composition among HIV-infected adults

Levels of intracellular HIV-DNA in patients with suppressive antiretroviral therapy

Cancer Risk and Use of Protease Inhibitor or Nonnucleoside Reverse Transcriptase Inhibitor–Based Combination Antiretroviral Therapy The D:A:D Study

Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study

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The effect of cumulating exposure to abacavir on the risk of cardiovascular disease events in patients from the Swiss HIV Cohort Study

Course and Clinical Significance of CD8+ T-Cell Counts in a Large Cohort of HIV-Infected Individuals

Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients

HIV-1 subtype B-infected MSM may have driven the spread of transmitted resistant strains in France in 2007-12: impact on susceptibility to first-line strategies

Influence of the Timing of Antiretroviral Therapy on the Potential for Normalization of Immune Status in Human Immunodeficiency Virus 1–Infected Individuals

Cross-sectional Comparison of the Prevalence of Age-Associated Comorbidities and Their Risk Factors Between HIV-Infected and Uninfected Individuals: The AGEhIV Cohort Study

CD4/CD8 ratio normalisation and non-AIDS-related events in individuals with HIV who achieve viral load suppression with antiretroviral therapy: an observational cohort study

Baseline HIV-1 resistance, virological outcomes, and emergent resistance in the SECOND-LINE trial: an exploratory analysis

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

Low Bone Mineral Density in Patients With Well-Suppressed HIV Infection: Association With Body Weight, Smoking, and Prior Advanced HIV Disease

Early versus delayed initiation of highly active antiretroviral therapy for HIV-positive adults with newly diagnosed pulmonary tuberculosis (TB-HAART): a prospective, international, randomised, placebo-controlled trial

A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans

Single-agent tenofovir versus combination emtricitabine plus tenofovir for pre-exposure prophylaxis for HIV-1 acquisition: an update of data from a randomised, double-blind, phase 3 trial

Predicting the outcomes of treatment to eradicate the latent reservoir for HIV-1

Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men
Published by Pedro CAHN

Updated: 12 February, 2016

Kingsley LA et al. AIDS. 2015 Nov 28;29(18):2427-34.

The MACS is an ongoing prospective observational study that enrolled MSM in four major US cities. This report presents data on both the incidence and progression of CAC among 825 men (541 HIV+ and 284 HIV-) who participated in the Multicenter AIDS Cohort Study (MACS) and underwent two or more cardiac CT scans over a mean follow-up of 5 years (range 2-8). Major objective was to investigate whether HIV+ compared with HIV- men are at greater risk for either incidence or progression of CAC after controlling for HIV-associated risk factors, especially duration of ART as well as traditional CVD risk factors.

Active MACS participants over 40 years of age, without a history of prior coronary or cerebrovascular disease, and who weighed less than 300 pounds were invited to undergo noncontrast CT scanning beginning in 2004 during the initial MACS CVD study (CVD1). Baseline CT scanning was completed in 945 men and 794 had a second CT scan a median 2.9 years later. The second MACS CVD study (CVD2) was initiated in 2010 and included both coronary CT angiography and noncontrast CAC scans. Analysis was restricted to men with at least two CAC scans (N=825, 541 HIV+ and 284 HIV-).

During follow-up, a higher hazard rate for incident CAC was observed in HIV+ than HIV- men (21.0 vs. 16.4%, respectively). The HR for CAC incidence among HIV+ compared with HIV- men was 1.74 (95% CI 1.15–2.62) adjusted for race, study site, and cohort period (Model 1). The HR was 1.76 (1.14–2.70), even after additional adjustment for smoking history, BMI, SBP, use of antihypertensive medication, fasting glucose, total cholesterol, LDL-C, triglycerides, lipid-lowering medication usage and HOMA-IR (Model 2). The HR was 1.64 (1.07–2.53) after further adjustment for the average value of covariates over the entire duration of follow-up (Model 3).

Among HIV+ men, factors associated with an increased hazard of incident CAC included current smoking, 2.26 (1.25– 4.10) and increased HOMA-IR (log-transformed), 1.67 (1.05–2.65). No associations were observed for dyslipidemia, duration of HAART usage, HIV RNA level, or CD4 + cell count/µl nadir and incident CAC.

Progression of CAC occurred in the great majority of men among whom CAC was present at baseline. Among 267 men with CAC above 10 at baseline, higher CAC Agatston scores were observed during follow-up in 258 of 267 (97%) with no difference observed by HIV serostatus in the proportion of men with CAC progression (96% of HIV+ and 97% of HIV-men). Overall, rates of progression were not significantly different by HIV serostatus; however, these data reflect the natural history of coronary artery calcification as the amount of CAC roughly doubles every 3–5 years.

Conclusions : In this large study of HIV+ and HIV- men who underwent serial cardiac CT scan imaging, HIV+ men were at significantly higher risk for development of CAC. In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together, these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIV+ men.