Significant amounts of atherosclerotic plaque have been found in the coronary arteries of people with HIV, even in those considered to be at low-to-moderate risk of future heart disease based on traditional measures, shows a study published in journal JAMA Network Open.
This finding emerged from the global REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) study, in which Harvard Medical School researchers at Massachusetts General Hospital played a key role.
Researchers found that the higher-than-expected levels of plaque could not be attributed simply to traditional cardiovascular disease risk factors like smoking, hypertension, and lipids in the blood, but were independently related to increased arterial inflammation and immune system activation.
REPRIEVE is one of the largest study of cardiovascular disease among people living with HIV, having enrolled 7,700 participants at more than 100 clinical sites in 12 countries around the world, in collaboration with the AIDS Clinical Trials Group.
The newly published results are from a subset of the overall trial, consisting of 755 individuals between the ages of 40 and 75 enrolled in 31 sites across the United States. “The prevalence of plaque found in people with HIV was striking, though the number of lesions was limited in most people and only a portion could be explained by traditional risk factors,” said co-author Michael Lu, HMS assistant professor of radiology and co-director of the Mass General Cardiovascular Imaging Research Center.
“While we know that people living with HIV who are receiving antiretroviral therapy are at increased risk of coronary artery disease, our understanding of the mechanisms behind this phenomenon have been very limited,” said Steven Grinspoon, Professor of medicine at HMS and Chief of the Mass General Metabolism Unit and co-principal investigator of REPRIEVE.
“The latest findings from REPRIEVE expand our knowledge and provide important insights that set the stage for further studies to identify effective plaque reduction or prevention strategies, such as the possible use of statin medicines,” stated Grinspoon.
“Data from REPRIEVE connect inflammation and immune activation to coronary artery disease in a large study of people with HIV under good virologic control and with low traditional risk,” wrote Udo Hoffmann, MD, of Massachusetts General Hospital, and colleagues. “This study found a substantial prevalence of [coronary artery disease] even in young people with HIV with low traditional ASCVD risk.”