title: HIV Infection Is Associated With Progression of Subclinical Carotid Atherosclerosis.
abstract: BACKGROUND
  Individuals infected with human immunodeficiency virus (HIV) live longer as a result of effective treatment, but long-term consequences of infection, treatment, and immunological dysfunction are poorly understood.
  
  
  METHODS
  We prospectively examined 1011 women (74% HIV-infected) in the Women's Interagency HIV Study and 811 men (65% HIV-infected) in the Multicenter AIDS Cohort Study who underwent repeated B-mode carotid artery ultrasound imaging in 2004-2013. Outcomes included changes in right common carotid artery intima-media thickness (CCA-IMT) and new focal carotid artery plaque formation (IMT >1.5 mm) over median 7 years. We assessed the association between HIV serostatus and progression of subclinical atherosclerosis, adjusting for demographic, behavioral, and cardiometabolic risk factors.
  
  
  RESULTS
  Unadjusted mean CCA-IMT increased (725 to 752 µm in women, 757 to 790 µm in men), but CCA-IMT progression did not differ by HIV serostatus, either in combined or sex-specific analyses. Focal plaque prevalence increased from 8% to 15% in women and 25% to 34% in men over 7 years. HIV-infected individuals had 1.6-fold greater risk of new plaque formation compared with HIV-uninfected individuals (relative risk [RR] 1.61, 95% CI, 1.12-2.32), adjusting for cardiometabolic factors; the association was similar by sex. Increased plaque occurred even among persistently virologically suppressed HIV-infected individuals compared with uninfected individuals (RR 1.56, 95% CI, 1.07-2.27). HIV-infected individuals with baseline CD4+ ≥ 500 cells/µL had plaque risk not statistically different from uninfected individuals.
  
  
  CONCLUSIONS
  HIV infection is associated with greater increases in focal plaque among women and men, potentially mediated by factors associated with immunodeficiency or HIV replication at levels below current limits of detection.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: David B
authors.initials: DB
authors.lastname: Hanna
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Deal
authors.affiliation: Departments of Medicine.
authors.forename: Howard N
authors.initials: HN
authors.lastname: Hodis
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
authors.affiliation: Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Mack
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gange
authors.affiliation: Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Landay
authors.affiliation: Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Lazar
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.affiliation: Department of Medicine, University of California-San Francisco.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.affiliation: Department of Medicine, University of California-Los Angeles.
authors.forename: Mallory D
authors.initials: MD
authors.lastname: Witt
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Xue
authors.affiliation: Department of Medicine, Georgetown University Medical Center, Washington D.C.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Young
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.affiliation: Departments of Infectious Diseases and Microbiology Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Kingsley
mesh_terms: D000328:Adult; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology; D011446:Prospective Studies; D017539:Tunica Intima / Q000473:pathology; D014463:Ultrasonography
keywords: HIV infection; atherosclerosis; cardiovascular disease; intima-media thickness; viral load