Key result
Sustained HIV viremia linked to ~18.4-fold higher odds of elevated coronary atherosclerosis risk score.
Why the study?
Youth living with perinatally acquired HIV infection are at risk of developing atherosclerotic cardiovascular disease.
Does HIV viremia increase surrogate cardiovascular atherosclerotic risk scores in youth with perinatally acquired HIV on long-term ART?
Cohort (n=218)
Yes
Does HIV viremia increase surrogate cardiovascular atherosclerotic risk scores in youth with perinatally acquired HIV on long-term ART?
Odds Ratio: 18.4
p-value: p=<0.01
Youth living with perinatally acquired HIV experiencing viremia have substantially higher surrogate markers of atherosclerotic risk, highlighting the critical importance of viral suppression to preserve long-term cardiovascular health.
Supports prioritizing suppression in viremic perinatally acquired HIV youth; leaves open prospective confirmation of cardiovascular benefit.
BACKGROUND: Youth living with perinatally acquired HIV infection (YLPHIV) are at risk of developing atherosclerotic cardiovascular disease. METHODS: We determined the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary arteries (CA) and abdominal aorta (AA) risk scores among YLPHIV who are ≥15 years old in Cape Town Adolescent and Antiretroviral Cohort. PDAY score was calculated using non-high-density lipoprotein, high-density lipoprotein cholesterol, hyperglycemia, hypertension, obesity, and smoking; a score ≥1 was considered elevated. HIV viremia was categorized as sustained (SV) = viral load (VL) >50 copies/mL, transient (TV) = mix of VL >50 and ≤50 copies/mL, or sustained-virologic suppression = VL <50 copies/mL throughout the study. Among YLPHIV, logistic models were fit to assess factors associated with elevated PDAY. RESULTS: Overall, 218 YLPHIV [median age 16.8 (interquartile range: 15.9-17.8) years, male 47%] were included. Among YLPHIV, 8% (n = 17) had SV, and 54% (n = 118) had TV. Median antiretroviral therapy (ART) duration was 12 (interquartile range: 8-14) years. Among YLPHIV, 30.3% and 18.4% had elevated PDAY for CA and AA, respectively.Among YLPHIV, SV [adjusted odds ratio (aOR) = 18.4, P < 0.01] and TV (aOR = 2.10, P = 0.04) compared with virologic suppression and ART duration in years (aOR = 1.12, P = 0.03) were associated with elevated CA. Male sex was associated with both elevated CA and AA (aOR = 2.14, P = 0.02, and aOR = 3.43, P = 0.01, respectively) and association of SV with elevated AA (aOR = 3.24, P = 0.09). CONCLUSIONS: A substantial proportion of YLPHIV have PDAY scores reflecting increased aggregate atherosclerotic risk. Among YLPHIV, viremia, lifetime ART duration, and male sex contribute to this risk, highlighting the importance of HIV control and the need to monitor cardiometabolic health.
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Mahtab et al. (2023) conducted a cohort in Perinatally acquired HIV infection (n=218). Sustained or transient HIV viremia vs. Sustained virologic suppression was evaluated on Elevated Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary artery (CA) risk score ≥1 (aOR 18.4, p=<0.01). Sustained HIV viremia compared to virologic suppression was associated with significantly increased odds of an elevated coronary artery PDAY atherosclerosis risk score (aOR 18.4, p<0.01).
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