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Carotid artery atherosclerosis is associated with mortality in HIV-positive women and men

Hanna, David B.a; Moon, Jee-Younga; Haberlen, Sabina A.b; French, Audrey L.c; Palella, Frank J. Jr.d; Gange, Stephen J.b; Witt, Mallory D.e; Kassaye, Seblef; Lazar, Jason M.g; Tien, Phyllis C.h,i; Feinstein, Matthew J.j; Kingsley, Lawrence A.k,l; Post, Wendy S.b,m; Kaplan, Robert C.a,n; Hodis, Howard N.o; Anastos, Kathryna,p

doi: 10.1097/QAD.0000000000001972
Epidemiology and Social
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Objective: Among people with HIV, there are few long-term studies of noninvasive ultrasound-based measurements of the carotid artery predicting major health events. We hypothesized that such measurements are associated with 10-year mortality in the Women's Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS), and that associations differ by HIV serostatus.

Design: Nested cohort study.

Methods: Participants without coronary heart disease underwent B-mode carotid artery ultrasound, with measurement of common carotid artery intima–media thickness (IMT); carotid artery plaque (focal IMT > 1.5 mm) at six locations; and Young's modulus of elasticity, a measure of arterial stiffness. We examined all-cause mortality using Cox models, controlling for demographic, behavioral, cardiometabolic, and HIV-related factors.

Results: Among 1722 women (median age 40 years, 90% nonwhite, 71% HIV-positive) and 1304 men (median age 50, 39% nonwhite, 62% HIV-positive), 11% died during follow-up. Mortality was higher among HIV-positive women [19.9 deaths/1000 person-years, 95% confidence interval (CI) 14.7–28.8] than HIV-positive men (15.1/1000, 95% CI 8.3–26.8). In adjusted analyses, plaque was associated with mortality (hazard ratio 1.44, 95% CI 1.10–1.88) regardless of HIV serostatus, and varied by sex (among women, hazard ratio 1.06, 95% CI 0.74–1.52; among men; hazard ratio 2.19, 95% CI 1.41–3.43). The association of plaque with mortality was more pronounced among HIV-negative (hazard ratio 3.87, 95% 1.95–7.66) than HIV-positive participants (hazard ratio 1.35, 95% CI 1.00–1.84). Arterial stiffness was also associated with mortality (hazard ratio 1.43 for highest versus lowest quartile, 95% CI 1.02–2.01). Greater common carotid artery-IMT was not associated with mortality.

Conclusion: Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.

aDepartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York

bDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

cDepartment of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County

dDepartment of Medicine, Northwestern University Medical Center, Chicago, Illinois

eDepartment of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California

fDepartment of Medicine, Georgetown University Medical Center, Washington, District of Columbia

gDepartment of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York

hDepartment of Medicine

iDepartment of Veterans Affairs, University of California, San Francisco, San Francisco, California

jDepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

kDepartment of Epidemiology

lDepartment of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania

mDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland

nPublic Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington

oAtherosclerosis Research Unit, University of Southern California, Los Angeles, California

pDepartment of Medicine, Montefiore Medical Center, Bronx, New York, USA.

Correspondence to David B. Hanna, PhD, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer 1306C, Bronx, NY 10461, USA. Tel: +1 718 839 7904; fax: +1 718 430 8780; e-mail: david.hanna@einstein.yu.edu

Received 7 May, 2018

Accepted 28 June, 2018

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