A study conducted in persons living with HIV (PLWH) revealed that viral persistence in treated HIV disease is independently associated with incident carotid plaque development, according to an article published in JAMA Network Open.
The analysis included 152 PLWH with undetectable viral loads for at least six months. The researchers measured changes in carotid artery intima-media thickness (IMT) over time, using high-resolution B mode ultrasonography. The main study outcomes were baseline IMT, annual IMT progression, and incident plaque, defined as a focal region of carotid IMT of greater than 1.5 mm.
Higher baseline mean IMT was associated with older age, smoking, medications for hypertension, higher low-density lipoprotein levels, and higher interleukin 6 levels, whereas higher levels of both cell-associated HIV RNA and HIV DNA were associated with incident plaque development but not baseline IMT or annual IMT progression. The association remained significant even after adjustment for traditional risk factors, HIV disease characteristics, and markers of inflammation.
These findings suggest that viral persistence and ongoing subclinical viral expression underlie HIV-associated cardiovascular disease. Strategies targeting the size of the reservoir as a means to cure or control HIV may help reduce the burden of comorbid disease in PLWH, the authors conclude.