In a related study, David Hanna of Albert Einstein College of Medicine in the Bronx, New York, and colleagues looked at the association between carotid artery atherosclerosis and mortality among HIV-positive and at-risk women in the Women’s Interagency HIV Study (WIHS) and men in MACS.
This analysis included 1722 women and 1304 men. In the WIHS group, 71% were HIV positive, the median age was about 40 years, 60% were black and about 45% were smokers. In the MACS group, 62% had HIV, the median age was about 50, about 30% were black and about 30% were smokers. About two-thirds of the women and the quarters of the men with HIV were on ART.
The researchers used ultrasound to measure carotid artery plaque in six different locations and common carotid artery intima-media thickness, or the thickness of the artery wall. They also measured arterial elasticity, or stiffness. At baseline, carotid plaque was more common in both HIV-positive and HIV-negative men (27% and 29%, respectively) than in their female counterparts (10% and 7%). Men also had higher arterial stiffness scores than women, but carotid intima-media thickness was similar regardless of sex or HIV status.
Over a median 10 years of follow-up, mortality rates per 1000 person-years were 19.9 for HIV-positive women, 14.7 for HIV-negative women, 15.3 for HIV-positive men and 7.9 for HIV-negative men.
In an adjusted analysis, the presence of carotid artery plaque was associated with a 46% greater risk of death overall. The association was most pronounced for the men, with more than double the risk (hazard ratio [HR] 2.28), but it did not reach statistical significance for the women (HR 1.06).
People with the greatest arterial stiffness scores had a 45% greater overall risk of death than those with the least stiffness. In this case, the association was stronger for the women (HR 1.71) but not significant for the men (HR 1.11). Carotid intima-media thickness was not associated with mortality in either group.
Interestingly, the association between carotid plaque and mortality was stronger among HIV-negative women and men combined (HR 3.84) than it was among HIV-positive people (HR 1.37), as was the association between arterial stiffness and death, potentially owing to non-cardiovascular-related AIDS deaths in the latter group.