Antiretroviral Drugs Associated with Subclinical Coronary Artery Disease in the Swiss HIV Cohort Study

BACKGROUND Coronary artery disease (CAD) events have been associated with certain antiretroviral therapy (ART) agents. In contrast, the influence of ART on subclinical atherosclerosis is not clear. The study objective was to assess the association between individual ART agents and the prevalence and extent of subclinical CAD. METHODS Coronary artery calcium (CAC) scoring and coronary CT angiography (CCTA) were performed in ≥45year old Swiss HIV Cohort Study participants. The following subclinical CAD endpoints were analyzed separately: CAC score >0, any plaque, calcified plaque, non-calcified/mixed plaque, segment involvement score (SIS) and segment severity score (SSS). Logistic regression models calculated by inverse probability of treatment weights (IPTW) were used to explore associations between subclinical CAD and cumulative exposure to the ten most frequently used drugs. RESULTS 403 patients underwent CCTA. CAC score >0 was recorded in 188 (47%), any plaque in 214 (53%), calcified plaque in 151 (38%), and non-calcified/mixed plaque in 150 (37%) participants. CAC score >0 was negatively associated with efavirenz (IPTW adjusted OR per 5 years 0.73 [0.56-0.96]), tenofovir disoproxil fumarate (0.68 [0.49-0.95]), and lopinavir (0.64 [0.43-0.96]). Any plaque was negatively associated with tenofovir disoproxil fumarate (0.71 [0.51-0.99]). Calcified plaque was negatively associated with efavirenz (0.7 [0.57-0.97]). Non-calcified/mixed plaque was positively associated with abacavir (1.46 [1.08-1.98]), and negatively associated with emtricitabine (0.67 [0.46-0.99]). For SSS and SIS we found no association with any drug. CONCLUSION An increased risk of non-calcified/mixed plaque was only found in patients exposed to abacavir. Emtricitabine was negatively associated with non-calcified/mixed plaque, while tenofovir disoproxil fumarate and efavirenz were negatively associated with any plaque and calcified plaque, respectively