Background:  Progression of surrogate markers of cardiovascular disease (CVD) in HIV infection is not well described, although the prevalence of CVD in HIV infection is of concern. Metabolic risk factors for CVD in HIV disease include low high density lipoprotein, high triglycerides, total cholesterol, serum lipoproteins (apolipoprotein A1, E, B, RLPC), homocysteine, CR-reactive protein, glucose, and insulin. Coronary calcification scores (CCS), as measured by Ultrafast CT, is a specific and sensitive surrogate marker of CVD.

Methods:  We evaluated CCS and metabolic markers for CVD risk at baseline and compared these with CCS after 3 years in the Nutrition for Healthy Living cohort. A total of 87 men and women completed the 3-year follow-up period; the study is ongoing. Correlations with CCS were assessed using Spearman’s correlation coefficient. Linear regression models were used to determine primary predictors of CCS risk. Statistical analyses were performed using SPSS 12.0. 

Results:  The cohort was 22% female, mean age was 46 years; the mean CD4 count was 453 cells/mm³; 60% were white, 28% African American; 53% of the cohort was overweight (body mass index >25). A detectable CCS (defined as CCS >0) was found in 56% of patients at baseline and at the 3-year follow-up. The 36% of the cohort with undetectable CCS at baseline continued to have an undetectable score at the 3-year follow-up. In those with a detectable score, the mean difference in CCS from baseline to follow up was 7.4 (p = 0.56). In those with a detectable score significant correlations of CCS at the 3-year follow-up were with age (0.41, p <0.001), total cholesterol (0.27, p = 0.013), and insulin sensitivity by QUICKI (–0.21, p = 0.05). Correlations with homocysteine and insulin were found in women alone (0.53, p <0.05 and 0.56, p <0.05). After controlling for those with undetectable CCS at follow up, CCS was significantly associated with age (0.527, p <0.001) and body mass index in males (–0.351, p <0.05), and apolipoprotein E (0.697, p <0.05), RLPC (0.770, p <0.05), and C-reactive protein (–0.803, p <0.05) in females. After controlling for gender and other covariates, age was the only predictor of abnormal CCS at 3 years in the linear regression model (B = 35.6, p =0.003). 

Conclusions:  While there appears to be an increased risk of CVD in HIV infection, abnormal CCS at 3 years was only apparent in those who already had a detectable CCS. Abnormal CCS was associated with the traditional CVD risk factors: age, total cholesterol, weight, and glucose intolerance. In those HIV-infected individuals who had undetectable CCS, there was no development of detectable CCS at 3 years.