Patients with HIV, CMV Face Higher Rates of Subclinical Cardiovascular Disease

Patients with HIV who had high levels of cytomegalovirus (CMV) immunoglobulin G (IgG) faced an increased risk of coronary artery calcium and higher levels of intima-media thickness, according to new research.

However, scientists found no association between CMV IgG and risk of the 2 coronary conditions in healthy controls.

It is well established that patients with HIV face higher risks of cardiovascular disease than the general public. The investigators, from the University of Copenhagen and Copenhagen University Hospital, in Denmark, wanted to evaluate whether CMV might play a role in this phenomenon, since CMV/HIV co-infection is common.

The team performed a cross-sectional study involving 105 patients who were HIV-positive and on antiretroviral therapy, but who had no cardiovascular disease. The control group was the same size, also without a history of cardiovascular disease, and was matched with the HIV-positive cohort based on age, gender, and smoking status.

The vast majority of HIV-positive patients—92%—tested positive for CMV IgG, as did two-thirds (68%) of the control group, though the HIV-positive group had higher levels of IgG, on average. That appeared to translate to higher levels of subclinical carotid disease, according to the authors, led by Andreas Knudsen, PhD, of the Department of Infectious Diseases at Copenhagen University Hospital.

“Several studies have found associations between CMV coinfection and different manifestations of subclinical carotid disease in HIV-infected patients, and our results seem to support this, with a significant association found between CMV IgG level and [intima-media thickness] independently of other herpes virus antibodies,” Knudsen and colleagues wrote.

They added that the similar correlation with coronary artery calcium aligns with other research on the topic.

Although the study furthers the case that CMV is associated with higher risk of cardiovascular disease, the exact reason for the link is not yet settled. The authors note that the virus “has been found in endothelial cells of patients with atherosclerosis and CMV IgG has been proposed to cause an autoimmune response by binding to endothelial cells.”

Furthermore, they note that CMV causes an upregulation in CD8 cells, the effects of which appear to be tied to comorbidity and cardiovascular disease in patients who are HIV positive.

The study adds to an increasing body of research offering insights for cardiologists who treat patients with HIV.

In a January article for the American College of Cardiology Foundation, Abdulrahman Abutaleb, MD, and Matthew J Feinstein, MD, wrote that coinfections, like hepatitis C virus, increase the risk of inflammation and atherosclerotic disease in patients with HIV. Certain antiretroviral therapies can also increase the risk of cardiovascular disease, they note.

Unfortunately, even with relatively robust data about the increased risk, Abutaleb and Feinstein stated that it is difficult to calculate the risk of cardiovascular disease for a particular HIV-positive patient.

“Thus, although we know that HIV-positive persons tend to have 1.5-fold to 2-fold greater risk for [atherosclerotic cardiovascular disease] than uninfected persons, optimal methods to integrate [atherosclerotic cardiovascular disease] risk prediction in the care of HIV-positive persons remain unclear,” they wrote.

The study, “Coronary artery calcium and intima-media thickness are associated with level of cytomegalovirus immunoglobulin G in HIV-infected patients,” was published in HIV Medicine.