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HIV and Cardiovascular Disease

June 2015

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Impact of Intestinal Microbiota on CVD Risks

Suman Srinivasa and colleagues described the association between a microbiota-derived precursor of TMAO, namely TMA, and coronary plaque.14

The study included 155 HIV positive individuals along with 67 HIV negative controls. Serum choline trimethylamine (TMA) and trimethylamine-N-oxide (TMAO) were assessed using mass-spectometry and cardiac CT angiography was used to assess coronary plaque. Among HIV positive patients, TMA was associated with number of plaques, calcified plaques, calcium score, plaque volume and mass and LPS. After adjustment for Framingham risk score, TMA remained significantly associated with total, calcified, calcium score, plaque volume and mass. After additional adjustment for LPS, TMA remained associated with total plaque segments, calcium score, and plaque mass. There was no association of TMAO to plaque in contrast.

Trimethylamine-N-oxide (TMAO) is metabolised by intestinal microbiota from dietary lipids. In HIV negative people, TMAO levels are associated with cardiovascular events.

Arjun Sinha and colleagues evaluated TMAO levels and carotid IMT in a small study from UCSF.15

The median TMAO levels were similar among HIV patients and controls; however, TMAO levels between HIV patients were similar to HIV negative patients with CAD. Traditional risk factors along with current ARV were associated with higher TMAO levels and TMAO was weakly associated with carotid IMT.



In summary, HIV and cardiovascular diseases were an expanding arena of investigation at CROI 2015.

The emphasis this year was on statin interventions, evaluation of the new ACC/AHA cholesterol guidelines in HIV, abacavir and risk of MI, comparison of risk calculators in HIV, and new markers of CV risk such as TMAO.

New event driven studies such as REPRIEVE and other smaller proof of concept studies designed to target inflammation in HIV are ongoing and NHLBI along with NIAID is committed to supporting studies in HIV with dedicated funding for HIV-related investigations.


Hsue P. HIV and Cardiovascular Disease: Report from 2015 CROI. The full report includes additional slides and tables. This article in HTB was lightly edited for a print format.


Unless stated otherwise, all references are to the Programme and Abstracts of the 2015 Conference on Retroviruses and Opportunistic Infections (CROI 2015), 23-26 February 2015, Seattle.

  1. Grinspoon S. Cardiovascular disease in HIV patients: an emerging paradigm and call to action.
  2. Lo J et al. Statin therapy reduces coronary noncalcified plaque volume in HIV patients: a randomized controlled trial. Oral sbstract 136.
  3. Lo J et al. et al. Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial. Lancet HIV. 2015; (published online Jan 9)
  4. Longenecker C et al. Rosuvastatin arrests progression of carotid intima-media thickness in treated HIV. Oral abstract 137.
  5. Baker D et al. Rosuvastatin vs. protease inhibitor switch for hypercholesterolaemia: a randomised trial -- the statin or switch (SoS) study. Poster abstract 733.
  6. Clement M et al. HIV-infected veterans and the new ACC/AHA cholesterol guidelines: got statins? Poster abstract 750.
  7. Regan S et al. Application of new ACC/AHA cholesterol guidelines to an HIV clinical care cohort. Poster abstract 734.
  8. Kohli P et al. PCSK9 Is elevated in HIV+ patients and may mediate HIV-associated dyslipidemia. Poster abstract 731.
  9. Regen S et al. Evaluation of the ACC/AHA CVD risk prediction algorithm among HIV-infected patients. Poster abstract 751.
  10. Thompson-Paul A et a. Cardiovascular disease risk prediction in the HIV Outpatient Study (HOPS). Poster abstract 747.
  11. Salinas J et al. Cumulative HIV care measures highly associated with acute myocardial infarction. Poster abstract 746.
  12. Palella F et al. Abacavir use and risk for myocardial infarction in the NA-ACCORD. Late breaker poster abstract 749LB.
  13. Drozd D et al. Incidence and risk of myocardial infarction (MI) by type in the NA-ACCORD. Poster abstract 748.
  14. Suman Srinivasa S et al. Calcified plaque burden Is associated with serum gut microbiota-generated TMA in HIV. Oral abstract 138.
  15. Sinha A et al. TMAO and HIV-associated atherosclerosis. Poster abstract 755.

Links to other websites are current at date of posting but not maintained.

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