P4 HIV Associated Cardiovascular Disease Based on Advanced Cardiac Imaging: a Systematic Review and Meta-Analysis

Objective To systematically review and meta-analyse data from advanced cardiovascular imaging studies evaluating computed tomography coronary angiography (CTCA), positron emission tomography (PET), and cardiac magnetic resonance (CMR), in people living with HIV (PLHIV) compared to uninfected individuals. Methods Three databases were searched for studies investigating the association between cardiovascular pathology and HIV using CTCA, CMR and PET in PLHIV from inception to February 11th 2022. Primary outcomes moderate to severe (>50%) coronary stenosis (CTCA), vascular and myocardial target-to-background ratio (PET), late gadolinium enhancement prevalence (CMR). Prevalence and risk ratios (RR) (comparing PLHIV to uninfected individuals) were pooled for using a random effects model. Results Forty-five studies including 5218 PLHIV (mean age 48.5 years) and 2414 uninfected individuals (mean age 49.1 years) met the inclusion criteria. Sixteen studies (n=5107 participants) evaluated CTCA, 10 (n=681) vascular PET, 3 (n=146) both CTCA and vascular PET, and 16 (n=1698) CMR. No studies originated from low-income countries. The prevalence of moderate/severe coronary disease in 17.3% in PLHIV and 13.8% in controls (RR 1.33, 95%CI 0.96–1.82, I2= 62%). The prevalence of myocardial fibrosis was 47.5% in PLHIV and 31.7% in controls (RR 2.34, 95% confidence interval [CI] 1.34–4.08, I2=88%). PET studies indicated that PLHIV have an increase in vascular inflammation however these findings are derived from populations with well controlled HIV in middle age. Conclusion Significant associations were observed between HIV and risk of myocardial fibrosis but not moderate to severe coronary disease. These findings were derived largely from populations in regions of low HIV endemicity.