Coronary Microcirculatory Dysfunction in People With HIV and Its Association With Antiretroviral Therapy

Abstract

Background HIV infection and abacavir‐containing antiretroviral regimens are associated with vascular endothelial dysfunction and increased cardiovascular risk. Positron emission tomography (PET)‐derived myocardial blood flow reserve (MBFR), the ratio of vasodilator stress to rest myocardial blood flow, is a well‐validated measure of coronary microvascular health and marker of cardiovascular risk. Our objective was to compare MBFR among people with HIV (PWH) with matched non‐HIV controls and to assess whether switching from dolutegravir/lamivudine/abacavir to the non‐abacavir regimen bictegravir/emtricitabine/tenofovir alafenamide (TAF) would improve MBFR. Methods and Results Thirty‐seven PWH were 1:2 matched on cardiovascular risk factors to 75 people without HIV, and MBFR corrected for differences in resting hemodynamics was compared in a cross‐sectional design. PWH were majority men (68%) with a mean age of 56 years. Mean stress myocardial blood flow (1.83 mL/min per g [95% CI, 1.68–1.98] versus 2.40 mL/min per g [95% CI, 2.25–2.54]; P <0.001) and MBFR (2.18 [95% CI, 1.96–2.40] versus 2.68 [95% CI, 2.47–2.89]; P =0.002) was significantly lower in PWH than in people without HIV. In a single‐arm, multicenter trial, a subset of 25 PWH who were virologically suppressed on dolutegravir/lamivudine/abacavir underwent positron emission tomography myocardial perfusion imaging at baseline and after switching to bictegravir/emtricitabine/TAF. MBFR was unchanged after switching to bictegravir/emtricitabine/TAF for a mean of 27 weeks (MBFR, 2.34 to 2.29; P =0.61), except in PWH with impaired MBFR at baseline (<2.00; N=6) in whom MBFR increased from 1.58 to 2.02 ( P =0.02). Conclusions PWH had reduced coronary microvascular function compared with controls without HIV. Coronary microvascular function did not improve after switching from dolutegravir/lamivudine/abacavir to bictegravir/emtricitabine/TAF. Registration URL: https://www.clinicaltrials.gov ; unique identifier: NCT03656783.