Detectable coronary artery score among people living with HIV with regional, study and population variations: A systematic review and meta-analysis

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: People living with HIV (PLWH) have a higher risk of coronary artery disease, partly due to chronic inflammation and antiretroviral therapy-related effects. Coronary artery calcium (CAC) scoring is a non-invasive marker of subclinical atherosclerosis and cardiovascular risk. Previous reviews reported high CAC prevalence in PLWH but lacked data on severity and regional or population-specific differences.

Methods: Systematic review and meta-analysis of records published before April 15, 2025, reporting the pooled percentage of PLWH with detectable CAC (CAC > 0), mild CAC (CAC 1-99), moderate CAC (CAC 100-400) and severe CAC (CAC >400). Subgroup analyses explored variation by region, study design, and population characteristics.

Results: Fifty-three records were included; 31 contributed to the meta-analysis. The pooled prevalence of detectable CAC was 43.6% (95% CI: 39.1-48.1), with high heterogeneity (I2 = 91%). Percentage of detectable CAC among PLWH was highest in North America (46.6%) and lowest in Africa (14.1%) and among general adult PLWH (55.8%) and less among those on ART (34.5%). The percentage of PLWH with detectable CAC was higher among cross sectional studies (44.2%) and prospective cohorts (43.3%) in comparison to clinical trials (35.5%). Regarding severity of CAC among PLWH, 27.6% had mild CAC, 10.8% moderate, and 5.1% severe CAC. No significant publication bias was detected.

Conclusions: Nearly half of PLWH have detectable CAC, with substantial regional and population-level differences. These findings highlight the need for targeted cardiovascular screening strategies in PLWH and support further research into the clinical utility of CAC scoring to guide preventive therapy.

Type

Article

PubMed ID

41860796

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