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13-08-2022 | Human Immunodeficiency Virus | Complications of HIV and Antiretroviral Therapy (GA McComsey, Section Editor)

Ectopic Fat and Cardiac Health in People with HIV: Serious as a Heart Attack

Authors: Ana N. Hyatt, Jordan E. Lake

Published in: Current HIV/AIDS Reports | Issue 5/2022

Abstract

Purpose of Review

This study aims to summarize knowledge of alterations in adipose tissue distribution among people with HIV (PWH), with a focus on the cardiac depot and how this relates to the known higher risk of cardiovascular disease in this unique population.

Recent Findings

Similar to the general population, cardiac fat depots mirror visceral adipose tissue in PWH. However, altered fat distribution, altered fat quality, and higher prevalence of enlarged epicardial adipose tissue depots are associated with increased coronary artery disease among PWH.

Summary

Adipose tissue disturbances present in PWH ultimately contribute to increased risk of cardiovascular disease beyond traditional risk factors. Future research should aim to understand how regulating adipose tissue quantity and quality can modify cardiovascular risk.

Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity. Data, Trend and Maps. https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html. Accessed Jun 20, 2022.

Lake JE. The fat of the matter: obesity and visceral adiposity in treated HIV infection. Curr HIV/AIDS Rep. 2017;14(6):211–9. https://doi.org/10.1007/s11904-017-0368-6.CrossRefPubMedPubMedCentral

Godfrey C, Bremer A, Alba D, Apovian C, Koethe JR, Koliwad S, et al. Obesity and fat metabolism in human immunodeficiency virus-infected individuals: immunopathogenic mechanisms and clinical implications. J Infect Dis. 2019;220(3):420–31. https://doi.org/10.1093/infdis/jiz118.CrossRefPubMedPubMedCentral

4.•

Bourgi K, Jenkins CA, Rebeiro PF, Palella F, Moore RD, Altoff KN, et al. Weight gain among treatment-naïve persons with HIV starting integrase inhibitors compared to non-nucleoside reverse transcriptase inhibitors or protease inhibitors in a large observational cohort in the United States and Canada. J Int AIDS Soc. 2020;23(4):e25484. https://doi.org/10.1002/jia2.25484Provides insightful results from a large contemporary observational study.CrossRefPubMedPubMedCentral

Sahagun SJ, Yeramosu T, Purdy JB, Reynolds JC, Hadigan CM. Associations between central obesity and lifelong antiviral therapy in adults living with HIV acquired from early childhood. J Acquir Immune Defic Syndr. 2022;89(2):208–14. https://doi.org/10.1097/qai.0000000000002841.CrossRefPubMed

Srinivasa S, Fitch KV, Torriani M, Zanni MV, Defilippi C, Christenson R, et al. Relationship of visceral and subcutaneous adipose depots to markers of arterial injury and inflammation among individuals with HIV. Aids. 2019;33(2):229–36. https://doi.org/10.1097/qad.0000000000002060.CrossRefPubMed

7.•

Bogorodskaya M, Fitch KV, Lu M, Torriani M, Zanni MV, Looby SE, et al. Measures of adipose tissue redistribution and atherosclerotic coronary plaque in HIV. Obesity (Silver Spring). 2020;28(4):749–55. https://doi.org/10.1002/oby.22742Robust study linking altered body composition in PWH and coronary artery disease.CrossRef

Dickey RA, Bartuska D, Bray GW, Callaway CW, Davidson ET, Feld S, et al. AACE/ACE position statement on the prevention, diagnosis, and treatment of obesity (1998 revision). Endocr Pract. 1998;4(5):297–350.

Oliveros E, Somers VK, Sochor O, Goel K, Lopez-Jimenez F. The concept of normal weight obesity. Prog Cardiovasc Dis. 2014;56(4):426–33. https://doi.org/10.1016/j.pcad.2013.10.003.CrossRefPubMed

10.

Erlandson KM, Fiorillo S, Masawi F, Scherzinger A, McComsey GA, Lake JE, et al. Antiretroviral initiation is associated with increased skeletal muscle area and fat content. Aids. 2017;31(13):1831–8. https://doi.org/10.1097/qad.0000000000001558.CrossRefPubMed

11.

Peters SAE, Bots SH, Woodward M. Sex differences in the association between measures of general and central adiposity and the risk of myocardial infarction: results from the UK Biobank. J Am Heart Assoc. 2018;7(5):e008507. https://doi.org/10.1161/jaha.117.008507.CrossRefPubMedPubMedCentral

12.

Manmathan GPR, Little C, Kotecha T, Ngwu N, Hunter A, Kinloch S, et al. P5336Waist:hip ratio (WHR): a better predictor of cardiovascular risk (CVR) than BMI in people living with HIV. Eur Heart J. 2019;40(Supplement_1):ehz746–0304. https://doi.org/10.1093/eurheartj/ehz746.0304.CrossRef

13.

Pike MM, Decker PA, Larson NB, St. Sauver JL, Takahashi PY, Roger VL, et al. Improvement in cardiovascular risk prediction with electronic health records. Journal of Cardiovascular. Transl Res. 2016;9(3):214–22. https://doi.org/10.1007/s12265-016-9687-z.CrossRef

14.••

Cypess AM. Reassessing human adipose tissue. N Engl J Med. 2022;386(8):768–79. https://doi.org/10.1056/NEJMra2032804Essential reading about current understanding of adipose tissue features.CrossRefPubMed

15.

Lee JJ, Pedley A, Therkelsen KE, Hoffmann U, Massaro JM, Levy D, et al. Upper body subcutaneous fat is associated with cardiometabolic risk factors. Am J Med. 2017;130(8):958–66 e1. https://doi.org/10.1016/j.amjmed.2017.01.044.CrossRefPubMedPubMedCentral

16.

Koethe JR, Lagathu C, Lake JE, Domingo P, Calmy A, Falutz J, et al. HIV and antiretroviral therapy-related fat alterations. Nat Rev Dis Primers. 2020;6(1):48. https://doi.org/10.1038/s41572-020-0181-1.CrossRefPubMed

17.

Capeau J, Lagathu C, Béréziat V, Fève B. Recent data on adipose tissue, insulin resistance, diabetes and dyslipidaemia in antiretroviral therapy controlled HIV-infected persons. Curr Opin HIV AIDS. 2021;16(3):141–7. https://doi.org/10.1097/coh.0000000000000674.CrossRefPubMed

18.

Trayhurn P. Hypoxia and adipose tissue function and dysfunction in obesity. Physiol Rev. 2013;93(1):1–21. https://doi.org/10.1152/physrev.00017.2012.CrossRefPubMed

19.

Erlandson KM, Lake JE. Fat matters: understanding the role of adipose tissue in health in HIV infection. Curr HIV/AIDS Rep. 2016;13(1):20–30. https://doi.org/10.1007/s11904-016-0298-8.CrossRefPubMedPubMedCentral

20.

Blüher M. Metabolically healthy obesity. Endocr Rev. 2020;41:3. https://doi.org/10.1210/endrev/bnaa004.CrossRef

21.

Gelpi M, Ueland PM, Troseid M, Mocroft A, Lebech AM, Ullum H, et al. Abdominal adipose tissue is associated with alterations in tryptophan-kynurenine metabolism and markers of systemic inflammation in people with human immunodeficiency virus. J Infect Dis. 2020;221(3):419–27. https://doi.org/10.1093/infdis/jiz465.CrossRefPubMed

22.

Guaraldi G, Milic J. Why am i getting fat? Exploring immune-metabolic pathways to central fat accumulation in persons with HIV. J Infect Dis. 2020;221(3):343–5. https://doi.org/10.1093/infdis/jiz466.CrossRefPubMed

23.•

Gelpi M, Vestad B, Raju SC, Hansen SH, Høgh J, Midttun Ø, et al. Association of the kynurenine pathway of tryptophan metabolism with human immunodeficiency virus-related gut microbiota alterations and visceral adipose tissue accumulation. J Infect Dis. 2022;225(11):1948–54. https://doi.org/10.1093/infdis/jiac018This study provides new data on Kyn/Trp metabolism and its relationship with visceral adipose tissue accumulation.CrossRefPubMed

24.

Murphy RA, Register TC, Shively CA, Carr JJ, Ge Y, Heilbrun ME, et al. Adipose tissue density, a novel biomarker predicting mortality risk in older adults. J Gerontol A Biol Sci Med Sci. 2014;69(1):109–17. https://doi.org/10.1093/gerona/glt070.CrossRefPubMed

25.•

Lake JE, Moser C, Johnston L, Magyar C, Nelson SD, Erlandson KM, et al. CT fat density accurately reflects histologic fat quality in adults with HIV on and off antiretroviral therapy. J Clin Endocrinol Metab. 2019;104(10):4857–64. https://doi.org/10.1210/jc.2018-02785This is an ACTG study validating the correlation between CT scan results and histology of adipose tissue in PWH.CrossRefPubMedPubMedCentral

26.

Miller CJ, Baker JV, Bormann AM, Erlandson KM, Huppler Hullsiek K, Justice AC, et al. Adjudicated morbidity and mortality outcomes by age among individuals with HIV infection on suppressive antiretroviral therapy. PLoS One. 2014;9(4):e95061. https://doi.org/10.1371/journal.pone.0095061.CrossRefPubMedPubMedCentral

27.••

Hsue PY, Waters DD. HIV infection and coronary heart disease: mechanisms and management. Nat Rev Cardiol. 2019;16(12):745–59. https://doi.org/10.1038/s41569-019-0219-9A review on epidemiology and clinical features of cardiovascular disease in PWH with a focus on coronary heart disease, the underlying mechanisms and available therapeutic strategies.CrossRefPubMedPubMedCentral

28.

Feinstein MJ, Nance RM, Delaney JAC, Heckbert SR, Budoff MJ, Drozd DR, et al. Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). BMC Med. 2019;17(1):149. https://doi.org/10.1186/s12916-019-1385-7.CrossRefPubMedPubMedCentral

29.

Nou E, Lo J, Hadigan C, Grinspoon SK. Pathophysiology and management of cardiovascular disease in patients with HIV. Lancet Diabetes Endocrinol. 2016;4(7):598–610. https://doi.org/10.1016/s2213-8587(15)00388-5.CrossRefPubMedPubMedCentral

30.

Shah ASV, Stelzle D, Lee KK, Beck EJ, Alam S, Clifford S, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: systematic review and meta-analysis. Circulation. 2018;138(11):1100–12. https://doi.org/10.1161/circulationaha.117.033369.CrossRefPubMedPubMedCentral

31.

Feinstein MJ, Steverson AB, Ning H, Pawlowski AE, Schneider D, Ahmad FS, et al. Adjudicated heart failure in HIV-infected and uninfected men and women. J Am Heart Assoc. 2018;7(21):e009985. https://doi.org/10.1161/jaha.118.009985.CrossRefPubMedPubMedCentral

32.

Feinstein MJ, Hsue PY, Benjamin LA, Bloomfield GS, Currier JS, Freiberg MS, et al. Characteristics, prevention, and management of cardiovascular disease in people living with HIV: a scientific statement from the American Heart Association. Circulation. 2019;140(2):e98–e124. https://doi.org/10.1161/cir.0000000000000695.CrossRefPubMedPubMedCentral

33.

Erqou S, Lodebo BT, Masri A, Altibi AM, Echouffo-Tcheugui JB, Dzudie A, et al. Cardiac dysfunction among people living with HIV: a systematic review and meta-analysis. JACC Heart Fail. 2019;7(2):98–108. https://doi.org/10.1016/j.jchf.2018.10.006.CrossRefPubMed

34.

Butler J, Greene SJ, Shah SH, Shah SJ, Anstrom KJ, Kim RJ, et al. Diastolic dysfunction in patients with human immunodeficiency virus receiving antiretroviral therapy: results from the CHART study. J Card Fail. 2020;26(5):371–80. https://doi.org/10.1016/j.cardfail.2019.10.011.CrossRefPubMed

35.

Palella FJ Jr, McKibben R, Post WS, Li X, Budoff M, Kingsley L, et al. Anatomic fat depots and coronary plaque among human immunodeficiency virus-infected and uninfected men in the multicenter AIDS cohort study. Open Forum. Infect Dis. 2016;3(2):ofw098. https://doi.org/10.1093/ofid/ofw098.CrossRef

36.

Glesby MJ, Hanna DB, Hoover DR, Shi Q, Yin MT, Kaplan R, et al. Abdominal fat depots and subclinical carotid artery atherosclerosis in women with and without HIV infection. J Acquir Immune Defic Syndr. 2018;77(3):308–16. https://doi.org/10.1097/qai.0000000000001606.CrossRefPubMedPubMedCentral

37.

•Goerlich E, Schar M, Bagchi S, Soleimani-Fard A, Brown T, Sarkar S, et al. Coronary endothelial dysfunction in people living with HIV is related to body fat distribution. J Acquir Immune Defic Syndr. 2022. https://doi.org/10.1097/QAI.0000000000002932This study describes the associations between impaired coronary endothelial function and altered body fat distribution in PWH.

38.

Schächinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation. 2000;101(16):1899–906. https://doi.org/10.1161/01.cir.101.16.1899.CrossRefPubMed

39.

•Lake JE, Debroy P, Ng D, Erlandson KM, Kingsley LA, Palella FJ, et al. Associations between subcutaneous fat density and systemic inflammation differ by HIV serostatus and are independent of fat quantity. Eur J Endocrinol. 2019;181(4):451–9. https://doi.org/10.1530/eje-19-0296This new analysis from the MACS offers further evidence that adipose tissue density by CT scan provides additional information compared to adipose tissue quantity measurement alone.CrossRefPubMedPubMedCentral

40.

Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol. 2020;73(1):202–9. https://doi.org/10.1016/j.jhep.2020.03.039.CrossRefPubMed

41.

Duell PB, Welty FK, Miller M, Chait A, Hammond G, Ahmad Z, et al. Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2022;42(6):e168–e85. https://doi.org/10.1161/ATV.0000000000000153.CrossRefPubMed

42.

Lake JE, Overton T, Naggie S, Sulkowski M, Loomba R, Kleiner DE, et al. Expert panel review on nonalcoholic fatty liver disease in persons with human immunodeficiency virus. Clin Gastroenterol Hepatol. 2022;20(2):256–68. https://doi.org/10.1016/j.cgh.2020.10.018.CrossRefPubMed

43.

Long MT, Noureddin M, Lim JK. AGA clinical practice update: diagnosis and management of nonalcoholic fatty liver disease in lean individuals: expert review. Gastroenterology. 2022. https://doi.org/10.1053/j.gastro.2022.06.023.

44.

Kaplan A, Simon TG, Henson JB, Wang T, Zheng H, Osganian SA, et al. Brief report: relationship between nonalcoholic fatty liver disease and cardiovascular disease in persons with HIV. J Acquir Immune Defic Syndr. 2020;84(4):400–4. https://doi.org/10.1097/qai.0000000000002359.CrossRefPubMed

45.

Maurice JB, Patel A, Scott AJ, Patel K, Thursz M, Lemoine M. Prevalence and risk factors of nonalcoholic fatty liver disease in HIV-monoinfection. Aids. 2017;31(11):1621–32. https://doi.org/10.1097/qad.0000000000001504.CrossRefPubMed

46.••

Iacobellis G. Epicardial adipose tissue. In: Contemporary Cardiology. Cham: Springer International Publishing; 2020 First book summarizing the current knowledge of the epicardic adipose tissue.

47.••

Guglielmo M, Lin A, Dey D, Baggiano A, Fusini L, Muscogiuri G, et al. Epicardial fat and coronary artery disease: role of cardiac imaging. Atherosclerosis. 2021;321:30–8. https://doi.org/10.1016/j.atherosclerosis.2021.02.008Comprehensive review on available imaging techniques used to assess cardiac fat tissue.CrossRefPubMed

48.

Mazurek T, Kobylecka M, Zielenkiewicz M, Kurek A, Kochman J, Filipiak KJ, et al. PET/CT evaluation of (18)F-FDG uptake in pericoronary adipose tissue in patients with stable coronary artery disease: independent predictor of atherosclerotic lesions' formation? J Nucl Cardiol. 2017;24(3):1075–84. https://doi.org/10.1007/s12350-015-0370-6.CrossRefPubMed

49.

Iacobellis G, Malavazos AE. Pericardial adipose tissue, atherosclerosis, and cardiovascular disease risk factors: the Jackson Heart Study: comment on Liu et Al. Diabetes Care. 2010;33(9):e127; author reply e8. https://doi.org/10.2337/dc10-0904.CrossRefPubMed

50.

Sacks HS, Fain JN, Bahouth SW, Ojha S, Frontini A, Budge H, et al. Adult epicardial fat exhibits beige features. J Clin Endocrinol Metab. 2013;98(9):E1448–55. https://doi.org/10.1210/jc.2013-1265.CrossRefPubMed

51.••

Oikonomou EK, Antoniades C. The role of adipose tissue in cardiovascular health and disease. Nat Rev Cardiol. 2019;16(2):83–99. https://doi.org/10.1038/s41569-018-0097-6Exhaustive review on adipose tissue and its relationship with cardiovascular system.CrossRefPubMed

52.

Iwabu M, Okada-Iwabu M, Yamauchi T, Kadowaki T. Adiponectin/adipor research and its implications for lifestyle-related diseases. Front Cardiovasc Med. 2019;6:116. https://doi.org/10.3389/fcvm.2019.00116.CrossRefPubMedPubMedCentral

53.

Iacobellis G, Mahabadi AA. Is epicardial fat attenuation a novel marker of coronary inflammation? Atherosclerosis. 2019;284:212–3. https://doi.org/10.1016/j.atherosclerosis.2019.02.023.CrossRefPubMed

54.

Holloway CJ, Ntusi N, Suttie J, Mahmod M, Wainwright E, Clutton G, et al. Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients. Circulation. 2013;128(8):814–22. https://doi.org/10.1161/circulationaha.113.001719.CrossRefPubMed

55.

Nelson MD, Szczepaniak LS, LaBounty TM, Szczepaniak E, Li D, Tighiouart M, et al. Cardiac steatosis and left ventricular dysfunction in HIV-infected patients treated with highly active antiretroviral therapy. JACC Cardiovasc Imaging. 2014;7(11):1175–7. https://doi.org/10.1016/j.jcmg.2014.04.024.CrossRefPubMedPubMedCentral

56.

Thiara DK, Liu CY, Raman F, Mangat S, Purdy JB, Duarte HA, et al. Abnormal myocardial function is related to myocardial steatosis and diffuse myocardial fibrosis in HIV-infected adults. J Infect Dis. 2015;212(10):1544–51. https://doi.org/10.1093/infdis/jiv274.CrossRefPubMedPubMedCentral

57.

Toribio M, Neilan TG, Awadalla M, Stone LA, Rokicki A, Rivard C, et al. Intramyocardial triglycerides among women with vs without HIV: hormonal correlates and functional consequences. J Clin Endocrinol Metab. 2019;104(12):6090–100. https://doi.org/10.1210/jc.2019-01096.CrossRefPubMedPubMedCentral

58.

Neilan TG, Nguyen K-L, Zaha VG, Chew KW, Morrison L, Ntusi NAB, et al. Myocardial steatosis among antiretroviral therapy–treated people with human immunodeficiency virus participating in the REPRIEVE trial. J Infect Dis. 2020;222(Supplement_1):S63–S9. https://doi.org/10.1093/infdis/jiaa245.CrossRefPubMedPubMedCentral

59.

Borga M, West J, Bell JD, Harvey NC, Romu T, Heymsfield SB, et al. Advanced body composition assessment: from body mass index to body composition profiling. J Investig Med. 2018;66(5):1–9. https://doi.org/10.1136/jim-2018-000722.CrossRefPubMedPubMedCentral

60.

Mihl C, Loeffen D, Versteylen MO, Takx RA, Nelemans PJ, Nijssen EC, et al. Automated quantification of epicardial adipose tissue (EAT) in coronary CT angiography; comparison with manual assessment and correlation with coronary artery disease. J Cardiovasc Comput Tomogr. 2014;8(3):215–21. https://doi.org/10.1016/j.jcct.2014.04.003.CrossRefPubMed

61.

Sadouni M, Boldeanu I, Durand M, Juneau D, Blais S, Tremblay C, et al. Quantification of epicardial fat using non contrast cardiac CT in an HIV population: reproducibility and association with other body fat indices. Eur J Radiol Open. 2021;8:100317. https://doi.org/10.1016/j.ejro.2020.100317.CrossRefPubMedPubMedCentral

62.

Parisi V, Petraglia L, Formisano R, Caruso A, Grimaldi MG, Bruzzese D, et al. Validation of the echocardiographic assessment of epicardial adipose tissue thickness at the Rindfleisch fold for the prediction of coronary artery disease. Nutr Metab Cardiovasc Dis. 2020;30(1):99–105. https://doi.org/10.1016/j.numecd.2019.08.007.CrossRefPubMed

63.

Mancio J, Azevedo D, Saraiva F, Azevedo AI, Pires-Morais G, Leite-Moreira A, et al. Epicardial adipose tissue volume assessed by computed tomography and coronary artery disease: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2018;19(5):490–7. https://doi.org/10.1093/ehjci/jex314.CrossRefPubMed

64.

Cheng VY. Plugging epicardial fat into a prediction algorithm. Circ Cardiovasc Imaging. 2019;12(1):e008629. https://doi.org/10.1161/circimaging.118.008629.CrossRefPubMed

65.

Eisenberg E, McElhinney PA, Commandeur F, Chen X, Cadet S, Goeller M, et al. Deep learning-based quantification of epicardial adipose tissue volume and attenuation predicts major adverse cardiovascular events in asymptomatic subjects. Circ Cardiovasc Imaging. 2020;13(2):e009829. https://doi.org/10.1161/circimaging.119.009829.CrossRefPubMedPubMedCentral

66.

Guaraldi G, Scaglioni R, Zona S, Orlando G, Carli F, Ligabue G, et al. Epicardial adipose tissue is an independent marker of cardiovascular risk in HIV-infected patients. Aids. 2011;25(9):1199–205. https://doi.org/10.1097/QAD.0b013e3283474b9f.CrossRefPubMed

67.

Orlando G, Guaraldi G, Zona S, Carli F, Bagni P, Menozzi M, et al. Ectopic fat is linked to prior cardiovascular events in men with HIV. J Acquir Immune Defic Syndr. 2012;59(5):494–7. https://doi.org/10.1097/QAI.0b013e31824c8397.CrossRefPubMed

68.

Brener M, Ketlogetswe K, Budoff M, Jacobson LP, Li X, Rezaeian P, et al. Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis. Aids. 2014;28(11):1635–44. https://doi.org/10.1097/qad.0000000000000116.CrossRefPubMed

69.•

Buggey J, Yun L, Hung CL, Kityo C, Mirembe G, Erem G, et al. HIV and pericardial fat are associated with abnormal cardiac structure and function among Ugandans. Heart. 2020;106(2):147–53. https://doi.org/10.1136/heartjnl-2019-315346Interesting study that found greater PCF volume, worse systolic LV function, and greater odds of DD in PWH from Uganda.CrossRefPubMed

70.

Lo J, Abbara S, Rocha-Filho JA, Shturman L, Wei J, Grinspoon SK. Increased epicardial adipose tissue volume in HIV-infected men and relationships to body composition and metabolic parameters. Aids. 2010;24(13):2127–30. https://doi.org/10.1097/QAD.0b013e32833c055a.CrossRefPubMed

71.•

Knudsen AD, Krebs-Demmer L, Bjørge NID, Elming MB, Gelpi M, Sigvardsen PE, et al. Pericardial adipose tissue volume is independently associated with human immunodeficiency virus status and prior use of stavudine, didanosine, or indinavir. J Infect Dis. 2020;222(1):54–61. https://doi.org/10.1093/infdis/jiaa057This study included over 1,000 participants and demonstrated that PCF volume was significantly larger in PWH with normal BMI, contributing to the current knowledge about dysfunctional adipose tissue, its abnormal redistribution, and subsequent cardiometabolic implications in lean PWH.CrossRefPubMed

72.

Shah RV, Anderson A, Ding J, Budoff M, Rider O, Petersen SE, et al. Pericardial, but not hepatic, fat by CT is associated with CV outcomes and structure: the multi-ethnic study of atherosclerosis. JACC Cardiovasc Imaging. 2017;10(9):1016–27. https://doi.org/10.1016/j.jcmg.2016.10.024.CrossRefPubMedPubMedCentral

73.

Lee JJ, Pedley A, Hoffmann U, Massaro JM, Keaney JF Jr, Vasan RS, et al. Cross-sectional associations of computed tomography (CT)-derived adipose tissue density and adipokines: the Framingham Heart Study. J Am Heart Assoc. 2016;5(3):e002545. https://doi.org/10.1161/jaha.115.002545.CrossRefPubMedPubMedCentral

74.

Liu Z, Wang S, Wang Y, Zhou N, Shu J, Stamm C, et al. Association of epicardial adipose tissue attenuation with coronary atherosclerosis in patients with a high risk of coronary artery disease. Atherosclerosis. 2019;284:230–6. https://doi.org/10.1016/j.atherosclerosis.2019.01.033.CrossRefPubMed

75.

Antonopoulos AS, Sanna F, Sabharwal N, Thomas S, Oikonomou EK, Herdman L, et al. Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med. 2017;9(398):eaal2658. https://doi.org/10.1126/scitranslmed.aal2658.CrossRefPubMed

76.

Song G, Qiao W, Sun L, Yu X. A meta-analysis of different types of cardiac adipose tissue in HIV patients. Biomed Res Int. 2020;2020:8234618. https://doi.org/10.1155/2020/8234618.CrossRefPubMedPubMedCentral

77.

Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336–45. https://doi.org/10.1056/NEJMoa072100.CrossRefPubMed

78.

Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, et al. CAD-RADS (TM) coronary artery disease - reporting and data system. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Cardiovasc Comput Tomogr. 2016;10(4):269–81. https://doi.org/10.1016/j.jcct.2016.04.005.CrossRefPubMed

79.

Hell MM, Motwani M, Otaki Y, Cadet S, Gransar H, Miranda-Peats R, et al. Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up. Eur Heart J Cardiovasc Imaging. 2017;18(12):1331–9. https://doi.org/10.1093/ehjci/jex183.CrossRefPubMedPubMedCentral

80.

Fitch KV, Srinivasa S, Abbara S, Burdo TH, Williams KC, Eneh P, et al. Noncalcified coronary atherosclerotic plaque and immune activation in HIV-infected women. J Infect Dis. 2013;208(11):1737–46. https://doi.org/10.1093/infdis/jit508.CrossRefPubMedPubMedCentral

81.

Post WS, Budoff M, Kingsley L, Palella FJ Jr, Witt MD, Li X, et al. Associations between HIV infection and subclinical coronary atherosclerosis. Ann Intern Med. 2014;160(7):458–67. https://doi.org/10.7326/M13-1754.CrossRefPubMedPubMedCentral

82.

Grinspoon S. Epicardial adipose tissue and atherogenesis: EAT your heart out. Aids. 2014;28(11):1679–81. https://doi.org/10.1097/qad.0000000000000117.CrossRefPubMed

83.

Metkus TS, Brown T, Budoff M, Kingsley L, Palella FJ Jr, Witt MD, et al. HIV infection is associated with an increased prevalence of coronary noncalcified plaque among participants with a coronary artery calcium score of zero: Multicenter AIDS Cohort Study (MACS). HIV Med. 2015;16(10):635–9. https://doi.org/10.1111/hiv.12262.CrossRefPubMedPubMedCentral

84.

Senoner T, Dichtl W, Feuchtner GM. The perivascular fat gradient in HIV-infected patients. Aids. 2020;34(3):490–1. https://doi.org/10.1097/qad.0000000000002449.CrossRefPubMed

85.

Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49–73. https://doi.org/10.1161/01.cir.0000437741.48606.98.CrossRefPubMed

86.

Grinspoon SK, Fitch KV, Overton ET, Fichtenbaum CJ, Zanni MV, Aberg JA, et al. Rationale and design of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE). Am Heart J. 2019;212:23–35. https://doi.org/10.1016/j.ahj.2018.12.016.CrossRefPubMedPubMedCentral

87.

Hoffmann U, Lu MT, Olalere D, Adami EC, Osborne MT, Ivanov A, et al. Rationale and design of the mechanistic substudy of the randomized trial to prevent vascular events in HIV (REPRIEVE): effects of pitavastatin on coronary artery disease and inflammatory biomarkers. Am Heart J. 2019;212:1–12. https://doi.org/10.1016/j.ahj.2019.02.011.CrossRefPubMedPubMedCentral

88.

••Hoffmann U, Lu MT, Foldyna B, Zanni MV, Karady J, Taron J, et al. Assessment of coronary artery disease with computed tomography angiography and inflammatory and immune activation biomarkers among adults with HIV eligible for primary cardiovascular prevention. JAMA Netw Open. 2021;4(6):e2114923. https://doi.org/10.1001/jamanetworkopen.2021.14923This large ACTG study demonstrates the elevated prevalence of the vulnerable non-calcified coronary plaque among PWH with low-to-moderated cardiovascular risk.CrossRefPubMedPubMedCentral

89.

Zanni MV, Foldyna B, Williams K et al. Subclinical Atherosclerosis and Immune Activation Among US Females vs. Males With HIV. Presented at: Conference on Retroviruses and Opportunistic Infections (CROI). Poster No. 577, 2022; Virtual

90.•

Sadouni M, Durand M, Boldeanu I, Danieli C, Bodson-Clermont P, Mansour S, et al. Association of epicardial fat with noncalcified coronary plaque volume and with low attenuation plaque in people with HIV. Aids. 2021;35(10):1575–84. https://doi.org/10.1097/qad.0000000000002911This study validates the use of non-contrast cardiac CT scan to measure epicardic adipose tissue volume in PWH.CrossRefPubMed

91.

Srinivasa S, Lu MT, Fitch KV, Hallett TR, O'Malley TK, Stone LA, et al. Epicardial adipose tissue volume and cardiovascular risk indices among asymptomatic women with and without HIV. Antivir Ther. 2018;23(1):1–9. https://doi.org/10.3851/imp3193.CrossRefPubMedPubMedCentral

92.•

Tumkosit M, Han WM, Tankittiwat K, Chattranukulchai P, Siwamogsatham S, Apornpong T, et al. Higher epicardial fat in older adults living with HIV with viral suppression and relationship with liver steatosis, coronary calcium and cardiometabolic risks. Aids. 2022. https://doi.org/10.1097/qad.0000000000003204This recent cross-sectional study described that PWH from Thailand had greater epicardic adipose tissue volume, independently associated with coronary artery calcium score.

Title: Ectopic Fat and Cardiac Health in People with HIV: Serious as a Heart Attack
Authors: Ana N. Hyatt
Jordan E. Lake
Publication date: 13-08-2022
Publisher: Springer US
Keyword: Human Immunodeficiency Virus
Published in: Current HIV/AIDS Reports / Issue 5/2022
Print ISSN: 1548-3568
Electronic ISSN: 1548-3576
DOI: https://doi.org/10.1007/s11904-022-00620-2

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