LAUSR

BACKGROUND HIV infection leads to endothelial activation, promoting platelet adhesion and accelerating atherosclerosis. Our goal was to determine whether biomarkers of endothelial activation and hemostasis/thrombosis were elevated in people with treated HIV (PWH) before myocardial infarction (MI). METHODS In a case-control study nested within the CFAR Network of Integrated Clinical Systems (CNICS) cohort, we compared 69 adjudicated cases with type 1 MI to 138 controls matched for ART regimen. We measured angiopoietin-1, angiopoietin-2 (ANG-2), ICAM-1, VCAM-1, ADAMTS13, von Willebrand factor, C-reactive protein (CRP), interleukin-6 (IL-6), plasminogen activation inhibitor-1, P-selectin, serum amyloid-A, soluble CD14, and apolipoprotein A1 in stored plasma. Conditional logistic regression identified associations with subsequent MI, with and without adjustment for Atherosclerotic Cardiovascular Disease (ASCVD) and Veterans Aging Cohort Study (VACS) scores. RESULTS Higher IL-6 was associated with MI after adjustment for ASCVD score (adjusted odds ratio [AOR] 1.51, 95% CI, 1.05-2.17 per standard-deviation-scaled log2 increment). In a separate model adjusting for VACS score, higher ANG-2 (AOR 1.49, 95% CI 1.04-2.14), higher CRP (AOR 1.45, 95% CI 1.06-2.00), and higher IL-6 (AOR 1.68, 95% CI 1.17-2.41) were associated with MI. In a sensitivity analysis excluding PWH with viral load ≥400 copies/mL, higher IL-6 remained associated with MI after adjustment for ASCVD score and after adjustment for VACS score. CONCLUSIONS Among PWH, higher levels of plasma IL-6, CRP, and ANG-2 predict subsequent type 1 MI, independent of conventional risk scores. IL-6 had the most consistent associations with type 1 MI, regardless of viral load suppression.