Research Article|Articles in Press

The association of epicardial adipose tissue volume and density with coronary calcium in HIV-positive and HIV-negative patients

Published:February 16, 2023DOI:


      • Cardiovascular disease is an increasing issue in patients living with HIV but the etiology of this excess risk is not established.
      • Previous work has demonstrated that adipocyte dysfunction exerts a pressure towards visceral fat accumulation in HIV-positive patients.
      • This well-characterized, retrospective analysis demonstrates that epicardial adipose tissue volume and density are significantly associated with coronary calcium in HIV-positive individuals but not HIV-negative.
      • Epicardial adipose tissue may be a therapeutic target for risk reduction strategies in the future.



      We sought to assess and compare the association of epicardial adipose tissue (EAT) with cardiovascular disease (CVD) in HIV-positive and HIV-negative groups.

      Methods and results

      Using existing clinical databases, we analyzed 700 patients (195 HIV-positive, 505 HIV-negative). CVD was quantified by the presence of coronary calcification from both dedicated cardiac computed tomography (CT) and non-dedicated CT of the thorax. Epicardial adipose tissue (EAT) was quantified using dedicated software. The HIV-positive group had lower mean age (49.2 versus 57.8, p < 0.005), higher proportion of male sex (75.9 % versus 48.1 %, p < 0.005), and lower rates of coronary calcification (29.2 % versus 58.2 %, p < 0.005). Mean EAT volume was also lower in the HIV-positive group (68mm3 versus 118.3mm3, p < 0.005). Multiple linear regression demonstrated EAT volume was associated with hepatosteatosis (HS) in the HIV-positive group but not the HIV-negative group after adjustment for BMI (p < 0.005 versus p = 0.066). In the multivariate analysis, after adjustment for CVD risk factors, age, sex, statin use, and body mass index (BMI), EAT volume and hepatosteatosis were significantly associated with coronary calcification (odds ratio [OR] 1.14, p < 0.005 and OR 3.17, p < 0.005 respectively). In the HIV-negative group, the only significant association with EAT volume after adjustment was total cholesterol (OR 0.75, p = 0.012).


      We demonstrated a strong and significant independent association of EAT volume and coronary calcium, after adjustment, in HIV-positive group but not in the HIV-negative group. This result hints at differences in the mechanistic drivers of atherosclerosis between HIV-positive and HIV-negative groups.


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