Mycobacterium tuberculosis Infection and Acute or Subclinical Coronary Artery Disease: the Swiss HIV Cohort Study

Background In tuberculosis medium/high prevalence countries, Mycobacterium tuberculosis (MTB) infection has been associated with acute coronary artery disease (CAD) events and subclinical atherosclerosis. We aimed to examine whether MTB infection contributes to clinical and subclinical CAD in people with HIV (PWH) in tuberculosis low incidence settings. Methods Regarding CAD events, cases were Swiss HIV Cohort Study (SHCS) participants with a first CAD event (2000-2022). CAD-free SHCS controls were matched on sex, age and observation time. Regarding subclinical atherosclerosis, SHCS participants underwent (2013-2019) non-contrast CT for detection of coronary artery calcification (CAC) and coronary CT angiography (CCTA) for the detection of coronary soft, mixed, or high-risk plaque (SMHRP). We obtained univariable/multivariable odds ratios (OR) for CAD events, CAC, and SMRHP, in participants with negative TB status, MTB infection, and active TB, analyzed in the context of traditional and HIV-related CAD risk factors. Results We included 465 patients with acute CAD events and 1123 controls (median age 56 years, 14% women, 86% with suppressed HIV RNA). MTB infection was not associated with CAD events in multivariable analysis (odds ratio [95% confidence interval], 0.92 [0.55-1.52]) vs. participants with negative TB status. In 402 participants undergoing CAC/CCTA (median age 53 years, 14% women, 96% with suppressed HIV RNA), MTB infection was not associated with SMHRP (OR=0.55 [0.19-1.55]) or with CAC (OR=0.38 [0.1-1.41]) in multivariable analysis. Conclusions In PWH in Switzerland, a tuberculosis low prevalence country, we found no evidence of any association between MTB infection and acute CAD events or subclinical coronary atherosclerosis.