Longenecker, ChrisDoshi, Shradha2023-09-272023-09-272023Doshi_washington_0250O_26103.pdfhttp://hdl.handle.net/1773/50634Thesis (Master's)--University of Washington, 2023BackgroundSevere chronic kidney disease (CKD), associated with HIV, is a risk factor for coronary artery disease (CAD). However, the impact of the more common, subclinical form of kidney disease in people living with HIV (PLWH) on CAD risk is less understood. Using non-invasive computed tomography angiography, we aim to determine if an association exists between mild CKD and plaque parameters indicative of CAD in persons living with and without HIV, in a sub-Saharan African population. Methods This cross-sectional analysis stems from the Ugandan sTudy of HIV effects on the Myocardium and Atherosclerosis (mUTIMA) study. mUTIMA compared 100 PLWH on stable antiretroviral therapy (ART) and 100 matched non-HIV participants, all aged over 45 with ≥1 cardiovascular disease risk factor. For 165 of these participants with available computer tomography angiography data, we performed multivariable Tobit regression to examine the association between the mild CKD parameters, estimated glomerular filtration rate (eGFR) (<90mL/min/1.73 m2), and albumin creatinine ratio (ACR) (≥30mg/g), with detectable CAD. CAD was assessed using segment involvement score (SIS) (>0), segment stenosis score (SSS) (≥3), or coronary artery calcium (CAC) (>0). Results Our findings indicate that in PLWH, lower eGFR values are associated with increased SIS (coefficient: 3.31, 95% CI: 0.41 to 6.21, p = 0.03), and increased SSS (coefficient: 5.95, 95% CI: 0.54 to 11.36, p = 0.03). The association with SIS, but not SSS, remained significant after adjusting for age, gender, and 10-year ASCVD score (coefficient: 2.58, 95% CI: 0.10 to 5.06, p = 0.04). There was no association among people not living with HIV. Conclusion Mild to moderately low eGFR is associated with increased CAD plaque parameters. Estimation of renal function by relatively simple methods like eGFR monitoring therefore may be a valuable tool for cardiovascular risk assessment among PLWH in addition to that provided by traditional risk factors. The observed association also highlights the need for early integrated cardiovascular and renal care in this population.application/pdfen-USnoneCoronary artery diseaseCoronary CT angiographyMild chronic kidney diseaseHealth sciencesMedical imagingGlobal HealthThesis