DOI: 10.1161/strokeaha.123.043922 ISSN: 0039-2499

Association of HIV and HCV Infection With Carotid Artery Plaque Echomorphology in the MACS/WIHS Combined Cohort Study

Claudio A. Bravo, Jee-Young Moon, Krista Davy, Robert C. Kaplan, Kathryn Anastos, Carlos J. Rodriguez, Wendy S. Post, Stephen J. Gange, Seble G. Kassaye, Lawrence A. Kingsley, Jason M. Lazar, Wendy J. Mack, Nataliya Pyslar, Phyllis C. Tien, Mallory D. Witt, Frank J. Palella, Yanjie Li, Mingzhu Yan, Howard N. Hodis, David B. Hanna
  • Advanced and Specialized Nursing
  • Cardiology and Cardiovascular Medicine
  • Neurology (clinical)


HIV and hepatitis C virus (HCV) are associated with increased risk of carotid artery atherosclerotic plaque and stroke. We examined associations of HIV- and HCV-related factors with echomorphologic features of carotid artery plaque.


This cross-sectional study included participants from the MACS (Multicenter AIDS Cohort Study)/WIHS (Women’s Interagency HIV Study) Combined Cohort Study who underwent high-resolution B-mode carotid artery ultrasound. Plaques were characterized from 6 areas of the right carotid artery. Poisson regression controlling for demographic and cardiometabolic risk factors determined adjusted prevalence ratios (aPRs) and 95% CIs for associations of HIV- and HCV-related factors with echomorphologic features.


Of 2655 participants (65% women, median age 44 [interquartile range, 37–50] years), 1845 (70%) were living with HIV, 600 (23%) were living with HCV, and 425 (16%) had carotid plaque. There were 191 plaques identified in 129 (11%) women with HIV, 51 plaques in 32 (7%) women without HIV, 248 plaques in 171 (28%) men with HIV, and 139 plaques in 93 (29%) men without HIV. Adjusted analyses showed that people with HIV and current CD4 + count <200 cells/µL had a significantly higher prevalence of predominantly echolucent plaque (aPR, 1.86 [95% CI, 1.08–3.21]) than those without HIV. HCV infection alone (aPR, 1.86 [95% CI, 1.08–3.19]) and HIV-HCV coinfection (aPR, 1.75 [95% CI, 1.10–2.78]) were each associated with higher prevalence of predominantly echogenic plaque. HIV-HCV coinfection was also associated with higher prevalence of smooth surface plaque (aPR, 2.75 [95% CI, 1.03–7.32]) compared with people without HIV and HCV.


HIV with poor immunologic control, as well as HCV infection, either alone or in the presence of HIV, were associated with different echomorphologic phenotypes of carotid artery plaque.

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