Electron Beam Computed Tomography for Assessment of Coronary Artery Disease in HIV-Infected Men Receiving Antiretroviral Therapy

Abstract

Hyperlipidemia has been seen in patients receiving protease inhibitor-based antiretroviral therapy, prompting concern that such patients are at risk for accelerated coronary artery disease (CAD). To assess the risk of CAD in antiretroviral-treated HIV-infected men, we quantified coronary artery calcium (CAC), a sensitive and established marker of subclinical CAD, using electron beam computed tomography (EBCT) of coronary vessels. Sixty HIV-infected men who met the following criteria (cases) were enrolled in the study: age of 40 years or older; naive to antiretroviral therapy or use of a stable antiretroviral regimen for >or=6 months (mean duration, 25.9 months; 41 patients were receiving protease inhibitor therapy); and no known CAD or no use of lipid-lowering agents. EBCT-derived CAC scores, serum lipid levels, history of antiretroviral therapy, and risk factors for CAD were obtained. Each case was compared with three age-, sex-, and race-matched HIV-negative controls randomly selected from a database including >9000 patients who had undergone EBCT. We determined differences in the proportion of cases and controls with CAC scores of >0 (detectable calcium) and clinically significant CAC for age range. There were no statistically significant differences between the number of cases and controls with detectable CAC (33% and 39%, respectively) and clinically significant CAC (18% and 17%, respectively). This study suggests that the rate of coronary atherosclerosis among HIV-infected patients who receive short-term antiretroviral therapy with or without protease inhibitors is not higher than that among age-, sex-, and race-matched HIV-negative controls. These results need to be confirmed in larger long-term studies, with controls well matched for coronary risk factors.

HIV positivity, protease inhibitor exposure and subclinical atherosclerosis: a systematic review and meta-analysis of observational studies

“…Five studies reported incidence of CAC among HIV positive versus HIV negative patients 8 18 20 28 30. The pooled odds ratio for raised CAC by cardiac CT was not significant comparing HIV positive with HIV negative patients: OR = 0.95 (95% CI 0.55 to 1.65, p = 0.851); I2 = 65%, p = 0.024.…”

“…Of 58 articles selected for detailed evaluation, 13 were excluded owing to missing data or comparison groups not relevant to our study question, 20 were duplicate data and 25 were included from the initial search 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32. After the addition of a study identified from the references of included articles a total of 26 articles were included 33.…”

“…Not all studies reported other covariates in the same manner (eg, some report mean LDL, others report incidence of hypercholesterolaemia). Twenty-three (88%) controlled for age and at least one other important confounder; three studies did not control for confounding 19 28 30. Eleven studies (42%) stated there was blinded assessment of the study outcome (ultrasound or CAC result) 8 10 13 15 19 20 21 23 25 32 33.…”

“…CIMT, carotid plaque and CAC are well-established direct measures of subclinical atherosclerosis burden and predict the risk of future cardiovascular events 42 43. However, studies of subclinical atherosclerosis among patients with HIV have had disparate results with odds ratios ranging from protective to harmful 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32. Cohort studies that have quantified the risk of coronary events among patients with HIV and those exposed to PIs have similarly yielded inconsistencies 34 35 36 37 38 39 40 41…”

Escore de cálcio na avaliação da aterosclerose em pacientes com HIV/AIDS

“…This finding is in agreement with the literature, where similar numbers were found when adjusted for the age of the patients studied (mean, 43.4 years) 10 . Talwani et al 11 had previously reported that the calcium score in the HIVpositive population on antiretroviral therapy for at least 6 months was not significantly different from that of persons not carrying the virus. Kingsley et al 10 found a positive calcium score in 12% of patients under 45 years of age and HIV positive and in 23% of patients aged 40-45 years.…”