Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men

Abstract

Objective The degree of subclinical coronary atherosclerosis in HIV-infected patients is unknown. We investigated the degree of subclinical atherosclerosis and the relationship of traditional and nontraditional risk factors to early atherosclerotic disease using coronary computed tomography angiography. Design and methods Seventy-eight HIV-infected men (age 46.5 ± 6.5 years and duration of HIV 13.5 ± 6.1 years, CD4 T lymphocytes 523 ± 282; 81% undetectable viral load), and 32 HIV-negative men (age 45.4 ± 7.2 years) with similar demographic and coronary artery disease (CAD) risk factors, without history or symptoms of CAD, were prospectively recruited. 64-slice multidetector row computed tomography coronary angiography was performed to determine prevalence of coronary atherosclerosis, coronary stenosis, and quantitative plaque burden. Results HIV-infected men demonstrated higher prevalence of coronary atherosclerosis than non-HIV-infected men (59 vs. 34%; P = 0.02), higher coronary plaque volume [55.9 (0–207.7); median (IQR) vs. 0 (0–80.5) μl; P = 0.02], greater number of coronary segments with plaque [1 (0–3) vs. 0 (0–1) segments; P = 0.03], and higher prevalence of Agatston calcium score more than 0 (46 vs. 25%, P = 0.04), despite similar Framingham 10-year risk for myocardial infarction, family history of CAD, and smoking status. Among HIV-infected patients, Framingham score, total cholesterol, low-density lipoprotein, CD4/CD8 ratio, and monocyte chemoattractant protein 1 were significantly associated with plaque burden. Duration of HIV infection was significantly associated with plaque volume (P = 0.002) and segments with plaque (P = 0.0009) and these relationships remained significant after adjustment for age, traditional risk factors, or duration of antiretroviral therapy. A total of 6.5% (95% confidence interval 2–15%) of our study population demonstrated angiographic evidence of obstructive CAD (>70% luminal narrowing) as compared with 0% in controls. Conclusion Young, asymptomatic, HIV-infected men with long-standing HIV disease demonstrate an increased prevalence and degree of coronary atherosclerosis compared with non-HIV-infected patients. Both traditional and nontraditional risk factors contribute to atherosclerotic disease in HIV-infected patients.

High prevalence at computed coronary tomography of non-calcified plaques in asymptomatic HIV patients treated with HAART: A meta-analysis

“…217 studies were first screened at abstract level, and after evaluation 9 studies with 1229 HIV patients and 1029 controls were included [20][21][22][23][24][25][26][27][28] . (see Figure 1).…”

Coronary Artery Disease in Patients with HIV Infection

“…One study found an increased NCAP volume in HIV-infected men compared with uninfected controls with a trend toward higher Agatston calcium scores among those patients with HIV. Within the HIV-infected group, plaque volume was associated with traditional markers of CVD risk and HIV-specific risk factors [45]. In another study, the data found an increased prevalence of vulnerable plaque features among a relatively young population of HIV-infected patients [14].…”

“…In a study using coronary CTA, HIV-infected men were found to have a greater extent of non-calcified plaque after CAD risk factor adjustment [13]. Only a small number of studies have characterized the degree of both CAC plaque and NCAP in HIV-infected adults [45,46]. One study found an increased NCAP volume in HIV-infected men compared with uninfected controls with a trend toward higher Agatston calcium scores among those patients with HIV.…”

Hepatitis C – Human Immunodeficiency Virus Coinfection and the Risk of Cerebro-Cardiovascular Diseases: Is There Enough Evidence to Draw Conclusion and Establish Guideline?

“…Studies using carotid intima-media thickness (CIMT) found that PLHIV asymptomatic had increased subclinical atherosclerosis [4,5]. Furthermore, study using coronary CT angiography (CCTA) confi rmed that PLHIV had increase coronary plaque even after controlling traditional CVD risk factors [6]. Interestingly, it was stated that PLHIV had unique plaque which altered morphology that susceptible to rupture.…”