Noncalcified Coronary Atherosclerotic Plaque and Immune Activation in HIV-Infected Women

Abstract

NCT00455793.

Coronary Artery Disease in Patients with HIV Infection

“…May use atorvastatin or rosuvastatin with caution (start with the lower possible dose and titrate based on tolerance and lipid-lowering efficacy). Avoid atorvastatin with TPV found in relatively young HIV-infected patients [14,15]. HIV suppression remains the standard in CVD reduction, as studies have suggested that higher CD4 cell counts and lower HIV RNA levels are associated with a decrease in MI risk [37,64].…”

“…These findings are not only limited to the male HIV-infected population. A study that focused on the female HIV population found that young, asymptomatic HIV-infected women also demonstrate increased NCAP [15]. This has led to a surge in interest in the association between HIV infection and CVD, specifically NCAP due to the increase of major adverse cardiac events (MACE) associated with it [16].…”

Review of Cardiovascular Disease in HIV-Infected Women

“…The presence of coronary plaques was similar in both groups, but HIV-infected females had a significantly higher prevalence of non-calcified coronary artery plaques (35% vs 12% in female control subjects; p=0.04) which remained significant even after adjustment for CV risk factors such as age, race, FRS, smoking status, levels of triglycerides (TGs), HDL-c and LDL-c, and BMI. The percentage of coronary segments with non-calcified plaques was significantly higher in HIV-infected women (median 75% IQR 63%-100%) compared to HIV-infected men (median 50% IQR 3%-100%; p<0.05,) [26] which is important because non-calcified plaques are considered vulnerable and more susceptible to rupture leading to acute coronary syndromes [27]. Coronary artery calcium scores (CAC) have been found to be higher in HIV-infected patients with metabolic syndrome compared to those without metabolic syndrome [20].…”

“…The same study showed that HIV-infected women had higher rates of metabolic syndrome compared with HIV-infected men. Conversely, another study found that HIV-uninfected women had statistically significant higher percentage of CAC >100 (p=0.02) compared to HIV-infected women [26]. Other studies did not demonstrate gender differences in CAC [20,28].…”

“…Soluble CD163 (sCD163) is a monocyte-macrophage specific scavenger receptor cleaved from activated monocytes and macrophages during inflammation, and elevated levels have been associated with coronary artery disease in the general population and HIV-infected men suggesting this inflammatory and immune pathway may be involved in the pathogenesis of atherosclerosis [34,35]. Fitch et al reported that sCD163 levels were significantly higher in HIV-infected females than HIV-infected and non-infected males [26]. 98% of the women were on ART with a median duration of eight years and 84% had undetectable viral loads.…”