Subclinical atherosclerosis more prevalent among HIV-infected men

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1. HIV-infected men had a greater prevalence and extent of both coronary artery calcium and plaques than uninfected men, even after adjusting for coronary artery disease (CAD) risk factors. 

2. Coronary artery stenosis greater than 50% was also more prevalent among HIV-infected men.  However, this association was no longer significant after adjusting for risk factors. 

Evidence Rating Level: 2 (Good)           

Study Rundown: While both HIV infection and antiretroviral therapy have been associated with increased risk for coronary artery disease (CAD), differences in populations and study designs as well as the low incidence of clinical CAD events among HIV-infected persons makes these relationships difficult to study. In contrast, subclinical coronary atherosclerosis is easy to assess using modern imaging techniques. While some studies have found that HIV-infected persons have more subclinical atherosclerosis than their uninfected counterparts, the results have been inconsistent. The current study used noncontrast cardiac CT scans and CT angiography to determine whether HIV-infected men have more coronary atherosclerosis than uninfected men. The authors found that HIV-infected men had a greater prevalence of both coronary artery calcium and plaques than uninfected men, as well as a greater extent of noncalcified plaques, even after adjusting for CAD risk factors.  Additionally, the prevalence of coronary artery stenosis greater than 50% was higher among HIV-infected men, though this association was no longer significant after CAD risk factor adjustment.

The conclusions are limited by the fact that the study was cross-sectional and used only men. Additionally, 96% of participants with HIV were on HAART therapy, making it difficult to deduce whether these associations were the result of the infection itself or of its treatment.  Nonetheless, the study supports the hypothesis that either HIV infection or its treatment increases the risk for coronary artery disease.

Click to read the study, published today in Annals of Internal Medicine

Relevant Reading: Subclinical coronary atherosclerosis, HIV infection and antiretroviral therapy: Multicenter AIDS Cohort Study

In-Depth [cross-sectional study]:  Study participants were selected from the Multicenter AIDS Cohort Study (MACS). Eligible patients for the current cardiovascular ancillary study were active MACS participants (both HIV-infected and uninfected), aged 40-70, who weighed less than 200 pounds and who had no history of cardiac surgery or percutaneous coronary intervention. All participants underwent noncontrast cardiac CT scanning and CT angiography to evaluate for CAC, plaques, or stenosis. Outcome measurements were the presence and extent of CAC and of plaques (total, calcified, mixed, and noncalcified), and coronary artery stenosis greater than 50%. 1001 men (618 HIV-infected and 383 uninfected) had noncontrast CT scan results and 759 of them had coronary CT angiography results. Baseline characteristics were similar between groups.  After adjustment for age, race, CT scanning center, and date of enrollment, HIV-infected men had a greater prevalence of CAC (prevalence ratio [PR], 1.21 [95% CI, 1.08 to 1.35]) and any plaque (PR, 1.14 [CI, 1.05 to 1.24]) than uninfected men. This association remained significant after CAD risk factor adjustment. HIV-infected men also had a greater extent of noncalcified plaque after CAD risk factor adjustment. Additionally, they had a greater prevalence of coronary artery stenosis greater than 50% (PR, 1.09 [CI, 0.69 to 0.94]) which was associated with longer duration of HAART and lower nadir CD4+ T-cell counts. However, this association was not significant after CAD risk factor adjustment.

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