Associations Between HIV Infection and Subclinical Coronary Atherosclerosis

• Published in: Annals of internal medicine Vol. 160; no. 7; pp. 458 - 467
• Main Authors: POST, Wendy S, BUDOFF, Matthew, KINGSLEY, Lawrence, PALELLA, Frank J, WITT, Mallory D, XIUHONG LI, GEORGE, Richard T, BROWN, Todd T, JACOBSON, Lisa P
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American College of Physicians 01-04-2014
• Subjects: Adult; Aged; Angiography; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular disease; CD4 Lymphocyte Count; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Cross-Sectional Studies; General aspects; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; Homosexuality, Male; Human immunodeficiency virus; Human viral diseases; Humans; Infections; Infectious diseases; Male; Medical sciences; Middle Aged; Plaque, Atherosclerotic - diagnostic imaging; Prospective Studies; Side effects; Studies; Time Factors; Tomography, X-Ray Computed; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Immunopathology; Coronary artery; Cardiovascular disease; AIDS; Asymptomatic; Immune deficiency; Coronary heart disease; Infection; Vascular disease; Medicine; Association; Viral disease; Atherosclerosis
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/M13-1754

Coronary artery disease (CAD) has been associated with HIV infection, but data are not consistent.
To determine whether HIV-infected men have more coronary atherosclerosis than uninfected men.
Cross-sectional study.
Multicenter AIDS Cohort Study.
HIV-infected (n = 618) and uninfected (n = 383) men who have sex with men who were aged 40 to 70 years, weighed less than 136 kg (200 lb), and had no history of coronary revascularization.
Presence and extent of coronary artery calcium (CAC) on noncontrast cardiac computed tomography (CT) and of any plaque; noncalcified, mixed, or calcified plaque; or stenosis on coronary CT angiography.
1001 men had noncontrast CT, of whom 759 had coronary CT angiography. After adjustment for age, race, CT scanning center, and cohort, HIV-infected men had a greater prevalence of CAC (prevalence ratio [PR], 1.21 [95% CI, 1.08 to 1.35]; P = 0.001) and any plaque (PR, 1.14 [CI, 1.05 to 1.24]; P = 0.001), including noncalcified (PR, 1.28 [CI, 1.13 to 1.45]; P < 0.001) and mixed (PR, 1.35 [CI, 1.10 to 1.65]; P = 0.004) plaque, than uninfected men. Associations between HIV infection and any plaque or noncalcified plaque remained significant (P < 0.005) after CAD risk factor adjustment. HIV-infected men had a greater extent of noncalcified plaque after CAD risk factor adjustment (P = 0.026). They also had a greater prevalence of coronary artery stenosis greater than 50% (PR, 1.48 [CI, 1.06 to 2.07]; P = 0.020), but not after CAD risk factor adjustment. Longer duration of highly active antiretroviral therapy (PR, 1.09 [CI, 1.02 to 1.17]; P = 0.007) and lower nadir CD4+ T-cell count (PR, 0.80 [CI, 0.69 to 0.94]; P = 0.005) were associated with coronary stenosis greater than 50%.
Cross-sectional observational study design and inclusion of only men.
Coronary artery plaque, especially noncalcified plaque, is more prevalent and extensive in HIV-infected men, independent of CAD risk factors.
National Heart, Lung, and Blood Institute and National Institute of Allergy and Infectious Diseases.