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Observational Study
. 2014 Apr 1;160(7):458-67.
doi: 10.7326/M13-1754.

Associations between HIV infection and subclinical coronary atherosclerosis

Wendy S Post, Matthew Budoff, Lawrence Kingsley, Frank J Palella Jr, Mallory D Witt, Xiuhong Li, Richard T George, Todd T Brown, Lisa P Jacobson
Observational Study

Associations between HIV infection and subclinical coronary atherosclerosis

Wendy S Post et al. Ann Intern Med. .

Abstract

Background: Coronary artery disease (CAD) has been associated with HIV infection, but data are not consistent.

Objective: To determine whether HIV-infected men have more coronary atherosclerosis than uninfected men.

Design: Cross-sectional study.

Setting: Multicenter AIDS Cohort Study.

Participants: 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.

Measurements: 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.

Results: 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%.

Limitation: Cross-sectional observational study design and inclusion of only men.

Conclusion: Coronary artery plaque, especially noncalcified plaque, is more prevalent and extensive in HIV-infected men, independent of CAD risk factors.

Primary funding source: National Heart, Lung, and Blood Institute and National Institute of Allergy and Infectious Diseases.

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Figures

Figure 1
Figure 1
Unadjusted prevalences with 95% confidence intervals of plaque stratified by HIV serostatus in 5 year age increments. N on the top of each panel shows the number of men in each group. Interaction for age by HIV serostatus for the presence of non-calcified plaque was significant (p= 0.006).
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