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Ann Intern Med. 2014 Apr 1;160(7):458-67. doi: 10.7326/M13-1754.

Associations between HIV infection and subclinical coronary atherosclerosis.

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.

PMID:
24687069
PMCID:
PMC4143766
DOI:
10.7326/M13-1754
[Indexed for MEDLINE]
Free PMC Article

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