Coronary artery plaque prevalent in men with HIV

Noncalcified coronary artery plaque was found to be more prevalent and extensive in HIV-infected men, which suggests an increased risk for cardiovascular events in this population, according to a study published on March 31 by Annals of Internal Medicine.

As the survival rate of those infected with HIV has increased, so has the appearance of chronic noninfectious age-related diseases like coronary artery disease (CAD). Though this association has been discovered in previous studies, data have been inconsistent. Lead author Wendy S. Post, MD, MS, of the Johns Hopkins University School of Medicine in Baltimore, and colleagues performed noncontrast cardiac CT scans and CT angiography to determine if HIV-infected men had more coronary artherosclerosis than uninfected men.

The researchers examined 618 HIV-infected men and 383 uninfected men between the ages of 40 and 70 who had sex with men, weighed less than 200 pounds and had no history of coronary revascularization. They investigated the presence and extent of coronary artery calcium and plaque on noncontrast cardiac CT and noncalcified, mixed, or calcified plaque or stenosis on coronary CT angiography.

Of the 1,001 men who underwent noncontrast CT, 759 also had coronary CT angiography. Analysis revealed that HIV-infected men who underwent noncontrast CT scans had a greater prevalence of coronary artery calcium at 53.1 percent versus 52 percent amongst the uninfected men.

There was also a greater prevalence of plaque in HIV-infected men who underwent contrast cardiac CT scans, with a prevalence rate of 77.6 percent versus 74.4 percent in uninfected men. Associations between HIV infection and any plaque or noncalcified plaque remained significant after adjustment for CAD risk factors.

Those with HIV had a greater extent of noncalcified plaque after CAD risk factor adjustment and a greater prevalence of coronary artery stenosis that was more than 50 percent before adjustment. Lastly, longer duration of highly active antiretroviral therapy and lower nadir CD4⁺ T-cell count were associated with coronary stenosis greater than 50 percent.

“Although coronary CT angiography is not indicated as a screening test in asymptomatic persons, these results emphasize the importance of assessing and modifying traditional cardiovascular risk factors in this population, especially in men with a history of low nadir CD4⁺ T-cell count,” concluded the authors.

In an associated editorial, co-written by Judith S. Currier, MD, MSc, of the University of California in Los Angeles and James H. Stein, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, the authors point to areas of future study and emphasize the importance of continuing to address other risk factors for cardiovascular disease.

“While we wait for results of longitudinal studies aimed at clarifying the mechanisms of disease and identifying effective strategies for prevention, it is critical that we not lose sight of the importance of addressing well-established risk factors for cardiovascular disease in the HIV-infected population,” wrote Currier and Stein.