Coronary Plaque Vulnerability Greater in HIV+ Men in Boston Study
Three features of coronary atherosclerotic plaque vulnerability were more prevalent in HIV-positive men than in HIV-negative men with similar ages and traditional cardiovascular risk profiles.
Several cohort studies show higher rates of myocardial infarction and sudden cardiac death in people with HIV infection than in the general population. To compare atherosclerotic plaque morphology in men with and without HIV, researchers in a Boston healthcare system used multidetector spiral coronary computed tomography angiography (coronary CTA) to analyze coronary arteries in 101 HIV-positive and 41 HIV-negative men.
The two groups were matched for age and cardiovascular risk factors, and no men had clinically apparent heart disease. The researchers analyzed coronary CTA for three vulnerability features: low attenuation, positive remodeling, and spotty calcification.
Almost all men with HIV (95%) were taking antiretroviral therapy (ART), and median ART duration was 7.9 years. Median CD4 count of the HIV group stood at 473 cells/μL, and median viral load lay below 50 copies/mL. Age and traditional cardiovascular risk factors were similar in the HIV-positive and HIV-negative groups.
Compared with HIV-negative men, HIV-positive men had significantly higher rates of low-attenuation plaque (22.8% versus 7.3%, P = 0.02), positively remodeled plaque (49.5% versus 31.7%, P = 0.05), and high-risk 3-feature plaque (7.9% versus 0%, P = 0.02).
In addition, men with HIV had a significantly higher number of low-attenuation plaques (P = 0.01) and positively remodeled plaques (P = 0.03) per patient.
The researchers conclude that “differences in coronary atherosclerotic plaque morphology—namely, increased vulnerable plaque among HIV-infected patients—are here for the first time reported and may contribute to increased rates of MI and sudden cardiac death in this population.”
Source: Markella V. Zanni, Suhny Abbara, Janet Lo, Bryan Wai, David Hark, Eleni Marmarelis, Steven K. Grinspoon. Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men. AIDS. 2013; 27: 1263-1272.
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Written by Mark Mascolini on behalf of the International AIDS Society