icon-    folder.gif   Conference Reports for NATAP  
  20th International AIDS Conference
July 20-25, 2014
Melbourne, Australia
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The burden of subclinical heart and lung disease detected on thoracic CT scans of HIV-infected individuals on antiretroviral therapy
  Reported by jules Levin
20th International AIDS Conference, July 20-25, 2014, Melbourne
Besutti G1, Raggi P2, Scaglioni R1, Santoro A3, Orlando G3, Zona S3, Ligabue G1, Mussini C3, Leipsic J4, Sin D5,6, Man P5,6, and Guaraldi G3
1 Department of Radiology University of Modena and Reggio Emilia, Modena, Italy - 2Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- 3Clinic of Infectious Diseases, University of Modena and
Reggio Emilia - 4 Department of Radiology, University of British Columbia Department of Medicine - 5UBC James Hogg Research Center, Canada - 6St. Paul's Hospital, Vancouver, British Columbia, Canada


Program Abstract
To determine the prevalence of lung and heart abnormalities on thoracic CT scans in HIV infected patients on anti-retroviral therapy.
Methods: Thoracic CT scans of 903 HIV patients (mean age 48 ±7 yrs, 29% females) were reviewed by 3 radiologists by consensus. Patients were phenotyped according to smoking status, pack years, and years since cessation for ex-smokers. Individuals with active lung or heart disease at the time of CT scanning were excluded. Multimorbidity lung and heart disease (MLHD) was defined by the presence of >2 lung or heart abnormalities.
Results: Table 1 describes CT findings according to pack year and Table 2 compares never smokers with previous smokers. MLHD was present in 484 patients (53.6%) and among 78 patients (16%) who never smoked.
MLHD increased proportional to cumulative smoking history (p for trend< 0.001) and decreased in proportion to the number of years since smoking cessation (p for trend=0.017). Independent predictors for MLHD were: age (OR=1.07, CI:1.05-1.10), sex (OR=1.59, CI:1.15-2.19), current smoking (OR=1.76, CI:1.08-2.89), and pack-year (OR=1.03, CI:1.02-1.05). In patients who never smoked, nadir CD4< 200 was significantly associated with MLHD after adjustment for age and sex (OR=1.98, CI:1.98-3.63).


Conclusions: MLHD is common in HIV-infected individuals even in non-smokers. Reduced CD4 count (hence severity of HIV infection) may be an important risk factor for chronic lung and heart disease. Thoracic CT scan may provide an excellent screening tool to detect MLHD in HIV patients.



Table 1 describes the overall demographic and clinical characteristics of the cohort.
1,446 subjects (28.8% females, n=417; mean age 48.4±7.6 years) with a minimum of one CT scan suitable for emphysema assessment.
No subjects reported a clinical diagnosis of COPD at the time of the CT scan. Thoracic CT scans revealed evidence of emphysema in 511 (35%) patients; 319 (22%) had mild to moderate emphysema and 192 (13%) had severe emphysema.
The distribution of calcium score in the coronary arteries was as follows: CAC=0 in 940 patients (65%), 1-100 in 367 (25.4%) and >100 in 139 (9.6%) patients.
Table 2 shows factors independently associated with CAC>0.
from Jules: the lipids parameters are relatively normal