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Coronary CT Sees Blockage in Half of HIV Group With No Heart Disease Symptoms
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XVIII International AIDS Conference, July 18-23, 2010, Vienna
Mark Mascolini
Coronary computed tomography angiography (CCTA) detected coronary artery stenosis in half of a group of HIV-infected people with no cardiovascular disease symptoms [1]. Results confirm findings in a slightly larger study of HIV-positive men at Massachusetts General Hospital [2].
Mass Gen Study published in AIDS:
Increased prevalence of subclinical coronary atherosclerosis ...
Dec 7, 2009 ... Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men (AIDS ...
www.natap.org/2009/HIV/121409_01.htm
"Our findings suggest a high prevalence and significant degree of coronary atherosclerosis among young HIV-infected men with a long duration of HIV disease, without any symptoms of cardiac disease or a prior diagnosis of cardiac disease and with a generally low Framingham risk score"...."Our data highlight the need to address cardiac risk reduction early on in the course of HIV disease, before significant subclinical disease accrues and before cardiac events occur."......
We found a significant and robust relationship between measures of coronary atherosclerosis and duration of known HIV infection.....Duration of HIV disease may, therefore, reflect a relevant integrated measure of chronic subacute inflammation and altered immune function, processes that may contribute to increased CAD beyond the risk due to traditional risk factors. CRP and IL-6 were not increased in our participants; however, the participants in this study were specifically selected to have no history of CAD and were not acutely ill, in contrast to other studies investigating CRP in relationship to rates of MIs between HIV and non-HIV-infected patients"
Researchers at Rome's University Sapienza studied 10 HIV-infected people with low cardiovascular risk, defined as a Framingham score below 10. All study participants had a body mass index below 25 kg/m(2) (the overweight threshold) and a negative exercise electrocardiogram. Forty-four people in the study group (85%) were men, and the group's age averaged 46.9 years (+/- 7.9). Forty-three people (82%) had taken combination antiretrovirals for an average 8.6 years (+/- 5.6), 38 (73%) had a viral load below 50 copies, and the group CD4 count averaged 500 (+/- 242).
Sixty-four-slice CCTA, a noninvasive "virtual angiogram," found coronary artery stenosis in 26 study participants (50%). The investigators classified stenosis as mild in 14 people, moderate in 5, and severe (more than 70%) in 5 (10% of the whole study group). In people with severe stenosis, coronary angiography confirmed the CT results. (The researchers did not explain why they did not report stenosis severity in 2 people.)
People with and without stenosis did not differ in demographic, clinical, or virologic variables assessed, except for age. Older age correlated with a higher risk of coronary artery plaque detection (r = 0.461, P < 0.001).
The University Sapienza researchers suggested that "intensified screening programs for coronary heart disease should be offered to all" HIV-infected people. They did not call for CCTA as a mass screening tool, probably because it would be too expensive.
The Massachusetts General study involved 78 HIV-infected men with no history or symptoms of coronary artery disease and a comparison group of 32 age-matched asymptomatic HIV-negative men [2]. Prevalence of coronary stenosis was significantly higher in men with HIV than in the control group (59% versus 34%, P = 0.02), and the HIV group had worse stenosis by several measures. Five men with HIV (6.5%) had evidence of obstructive coronary artery disease, with more than 70% narrowing. The first HIV-positive man screened in this study needed a coronary artery bypass.
References
1 d'Ettore G, Cecarelli G, Francone M, et al. Coronary computed tomography angiogram shows a high prevalence of coronary stenosis in asymptomatic HIV-infected subjects with low cardiovascular risk. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract WEPE0129.
2. Lo J, Abbara S, Shturman L, et al. Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men. AIDS. 2010;24:243-253
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