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Higher Rate and Extent of Noncalcified
Coronary Artery Plaque in HIV+ MACS Men
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19th Conference on Retroviruses and Opportunistic Infections, March 5-8, 2012, Seattle
Mark Mascolini
Compared with HIV-negative men in the US Multicenter AIDS Cohorts Study (MACS), HIV-positive men had a higher prevalence and extent of noncalcified coronary artery plaques [1]. Among men with HIV, a viral load above 50 copies was associated with presence and extent of noncalcified plaques. Traditional cardiovascular risk factors predicted extent of noncalcified plaques in HIV-positive and negative men.
Coronary CT angiography can noninvasively assess presence and extent of coronary artery plaques, which are associated with clinical coronary artery disease in the general population. Compared with calcified plaques, MACS investigators noted, noncalcified and mixed plaques may be more prone to rupture. They planned this study to examine relations between HIV infection and prevalence and extent of coronary artery plaque.
MACS is an ongoing observational study of men who have sex with men (MSM) with HIV or at risk of HIV. This analysis involved 343 HIV-positive men and 176 HIV-negative men who had coronary CT angiography to identify plaques, to classify them as calcified, noncalcified, or mixed, and to calculate total, calcified, noncalcified, and mixed plaque scores (the sum of each plaque size score for each type of plaque). Classic cardiovascular risk factors considered in statistical analyses included diabetes, hypertension, abnormal lipids, smoking, and body mass index.
HIV-positive men were younger than the HIV-negative group (average 53.6 versus 57.2) and included a lower proportion of whites (51.6% versus 67.6%). A higher proportion of positive men smoked (30.4% versus 20.6%), a higher proportion had diabetes (28.3% versus 22.2%), and average triglycerides were higher in the HIV group (172 versus 122 mg/dL). The groups did not differ substantially in rates of hypertension or average glucose or cholesterol. About one third of men in each group was taking lipid-lowering drugs.
Among men with HIV, CD4 counts averaged 599, time on ART averaged 10.7 years, 24% had a detectable viral load, and only 11% had a history of clinical AIDS.
Men with HIV had a significantly higher prevalence of noncalcified plaques--72% versus 62% (P = 0.02). An analysis adjusted for age and race/ethnicity determined that men with HIV had about a 60% higher risk of noncalcified plaques (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.08 to 2.41). Plaque prevalence did not differ significantly between HIV-positive and negative men for all plaques considered together (83% versus 80%) or for mixed plaques (35% versus 32%) or calcified plaques (35% versus 36%). The two groups were also equivalent in prevalence of 70% or greater stenosis (7.3% versus 6.5%) and prevalence of 50% or greater stenosis (17% versus 13%).
An analysis adjusted for age, race, and cardiovascular risk factors determined that the prevalence of a noncalcified plaque score above 3 was significantly higher in HIV-positive men (19.6% and 10.9%, P = 0.01). Overall noncalcified plaque score was marginally higher in HIV-positive men (P = 0.06) in an analysis adjusted for age and race; after further adjustment for cardiovascular risk factors, the higher noncalcified plaque score in men with HIV became significant (P = 0.03).
HIV positivity predicted extent of noncalcified plaque (beta coefficient 0.17, P = 0.03), as did three traditional risk factors: diabetes (beta 0.17, P = 0.045), hypertension (beta 0.23, P = 0.008), and abnormal lipids (beta 0.23, P = 0.02). In this analysis black race was associated with lower noncalcified plaque extent (beta -0.17, P = 0.055).
An analysis limited to HIV-positive men and adjusted for age and race/ethnicity determined that a viral load above 50 copies was associated with presence and extent of noncalcified plaque (OR 1.73, P
An analysis adjusted for age and race/ethnicity in HIV-positive men figured that a viral load above 50 copies doubled the risk of 50% or greater coronary stenosis (OR 2.08, 95% CI 1.07 to 4.05, P= 0.03), while every 10 years on ART raised the risk 15% (OR 1.15, 95% CI 1.05 to 1.26, P = 0.004). Everyone 100-cell higher nadir CD4 count lowered the risk of 50% or greater stenosis almost 30% (OR 0.71, 95% CI 0.57 to 0.89, P = 0.003). Those associations remained significant when the analysis also considered detectable viral load, nadir CD4 count, years on ART, and cardiovascular risk factors.
Reference
1. Post W, Jacobson L, Li X, Palella et al, and the Multicenter AIDS Cohort Study. HIV infection is associated with greater amounts of non-calcified coronary artery plaque: MACS. 19th Conference on Retroviruses and Opportunistic Infections. March 5-8, 2012. Seattle. Abstract 809.
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