Increased Presence, Severity of Coronary Artery Plaques in HIV-Infected Men

Young to middle-aged men with longstanding HIV infection were significantly more likely to have coronary atherosclerotic plaques than uninfected men in a new study. One hundred and ten men (78 HIV-positive, 32 HIV-negative) ages 18-55 with few traditional cardiovascular risk factors were examined for the study with CT scans and CT angiography by Massachusetts General Hospital (MGH) researchers. All were asymptomatic for cardiovascular disease. The vast majority of HIV-positive subjects were receiving antiretroviral therapy.

"We were particularly surprised to find that several of the HIV patients -- none of whom had symptoms of heart disease -- had obstructive coronary artery disease, which was found in none of the controls," said Janet Lo, MD, of MGH's Department of Medicine. "It appears that both traditional and nontraditional risk factors are contributing to atherosclerotic disease in HIV-infected patients."

While the CT scan can identify calcium deposits in coronary arteries, CT angiography can also detect non-calcified arterial plaques. Among those with HIV, the scans showed coronary calcium that might be expected, based on past studies, in men who were six years older. Angiography found atherosclerosis in 59 percent of HIV patients, compared with 34 percent among HIV-negative men. Five of the men with HIV had critical coronary stenosis, or a 70 percent or greater restriction, while none of the uninfected men did.

"Our findings highlight the need to address reduction of cardiac risk factors early in the course of HIV disease and for caregivers to consider that even asymptomatic patients with longstanding HIV disease and minimal cardiac risk factors may have significant coronary artery disease," Lo said. "We also found interesting associations between atherosclerosis levels and how long participants had been infected with HIV and with several inflammatory and immune factors. Future studies are needed to clarify the role of these nontraditional risk factors and find the best prevention and treatment strategies for these patients."

The full report, "Increased Prevalence of Subclinical Coronary Atherosclerosis Detected by Coronary Computed Tomography Angiography in HIV-Infected Men," was published in the journal AIDS (2010;24(2):243-253).

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