Published Online
on January 12, 2004

A more recent version of this article appeared on January 27, 2004

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Submitted on October 31, 2003
Revised on December 3, 2003
Accepted on December 4, 2003

Clinical Features of Acute Coronary Syndromes in Patients With Human Immunodeficiency Virus Infection

Priscilla Y. Hsue MD, Kamini Giri MD, Sara Erickson MD, John S. MacGregor MD, Naji Younes PhD, Amandeep Shergill MD, and David D. Waters MD^*

From the Division of Cardiology, San Francisco General Hospital, and the Department of Medicine, University of California, San Francisco.

^* To whom correspondence should be addressed. E-mail: dwaters{at}medsfgh.ucsf.edu.

Background--Patients with HIV infection exhibit increased rates of coronary events; however, the clinical features of acute coronary syndromes (ACS) in HIV-infected patients have not been well defined.

Methods and Results--Between 1993 and 2003, 68 HIV-infected patients were hospitalized with ACS. We compared the clinical features and outcome of these patients with those of 68 randomly selected control patients with ACS without HIV. HIV patients were on average more than a decade younger than controls and more likely to be male and current smokers and to have low HDL cholesterol. They were less likely than controls to have diabetes or hyperlipidemia, and their TIMI (Thrombolysis In Myocardial Infarction) risk scores on admission were significantly lower. At coronary angiography, the number of vessels with >50% stenosis was 1.3±1.0 in HIV patients and 1.9±1.2 in controls (P=0.007). Restenosis developed in 15 of 29 HIV patients who underwent percutaneous coronary intervention compared with 3 of 21 controls (52% versus 14%, P=0.006).

Conclusions--HIV patients with ACS are younger and more likely to be males and current smokers and to have low HDL cholesterol levels compared with other ACS patients. Their TIMI risk scores are lower, and they are more likely to have single-vessel disease; however, their restenosis rates after percutaneous coronary intervention are unexpectedly high.

Key words: risk factors • restenosis • coronary disease • angina • infection

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