Abstract 3298: High Prevalence of Detectable Coronary Calcium Among Asymptomatic HIV Patients
Background: Recent studies suggest that the HIV-infected patients are at increased risk for cardiovascular events; however, optimal methods for assessing cardiovascular risk in HIV-infected patients are uncertain.
Methods: We measured coronary risk factors, HIV disease characteristics, and coronary artery calcium by multislice CT scan in 210 HIV-infected patients and 39 uninfected controls. All patients were asymptomatic. Scoring was determined using the modified Agatston method. Predictors of coronary calcium were identified using multivariable logistic and linear models.
Results: The mean age was 49 ± 8 years and 220 (88%) were male. One hundred sixty-six patients (79%) were treated with antiretroviral therapy, and 130 (62%) had an undetectable plasma HIV RNA level. The average duration of HIV infection was 14.5 years (IQR 11–19), the median CD4 count was 469 cells/mm3, and the median duration of protease inhibitor therapy was 5 years. None of the patients had renal disease. Eighty-six (41%) of the HIV-infected patients had detectable calcium on CT scan as compared to 6 (15%) of controls p=0.002). Thirty-nine (19%) of the HIV patients had a calcium score >100 compared to 3 (7.7%) of controls, p=0.040. After adjusting for age, pack-years, DM, hypertension, family history of CAD, and LDL-cholesterol, HIV infection was associated with a 3.32 greater odds of having detectable calcium on CT scan (95% CI 1.15 –9.56, p=0.026). Among HIV-infected patients, only age and duration of cigarette smoking were associated with higher odds of detectable calcium (OR 1.11/year; 95% CI: 1.06 –1.16 and OR 1.02/pack-year; 95% CI: 1.00 –1.04, respectively). Neither duration of protease inhibitor therapy nor detectable HIV RNA level were associated with the presence of coronary calcium.
Conclusions: HIV infection is associated with a very high prevalence of coronary calcium in young/middle-aged adults. Based on this test’s ability to predict coronary events in non-HIV subjects, coronary calcium assessment may prove to be a useful test in HIV patients, both to determine cardiovascular risk and to optimize treatment of risk factors.