Abstract 1190: Increased Prevalence of Subclinical Coronary Atherosclerosis Detected by Coronary Computed Tomography Angiography in HIV-Infected Men
Introduction/Hypothesis: Patients with HIV have metabolic abnormalities that might predispose to earlier development of coronary artery disease (CAD). We hypothesized HIV patients would have higher prevalence and greater degree of subclinical coronary atherosclerosis compared to HIV-seronegative controls with similar demographic and CAD risk factors.
Methods: Seventy-eight HIV-infected men (age 46.5±6.5 yrs and duration of HIV infection 13.5±6.1 yrs) and 32 HIV-seronegative men (age 45.4±7.2 yrs) with similar demographic and CAD risk factors, without history or symptoms of CAD, were prospectively recruited. 64-slice MDCT coronary angiography was performed to determine prevalence of coronary atherosclerosis, coronary stenosis and quantitative plaque burden.
Results: HIV-infected men demonstrated higher prevalence of coronary atherosclerosis than HIV-negative men (59% vs. 34%; p=0.02) and higher plaque volume (55.9 [0, 207.7](median [IQR]) vs. 0 [0,80.5] mm3; p=0.02), greater number of segments with plaque (1 [0, 3] vs. 0 [0, 1] segments; p=0.03) and higher prevalence of Agatston calcium score >0 (46% vs. 25%, p=0.04), despite similar Framingham 10-yr risk for MI (4 [2,8]% vs. 4.5 [2,6]%, p=0.45), family history of CAD (19% vs. 14%, p= 0.53), smoking status (35% vs. 31% current smokers, p=0.70), and CRP (1.6 [0.7, 4.0] vs. 1.8 [0.6, 3.5] mg/L, p=0.82) in HIV vs. non-HIV respectively. Framingham risk score, total cholesterol, LDL-cholesterol, and CD4/CD8 ratio were significantly associated with number of segments with plaque and with plaque volume. Duration of HIV infection was significantly associated with plaque volume and segments with plaque independent of age, Framingham score or duration of antiretroviral therapy. Surprisingly, even among asymptomatic young HIV-infected men, 7% (95% CI 2–15%) had angiographic evidence of obstructive CAD (>70% luminal narrowing) as compared to 0% in the control group.
Conclusions: Prevalence of coronary atherosclerosis is high in young, asymptomatic, HIV-infected men with low Framingham risk scores. In HIV patients, atherosclerotic disease burden is associated with traditional cardiovascular risk factors as well as longer duration of HIV infection and altered CD4+/CD8+ T-lymphocyte ratio.