Coronary atherosclerosis characteristics in HIV-infected patients on long-term antiretroviral therapy: insights from coronary computed tomography-angiography.
AIDS
; 33(12): 1853-1862, 2019 10 01.
Article
in En
| MEDLINE
| ID: mdl-31259763
ABSTRACT
OBJECTIVE:
The aim of the study was to assess coronary artery disease (CAD) characteristics by coronary computed tomography-angiography (CCTA) in individuals with HIV infection on long-term antiretroviral therapy (ART)DESIGN:
Retrospective case-controlled matched cohort study.METHODS:
Sixty-nine HIV-positive patients who underwent 128-slice dual source CCTA (mean age 54.9 years, 26.1% women) with mean 17.8â±â9.4 years of HIV infection and a mean duration on ART of 13â±â7.3 years were propensity score-matched (1ââ1) for age, sex, BMI, and five cardiovascular risk factors with 69 controls. CCTA was evaluated for stenosis severity [according to Coronary Artery Disease - Reporting and Data System (CAD-RADS)], total plaque burden [segment involvement score (SIS) and mixed-noncalcified plaque burden (G-score)]. As inflammatory biomarkers, high-risk plaque (HRP) features (napkin-ring sign, low-attenuation plaque, spotty calcification, positive remodeling), perivascular fat attenuation index (FAI), and ectatic coronary arteries were assessed.RESULTS:
CAD-RADS was higher in HIV-positive participants as compared with controls (2.21â±â1.4 vs. 1.69â±â1.5, Pâ=â0.031). A higher prevalence of CAD and G-score (Pâ=â0.043 and Pâ=â0.003) was found. HRP prevalence [23 (34.3%) vs. 8 (12.1%); Pâ=â0.002] and the number of HRP (36 vs. 10, Pâ<â0.001) were higher in HIV-positive individuals. A perivascular FAI greater than -70 Hounsfield units was present in 27.8% of HRP. Ectatic coronary arteries were found in 10 (14.5%) HIV-positive persons vs. 0% in controls (Pâ=â0.003).CONCLUSION:
Noncalcified and HRP burden in HIV-infected individuals on long-term ART is higher and associated with higher cardiovascular risk. Moreover, HIV-positive individuals displayed a higher stenosis severity (CAD-RADS) and more ectatic coronary arteries compared with the control group.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Coronary Artery Disease
/
HIV Infections
/
Anti-Retroviral Agents
Type of study:
Etiology_studies
/
Observational_studies
/
Prevalence_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
AIDS
Journal subject:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Year:
2019
Type:
Article