6/1/2014 Annals of Internal Medicine | Associations Between HIV Infection and Subclinical Coronary AtherosclerosisAssociations Between HIV Infection

and Subclin

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Original Research | 1 April 2014

Associations Between HIV Infection and Subclinical

Coronary Atherosclerosis
Wendy S. Post, MD, MS; Matthew Budoff, MD; Lawrence Kingsley, PhD; Frank J. Palella Jr., MD; Mallory D. Witt, MD;
Xiuhong Li, MS; Richard T. George, MD; Todd T. Brown, MD, PhD; and Lisa P. Jacobson, ScD
[+] Article and Author Information

See Also:
HIV and Atherosclerosis: Moving From Associations to Mechanisms and Interventions
Ann Intern Med. 2014;160(7):458-467. doi:10.7326/M13-1754

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Background: Coronary artery disease (CAD) has been associated with HIV infection, but data are not
consistent.
Objective: To determine whether HIV-infected men have more coronary atherosclerosis than uninfected
men.
Design: Cross-sectional study.
Setting: Multicenter AIDS Cohort Study.
Participants: HIV-infected (n = 618) and uninfected (n = 383) men who have sex with men who were aged
40 to 70 years, weighed less than 136 kg (200 lb), and had no history of coronary revascularization.
Measurements: Presence and extent of coronary artery calcium (CAC) on noncontrast cardiac computed
tomography (CT) and of any plaque; noncalcified, mixed, or calcified plaque; or stenosis on coronary CT
angiography.
Results: 1001 men had noncontrast CT, of whom 759 had coronary CT angiography. After adjustment for
age, race, CT scanning center, and cohort, HIV-infected men had a greater prevalence of CAC (prevalence
ratio [PR], 1.21 [95% CI, 1.08 to 1.35]; P = 0.001) and any plaque (PR, 1.14 [CI, 1.05 to 1.24]; P = 0.001),
including noncalcified (PR, 1.28 [CI, 1.13 to 1.45]; P < 0.001) and mixed (PR, 1.35 [CI, 1.10 to 1.65]; P =
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0.004) plaque, than uninfected men. Associations between HIV infection and any
plaque or noncalcified
plaque remained significant (P < 0.005) after CAD risk factor adjustment. HIV-infected men had a greater
extent of noncalcified plaque after CAD risk factor adjustment (P = 0.026). They also had a greater
prevalence of coronary artery stenosis greater than 50% (PR, 1.48 [CI, 1.06 to 2.07]; P = 0.020), but not
after CAD risk factor adjustment. Longer duration of highly active antiretroviral therapy (PR, 1.09 [CI, 1.02 to
1.17]; P = 0.007) and lower nadir CD4+ T-cell count (PR, 0.80 [CI, 0.69 to 0.94]; P = 0.005) were

http://annals.org/article.aspx?articleid=1852867

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HIV and Atherosclerosis: Moving From
Associations to Mechanisms and Interventions
Ann Intern Med. 2014;160(7):509-510.
HIV Cure: The Target Is Clearer but Not Yet Close
Ann Intern Med. 2014;160(7):505-506.
[+] View More

Journal Club
Review: In stable obstructive CAD, PCI plus
medical therapy (MT) does not differ from MT
alone
Ann Intern Med. 2014;160(8):JC8.
Prophylactic tenofovir reduced HIV infection in
injectable drug users
Ann Intern Med. 2013;159(6):JC8.
[+] View More

Related Point of Care

Management of Newly Diagnosed HIV Infection

Ann Intern Med. 2011;155(7):ITC4-1.
Peripheral Arterial Disease
Ann Intern Med. 2007;146(5):ITC3-1.

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6/1/2014 Annals of Internal Medicine | Associations Between HIV Infection and Subclinical Coronary AtherosclerosisAssociations Between HIV Infection and Subclin
associated with coronary stenosis greater than 50%.
Limitation: Cross-sectional observational study design and inclusion of only men.
Conclusion: Coronary artery plaque, especially noncalcified plaque, is more prevalent and extensive in
HIV-infected men, independent of CAD risk factors.

HIV in Pregnancy
Benjamin Chi, MD

Primary Funding Source: National Heart, Lung, and Blood Institute and National Institute of Allergy and
Infectious Diseases.

Human Immunodeficiency Virus Disease

(Complementary/Alternative Medicine)
Marcin Chwistek, MD

Topics

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atherosclerosis ; hiv ; acquired immunodeficiency syndrome ; coronary arteriosclerosis ; hiv infection ;

coronary heart disease risk ; computed tomography

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PubMed Articles
Calcification of the internal elastic lamina of
coronary arteries. Mod Pathol 2008;21(8):101928.
Progressive human immunodeficiency virusassociated vasculopathy: time to revise
antiretroviral therapy guidelines? Cardiovasc J Afr
2011 Jul-Aug;22(4):197-200.

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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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