Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2014 Apr 1;160(7):458-67.
doi: 10.7326/M13-1754.

Associations between HIV infection and subclinical coronary atherosclerosis

Wendy S Post, Matthew Budoff, Lawrence Kingsley, Frank J Palella Jr, Mallory D Witt, Xiuhong Li, Richard T George, Todd T Brown, Lisa P Jacobson
Observational Study

Associations between HIV infection and subclinical coronary atherosclerosis

Wendy S Post et al. Ann Intern Med. .

Abstract

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 = 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 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.

Primary funding source: National Heart, Lung, and Blood Institute and National Institute of Allergy and Infectious Diseases.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Unadjusted prevalences with 95% confidence intervals of plaque stratified by HIV serostatus in 5 year age increments. N on the top of each panel shows the number of men in each group. Interaction for age by HIV serostatus for the presence of non-calcified plaque was significant (p= 0.006).
See this image and copyright information in PMC

Comment in

References

    1. May MT, Sterne JA, Costagliola D, et al. HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis. Lancet. 2006;368:451. - PubMed
    1. Wada N, Jacobson LP, Cohen M, et al. Cause-specific life expectancies after 35 years of age for human immunodeficiency syndrome-infected and human immunodeficiency syndrome-negative individuals followed simultaneously in long-term cohort studies, 1984–2008. Am J Epidemiol. 2013;177(2):116–125. - PMC - PubMed
    1. Palella FJ, Jr, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43(1):27–34. - PubMed
    1. Mary-Krause M, Cotte L, Simon A, et al. Increased risk of myocardial infarction with duration of protease inhibitor therapy in HIV-infected men. AIDS. 2003;17:2479. - PubMed
    1. Friis-Moller N, Reiss P, Sabin CA, et al. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356:1723. - PubMed

Publication types