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. 2014 Dec 15;59(12):1779-86.
doi: 10.1093/cid/ciu672. Epub 2014 Aug 25.

Increased coronary vessel wall thickness in HIV-infected young adults

Khaled Z Abd-Elmoniem  1 , Aylin B Unsal  2 , Sarah Eshera  1 , Jatin R Matta  1 , Nancy Muldoon  3 , Dorothea McAreavey  3 , Julia B Purdy  3 , Rohan Hazra  4 , Colleen Hadigan  2 , Ahmed M Gharib  1
Affiliations

Increased coronary vessel wall thickness in HIV-infected young adults

Khaled Z Abd-Elmoniem et al. Clin Infect Dis. .

Abstract

Background: Individuals with long-term human immunodeficiency virus (HIV) infection are at risk for premature vasculopathy and cardiovascular disease (CVD). We evaluated coronary vessel wall thickening, coronary plaque, and epicardial fat in patients infected with HIV early in life compared with healthy controls.

Methods: This is a prospective cross-sectional study of 35 young adults who acquired HIV in early life and 11 healthy controls, free of CVD. Time resolved phase-sensitive dual inversion recovery black-blood vessel wall magnetic resonance imaging (TRAPD) was used to measure proximal right coronary artery (RCA) wall thickness, and multidetector computed tomography (CT) angiography was used to quantify coronary plaque and epicardial fat.

Results: RCA vessel wall thickness was significantly increased in HIV-infected patients compared with sex- and race-matched controls (1.32 ± 0.21 mm vs 1.09 ± 0.14 mm, P = .002). No subject had discrete plaque on CT sufficient to cause luminal narrowing, and plaque was not related to RCA wall thickness. In multivariate regression analyses, smoking pack-years (P = .004) and HIV infection (P = .007) were independently associated with thicker RCA vessel walls. Epicardial fat did not differ between groups. Among the HIV-infected group, duration of antiretroviral therapy (ART) (P = .02), duration of stavudine exposure (P < .01), low-density lipoprotein cholesterol (P = .04), and smoking pack-years (P < .01) were positively correlated with RCA wall thickness.

Conclusions: This investigation provides evidence of subclinical coronary vascular disease among individuals infected with HIV in early life. Increased duration of ART, hyperlipidemia, and smoking contributed to proximal RCA thickening, independent of atherosclerotic plaque quantified by CT. These modifiable risk factors appear to influence early atherogenesis as measured by coronary wall thickness and may be important targets for CVD risk reduction.

Keywords: antiretroviral therapy; cardiovascular disease; coronary artery; perinatal HIV; smoking.

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Figures

Figure 1.
Figure 1.
Time-resolved acquisition of phase-sensitive dual inversion recovery (TRAPD) vessel wall magnetic resonance imaging of the proximal right coronary artery (RCA) in a control subject (A) and a human immunodeficiency virus (HIV)-infected patient (B). Shown on the left side of each panel are the TRAPD RCA wall image (top) and the calculation of the mean wall thickness (bottom). Slices were acquired in the proximal segment of the RCA as shown on the corresponding coronary magnetic resonance angiography (MRA) image on the right side of each panel (dotted lines).
Figure 2.
Figure 2.
Box plot of right coronary artery (RCA) vessel wall thickness of control subjects vs human immunodeficiency virus (HIV)-infected subjects with a viral load of <50 copies/mL and HIV-infected subjects with a viral load of >50 copies/mL. Bars represent full range of RCA vessel wall thickness within each group.
See this image and copyright information in PMC

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