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Meta-Analysis
. 2025 Feb 11;15(2):e092264.
doi: 10.1136/bmjopen-2024-092264.

Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis

Tarin Phillips  1   2 , Gregory M Blake  3 , Jonathan A Aun  4   5 , Lisa M Conte  3 , Ritika Gadodia  6   7 , Aakash Tuli  6   7 , Binh T Nguyen  8 , Sara L Robinson  4   9 , Travis E Harrell  3 , Venkatesh L Murthy  10 , Edward Hulten  3   11
Affiliations
Meta-Analysis

Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis

Tarin Phillips et al. BMJ Open. .

Abstract

Objectives: People living with HIV (PLWH) were previously shown to have a higher prevalence of non-calcified coronary plaque with discrepant results for coronary stenosis and any plaque prevalence. This systematic review and meta-analysis summarise and estimate pooled effect sizes for observational studies among PLWH using comprehensive coronary CT angiography (CTA).

Design: Preferred Reporting Items for Systematic Review and Meta-analysis reporting guidelines were used.

Data sources: PubMed, Embase, Web of Science, CINAHL, Cochrane Clinical Trials and EBM were searched from inception to 23 February 2024.

Eligibility criteria: We included studies evaluating coronary atherosclerosis in adult PLWH with controls and CTA results for plaque prevalence, extent, severity and high-degree stenosis.

Data extraction and synthesis: Two independent reviewers used standardised methods to screen for relevance by title, abstract and full-text review. Two unblinded independent reviewers manually extracted data and rated study quality using the Newcastle-Ottawa Scale. Meta-analysis was conducted using random effects models. A sensitivity analysis was performed with a fixed effects model. Publication bias was assessed by visual inspection of funnel plots and formal testing by Egger's and Begg's tests. Segment scores were evaluated using the difference of medians.

Results: PLWH showed a significantly higher prevalence of non-calcified plaque (34% (95% CI: 15% to 53%)) compared with controls (22% (95% CI: 6% to 38%)) with an OR of 1.61 (1.13-2.30, p=0.009). There was no significant difference in partially calcified plaque prevalence (OR=1.20, 0.96-1.49), stenosis prevalence (OR=1.34, 0.92-1.96) and median difference in Segment Involvement Score (SIS; 0.39, -0.01 to 0.79) in PLWH compared with controls who have a non-significant difference in calcified plaque (OR=0.80, 0.61-1.04). The prevalence of any plaque (OR=1.22, 0.93-1.61) and difference in median Segment Stenosis Score (-0.12, -0.60 to 0.35) did not differ between groups.

Conclusion: This study demonstrates a greater prevalence of non-calcified plaque in PLWH than controls. Additional research is needed to assess quantitative CTA measurements. Increased power may reveal a difference in the prevalence of high-degree stenosis and median SIS score in PWLH, while controls may have a greater prevalence of calcified plaque.

Keywords: Coronary heart disease; HIV & AIDS; Risk Factors.

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Conflict of interest statement

Competing interests: VLM owns stock in GE Healthcare, Cardinal Health, Merck, Johnson & Johnson, Lonetix and Pfizer, reports consulting payments from INVIA Medical Imaging Solutions and Siemens Healthineers, has received research support through his institution from Siemens Healthineers, is supported by the Melvyn Rubenfire Professorship in Preventive Cardiology and is also supported by R01AG059729, R01HL136685 and U01DK123013 from the National Institutes of Health and AHA Strategically Focused Research Network 20SFRN35120123. The other authors have no competing interests to declare relevant to the content of this article.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram of study selection process.
Figure 2
Figure 2. Plaque prevalence forest plot: people living with HIV (PLWH) versus controls.
Figure 3
Figure 3. High degree stenosis prevalence forest plot: people living with HIV (PLWH) versus controls.
Figure 4
Figure 4. The difference in median Segment Involvement Score (SIS) forest plot: people living with HIV (PLWH) versus controls. RE, Random Effects.
Figure 5
Figure 5. The difference in median Segment Severity Score (SSS) forest plot: people living with HIV (PLWH) versus controls. RE, Random Effects.
See this image and copyright information in PMC

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