Key result
HIV-infected individuals on long-term ART had higher coronary stenosis severity and higher prevalence of high-risk plaques compared with matched controls.
Why the study?
The study aimed to assess coronary artery disease characteristics by CCTA in individuals with HIV infection receiving long-term antiretroviral therapy.
Does HIV infection on long-term ART associate with worse coronary atherosclerosis characteristics on CCTA compared to matched controls?
Case-Control (n=138)
Does HIV infection on long-term ART associate with worse coronary atherosclerosis characteristics on CCTA compared to matched controls?
HIV-infected individuals on long-term ART have a higher burden of noncalcified and high-risk coronary plaques, as well as more severe stenosis, compared to matched controls.
Answers are grounded in this paper and cite their sources.
Supports closer CAD surveillance in long-term ART patients; leaves open whether HIV or ART drives plaque burden.
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 17.8 ± 9.4 years of HIV infection and a mean duration on ART of 13 ± 7.3 years were propensity score-matched (1 : 1) 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 (2.21 ± 1.4 vs. 1.69 ± 1.5, P = 0.031). A higher prevalence of CAD and G-score (P = 0.043 and P = 0.003) was found. HRP prevalence [23 (34.3%) vs. 8 (12.1%); P = 0.002] and the number of HRP (36 vs. 10, P < 0.001) 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 (P = 0.003). 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.
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Senoner et al. (2019) conducted a case-control in HIV infection (n=138). HIV infection on long-term ART vs. Matched controls was evaluated on Stenosis severity (CAD-RADS) (p=0.031). HIV-infected individuals on long-term ART had higher coronary stenosis severity and higher prevalence of high-risk plaques compared with matched controls.
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