Electron beam computed tomography for assessment of coronary artery disease in HIV-infected men receiving antiretroviral therapy.
Hyperlipidemia has been seen in patients receiving protease inhibitor-based antiretroviral therapy, prompting concern that such patients are at risk for accelerated coronary artery disease (CAD). To assess the risk of CAD in antiretroviral-treated HIV-infected men, we quantified coronary artery calcium (CAC), a sensitive and established marker of subclinical CAD, using electron beam computed tomography (EBCT) of coronary vessels. Sixty HIV-infected men who met the following criteria (cases) were enrolled in the study: age of 40 years or older; naive to antiretroviral therapy or use of a stable antiretroviral regimen for >or=6 months (mean duration, 25.9 months; 41 patients were receiving protease inhibitor therapy); and no known CAD or no use of lipid-lowering agents. EBCT-derived CAC scores, serum lipid levels, history of antiretroviral therapy, and risk factors for CAD were obtained. Each case was compared with three age-, sex-, and race-matched HIV-negative controls randomly selected from a database including >9000 patients who had undergone EBCT. We determined differences in the proportion of cases and controls with CAC scores of >0 (detectable calcium) and clinically significant CAC for age range. There were no statistically significant differences between the number of cases and controls with detectable CAC (33% and 39%, respectively) and clinically significant CAC (18% and 17%, respectively). This study suggests that the rate of coronary atherosclerosis among HIV-infected patients who receive short-term antiretroviral therapy with or without protease inhibitors is not higher than that among age-, sex-, and race-matched HIV-negative controls. These results need to be confirmed in larger long-term studies, with controls well matched for coronary risk factors.
Talwani
Rohit
R
Section of Infectious Diseases, Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
Falusi
Oluwatoyin M
OM
Mendes de Leon
Carlos F
CF
Nerad
Judith L
JL
Rich
Stuart
S
Proia
Laurie A
LA
Sha
Beverly E
BE
Smith
Kimberly Y
KY
Kessler
Harold A
HA
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed