Pilot study of coronary atherosclerotic risk and plaque burden in HIV patients: 'a call for cardiovascular prevention'.
BACKGROUND
Highly active antiretroviral therapy (HAART) has dramatically improved the life expectancy of patients with human immunodeficiency virus (HIV) prompting increasing concerns related to chronic management. Suggestions of greater cardiovascular risk, partially related to recently proposed HAART-induced dyslipidemia and glucose intolerance, amplify these concerns. At this time, further corroboration of the emerging evidence for increased coronary risk, as well as complimentary estimates of coronary artery atherosclerotic burden, would be valuable to practicing physicians.


METHODS
Seventeen HIV patients on HAART (all from the same HIV clinic population) without coronary artery disease (CAD) were referred to Preventive Cardiology for treatment of dyslipidemia ('referred group'). Upon entry, they underwent computed tomography (CT) of the coronary arteries. Subsequently, the referred group was matched (1:4) for age, gender and traditional risk to non-HIV non-CAD subjects (matched group, n=68) from the University of Illinois CT database. A serial review of 90 subjects from the original HIV population was sampled to determine general cardiovascular risk.


RESULTS
Thirteen (76%) of the 17 referred patients revealed the presence of coronary calcium compared with 63% in the matched HIV seronegative controls (P=0.18). Log-transformed median calcium score was 2.93+/-2.3 in the referred group versus 1.97+/-2.5 in the matched group (P=0.09). Fifty one percent of the overall population smoked cigarettes, 11% were diabetic (30% diagnosed pre-HAART and 70% post-HAART) and 30% were hypertensive (33% diagnosed pre-HAART and 67% post-HAART).


CONCLUSIONS
In a particularly dyslipidemic subgroup of HIV subjects without known CAD we found evidence for atherosclerosis in three-quarters based on coronary calcium. Further, in this population of HIV patients on HAART, we found an enhanced prevalence of traditional cardiovascular risk. This pilot study encourages the development of preventive strategies in this population.
Acevedo
Monica
M
Section of Preventive Cardiology and Rehabilitation, Department of Cardiology, The Cleveland Clinic Foundation, OH 44195, USA.
Sprecher
Dennis L
DL
Calabrese
Leonard
L
Pearce
Gregory L
GL
Coyner
Denise L
DL
Halliburton
Sandra S
SS
White
Richard D
RD
Sykora
Elizabeth
E
Kondos
George T
GT
Hoff
Julie A
JA
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D018149:Glucose Intolerance / Q000139:chemically induced; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D012306:Risk