Coronary artery disease in HIV infected patients.
OBJECTIVE
To assess the incidence, clinical features, treatment, and follow-up of coronary events in HIV-infected patients over a period of 5 years.


METHODS
A cohort of 840 patients.


RESULTS
A coronary event occurred in 17 patients (5.9/1000 persons-years). Sixteen of them were exposed to highly active antiretroviral therapy (HAART). Patients with coronary events differed in age (48.3 vs. 43 years), CD4 T-cell count (284 vs. 486/mm(3)), total cholesterol (6.2 vs. 5.3 mmol/l), HDL cholesterol (0.72 vs. 1.16 mmol/l), and LDL cholesterol (4.95 vs. 3.391.61 mmol/l). No difference was observed regarding duration of HAART, weight, glucose level, or smoking status between the two groups. Acute coronary syndrome was the first manifestation in 14 patients. Coronary angiography showed 2.56 stenosis per patient, with a single vessel involvement in one-half. Percutaneous angioplasty was performed in all cases, with stenting in 11. After a mean follow-up of 36 months, 14 patients remain alive. Restenosis ( n=4) occurred in 3 patients (PTCA 3; stenting 4). All 14 patients are free of heart failure symptoms. Their mean left ventricular ejection fraction is 61%.


CONCLUSIONS
A higher coronary-event rate is observed among HIV-infected patients, associated with drug-induced metabolic disturbances and a high prevalence of tobacco smoking. However, treatment and prognosis of acute myocardial infarction has no specificity.
Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France.
Lelia
L
Escaut
Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France.
Jean Jacques
JJ
Monsuez
Service des Maladies Cardiovasculaires, Hôpital Broussais, Paris, France.
Gilles
G
Chironi
Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France.
Mansouriah
M
Merad
Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France.
Elina
E
Teicher
Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France.
Denis
D
Smadja
Service des Maladies Cardiovasculaires, Hôpital Broussais, Paris, France.
Alain
A
Simon
Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France. daniel.vittecoq@pbr.ap-hop-paris.fr.
Daniel
D
Vittecoq
D000328:Adult; D000359:Aftercare; D015906:Angioplasty, Balloon, Coronary; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D015607:Stents; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D002784:Cholesterol