title: Coronary atherosclerotic lesions in human immunodeficiency virus-infected patients: a histopathologic study.
abstract: BACKGROUND
  Studies suggest human immunodeficiency virus-positive (HIV+) patients have an increased risk of coronary artery disease (CAD), yet little is known about the histopathology, severity, or distribution of lesions.
  
  
  METHODS
  The coronary arteries of 66 deceased AIDS patients and 19 HIV controls (age <55) were dissected and graded for percent luminal stenosis by intimal lesions, percent of intima involved with lipid, and extent of intimal calcification on a scale of 0 to 3. Medical histories, antiretroviral therapies, and CAD risk factors were reviewed.
  
  
  RESULTS
  HIV+ patients were older than controls (P=.06), and more were male (P=.02). Thirty-five percent of HIV+ patients had stenosis >or=75% of at least one artery. Compared to controls, HIV+ patients had three times greater odds of stenosis >or=75%, controlling for age and sex (one-sided P=.03). Older age and male sex were also risk factors (one-sided P<.001). HIV seropositivity was associated with increased plaque lipid content (one-sided P=.02) and calcification (one-sided P=.08). Duration of HIV infection, antiretroviral therapy, and immune status did not predict severe disease in multivariate analyses. Previously unreported patterns of dystrophic calcification were observed in HIV+ patients and older controls.
  
  
  CONCLUSIONS
  Young to middle-aged patients dying from advanced AIDS have atherosclerotic CAD that may result in luminal narrowing, heavy calcification, and high plaque lipid content. The pattern of disease, location of lesions, and plaque composition are typical of atherosclerosis in HIV-negative patients. No relationship between antiretroviral therapies and atherosclerosis was seen in this small study of heavily treated patients.
authors.affiliation: University of California, Los Angeles, Los Angeles, CA, USA. rgm7@duke.edu
authors.forename: Robert G
authors.initials: RG
authors.lastname: Micheletti
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Fishbein
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fishbein
authors.forename: Elyse J
authors.initials: EJ
authors.lastname: Singer
authors.forename: Robert E
authors.initials: RE
authors.lastname: Weiss
authors.forename: Robin A
authors.initials: RA
authors.lastname: Jeffries
authors.forename: Judith S
authors.initials: JS
authors.lastname: Currier
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000328:Adult; D015992:Body Mass Index; D002114:Calcinosis / Q000473:pathology; D003324:Coronary Artery Disease / Q000150:complications / Q000473:pathology*; D023921:Coronary Stenosis / Q000473:pathology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index