title: Subclinical coronary atherosclerosis, HIV infection and antiretroviral therapy: Multicenter AIDS Cohort Study.
abstract: OBJECTIVE
  To evaluate the association of HIV infection and cumulative exposure to highly active antiretroviral therapy (HAART) with the presence and extent of coronary artery calcification (CAC).
  
  
  METHODS
  A cross-sectional study of 947 male participants (332 HIV-seronegative, 84 HAART-naive and 531 HAART-experienced HIV-infected) from the Multicenter AIDS Cohort Study.
  
  
  METHODS
  The main outcome was CAC score calculated as the geometric mean of the Agatston scores of two computed tomography replicates. Presence of CAC was defined as calcification score above 10, and extent of CAC by the score for those with CAC present. Multivariable regression was used to evaluate the association between HIV infection and HAART and presence and extent of calcification.
  
  
  RESULTS
  Increasing age was most strongly associated with both prevalence and extent of CAC for all study groups. After adjustment for age, race, family history, smoking, high-density lipoprotein-C, low-density lipoprotein-C and hypertension, HIV infection (odds ratio, 1.35; 95% confidence interval, 0.70, 2.61) and long-term HAART use (odds ratio, 1.33; 95% confidence interval, 0.87, 2.05) increased the odds for presence of CAC. In contrast, after adjustment for these covariates, the extent of CAC was lower among HAART users. Among those not taking lipid-lowering therapy, HAART usage of at least 8 years was associated with significantly reduced CAC scores (relative CAC score, 0.43; 95% confidence interval, 0.24, 0.79).
  
  
  CONCLUSIONS
  HAART use may have different effects on the presence and extent of coronary calcification. Although prevalence of calcification was marginally increased among long-term HAART users, the extent of calcification was significantly reduced among HAART users compared with HIV-seronegative controls.
authors.affiliation: Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. kingsley@pitt.edu
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Kingsley
authors.forename: Juliana
authors.initials: J
authors.lastname: Cuervo-Rojas
authors.forename: Alvaro
authors.initials: A
authors.lastname: Muñoz
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.forename: Wendy
authors.initials: W
authors.lastname: Post
authors.forename: Mallory D
authors.initials: MD
authors.lastname: Witt
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.forename: Lewis
authors.initials: L
authors.lastname: Kuller
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D002908:Chronic Disease; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D019380:Anti-HIV Agents; D008055:Lipids