Acute coronary syndromes in treatment-naïve black South africans with human immunodeficiency virus infection.
BACKGROUND
HIV patients on protease inhibitors have greater risk of acute coronary syndromes (ACS) but little is known about treatment-naïve patients.


RESULTS
Authors conducted a prospective single-center study from Soweto, South Africa, comparing the clinical and angiographic features of treatment-naïve HIV positive and negative patients with ACS. Between March 2004 and February 2008, 30 consecutive treatment-naïve HIV patients with ACS were compared to the next HIV-negative patient as a 1:1 control. HIV patients were younger (43 +/- 7 vs. 54 +/- 13, P = 0.004) and, besides smoking (73% vs. 33%, P = 0.002), had fewer risk factors than the control group with less hypertension (23% vs. 77%, P = 0.0001), diabetes (3% vs. 23%, P = 0.05), LDL hyperlipidemia (2.2 +/- 0.9 vs. 3.0 +/- 1.2, P = 0.006), and other coronary risk factors (7% vs. 53%, P = 0.0001). HDL was lower in the HIV group (0.8 +/- 0.3 vs. 1.1 +/- 0.4, P = 0.001). Atherosclerotic burden was lower in the HIV group with more normal infarct-related arteries (47% vs. 13%, P = 0.005) but a higher degree of large thrombus burden (43% vs. 17%, P = 0.02). Stents were used to a similar degree in HIV and control patients (30% vs. 37%, P = 0.78) with more target lesion revascularization in the HIV group (56% vs. 0%, P = 0.008).


CONCLUSIONS
Treatment-naïve HIV patients with ACS are younger and have fewer traditional risk factors than HIV-negative patients. HIV patients have less atherosclerotic but higher thrombotic burden which may imply a prothrombotic state in the pathogenesis of ACS in these patients.
Becker
A C
AC
Division of Cardiology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa. abecker@worldonline.co.za
Sliwa
K
K
Stewart
S
S
Libhaber
E
E
Essop
A R
AR
Zambakides
C A
CA
Essop
M R
MR
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D044383:Black People; D016022:Case-Control Studies; D008078:Cholesterol, LDL; D016001:Confidence Intervals; D017023:Coronary Angiography; D003920:Diabetes Mellitus; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology*; D015497:HIV-1; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use; D012907:Smoking / Q000009:adverse effects; D013019:South Africa / Q000453:epidemiology; D013223:Statistics as Topic; D014463:Ultrasonography
D019380:Anti-HIV Agents; D008078:Cholesterol, LDL; D011480:Protease Inhibitors