title: Associations between HIV infection and subclinical coronary atherosclerosis.
abstract: BACKGROUND
  Coronary artery disease (CAD) has been associated with HIV infection, but data are not consistent.
  
  
  OBJECTIVE
  To determine whether HIV-infected men have more coronary atherosclerosis than uninfected men.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Multicenter AIDS Cohort Study.
  
  
  METHODS
  HIV-infected (n = 618) and uninfected (n = 383) men who have sex with men who were aged 40 to 70 years, weighed less than 136 kg (200 lb), and had no history of coronary revascularization.
  
  
  METHODS
  Presence and extent of coronary artery calcium (CAC) on noncontrast cardiac computed tomography (CT) and of any plaque; noncalcified, mixed, or calcified plaque; or stenosis on coronary CT angiography.
  
  
  RESULTS
  1001 men had noncontrast CT, of whom 759 had coronary CT angiography. After adjustment for age, race, CT scanning center, and cohort, HIV-infected men had a greater prevalence of CAC (prevalence ratio [PR], 1.21 [95% CI, 1.08 to 1.35]; P = 0.001) and any plaque (PR, 1.14 [CI, 1.05 to 1.24]; P = 0.001), including noncalcified (PR, 1.28 [CI, 1.13 to 1.45]; P &lt; 0.001) and mixed (PR, 1.35 [CI, 1.10 to 1.65]; P = 0.004) plaque, than uninfected men. Associations between HIV infection and any plaque or noncalcified plaque remained significant (P &lt; 0.005) after CAD risk factor adjustment. HIV-infected men had a greater extent of noncalcified plaque after CAD risk factor adjustment (P = 0.026). They also had a greater prevalence of coronary artery stenosis greater than 50% (PR, 1.48 [CI, 1.06 to 2.07]; P = 0.020), but not after CAD risk factor adjustment. Longer duration of highly active antiretroviral therapy (PR, 1.09 [CI, 1.02 to 1.17]; P = 0.007) and lower nadir CD4+ T-cell count (PR, 0.80 [CI, 0.69 to 0.94]; P = 0.005) were associated with coronary stenosis greater than 50%.
  
  
  CONCLUSIONS
  Cross-sectional observational study design and inclusion of only men.
  
  
  CONCLUSIONS
  Coronary artery plaque, especially noncalcified plaque, is more prevalent and extensive in HIV-infected men, independent of CAD risk factors.
  
  
  BACKGROUND
  National Heart, Lung, and Blood Institute and National Institute of Allergy and Infectious Diseases.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kingsley
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.forename: Mallory D
authors.initials: MD
authors.lastname: Witt
authors.forename: Xiuhong
authors.initials: X
authors.lastname: Li
authors.forename: Richard T
authors.initials: RT
authors.lastname: George
authors.forename: Todd T
authors.initials: TT
authors.lastname: Brown
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D018791:CD4 Lymphocyte Count; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed