Increased arterial inflammation relates to high-risk coronary plaque morphology in HIV-infected patients.
BACKGROUND
Mechanisms predisposing HIV-infected patients to increased cardiovascular disease (CVD) risk remain unclear.


OBJECTIVE
To determine the interrelationship between arterial inflammation and high-risk coronary plaque morphology in HIV-infected patients with subclinical coronary atherosclerosis.


METHODS
Forty-one HIV-infected patients on stable antiretroviral therapy without known CVD but with atherosclerotic plaque on coronary CT angiography were evaluated with F-FDG-PET. Patients were stratified into 2 groups based on relative degree of arterial inflammation [aortic target-to-background ratio (TBR)]. High-risk coronary atherosclerotic plaque morphology features were compared between groups.


RESULTS
HIV-infected patients with higher and lower TBRs were similar with respect to traditional CVD risk parameters. Among HIV-infected patients with higher TBR, an increased percentage of patients demonstrated at least 1 low-attenuation coronary atherosclerotic plaque (40% vs. 10%, P = 0.02) and at least 1 coronary atherosclerotic plaque with both low attenuation and positive remodeling (35% vs. 10%, P = 0.04). Moreover, in the higher TBR group, both the number of low-attenuation plaques per patient (P = 0.02) and the number of vulnerability features in the most vulnerable plaque (P = 0.02) were increased. TBR grouping remained significantly related to the number of low-attenuation plaques/subject (β = 0.35, P = 0.004), controlling for age, gender, low-density lipoprotein, duration of HIV, and CD4.


CONCLUSIONS
These data demonstrate a relationship between arterial inflammation on F-FDG-PET and high-risk coronary atherosclerotic plaque features among HIV-infected patients with subclinical coronary atherosclerosis. Further studies are needed to determine whether arterial inflammation and related high-risk coronary morphology increase the risk of clinical CVD events in the HIV population.
*Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA; †Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and ‡Cardiovascular Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Ahmed
A
Tawakol
Janet
J
Lo
Markella V
MV
Zanni
Eleni
E
Marmarelis
Ezinne J
EJ
Ihenachor
Megan
M
MacNabb
Bryan
B
Wai
Udo
U
Hoffmann
Suhny
S
Abbara
Steven
S
Grinspoon
D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active; D001167:Arteritis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018791:CD4 Lymphocyte Count; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography; D012307:Risk Factors
D044966:Anti-Retroviral Agents