title: High prevalence at computed coronary tomography of non-calcified plaques in asymptomatic HIV patients treated with HAART: a meta-analysis.
abstract: BACKGROUND
  Asymptomatic patients with human immunodeficiency virus (HIV) infection are at increased risk of vascular disease. Whether asymptomatic HIV patients have increased prevalence or structural differences in coronary artery plaques is not clear.
  
  
  METHODS
  Pubmed, Cochrane and Google Scholar were searched for articles evaluating asymptomatic HIV patients evaluated with coronary computed tomography. The prevalence of coronary stenosis (defined as >30% and >50%), of calcified coronary plaques (CCP) viewed as more 'stable' plaques, and of non-calcified coronary plaques (NCP) viewed as more 'vulnerable' plaques were the end points of interest.
  
  
  RESULTS
  9 studies with 1229 HIV patients and 1029 controls were included. No significant differences were detected about baseline cardiovascular risk profile. The prevalence of significant coronary stenosis>30% or >50% did not differ between HIV+ and HIV- patients (42% [37-44] and 46% [35-52] with an Odds Ratio [OR] of 1.38 [0.86-2.20] for >30% stenosis) and (15% [9-21] and 14% [7-22] with an OR of 1.11 [0.81-1.52]), respectively. The prevalence of calcified coronary plaques (CCP) (31% [24-32] and 21% [14-30] with an OR of 1.17 [0.63-2.16]) also did not differ among HIV+ and HIV- patients. On the contrary rates of NCP were >3-fold higher in HIV-positive patients [58% (48-60) and 17% (14-27) with an OR of 3.26 (1-30-8.18)], with an inverse relationship with CD4 cell count at meta-regression (Beta -0.20 [-0.35-0.18], p 0.04).
  
  
  CONCLUSIONS
  Asymptomatic HIV patients present a similar burden of coronary stenosis and calcified coronary artery plaques but significantly higher rates of non-calcific coronary plaques at computed tomography. The association between HIV infection, reduced CD4 cell counts and higher prevalence on non-calcific coronary artery plaques may shed light into the pathogenesis in HIV-associated coronary artery disease, stressing the importance of primary prevention in this population.
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy; Cardiogroup.org Collaborative Group, Italy. Electronic address: fabrizio.dascenzo@gmail.com.
authors: Fabrizio
authors: F
authors: D'Ascenzo
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy; Cardiogroup.org Collaborative Group, Italy.
authors: Enrico
authors: E
authors: Cerrato
authors: Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy.
authors: Andrea
authors: A
authors: Calcagno
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Walter
authors: W
authors: Grossomarra
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Flavia
authors: F
authors: Ballocca
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Pierluigi
authors: P
authors: Omedè
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Antonio
authors: A
authors: Montefusco
authors: Division of Radiology, Turin, Italy.
authors: Simona
authors: S
authors: Veglia
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Umberto
authors: U
authors: Barbero
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Sebastiano
authors: S
authors: Gili
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Margherita
authors: M
authors: Cannillo
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Martina
authors: M
authors: Pianelli
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Elisa
authors: E
authors: Mistretta
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Alessio
authors: A
authors: Raviola
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Davide
authors: D
authors: Salera
authors: Division of Radiology, Turin, Italy.
authors: Domenica
authors: D
authors: Garabello
authors: Policlinico Umberto I "Sapienza", University of Rome, Italy.
authors: Massimo
authors: M
authors: Mancone
authors: Hospital Clinicos San Carlos, Madrid, Spain.
authors: Vicente
authors: V
authors: Estrada
authors: Hospital Clinicos San Carlos, Madrid, Spain; Cardiogroup.org Collaborative Group, Italy.
authors: Javier
authors: J
authors: Escaned
authors: Division of Cardiology, Hospital Maria Vittoria, Italy.
authors: Daniela
authors: D
authors: De Marie
authors: VCU Pauley Heart Center, Richmond, VA, USA.
authors: Antonio
authors: A
authors: Abbate
authors: Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy.
authors: Stefano
authors: S
authors: Bonora
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Cardiogroup.org Collaborative Group, Italy.
authors: Giuseppe Biondi
authors: GB
authors: Zoccai
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy; Cardiogroup.org Collaborative Group, Italy.
authors: Claudio
authors: C
authors: Moretti
authors: Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
authors: Fiorenzo
authors: F
authors: Gaita
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D058070:Asymptomatic Diseases; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology
keywords: CCT; HAART; HIV; Non calcific plaques