Independent association of subclinical coronary artery disease and emphysema in HIV-infected patients.
OBJECTIVE
Chronic obstructive pulmonary disease (COPD) and coronary artery disease are inflammatory states with a significant clinical impact. The relationship between them has not been investigated in patients with HIV infection. We assessed the presence of subclinical emphysema and coronary artery disease using chest computed tomography (CT) imaging in a cohort of HIV-infected patients receiving antiretroviral therapy.


METHODS
Gated chest CT scans were performed in 1446 consecutive patients to assess the presence and severity of coronary artery calcium (CAC) (classified as a score of 0, 1-100 or > 100) and emphysema (classified using a visual semiquantitative scale: 0, absent; 1-4, mild to moderate; > 4, severe). Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with CAC and emphysema.


RESULTS
The emphysema score was significantly higher in patients with CAC scores of 1-100 and > 100 compared with those with a CAC score of 0. After adjustments for age, sex, smoking status, pack-years of smoking, visceral adiposity and duration of HIV infection, the presence of any emphysema was significantly associated with a CAC score > 0 [odds ratio (OR) 1.43; 95% confidence interval (CI) 1.08-1.88; P = 0.012]. The association persisted after adjustment for the Framingham risk score (OR 1.52; 95% CI 1.16-1.99; P = 0.002). There was a dose-dependent effect in the association between emphysema score and CAC score.


CONCLUSIONS
In this cross-sectional study of HIV-infected patients, there was an independent association between emphysema and CAC, after adjustment for traditional cardiovascular risk factors, suggesting a common pathogenesis of these chronic inflammatory conditions in a chronic inflammatory disease such as HIV infection.
Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy.
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Besutti
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
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P
Raggi
Department of Medical and Surgical Sciences for Children & Adults (Infectious Disease Clinic), University of Modena and Reggio Emilia, Modena, Italy.
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Zona
Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy.
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Scaglioni
Department of Medical and Surgical Sciences for Children & Adults (Infectious Disease Clinic), University of Modena and Reggio Emilia, Modena, Italy.
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Santoro
Department of Medical and Surgical Sciences for Children & Adults (Infectious Disease Clinic), University of Modena and Reggio Emilia, Modena, Italy.
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Orlando
Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy.
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Ligabue
Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
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Leipsic
Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada.|UBC James Hogg Research Center, St Paul's Hospital, Vancouver, BC, Canada.
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Sin
Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada.|UBC James Hogg Research Center, St Paul's Hospital, Vancouver, BC, Canada.
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SF
Man
Department of Medical and Surgical Sciences for Children & Adults (Infectious Disease Clinic), University of Modena and Reggio Emilia, Modena, Italy.
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G
Guaraldi
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011656:Pulmonary Emphysema / Q000175:diagnosis*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
HIV; chronic obstructive pulmonary disease epidemiology; computed tomography; coronary artery calcium; emphysema