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Study Finds Increased Presence, Severity of Coronary Artery Plaques in HIV-Positive Men BOSTON -- January 7, 2010 -- Relatively young men with longstanding HIV infection and minimal cardiac risk factors have significantly more coronary atherosclerotic plaques -- some involving serious arterial blockage -- than uninfected men with similar cardiovascular risk, according to a study published in the January 2010 issue of the journal AIDS. The study is the first to use computed tomography (CT) angiography to identify coronary artery plaques in individuals with HIV. “We were particularly surprised to find that several of the HIV patients -- none of whom had symptoms of heart disease -- had obstructive coronary artery disease, which was found in none of the controls,” said lead author Janet Lo, MD, Program in Nutritional Metabolism, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. “It appears that both traditional and nontraditional risk factors are contributing to atherosclerotic disease in HIV-infected patients.” Several previous studies have found increased incidence of myocardial infarction and other cardiovascular events among HIV-positive individuals, but it has not been clear whether that risk was attributable to recognised risk factors, such as elevated cholesterol and smoking, or to HIV-related immune system factors. The current study enrolled 110 men aged 18 to 55 years without symptoms of cardiovascular disease, of which 78 were HIV-positive. Both groups had low levels of traditional cardiovascular risk factors. The HIV-positive participants had longstanding infection, were generally healthy, and the great majority were receiving antiretroviral therapy. After a detailed interview and physician examination, participants received both a standard cardiac CT scan using a 64-slice multidetector CT scanner and CT angiography. The standard scans showed that the HIV-infected participants had levels of coronary calcium that, based on previous studies, would be expected in men who were 6 years older. The CT angiography revealed coronary atherosclerosis in 59% of the HIV-infected patients, compared with only 34% of controls. Five of the HIV-positive participants had critical coronary stenosis -- 70% or greater narrowing of 1 or more arterial segments -- something seen in none of the controls. Those participants were all referred to cardiologists for further evaluation and treatment. “Our findings highlight the need to address reduction of cardiac risk factors early in the course of HIV disease and for caregivers to consider that even asymptomatic patients with longstanding HIV disease and minimal cardiac risk factors may have significant coronary artery disease,” said Dr. Lo. “We also found interesting associations between the degree of atherosclerosis and how long participants had been infected with HIV and with several inflammatory and immune factors. Future studies are needed to clarify the role of these nontraditional risk factors and find the best prevention and treatment strategies for these patients.” SOURCE: Massachusetts General Hospital E-mail this page to a friend or colleague! To print, use this version