Progression of coronary artery calcium in men affected by human immunodeficiency virus infection
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Published on: August 28, 2018
Giovanni Guaraldi1, Stefano Zona, Gabriella Orlando
1Metabolic Clinic, Infectious and Tropical Diseases Unit, Department of Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Insights
HIV patients on antiretroviral therapy show increased coronary artery calcium (CAC) progression. Factors like age, LDL cholesterol, abdominal fat, and CD4+ cell count influence this atherosclerosis progression.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Cardiovascular disease (CVD) risk is elevated in individuals with human immunodeficiency virus (HIV) infection.
- Antiretroviral therapy (ART) has improved HIV management but CVD remains a concern.
- Understanding atherosclerosis progression in HIV is crucial for risk stratification.
Purpose of the Study:
- To assess the progression of coronary artery calcium (CAC) in HIV-infected men on chronic ART.
- To identify traditional and HIV-specific factors associated with CAC progression.
Main Methods:
- Prospective, observational study involving 132 HIV-infected men on ART.
- Sequential 64-slice CT scans measured CAC progression over an average of 11 months.
- Assessment of traditional atherosclerosis risk factors and CD4+ T-helper cell counts.
Main Results:
- 34% of patients demonstrated absolute CAC progression.
- A significant proportion (34%) showed >15% yearly CAC progression, a marker for high myocardial infarction risk.
- Age, LDL cholesterol, visceral abdominal fat, and current CD4+ cell count were independently associated with absolute CAC progression.
Conclusions:
- Subclinical atherosclerosis, measured by CAC progression, is influenced by both traditional risk factors and HIV-related factors like CD4+ cell count.
- Immunologic alterations due to HIV infection may play a role in accelerating atherosclerosis.
- These findings highlight the need for comprehensive cardiovascular risk management in HIV-infected individuals.
Abstract:
Cardiovascular risk is increased in HIV infected patients. We assessed progression of coronary artery calcium (CAC) in patients with HIV infection to identify factors that may help explain progression of atherosclerosis. Prospective, observational study of 132 HIV-infected men receiving chronic antiretroviral therapy (ART); we measured traditional atherosclerosis risk factors and assessed progression of CAC on sequential 64-slice CT scans at an average interval of 11 months (range 6-36). CAC score progression was defined as absolute and percentage change from baseline. During follow-up 45 patients (34%) showed absolute progression of CAC and 34 of them showed >15% yearly progression, a threshold previously associated with a high risk of myocardial infarction. Age, LDL cholesterol, visceral abdominal fat and current T-helper (CD4+) cell count were significantly associated with absolute CAC progression. Progression of subclinical atherosclerosis in HIV patients is associated with traditional coronary risk factors as well as HIV related factors such as the CD4+ cell count. Therefore, immunologic perturbations secondary to HIV infection may contribute to atherosclerosis progression.
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