Extra-coronary calcification (aortic valve calcification, mitral annular calcification, aortic valve ring calcification and thoracic aortic calcification) in HIV seropositive and seronegative men: Multicenter AIDS Cohort Study
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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Panteha Rezaeian1,2, P Elliott Miller3, Sabina A Haberlen4
1Department of Family Medicine, Loma Linda University School of Medicine; Loma Linda, CA.
Insights
HIV infection is linked to increased odds of mitral annular calcification (MAC) and aortic valve calcification (AVC). Further research is needed to determine if these calcifications predict mortality in HIV-positive individuals.
Area of Science:
- Cardiovascular Health
- Infectious Diseases
- Radiology
Background:
- Previous studies indicate a link between HIV infection and coronary artery disease (CAD).
- However, the association between HIV and extra-coronary calcification (ECC) remains less understood.
- This study investigates ECC in HIV-infected individuals.
Purpose of the Study:
- To determine the association between HIV infection and specific types of extra-coronary calcification (ECC).
- To explore the relationship between ECC, inflammatory biomarkers, and coronary plaque morphology in HIV-infected men.
Main Methods:
- Analysis of non-contrast computed tomography (CT) scans from 621 HIV-positive (HIV+) and 384 HIV-negative (HIV-) men.
- Calculation of Agatston scores for mitral annular calcification (MAC), aortic valve calcification (AVC), aortic valve ring calcification (AVRC), and thoracic aortic calcification (TAC).
- Multivariable logistic regression used to evaluate associations between HIV status and ECC presence, inflammatory markers, and plaque morphology.
Main Results:
- HIV+ men showed significantly higher odds of MAC (OR=3.2) and AVC (OR=1.8) compared to HIV- men.
- No significant association was found between HIV serostatus and TAC or AVRC.
- ECC types were associated with specific inflammatory biomarkers (Il-6, sCD163, ICAM-1, TNF-α RII) and coronary plaque characteristics in HIV+ individuals.
Conclusions:
- HIV infection independently predicts mitral annular calcification (MAC) and aortic valve calcification (AVC).
- The clinical significance of these calcifications in predicting mortality among HIV-positive patients warrants further investigation.
Introduction:
Previous studies have demonstrated an association between HIV infection and coronary artery disease (CAD); little is known about potential associations between HIV infection and extra-coronary calcification (ECC).
Methods:
We analyzed 621 HIV infected (HIV+) and 384 HIV uninfected (HIV-) men from the Multicenter AIDS Cohort Study who underwent non-contrast computed tomography (CT) from 2010-2013. Agatston scores were calculated for mitral annular calcification (MAC), aortic valve calcification (AVC), aortic valve ring calcification (AVRC), and thoracic aortic calcification (TAC). The associations between HIV infection and the presence of each type of ECC (score > 0) were evaluated by multivariable logistic regression. We also evaluated the association of ECC with inflammatory biomarker levels and coronary plaque morphology.
Results:
Among HIV+ and HIV- men, the age-standardized prevalences were 15% for TAC (HIV+ 14%/HIV- 16%), 10% for AVC (HIV+ 11%/HIV- 8%), 24% for AVRC (HIV+ 23% HIV- 24%), and 5% for MAC (HIV+ 7%/HIV- 3%). After adjustment, HIV+ men had 3-fold greater odds of MAC compared to HIV- men (OR = 3.2, 95% CI: 1.5-6.7), and almost twice the odds of AVC (1.8, 1.1-2.9). HIV serostatus was not associated with TAC or AVRC. AVRC was associated with higher Il-6 and sCD163 levels. TAC was associated with higher ICAM-1, TNF-α RII, and Il-6 levels. AVC and AVRC calcification were associated with presence of non-calcified plaque in HIV+ but not HIV- men.
Conclusion:
HIV infection is an independent predictor of MAC and AVC. Whether these calcifications predict mortality in HIV+ patients deserves further investigation.
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