Subclinical Atherosclerosis Imaging in People Living with HIV

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• People living with HIV (PLWH) exhibit an elevated risk of coronary artery disease (CAD) events compared to the general population.
• Early detection of subclinical atherosclerosis in PLWH is crucial due to increased cardiovascular risk factors.
• Existing imaging techniques like carotid artery intima-media thickness (CIMT) and coronary artery calcification (CAC) have limitations in comprehensively assessing atherosclerosis in this population.

Purpose of the Study:

• To evaluate the utility of various cardiac imaging modalities for the early, non-invasive detection of subclinical atherosclerosis in people living with HIV (PLWH).
• To determine the most promising imaging technique for assessing coronary artery disease (CAD) in PLWH, particularly in younger individuals.

Main Methods:

• Review of ultrasound studies assessing carotid artery intima-media thickness (CIMT).
• Analysis of coronary artery calcification (CAC) determination using non-contrast computed tomography (CT).
• Evaluation of coronary CT angiography (CCTA) for detecting calcified and non-calcified plaque.
• Consideration of advanced research imaging techniques like black-blood MRI and FDG-PET.

Main Results:

• CIMT studies suggest greater thickness in HIV+ individuals, potentially due to increased cardiovascular risk factors.
• CAC is useful for predicting events but limited to calcified plaque.
• CCTA demonstrates superior CAD prediction compared to CAC or CIMT, with a normal CCTA indicating long-term event-free survival.
• Research imaging techniques offer insights but have limited clinical applicability.

Conclusions:

• Coronary CT angiography (CCTA) is currently the most promising cardiac imaging modality for evaluating suspected CAD in people living with HIV (PLWH).
• CCTA is particularly valuable in patients under 50 years old, where atherosclerotic lesions are often non-calcified.