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Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis
Tarin Phillips1,2, Gregory M Blake3, Jonathan A Aun4,5
1Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA tarincphillips.do@gmail.com.
Insights
People living with HIV (PLWH) have a higher prevalence of non-calcified coronary plaque compared to controls. Further research is needed to explore quantitative measurements and potential differences in stenosis and calcified plaque prevalence.
Area of Science:
- Cardiology
- Infectious Diseases
- Radiology
Background:
- People living with HIV (PLWH) may have an increased risk of cardiovascular disease.
- Previous studies show conflicting results regarding coronary plaque prevalence and stenosis in PLWH.
Purpose of the Study:
- To systematically review and meta-analyze observational studies on coronary atherosclerosis in PLWH.
- To estimate pooled effect sizes for coronary plaque characteristics using coronary CT angiography (CTA).
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Comprehensive literature search of major databases (PubMed, Embase, Web of Science, etc.).
- Inclusion of studies comparing coronary CTA findings in adult PLWH with controls.
Main Results:
- PLWH showed a significantly higher prevalence of non-calcified plaque (OR=1.61).
- No significant differences were found in partially calcified plaque, stenosis prevalence, or Segment Involvement Score (SIS).
- No significant difference in any plaque prevalence or Segment Stenosis Score (SSS) between groups.
Conclusions:
- PLWH exhibit a greater prevalence of non-calcified coronary plaque.
- Further research is required for quantitative CTA measurements and to investigate potential differences in stenosis and calcified plaque prevalence with increased statistical power.
Objectives:
People living with HIV (PLWH) were previously shown to have a higher prevalence of non-calcified coronary plaque with discrepant results for coronary stenosis and any plaque prevalence. This systematic review and meta-analysis summarise and estimate pooled effect sizes for observational studies among PLWH using comprehensive coronary CT angiography (CTA).
Design:
Preferred Reporting Items for Systematic Review and Meta-analysis reporting guidelines were used.
Data Sources:
PubMed, Embase, Web of Science, CINAHL, Cochrane Clinical Trials and EBM were searched from inception to 23 February 2024.
Eligibility Criteria:
We included studies evaluating coronary atherosclerosis in adult PLWH with controls and CTA results for plaque prevalence, extent, severity and high-degree stenosis.
Data Extraction And Synthesis:
Two independent reviewers used standardised methods to screen for relevance by title, abstract and full-text review. Two unblinded independent reviewers manually extracted data and rated study quality using the Newcastle-Ottawa Scale. Meta-analysis was conducted using random effects models. A sensitivity analysis was performed with a fixed effects model. Publication bias was assessed by visual inspection of funnel plots and formal testing by Egger's and Begg's tests. Segment scores were evaluated using the difference of medians.
Results:
PLWH showed a significantly higher prevalence of non-calcified plaque (34% (95% CI: 15% to 53%)) compared with controls (22% (95% CI: 6% to 38%)) with an OR of 1.61 (1.13-2.30, p=0.009). There was no significant difference in partially calcified plaque prevalence (OR=1.20, 0.96-1.49), stenosis prevalence (OR=1.34, 0.92-1.96) and median difference in Segment Involvement Score (SIS; 0.39, -0.01 to 0.79) in PLWH compared with controls who have a non-significant difference in calcified plaque (OR=0.80, 0.61-1.04). The prevalence of any plaque (OR=1.22, 0.93-1.61) and difference in median Segment Stenosis Score (-0.12, -0.60 to 0.35) did not differ between groups.
Conclusion:
This study demonstrates a greater prevalence of non-calcified plaque in PLWH than controls. Additional research is needed to assess quantitative CTA measurements. Increased power may reveal a difference in the prevalence of high-degree stenosis and median SIS score in PWLH, while controls may have a greater prevalence of calcified plaque.
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