People living with HIV – but showing no signs of cardiovascular disease – actually have two to three times more unqualified coronary plaque than healthy people, according to new research.
HIV-positive patients are known to be 1.5 to 2.1 times more likely to have a heart attack than the general population without the virus. However, data and findings on non-calcified coronary plaque have been controversial and unclear to date.
Now in a study published on April 20 in Radiology, investigators at the Center hospitalier de l’Université de Montréal have actually shown that HIV is, in fact, associated with an increase in plaque prevalence and plaque pregnancy. This knowledge is critical, said the team, led by Carl Chartrand-Lefebvre, MD, M.Sc., clinical professor, because modern advances in antiretroviral drugs have changed life expectancy for people living with the virus.
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“People with HIV are now living longer and experiencing more and more age-related diseases, such as coronary heart disease (CAD),” the team said, noting that drugs used to manage HIV could contribute to the burden of the disease. .
To determine whether people living with HIV had different experiences with CAD and different CT features of the coronary plaque, the Chartrand-Lefebvre teams conducted a prospective study with 265 participants – 181 people living with HIV and 84 healthy volunteers. The mean age of HIV patients and healthy participants was 56 years and 57 years, respectively.
More HIV patients than healthy cohorts were tobacco smokers (30 percent and 11 percent, respectively), and more HIV patients actively took statin therapy (31 percent versus 18 percent, respectively). In addition, 92.3 percent of HIV-positive individuals had received antiretroviral therapy for an average of 13.6 years.
For the study, each participant underwent a coronary CT angiography with a CT scanner with 256 sections and 370 mg / ml iopamidol at a rate of 5 ml / sec. The team also performed a non-contrast CT for the coronary calcium score. For analysis, the interpreting radiologists were unaware of HIV-positive patients.
While their analysis did not reveal any difference between coronary artery calcium score and overall plaque prevalence between the two groups, the evaluation showed that the prevalence of noncalcified plaque and the volume seen on CT angiography were two to three times higher. high in HIV patients after adjusting for cardiovascular risk factors.
“Our study shows that non-calcified coronary plaque is increased in people living with HIV,” said Lefebvre. And, non-calcified plaque has previously been shown to be associated with a worse cardiovascular outcome than calcified or mixed plaques. ”
In addition, the team found that HIV patients had a 40% reduced frequency of calcified plaque. While the difference in frequency between groups can probably be attributed to a variety of factors, they highlighted the use of antiretroviral therapy as a likely significant factor.
“Multiple studies suggest that there is likely to be an impact of antiretroviral therapy that could increase the risk of coronary heart disease, although there are many more benefits for people living with HIV to take antiretroviral therapy instead of taking it,” they said. said.
According to Shenghan Lai, MD, MPH, a professor in the Department of Epidemiology and the Institute of Human Virology at the University of Maryland School of Medicine, this study goes beyond other existing studies that have examined coronary heart disease in HIV patients. In an accompanying editorial, he explained that using volume to quantify the plate load can provide a more complete representation of the plate.
“This study showed for the first time that HIV infection is associated with increased plaque prevalence and plaque volume and that the latter conclusion is based on a more accurate characterization of plaque pregnancy than other previous methods,” he said. Coronary CT angiography should be considered the non-invasive imaging option of choice in other clinical, prognostic, and mechanistic studies of HIV-associated atherosclerosis.
The Chartrand-Lefebvre team agreed, adding that their results indicate a healthier lifestyle, which can fight atherosclerosis, is especially important for patients living with HIV. It is imperative, the team stressed, that the group of patients be aware of the additional risks associated with smoking, diabetes, high blood pressure, obesity and lack of exercise.
In addition, they said, the results also inform how radiologists can use these scans.
“For radiologists, these results suggest that interpretation of coronary CT angiography in people living with HIV should probably include quantification of coronary plaque by subtypes to allow better stratification of cardiovascular risk,” said Chartrand-Lefebvre.
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