Coronary atherosclerosis characteristics in HIV infected patients on long term antiretroviral therapy: insights from coronary computed tomography angiography.

OBJECTIVE: The aim of the study was to assess coronary artery disease (CAD) characteristics by coronary CT-angiography (CCTA) in individuals with HIV-infection on long-term antiretroviral therapy (ART) DESIGN:: Retrospective case-controlled matched cohort study METHODS:: 69 HIV positive patients who underwent 128-slice dual source CCTA (mean age 54.9 years, 26.1% females) with mean 17.8 ± 9.4 years of HIV-infection and a mean duration on ART of 13 ± 7.3 years were propensity score matched (1:1) for age, gender, BMI, and 5 cardiovascular risk factors with 69 controls.CCTA was evaluated for: stenosis severity (according to Coronary Artery Disease - Reporting and Data System (CAD-RADS)), total plaque burden (segment involvement score (SIS) and mixed-non-calcified plaque burden (G-score). As inflammatory biomarkers, high-risk-plaque (HRP) features (napkin-ring-sign, low-attenuation-plaque, spotty calcification, positive remodeling), perivascular fat attenuation index (FAI), and ectatic coronary arteries were assessed.

RESULTS: CAD-RADS was higher in HIV-positive participants as compared to controls (2.21 ± 1.4 vs 1.69 ± 1.5, p = 0.031). A higher prevalence of CAD and G-score (p = 0.043 and p = 0.003) was found.HRP prevalence (23 (34.3%) vs 8 (12.1%); p = 0.002) and the number of HRP (36 vs 10, p < 0.001) were higher in HIV-positive individuals. A perivascular FAI >-70 HU was present in 27.8% of HRP. Ectatic coronary arteries were found in 10 (14.5%) HIV-positive persons vs 0% in controls (p = 0.003).

CONCLUSIONS: Non-calcified and HRP burden in HIV-infected individuals on long-term ART is higher and associated with higher cardiovascular risk. Moreover, HIV-positive individuals displayed a higher stenosis severity (CAD-RADS) and more ectatic coronary arteries compared to the control group.