People living with HIV – but who show no signs of cardiovascular disease – actually have two to three times as many non-calcified heart plates as healthy individuals, according to new research.
HIV-positive patients are known to have a 1.5 to 2.1 higher risk of heart attack than the general population who do not carry the virus. But the data and findings on non-calcified crown plate have been controversial and so far unclear.
Now, in a study released on April 20 in Radiology, investigators from the Center hospitalier de l’Université de Montréal have effectively shown that HIV is in fact linked to an increase in the incidence of plaque and plaque. This knowledge is critical, the team led by Carl Chartrand-Lefebvre, MD, M.Sc., clinical professor, as modern advances in antiretroviral medicine have changed the life expectancy of people living with the virus.
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“People with HIV infection are now living longer and increasingly experiencing age-related diseases, such as coronary artery disease,” the team said, pointing out that the drugs used in HIV management can contribute to the disease burden.
To determine if individuals living with HIV had different experiences with CAD and different CT characteristics of heart plaque, Chartrand-Lefebvre’s teams conducted a prospective study with 265 participants – 181 people living with HIV and 84 healthy volunteers. has. The mean age of patients with HIV and healthy participants was 56 years and 57 years, respectively.
More patients with HIV than healthy groups were tobacco smokers (30 percent and 11 percent, respectively), and more patients with HIV took active statin therapy (31 percent versus 18 percent, respectively). In addition, 92.3 percent of HIV-positive individuals received an average of 13.6 years of antiretroviral treatment.
For the study, each participant underwent coronary CT angiography with a 256-section CT scanner and 370 mg / ml iopamidol at a rate of 5 ml / sec. The team also performed a CT scan without contrast for coronary calcium count. For the analysis, the interpretation of radiologists was not aware of which patients were HIV-positive.
While their analysis showed no difference between the calcium count of the coronary artery and the general appearance of the plaque between both groups, the evaluation did show that the non-calcified plaque appearance and volume visualized on CT angiography were two to three. was higher in patients with HIV after adjusting for cardiovascular risk factors.
“Our study shows that non-calcified coronary arteries are increased in people living with HIV,” Lefebvre said. “And previously it has been shown that non-calcified plaque is associated with worse cardiovascular outcomes than calcified or mixed plaques.”
In addition, the team discovered that patients with HIV have a reduced calcification rate of 40 percent. Although the difference in frequency between groups can probably be attributed to different factors, it has indicated the use of antiretroviral therapy as a major contributor.
“Multiple studies suggest that there is likely to be an impact of antiretroviral therapy that may increase the risk of coronary artery disease, although there are many more benefits for people with HIV to use antiretroviral therapy, rather than not taking it,” they say. said.
According to Shenghan Lai, MD, MPH, a professor in the epidemiology department and the Institute of Human Virology at the University of Maryland School of Medicine, this study is better than other studies that have examined coronary artery disease in patients with HIV. In an accompanying editorial, he explained that the use of volume to quantify plaque class can provide a more complete representation of the plaque.
“This study showed for the first time that HIV infection is associated with an increase in the incidence of plaque and plaque volume, and that the latter conclusion is based on a more accurate characterization of the plaque than some other previous methods,” he said. “Coronary CT angiography should be considered as the non-invasive imaging option preferred in further clinical, prognostic and mechanistic studies of HIV-associated atherosclerosis.”
The Chartrand-Lefebvre team agrees, adding that their results suggest a healthier lifestyle that can combat atherosclerosis is particularly critical for patients with HIV. The team emphasizes that it is essential that the patient group is aware of the additional risks associated with smoking, diabetes, high blood pressure, obesity and lack of exercise.
In addition, the results also said how radiologists can use these scans.
“For radiologists, these results suggest that interpretation of coronary CT angiography in people with HIV should probably include quantification of the coronary plaque according to subtypes to allow better stratification of the cardiovascular risk,” Chartrand-Lefebvre said.
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