Coronary artery disease in HIV-infected patients
Objectives: Studies suggest HIV+ patients have an increased risk of coronary artery disease, yet little is known about the histopathology, severity, or distribution of the lesions.
Methods: The coronary arteries of 66 patients with advanced AIDS (all age <55) were dissected at 3mm intervals and graded histologically for percent luminal stenosis by intimal lesions, percent of intima involved with lipid, and the extent of intimal calcification on a scale of 0 to 3. Chart reviews were conducted where available for relevant medical histories, antiretroviral therapies, and coronary artery disease (CAD) risk factors.
Results: The average patient age was 43 ± 6. 86% were men, and 40% were smokers. Results of the histological examination are shown below for HIV+ patients only:
Abbreviations: LAD=left anterior descending; LCX=left circumflex; LM=left main; RCA=right coronary artery
|Average Narrowing per Artery, Percent (±s.d.)||26.8(±21.5)||50.5(±26.0)||37.4(±25.3)||43.3(±24.9)|
|Number of Arteries with ³75% Stenosis (%)||2/65(3.1%)||17/66(25.8%)||7/66(10.6%)||10/66(15.2%)|
|Vessel Sections with Grade 2 or 3 Calcification (%)||20/66(30.3)||40/66(60.6)||20/66(30.3)||23/66(34.8)|
|Average Intimal Lipid Content, Percent (±s.d.)||25.6(±24.9)||37.0(±27.0)||29.0(±27.7)||34.5(±28.9)|
Conclusions: Young to middle-aged patients dying from advanced AIDS have a burden of coronary artery disease that at times results in clinically significant narrowing and heavy calcification that could be detected by imaging studies. Based on clinical experience and published reports of the natural history of atherosclerosis, the pattern of disease and plaque composition are typical of atherosclerosis that occurs in HIV- patients. Comparison of these data to a large age and sex-matched control population is necessary before further conclusions can be drawn.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
"MichelettiR., et al.
Coronary artery disease in HIV-infected patients.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention: