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Coronary atherosclerosis characteristics in HIV-infected patients on long-term antiretroviral therapy

insights from coronary computed tomography–angiography

Senoner, Thomasa; Barbieri, Fabiana; Adukauskaite, Agnea; Sarcletti, Mariob; Plank, Fabiana; Beyer, Christophc; Dichtl, Wolfganga; Feuchtner, Gudrun M.c

doi: 10.1097/QAD.0000000000002297

Objective: The aim of the study was to assess coronary artery disease (CAD) characteristics by coronary computed tomography–angiography (CCTA) in individuals with HIV infection on long-term antiretroviral therapy (ART)

Design: Retrospective case-controlled matched cohort study.

Methods: Sixty-nine HIV-positive patients who underwent 128-slice dual source CCTA (mean age 54.9 years, 26.1% women) 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, sex, BMI, and five 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-noncalcified 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 with 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 greater than −70 Hounsfield units 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).

Conclusion: Noncalcified 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 with the control group.

aDepartment of Internal Medicine III, Cardiology

bDepartment of Dermatology

cDepartment of Radiology, Innsbruck Medical University, Innsbruck, Austria.

Correspondence to Dr Thomas Senoner, Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria. Tel: +43 512 504 83648; fax: +43 512 504 23264; e-mail:

Received 8 March, 2019

Revised 21 May, 2019

Accepted 22 May, 2019

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