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Electron Beam Computed Tomography for Assessment of Coronary Artery Disease in HIV-Infected Men Receiving Antiretroviral Therapy

Talwani Rohit; Falusi, Oluwatoyin M.; de Leon, Carlos F. Mendes; Nerad, Judith L.; Rich, Stuart; Proia, Laurie A.; Sha, Beverly E.; Smith, Kimberly Y.; Kessler, Harold A.
JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2002
doi: 10.1097/01.QAI.0000014764.47046.13
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Hyperlipidemia has been seen in patients receiving protease inhibitorbased antiretroviral therapy, prompting concern that such patients are at risk for accelerated coronary artery disease (CAD). To assess the risk of CAD in antiretroviraltreated HIV-infected men, we quantified coronary artery calcium (CAC), a sensitive and established marker of subclinical CAD, using electron beam computed tomography (EBCT) of coronary vessels. Sixty HIV-infected men who met the following criteria (cases) were enrolled in the study: age of 40 years or older; naive to antiretroviral therapy or use of a stable antiretroviral regimen for ≥6 months (mean duration, 25.9 months; 41 patients were receiving protease inhibitor therapy); and no known CAD or no use of lipid-lowering agents. EBCT-derived CAC scores, serum lipid levels, history of antiretroviral therapy, and risk factors for CAD were obtained. Each case was compared with three age-, sex-, and race-matched HIV-negative controls randomly selected from a database including >9000 patients who had undergone EBCT. We determined differences in the proportion of cases and controls with CAC scores of >0 (detectable calcium) and clinically significant CAC for age range. There were no statistically significant differences between the number of cases and controls with detectable CAC (33% and 39%, respectively) and clinically significant CAC (18% and 17%, respectively). This study suggests that the rate of coronary atherosclerosis among HIV-infected patients who receive short-term antiretroviral therapy with or without protease inhibitors is not higher than that among age-, sex-, and racematched HIV-negative controls. These results need to be confirmed in larger long-term studies, with controls well matched for coronary risk factors.

Dr. R. Talwani is currently affiliated with the Division of Infectious Diseases, Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina.

This study was presented in part at the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 17-20 2000, Toronto, Ontario, Canada.

Dr. Falusi was supported in part by the NIH/NIAID AIDS Clinical Trials Group Minority AIDS Training Program (contact no. AACTG.29.MATP.06-RUSH).

Address correspondence and reprint requests to Harold A. Kessler, MD, Section of Infectious Diseases, Rush-Presbyterian-St. Luke's Medical Center, Suite 143 AAF, 600 South Paulina, Chicago, IL 60612; e-mail: hkessler@rush.edu

Manuscript received August 22, 2001; accepted February 19, 2002.

© 2002 Lippincott Williams & Wilkins, Inc.