Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
AIDS. 2013 May 15;27(8):1263-72. doi: 10.1097/QAD.0b013e32835eca9b.
Among HIV-infected patients, high rates of myocardial infarction (MI) and sudden cardiac death have been observed. Exploring potential underlying mechanisms, we used multidetector spiral coronary computed tomography angiography (coronary CTA) to compare atherosclerotic plaque morphology in HIV-infected patients and non-HIV-infected controls.
Coronary atherosclerotic plaques visualized by CTA in HIV-infected (101) and non-HIV-infected (41) men without clinically apparent heart disease matched on cardiovascular risk factors were analyzed for three vulnerability features: low attenuation, positive remodeling, and spotty calcification.
Ninety-five percent of HIV-infected patients were receiving ART (median duration 7.9 years) and had well controlled disease (median CD4 cell count, 473 cells/μl; median HIV RNA <50 copies/ml). Age and traditional cardiovascular risk factors were similar in HIV-infected patients and controls. Among the HIV-infected (versus control) group, there was a higher prevalence of patients with at least one: low attenuation plaque (22.8 versus 7.3%, P = 0.02), positively remodeled plaque (49.5 versus 31.7%, P = 0.05) and high-risk 3-feature plaque (7.9 versus 0%, P = 0.02). Moreover, patients in the HIV-infected (versus control) group demonstrated a higher number of low attenuation plaques (P = 0.01) and positively remodeled plaques (P = 0.03) per patient.
Our data demonstrate an increased prevalence of vulnerable plaque features among relatively young HIV-infected patients. Differences in coronary atherosclerotic plaque morphology - namely, increased vulnerable plaque among HIV-infected patients - are here for the first time reported and may contribute to increased rates of MI and sudden cardiac death in this population.
在 HIV 感染者中，心肌梗死（MI）和心源性猝死的发生率较高。为了探究潜在的发病机制，我们采用多排螺旋冠状动脉 CT 血管造影（coronary CTA）比较了 HIV 感染者和非 HIV 感染者的动脉粥样硬化斑块形态。
我们分析了 101 例无明显心脏病的 HIV 感染者和 41 例非 HIV 感染者的冠状动脉 CT 血管造影显示的粥样硬化斑块，评估了三种易损斑块特征：低衰减、正性重构和点状钙化。
95%的 HIV 感染者正在接受抗逆转录病毒治疗（ART）（中位治疗时间 7.9 年），且疾病控制良好（中位 CD4 细胞计数为 473 个/μl；中位 HIV RNA <50 拷贝/ml）。HIV 感染者和对照组的年龄和传统心血管危险因素相似。与对照组相比，HIV 感染者中至少有一种易损斑块特征的患者比例更高：低衰减斑块（22.8%比 7.3%，P=0.02）、正性重构斑块（49.5%比 31.7%，P=0.05）和高危 3 种特征斑块（7.9%比 0%，P=0.02）。此外，HIV 感染者组的低衰减斑块（P=0.01）和正性重构斑块（P=0.03）数量均多于对照组。
我们的数据表明，在相对年轻的 HIV 感染者中，易损斑块特征的发生率增加。HIV 感染者冠状动脉粥样硬化斑块形态的差异——即易损斑块的增加——在此首次被报道，可能导致该人群 MI 和心源性猝死的发生率增加。
