D'Ascenzo Fabrizio, Cerrato Enrico, Calcagno Andrea, Grossomarra Walter, Ballocca Flavia, Omedè Pierluigi, Montefusco Antonio, Veglia Simona, Barbero Umberto, Gili Sebastiano, Cannillo Margherita, Pianelli Martina, Mistretta Elisa, Raviola Alessio, Salera Davide, Garabello Domenica, Mancone Massimo, Estrada Vicente, Escaned Javier, De Marie Daniela, Abbate Antonio, Bonora Stefano, Zoccai Giuseppe Biondi, Moretti Claudio, Gaita Fiorenzo
Division of Cardiology, Department of Medical Sciences, University of Turin, Italy; Cardiogroup.org Collaborative Group, Italy.
Division of Cardiology, Department of Medical Sciences, University of Turin, Italy; Cardiogroup.org Collaborative Group, Italy.
Atherosclerosis. 2015 May;240(1):197-204. doi: 10.1016/j.atherosclerosis.2015.03.019. Epub 2015 Mar 16.
Asymptomatic patients with human immunodeficiency virus (HIV) infection are at increased risk of vascular disease. Whether asymptomatic HIV patients have increased prevalence or structural differences in coronary artery plaques is not clear.
Pubmed, Cochrane and Google Scholar were searched for articles evaluating asymptomatic HIV patients evaluated with coronary computed tomography. The prevalence of coronary stenosis (defined as >30% and >50%), of calcified coronary plaques (CCP) viewed as more 'stable' plaques, and of non-calcified coronary plaques (NCP) viewed as more 'vulnerable' plaques were the end points of interest.
9 studies with 1229 HIV patients and 1029 controls were included. No significant differences were detected about baseline cardiovascular risk profile. The prevalence of significant coronary stenosis>30% or >50% did not differ between HIV+ and HIV- patients (42% [37-44] and 46% [35-52] with an Odds Ratio [OR] of 1.38 [0.86-2.20] for >30% stenosis) and (15% [9-21] and 14% [7-22] with an OR of 1.11 [0.81-1.52]), respectively. The prevalence of calcified coronary plaques (CCP) (31% [24-32] and 21% [14-30] with an OR of 1.17 [0.63-2.16]) also did not differ among HIV+ and HIV- patients. On the contrary rates of NCP were >3-fold higher in HIV-positive patients [58% (48-60) and 17% (14-27) with an OR of 3.26 (1-30-8.18)], with an inverse relationship with CD4 cell count at meta-regression (Beta -0.20 [-0.35-0.18], p 0.04).
Asymptomatic HIV patients present a similar burden of coronary stenosis and calcified coronary artery plaques but significantly higher rates of non-calcific coronary plaques at computed tomography. The association between HIV infection, reduced CD4 cell counts and higher prevalence on non-calcific coronary artery plaques may shed light into the pathogenesis in HIV-associated coronary artery disease, stressing the importance of primary prevention in this population.
人类免疫缺陷病毒（HIV）感染的无症状患者患血管疾病的风险增加。无症状HIV患者冠状动脉斑块的患病率是否增加或结构是否存在差异尚不清楚。
检索了PubMed、Cochrane和谷歌学术，以查找评估无症状HIV患者冠状动脉计算机断层扫描的文章。研究的终点是冠状动脉狭窄（定义为>30%和>50%）、被视为更“稳定”斑块的钙化冠状动脉斑块（CCP）以及被视为更“易损”斑块的非钙化冠状动脉斑块（NCP）的患病率。
纳入了9项研究，共1229名HIV患者和1029名对照。在基线心血管风险状况方面未发现显著差异。HIV阳性和HIV阴性患者中显著冠状动脉狭窄>30%或>50%的患病率无差异（>30%狭窄时分别为42%[37-44]和46%[35-52]，优势比[OR]为1.38[0.86-2.20]）以及（分别为15%[9-21]和14%[7-22]，OR为1.11[0.81-1.52]）。钙化冠状动脉斑块（CCP）的患病率（分别为31%[24-32]和21%[14-30]，OR为1.17[0.63-2.16]）在HIV阳性和HIV阴性患者中也无差异。相反，HIV阳性患者的NCP发生率高出3倍以上[58%（48-60）和17%（14-27），OR为3.26（1.30-8.18）]，在meta回归中与CD4细胞计数呈负相关（β-0.20[-0.35-0.18]，p=0.04）。
无症状HIV患者冠状动脉狭窄和钙化冠状动脉斑块的负担相似，但计算机断层扫描显示非钙化冠状动脉斑块的发生率显著更高。HIV感染、CD4细胞计数降低与非钙化冠状动脉斑块患病率较高之间的关联可能有助于揭示HIV相关冠状动脉疾病的发病机制，强调了该人群一级预防的重要性。
