Boldeanu Irina, Sadouni Manel, Mansour Samer, Baril Jean-Guy, Trottier Benoît, Soulez Gilles, S Chin Anne, Leipsic Jonathon, Tremblay Cécile, Durand Madeleine, Chartrand-Lefebvre Carl
From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments.
Radiology. 2021 Jun;299(3):571-580. doi: 10.1148/radiol.2021203297. Epub 2021 Apr 20.
Background People living with HIV (PLWH) have a higher risk of myocardial infarction. Coronary atherosclerotic plaque CT characterization helps to predict cardiovascular risk. Purpose To measure CT characteristics of coronary plaque in PLWH without known cardiovascular disease and healthy volunteers without HIV. Materials and Methods In this prospective study, noncontrast CT (all participants, = 265) was used for coronary artery calcium (CAC) scoring in asymptomatic PLWH and healthy volunteers without HIV, without known cardiovascular disease, from 2012 to 2019. At coronary CT angiography ( = 233), prevalence, frequency, and volume of calcified, mixed, and noncalcified plaque were measured. Poisson regressions were used with adjustment for cardiovascular risk factors. Results There were 181 PLWH (mean age, 56 years ± 7; 167 men) and 84 healthy volunteers (mean age, 57 years ± 8; 65 men) evaluated by using noncontrast CT. CT angiography was performed in 155 PLWH and 78 healthy volunteers. Median 10-year Framingham risk score was not different between PLWH and healthy volunteers (10% vs 9%, respectively; = .45), as were CAC score (odds ratio [OR], 1.06; 95% CI: 0.58, 1.94; = .85) and overall plaque prevalence (prevalence ratio, 1.07; 95% CI: 0.86, 1.32; = .55) after adjustment for cardiovascular risk. Noncalcified plaque prevalence (prevalence ratio, 2.5; 95% CI: 1.07, 5.67; = .03) and volume (OR, 2.8; 95% CI: 1.05, 7.40; = .04) were higher in PLWH. Calcified plaque frequency was reduced in PLWH (OR, 0.6; 95% CI: 0.40, 0.91; = .02). Treatment with protease inhibitors was associated with higher volume of overall (OR, 1.8; 95% CI: 1.09, 2.85; = .02) and mixed plaque (OR, 1.6; 95% CI: 1.04, 2.45; = .03). Conclusion Noncalcified coronary plaque burden at coronary CT angiography was two- to threefold higher in asymptomatic people living with HIV without known cardiovascular disease compared with healthy volunteers without HIV. © RSNA, 2021 . See also the editorial by Lai in this issue.
人类免疫缺陷病毒（HIV）感染者（PLWH）发生心肌梗死的风险较高。冠状动脉粥样硬化斑块的CT特征有助于预测心血管风险。目的：测量无已知心血管疾病的PLWH和无HIV的健康志愿者冠状动脉斑块的CT特征。材料与方法：在这项前瞻性研究中，2012年至2019年期间，对无症状的PLWH和无HIV、无已知心血管疾病的健康志愿者进行了非增强CT（所有参与者，n = 265）冠状动脉钙化（CAC）评分。在冠状动脉CT血管造影（n = 233）中，测量钙化、混合和非钙化斑块的患病率、频率和体积。采用泊松回归并对心血管危险因素进行校正。结果：通过非增强CT评估的有181例PLWH（平均年龄，56岁±7；167例男性）和84例健康志愿者（平均年龄，57岁±8；65例男性）。155例PLWH和78例健康志愿者进行了CT血管造影。校正心血管危险因素后，PLWH和健康志愿者的10年弗明汉风险评分中位数无差异（分别为10%和9%；P = 0.45），CAC评分（优势比[OR]，1.06；95%CI：0.58，1.94；P = 0.85）和总体斑块患病率（患病率比，1.07；95%CI：0.86，1.32；P = 0.55）也无差异。PLWH中非钙化斑块患病率（患病率比，2.5；95%CI：1.07，5.67；P = 0.03）和体积（OR，2.8；95%CI：1.05，7.40；P = 0.04）较高。PLWH中钙化斑块频率降低（OR，0.6；95%CI：0.40，0.91；P = 0.02）。蛋白酶抑制剂治疗与总体（OR，1.8；95%CI：1.09，2.85；P = 0.02）和混合斑块体积较大（OR，1.6；95%CI：1.04，2.45；P = 0.03）相关。结论：在无已知心血管疾病的无症状HIV感染者中，冠状动脉CT血管造影显示的非钙化冠状动脉斑块负荷比无HIV的健康志愿者高两到三倍。©RSNA，2021。另见本期赖的社论。
