Abstract

BackgroundHIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals.Methods and ResultsWe studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell’s C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).ConclusionIn HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death.

Highlights

  • We studied 152 asymptomatic Human Immunodeficiency Virus (HIV)-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT)

  • The median duration of HIV infection was 16 years (IQR 11 to 19 years), 127 subjects were on antiretroviral therapy (83.7%), and 97 subjects (64%) had an undetectable viral load

  • The current study demonstrates that 1) Mitral Annular Calcification (MAC) and CAC among HIV-infected individuals are common, 2) the presence of both CAC and MAC identify HIV-positive patients at elevated risk for all-cause mortality, 3) there is a significant association between mitral annular calcification and age- and gender-adjusted coronary calcium percentile, and 4) traditional risk factors along with HIV viral load are independently associated with CAC

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Summary

Objectives

The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals. The purpose of this study was to examine the association between MAC and CAC, and to characterize their predictive value for mortality among asymptomatic HIV-infected individuals

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