Abstract
In many, but not all studies, people living with HIV (PLWH) have an increased risk of coronary artery disease (CAD) events compared to the general population. This has generated considerable interest in the early, non-invasive detection of asymptomatic (subclinical) atherosclerosis in PLWH. Ultrasound studies assessing carotid artery intima-media thickness (CIMT) have tended to show a somewhat greater thickness in HIV+ compared to HIV−, likely due to an increased prevalence of cardiovascular (CV) risk factors in PLWH. Coronary artery calcification (CAC) determination by non-contrast computed tomography (CT) seems promising to predict CV events but is limited to the detection of calcified plaque. Coronary CT angiography (CCTA) detects calcified and non-calcified plaque and predicts CAD better than either CAC or CIMT. A normal CCTA predicts survival free of CV events over a very long time-span. Research imaging techniques, including black-blood magnetic resonance imaging of the vessel wall and 18F-fluorodeoxyglucose positron emission tomography for the assessment of arterial inflammation have provided insights into the prevalence of HIV-vasculopathy and associated risk factors, but their clinical applicability remains limited. Therefore, CCTA currently appears as the most promising cardiac imaging modality in PLWH for the evaluation of suspected CAD, particularly in patients <50 years, in whom most atherosclerotic coronary lesions are non-calcified.
Highlights
Cardiovascular disease (CVD) has become one of the leading causes of death in people living with HIV (PLWH) worldwide [1,2,3,4]
Data is inconsistent with respect to whether PLWH have an increased incidence of coronary artery disease (CAD) events compared to the general population [2,7] or not [8,9,10]
Consistent with the multicenter AIDS cohort study (MACS) findings, the Swiss patients with a low nadir CD4+ cell count had more non-calcified plaque [18,44] and more coronary stenosis greater than 50% [44]. These findings suggest that advanced immunosuppression may contribute to subclinical atherosclerosis in PLWH [100]
Summary
Cardiovascular disease (CVD) has become one of the leading causes of death in people living with HIV (PLWH) worldwide [1,2,3,4]. Reports have observed a 2- to almost 4-fold increased rate in CAD events as compared to HIV-negative patients [11,12], but traditional risk factors, smoking, and socioeconomic factors were not always adjusted for in those studies [13].
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