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Coronary Artery Disease in Patients with HIV Infection: An Update

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Abstract

Premature cardiovascular disease among the HIV-infected population is of great concern among clinicians. The increased life expectancy of HIV-infected individuals is mainly due to the early detection of infection and the advent of antiretroviral therapy. Once known as a deadly disease, HIV infection has transitioned into a chronic condition. Cardiovascular disease in this population is thought to progress early due to traditional and non-traditional risk factors. Early detection of subclinical atherosclerosis has become a center of focus in research as our complete understanding of this process it not yet well known. Advancements in cardiac computed tomography angiography has enabled the exploration of coronary artery disease by further evaluation of coronary stenosis and plaque analysis. An increase in cardiovascular event rates in this population is currently thought to be linked to antiretroviral therapy, Framingham risk factors, and HIV. We sought to present an updated comprehensive review of the available literature on HIV related to atherosclerosis and cardiovascular risk.

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References

  1. Shah ASV, Stelzle D, Lee KK, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV. Circulation. 2018;138:1100–12.

    PubMed  PubMed Central  Google Scholar 

  2. Bussolino F, Mitola S, Serini G, et al. Interactions between endothelial cells and HIV-1. Int J Biochem Cell Biol. 2001;33:371–90.

    CAS  PubMed  Google Scholar 

  3. Nou E, Lo J, Grinspoon SK. Inflammation, immune activation, and cardiovascular disease in HIV. AIDS. 2016;30:1495–509.

    CAS  PubMed  Google Scholar 

  4. Paisible AL, Chang CC, So-Armah KA, et al. HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction. J Acquir Immune Defic Syndr. 2015;68(2):209–16.

    PubMed  Google Scholar 

  5. Triant VA, Lee H, Hadigan C, et al. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92:2506–12.

    CAS  PubMed  Google Scholar 

  6. Post WS, Budoff M, Kingsley L, et al. Associations between HIV infection and subclinical coronary atherosclerosis. Ann Intern Med. 2014;160(7):458–67. https://doi.org/10.7326/M13-1754.

    Article  PubMed  PubMed Central  Google Scholar 

  7. D’Ascenzo F, Cerrato E, Calcagno A, et al. High prevalence at computed coronary tomography of non-calcified plaques in asymptomatic HIV patients treated with HAART: a meta-analysis. Atherosclerosis. 2015;240:197–204.

    PubMed  Google Scholar 

  8. Lo J, Abbara S, Shturman L, et al. Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men. AIDS. 2010;24:243–53.

    PubMed  Google Scholar 

  9. Feinstein MJ, Hsue PY, Benjamin LA, et al. Characteristics, prevention, and management of cardiovascular disease in people living with HIV: a scientific statement from the American Heart Association. Circulation. 2019;9:e98-124.

    Google Scholar 

  10. Smith CJ, Ryom L, Weber R, D:A: D Study Group, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet. 2014;384:241–8.

    PubMed  Google Scholar 

  11. D’Agostino RB, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117:743–53.

    PubMed  Google Scholar 

  12. Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2935–59.

    PubMed  Google Scholar 

  13. Friis-Møller N, Thiébaut R, Reiss P, et al. Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study. Eur J Cardiovasc Prev Rehabil. 2010;17:491–501.

    PubMed  Google Scholar 

  14. Krikke M, Hoogeveen R, Hoepelman A, et al. Cardiovascular risk prediction in HIV-infected patients: comparing the Framingham, atherosclerotic cardiovascular disease risk score (ASCVD), Systematic Coronary Risk Evaluation for the Netherlands (SCORE-NL) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Risk Prediction Models. HIV Med. 2016;17(4):289–97.

    CAS  PubMed  Google Scholar 

  15. Jung M, Parrinello CM, Xue X, et al. Echolucency of the carotid artery intima-media complex and intima-media thickness have different cardiovascular risk factor relationships: the Women’s Interagency HIV Study. J Am Heart Assoc. 2015;4(2):e001405.

    PubMed  PubMed Central  Google Scholar 

  16. Womack JA, Chang CC, So-Armah KA, et al. HIV infection and cardiovascular disease in women. J Am Heart Assoc. 2014;3(5):e001035.

    PubMed  PubMed Central  Google Scholar 

  17. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–45.

    CAS  PubMed  Google Scholar 

  18. Hsue P, Ordovas K, Lee T, et al. Carotid intima-media thickness among HIV-infected patients without coronary calcium. Am J Cardiol. 2012;109(5):742–7.

    CAS  PubMed  Google Scholar 

  19. Hulten E, Mitchell J, Scally J, et al. HIV positivity, protease inhibitor exposure and subclinical atherosclerosis: a systematic review and meta-analysis of observational studies. Heart. 2009;95:1826–35.

    CAS  PubMed  Google Scholar 

  20. McComsey GA, O’Riordan M, Hazen SL, et al. Increased carotid intima media thickness and cardiac biomarkers in HIV infected children. AIDS. 2007;21:921–7.

    PubMed  Google Scholar 

  21. Grunfeld C, Delaney JA, Wanke C, et al. Preclinical atherosclerosis due to HIV infection: carotid intima-medial thickness measurements from the FRAM study. AIDS. 2009;23:1841–9.

    PubMed  Google Scholar 

  22. Baker JV, Henry WK, Patel P, Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy Investigators, et al. Progression of carotid intima-media thickness in a contemporary human immunodeficiency virus cohort. Clin Infect Dis. 2011;53(8):826–35.

    PubMed  PubMed Central  Google Scholar 

  23. Budoff MJ, Young R, Lopez VA, et al. Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2013;61:12319.

    Google Scholar 

  24. Budoff MJ, Hokanson JE, Nasir K, et al. Progression of coronary artery calcium predicts all-cause mortality. JACC Cardiovasc Imaging. 2010;3:1229–36.

    PubMed  Google Scholar 

  25. Shaw LJ, Raggi P, Schisterman E, et al. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology. 2003;228:826–33.

    PubMed  Google Scholar 

  26. Raggi P, Cooil B, Shaw LJ, et al. Progression of coronary calcium on serial electron beam tomographic scanning is greater in patients with future myocardial infarction. Am J Cardiol. 2003;92:827–9.

    PubMed  Google Scholar 

  27. Polonsky TS, McClelland RL, Jorgensen NW, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010;303:1610–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Kingsley LA, Cuervo-Rojas J, Munoz A, et al. Subclinical coronary atherosclerosis, HIV infection and antiretroviral therapy: Multicenter AIDS Cohort Study. AIDS. 2008;22(13):1589–99.

    PubMed  Google Scholar 

  29. Chow D, Young R, Valcour N, et al. HIV and coronary artery calcium score: comparison of the Hawaii aging with HIV cardiovascular study and multi-ethnic study of atherosclerosis (MESA) cohorts. HIV Clin Trials. 2015;16:130–8.

    PubMed  PubMed Central  Google Scholar 

  30. Krishnam M, Chae EJ, Hernandez-Rangel E, et al. Utility of routine non-gated CT chest in detection of subclinical atherosclerotic calcifications of coronary arteries in hospitalized HIV patients. Br J Radiol. 2020;93:20190462.

    PubMed  PubMed Central  Google Scholar 

  31. Tarr PE, Ledergerber B, Calmy A, et al. Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons. Eur Heart J. 2018;39:2147–54.

    CAS  PubMed  Google Scholar 

  32. Miller PE, Budoff M, Zikusoka M, et al. Comparison of racial differences in plaque composition and stenosis between HIV-positive and HIV-negative men from the multicenter AIDS cohort study. Am J Cardiol. 2014;114(3):369–75.

    PubMed  PubMed Central  Google Scholar 

  33. Shikuma CM, Barbour JD, Ndhlovu LC, et al. Plasma monocyte chemoattractant protein-1 and tumor necrosis factor-α levels predict the presence of coronary artery calcium in HIV-infected individuals independent of traditional cardiovascular risk factors. AIDS Res Hum Retroviruses. 2014;30(2):142–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. McKibben RA, Margolick JB, Grinspoon S, et al. Elevated levels of monocyte activation markers are associated with subclinical atherosclerosis in HIV-infected and -uninfected men. J Infect Dis. 2015;211(8):1219–28.

    CAS  PubMed  Google Scholar 

  35. Ketlogetswe KS, Post WS, Li X, et al. Lower adiponectin is associated with subclinical cardiovascular disease among HIV-infected men. AIDS. 2014;28(6):901–9.

    CAS  PubMed  Google Scholar 

  36. Shikuma C, Seto T, Liang CY, et al. Vitamin D levels and markers of arterial dysfunction in HIV. AIDS Res Hum Retroviruses. 2012;28:793–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med. 2005;352:48–62.

    CAS  PubMed  Google Scholar 

  38. Patel AA, Budoff MJ. Coronary artery disease in patients with HIV infection. Am J Cardiovasc Drugs. 2015;15(2):81–7.

    PubMed  Google Scholar 

  39. Patel AA, Fine J, Naghavi M, et al. Radiation exposure and coronary artery calcium scans in the society for heart attack prevention and eradication cohort. Int J Cardiovasc Imaging. 2019;35(1):179–83.

    PubMed  Google Scholar 

  40. Messenger B, Li D, Nasir K, et al. Coronary calcium scans and radiation exposure in the multi-ethnic study of atherosclerosis. Int J Cardiovasc Imaging. 2016;32(3):525–9.

    PubMed  Google Scholar 

  41. Ahmadi N, Nabavi V, Hajsadeghi F, et al. Mortality incidence of patients with non-obstructive coronary artery disease diagnosed by computed tomography angiography. Am J Cardiol. 2011;107:10–6.

    PubMed  Google Scholar 

  42. Motoyama S, Kondo T, Sarai M, et al. Multi-slice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319–26.

    PubMed  Google Scholar 

  43. Budoff MJ, Achenbach S, Blumenthal RS, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006;114:1761–91.

    PubMed  Google Scholar 

  44. Zanni MV, Abbara S, Lo J, et al. Increased coronary atherosclerotic plaque vul- nerability by coronary computed tomography angiography in HIV-infected men. AIDS. 2013;27(8):1263–72.

    CAS  PubMed  Google Scholar 

  45. Fitch KV, Srinivasa S, Abbara S, et al. Noncalcified coronary atherosclerotic plaque and immune activation in HIV-infected women. J Infect Dis. 2013;208:1737–46.

    PubMed  PubMed Central  Google Scholar 

  46. Theodoropoulos K, Mennuni MG, Sartori S, et al. Quantitative angio- graphic characterization of coronary artery disease in patients with human immunodeficiency virus (HIV) infection undergoing percutaneous coronary intervention. EuroIntervention. 2017;12:1757–65.

    PubMed  Google Scholar 

  47. O’Dwyer EJ, Bhamra-Ariza P, Rao S, et al. Lower coronary plaque burden in patients with HIV presenting with acute coronary syndrome. Open Heart. 2016;3(2):e000511.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Anne-Lise P, Change CCH, So-Armah K, et al. Human immunodeficiency virus infection, cardiovascular risk factor profile and risk for acute myocardial infarction. J Acquir Immune Defic Syndr. 2015;68(2):209–16.

    PubMed Central  Google Scholar 

  49. Freiberg MS, Chang CCH, Kuller LH, et al. HIV Infection and the Risk of Acute Myocardial Infarction. JAMA Intern Med. 2013;173(8):614–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Friis-Møller N, Reiss P, Sabin CA, DAD Study Group, et al. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356(17):1723–35.

    PubMed  Google Scholar 

  51. El-Sadr WM, Lundgren JD, Neaton JD, Strategies for Management of Antiretroviral Therapy (SMART) Study Group, et al. CD4+ count–guided interruption of antiretroviral treatment. N Engl J Med. 2006;355(22):2283–96.

    CAS  PubMed  Google Scholar 

  52. Triant VA, Meigs JB, Grinspoon SK. Association of C-reactive protein and HIV infection with acute myocardial infarction. J Acquir Immune Defic Syndr. 2009;51(3):268–73.

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Lichtenstein KA, Armon C, Buchacz K, HIV Outpatient Study (HOPS) In-vestigators, et al. Low CD4+ T cell count is a risk factor for cardiovascular disease events in the HIV outpatient study. Clin Infect Dis. 2010;51(4):435–47.

    CAS  PubMed  Google Scholar 

  54. Kuller LH, Tracy R, Belloso W, INSIGHT SMART Study Group, et al. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med. 2008;5(10):e203.

    PubMed  PubMed Central  Google Scholar 

  55. Riddler SA, Smit E, Cole SR, et al. Impact of HIV infection and HAART on serum lipids in men. JAMA. 2003;289(22):2978–82.

    CAS  PubMed  Google Scholar 

  56. Baker JV, Duprez D, Rapkin J, et al. Untreated HIV infection and large and small artery elasticity. J Acquir Immune Defic Syndr. 2009;52(1):25–31.

    PubMed  PubMed Central  Google Scholar 

  57. Torriani FJ, Komarow L, Parker RA, ACTG 5152s Study Team, et al. Endothelial function in human immunodeficiency virus–infected antiretroviral-naive subjects before and after starting potent antiretroviral therapy: the ACTG (AIDS Clinical Trials Group) Study 5152s. J Am Coll Cardiol. 2008;52(7):569–76.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Grunfeld C, Saag M, Cofrancesco J Jr, et al. Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM). Regional adipose tissue measured by MRI over 5 years in HIV-infected and control participants indicates persistence of HIV-associated lipoatrophy. AIDS. 2010;24(11):1717–26.

    PubMed  Google Scholar 

  59. Wohl D, Scherzer R, Heymsfield S, FRAM Study Investigators, et al. The associations of regional adipose tissue with lipid and lipoprotein levels in HIV-infected men. J Acquir Immune Defic Syndr. 2008;48(1):44–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Armah KA, Chang CC, Baker JV, et al. Prehypertension, hypertension, and the risk of acute myocardial infarction in HIV-infected and -uninfected veterans. Clin Infect Dis. 2014;58(1):121–9.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA

    Amish A. Patel & Matthew J. Budoff

  2. Division of Cardiology, University of California Riverside School of Medicine, Riverside, CA, USA

    Amish A. Patel

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  1. Amish A. Patel
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Correspondence to Matthew J. Budoff.

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Patel, A.A., Budoff, M.J. Coronary Artery Disease in Patients with HIV Infection: An Update. Am J Cardiovasc Drugs 21, 411–417 (2021). https://doi.org/10.1007/s40256-020-00451-9

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