Prevalence of incidental premature cardiac calcifications in an HIV-infected South African population using conventional computed tomography chest radiography

Abstract

Background: International literature reported an increased prevalence of cardiovascular disease in persons living with HIV (PLWH), inferring an association with accelerated coronary atherosclerosis and plaque formation. Few local studies of HIV-related cardiac disease have confirmed this. Early identification of cardiac plaques would assist clinicians with risk stratification and implementation of treatment strategies to reduce morbidity and mortality. In resource-limited settings the use of conventional computed tomography (CT) may have a role in identifying at-risk individuals.

Objectives: This hypothesis-generating study was aimed at determining the contribution of HIV to accelerated vascular aging by assessing cardiac calcifications, incidentally detected on conventional CT chest imaging, in a young HIV-positive population.

Method: A retrospective quantitative analysis was performed at a tertiary hospital in KwaZulu-Natal, South Africa, over a 5-year period. Young patients (18–45 years) who underwent CT chest imaging for varied indications were included, further sub-categorised by immune status, the presence, absence and location of calcifications. Patients with unknown HIV statuses were excluded.

Results: An increased probability of cardiac calcification with increasing age, independent of the HIV status, was established. No statistically significant difference could be demonstrated between the cohorts. In the pre-contrasted subcategory, a lower P-value suggested an ‘imminent’ statistical significance. Contrast may have obscured some calcifications. The failure to record the immune status in a large number of patients resulted in their exclusion and limited the study.

Conclusion: The increased prevalence of incidentally detected cardiac calcifications in young HIV-infected individuals warrants further evaluation and cardiovascular risk stratification.