Inflammation, other immune-system factors may increase cardiovascular risk
A Massachusetts General Hospital (MGH) study has found that relatively young men with longstanding HIV infection and minimal cardiac risk factors had significantly more coronary atherosclerotic plaques - some involving serious arterial blockage - than did uninfected men with similar cardiovascular risk. The investigation appearing in the January 2010 issue of the journal AIDS is the first to use CT angiography to identify coronary artery plaques in HIV-infected participants.
"We were particularly surprised to find that several of the HIV patients - none of whom had symptoms of heart disease - had obstructive coronary artery disease, which was found in none of the controls," says Janet Lo, MD, of the Program in Nutritional Metabolism in the MGH Department of Medicine, who led the study. "It appears that both traditional and nontraditional risk factors are contributing to atherosclerotic disease in HIV-infected patients."
Several previous studies have found increased incidence of heart attacks and other cardiovascular events among HIV-infected patients, but it has not been clear whether that risk was attributable to recognized risk factors, such as elevated cholesterol and smoking, or to HIV-related immune system factors. The current study enrolled 110 men - 78 with HIV infection and 32 uninfected controls - without symptoms of cardiovascular disease. Participants ranged in age from 18 to 55, and both groups had low levels of traditional cardiovascular risk factors. The HIV-positive participants had longstanding infection, were generally healthy, and the great majority were receiving antiretroviral therapy.