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CROI 2013: Inflammation & coronary heart disease are more aggressive in HIV

Coronary heart disease in HIV-infected individuals may have more high-risk anatomic features and a different pathogenesis, as suggested in an abstract presented at CROI 2013 by Zanni et al [1]. In the general population, several angiographic features have been identified as correlates of increased risk of plaque rupture, leading to acute coronary syndrome, MI and sudden coronary death. Eccentric remodeling of the artery wall, low-attenuation plaque (LAP) and spotty microcalcification identify vulnerable plaque that is at increased risk for rupture.

Using CT angiography, these investigators looked for vulnerable plaque features in 106 HIV-positive men, predominantly on ART, and 41 matched HIV-negative controls. None had known coronary heart disease. They found vulnerable plaque features (LAP and eccentric remodeling, but not microcalcification) were more common in HIV-positives. Vulnerable plaque with all 3 features were seen in 8% of HIV-positives and no controls. In univariate analysis, the presence of LAP correlated with both traditional CVD risk factors and inflammatory markers, but only plasma levels of soluble CD163, a marker of monocyte activation, remained independently associated with LAP in multivariate analysis.

Similar data was described in women in a late-breaker poster [2]. This study suggests that CVD in HIV-positive individuals may be a more aggressive disease with more features that lead to serious events, and that systemic inflammation, particularly involving innate immunity and the monocyte/macrophage axis is central to the pathogenesis.


1. Zanni M, Lo J, Wai B, et al. Increased Coronary Atherosclerotic Plaque Vulnerability Features on Computed Tomography Angiography among HIV+ Subjects vs Matched HIV– Controls. Presented March 4, 2013 at the 20th CROI, Atlanta Georgia. Oral Abstract 63;

2. Fitch K, Abbara S, T Burdo Y, et al. Non-Calcified Coronary Plaque and Macrophage Activation Markers Are Increased in HIV+ Women. Presented March 6, 2013 at the 20th CROI, Atlanta Georgia. Poster Abstract 185LB;

Source: Reporting for PRN News: David H. Shepp, MD