Increased Arterial Inflammation Relates to High-Risk Coronary Plaque Morphology in HIV-Infected Patients

Abstract

Background Mechanisms predisposing HIV-infected patients to increased CVD risk remain unclear. Objective To determine the interrelationship between arterial inflammation and high-risk coronary plaque morphology in HIV-infected patients with subclinical coronary atherosclerosis. Methods 41 HIV-infected patients on stable ART without known CVD but with atherosclerotic plaque on coronary CT angiography were evaluated with 18F-FDG-PET. Patients were stratified into two groups based on relative degree of arterial inflammation (aortic target-to-background-ratio, or TBR). High-risk coronary atherosclerotic plaque morphology features were compared between groups. Results HIV-infected patients with higher and lower TBR’s were similar with respect to traditional CVD risk parameters. Among HIV-infected patients with higher TBR, an increased percentage of patients demonstrated at least one low attenuation coronary atherosclerotic plaque (40% vs. 10%, p = 0.02) and at least one coronary atherosclerotic plaque with both low attenuation and positive remodeling (35% vs. 10%, p = 0.04). Moreover, in the higher TBR group, both the number of low attenuation plaques (LAP’s) per patient (p = 0.02) and the number of vulnerability features in the most vulnerable plaque (p = 0.02) were increased. TBR grouping remained significantly related to the number of LAP’s/subject (β=0.35, p = 0.004), controlling for age, gender, LDL, duration HIV, and CD4. Conclusion These data demonstrate a relationship between arterial inflammation on 18F-FDG-PET and high-risk coronary atherosclerotic plaque features among HIV-infected patients with sublclinical coronary atherosclerosis. Further studies are needed to determine whether arterial inflammation and related high-risk coronary morphology increase the risk of clinical CVD events in the HIV population.

Presence, Characteristics, and Prognostic Associations of Carotid Plaque Among People Living With HIV

“…Among PLWHIV, data using CT have shown that there is a marked increase in the prevalence of both non-calcified plaque 32 and HRP in coronary arteries of PLWHIV 8, 33 . For example, Post et al, showed in a study of 618 PLWHIV that the prevalence of any non-calcified coronary plaque was 63% as compared to 53% in uninfected controls 21 .…”

Inflammation and Fibrosis in HIV

“…One such study showed that the atherosclerotic inflammation correlates with markers of monocyte activation. Subsequent studies showed an association between arterial inflammation and structural measures of coronary atherosclerosis, including the presence of high-risk morphological features 14 . Further, among HIV-infected individuals, immune activation and chronic inflammation persist and are thought to lead to collagen deposition and fibrosis of lymphoid tissue; 15 as fibrosis has been reported in other organs such as the liver 16 as well as the myocardium.…”

Imaging atherosclerotic burden and inflammation: Insights into the spectrum of atherosclerotic disease in HIV

“…Furthermore, we observed that the degree of arterial inflammation in HIV correlates with markers of monocyte activation, 7 and in a separate study, we observed that extra-coronary arterial inflammation correlates with the presence of high-risk coronary plaques. 37 Hsue et al recently extended those findings, and observed that the tissue measures on FDG accumulation relate to markers of viral persistence in HIV. 38 Hence a substantial literature has emerged in HIV-positive individuals, which links immune activation to arterial inflammation.…”