9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 19-21 July 2007, Sydney, Australia

SUBCLINICAL CORONARY ATHEROSCLEROSIS, HIV-INFECTION AND ANTIRETROVIRAL THERAPY: RESULTS FROM THE MULTI-CENTRE AIDS COHORT STUDY

Antiviral Therapy 2007; 12(Suppl. 2):L11 (abstract no. O-12)

LA Kingsley¹, J Cuervo², A Munoz², FJ Palella³, M Budoff⁴, W Post⁵, M Witt⁶ and LH Kuller^1
1University of Pittsburgh, Pittsburgh PA, USA; ²Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; ³Northwestern University, Chicago IL, USA; ⁴Harbor-UCLA Medical Center, Torrance, CA, USA; ⁵Johns Hopkins School of Medicine, Baltimore, MD USA; ⁶University of California, David Geffen School of Medicine and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, CA, USA

OBJECTIVES: Highly active antiretroviral therapy (HAART) use has raised clinical concern about atherogenic lipid and metabolic changes that could increase risk for coronary atherosclerosis in HIV-infected persons. We examined the effect of HIV itself and cumulative HAART exposure on the presence and extent of coronary artery calcification (CAC).

METHODS: A cross-sectional study of 947 men (332 HIV-seronegative, 84 HAART-naïve and HIV-infected, and 531 HAART-experienced and HIV-infected). Eligibility criteria included informed consent, age ≥40, no self reported or confirmed coronary or cerebrovascular disease, and weight <136.4 kg. The main outcome measure was the geometric mean of the Agatston scores (AS) of two CT replicates. The presence of coronary calcium (CAC) was defined as a geometric mean above 10, and CAC quantity measured by the value of the geometric mean for those with evidence of any CAC. Multiple logistic and linear-regression analyses assessed effects of risk factors on presence and extent of CAC.

RESULTS: Increasing age was strongly associated with both CAC prevalence and extent for all groups studied. In those of similar age and in comparison with HIV-seronegative controls, HIV infection (OR=1.4, 95% CI=0.81–2.50) and long-term HAART use (OR=1.5, 95% CI=1.04–2.25) increased the likelihood of CAC. In contrast, compared with HIV-negative controls of similar age, HAART use was associated with a lower CAC score (for 1–7 years: relative CAC extent=0.74; 95% CI=0.52–1.05), HAART use=8 years, relative CAC extent=0.68; 95% CI=0.49–0.95). However, after adjustment for traditional CHD risk factors, HAART had no significant effects on the presence or extent of CAC.

CONCLUSIONS: Long-term HAART use (>8 years) was not associated with increases in either the prevalence or extent of coronary atherosclerosis when compared to HIV seronegative men with similar cardiovascular risk profiles.

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2007-07-24
O-12

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