Background: Mortality rate in patients with Human immunodeficiency virus (HIV) infection has significantly decreased since the use of antiretroviral therapy (ART). However, the use of ART brought new concerns of metabolic disturbances including diabetes and dyslipidemia leading to coronary artery disease (CAD).
Aim: To assess the effect of HIV disease on CAD, and to evaluate the role of ART and inflammatory markers.
Methods: A retrospective study of 9,029 patients presented with chest pain and underwent cardiac catheterization between 01/01/2005 to 12/31/2016. Patients with documented HIV history were identified. We assessed variables related to HIV disease such as CD4 count, CRP and ESR. CAD extent was categorized into obstructive (left main stenosis of ≥50% or any stenosis of ≥70%), non-obstructive (≥1 stenosis ≥20%, but no stenosis ≥70%) and normal coronaries (no stenosis >20%).
Results: Of 9,029 patients who had cardiac catheterization, 111 (1.2%) had documented HIV infection, of them 102 (92 %) had evidence of CAD versus 7,572/8919 (85%) in non-HIV patients (OR: 2, 95% CI: 1.1-4, p: 0.04). Average age of CAD in HIV group was 55 years (SD: 51-57) versus 62 years (SD 60-64) in non-HIV group (p<0.0001). In patients with CAD who also had HIV infection, 36.3% had non-obstructive coronaries compared to 26% in those with CAD but without HIV (OR: 1.6, 95% CI: 1.1-2.3, p=0.03). Average CD4 count in HIV-CAD group was 521 (+/-75) versus 310 in HIV-no CAD group (p=0.007). In the HIV-CAD group 82.4% were on ART versus 53.3% in HIV patients without CAD (OR: 4.1, 95% CI: 1.3-12.7, p=0.01). Patients with HIV-CAD had average CRP of 3.6 (+/-1.5) versus 0.96 in HIV without CAD (p=0.7). Average ESR in HIV-CAD was 43 versus 32 in HIV without CAD (p=0.3). Average A1C among HIV-CAD who were on ART was 6.2 versus 5.8 in those not on ART (p=0.3). Average LDL level was higher in HIV-CAD patients who were on ART than those not on ART (p=0.4).
Conclusion: HIV carries a higher risk of developing CAD at an earlier age. Patients with HIV have a higher incidence of non-obstructive disease. Higher CD4 counts and use of ART were associated with higher risk of CAD. Implicated etiology could be the side effects of ART or the inflammatory response linked to HIV infection implied by higher CRP and ESR among these patients.