Concerns that HIV-infected individuals are at heightened risk for cardiovascular disease can induce angina. The numbers do not lie: Rates of heart attacks and strokes are higher among the infected compared to the uninfected. Of course, they should be, as more people with HIV smoke than those in the general population. So, the trick to determining if HIV and HIV-related factors are responsible for excess cardiovascular disease risk is to get a great control group to compare infected persons with. (Good luck.)
The closest we have to such a comparator is in the Multicenter AIDS Cohort Study (MACS). This observational study has been following a few MSM in a few U.S. cities for decades. Both HIV-infected and -uninfected men are enrolled, providing an excellent opportunity for comparison of cardiovascular disease and its determinants.
In a cross-sectional study of MACS participants including 618 HIV-infected and 383 HIV-uninfected men without a history of cardiac surgery/intervention and between the ages of 40 to 70 years, CT scans for coronary calcium scoring were performed. In addition, CT angiography was done to assess for plaque characteristics in 450 of the HIV-infected and 309 of the HIV-uninfected participants who had no evidence of chronic renal insufficiency.
Remarkably, plaque was ubiquitous in both infected and uninfected men: 78% and 74%, respectively. After full adjustment for major confounders, there remained a higher prevalence of plaque in those who were HIV infected -- although after adjusting for age, race, CT scanning center, cohort and CAD risk factors, the association between HIV and presence of coronary calcium became only "borderline significant."
Importantly, HIV-infected men were also more likely to have noncalcified plaques (the most vulnerable to rupture). Older age was associated with noncalcified plaque in the HIV-infected but not HIV-uninfected men, and this seemed to drive the overall differences between these groups. Actual coronary stenosis was seen in 17% of HIV positives and 15% of HIV negatives, and no significant differences were found after adjustment.