The Research On The Relationship Between Antiretroviral Therapy And Coronary Plaque Quality And Degree Of Stenosis In HIV(+)Chinese Patients

ObjectiveIn addition to the traditional cardiovascular risk factors,hiv-positive patients(HIV+)are also faced with the effects of hiv-1 virus itself and long-term highly active antiretroviral therapy(HAART),so HIV(+)patients are more likely to have adverse cardiovascular events than HIV(-)patients.This study is aimed to investigate the relationship between long-term highly active antiretroviral therapy(HAART)and coronary atherosclerosis in HIV(+)patients.MethodsA total of 158 HIV(+)patients were enrolled in this study.126 patients took HAART drugs regularly,including 37 patients took drugs for less than 3 years,38 patients took drugs for 3-8 years,51 patients took drugs for more than 8 years,and 32 patients did not take HAART drugs.Coronary calcification score(CAC)and CTA scans were performed in all patients.The incidence of total coronary plaques,calcified plaques,non-calcified plaques and mixed plaques and the number of coronary segments involved were compared among the groups.Multivariate Logistic regression analysis was used to evaluate the relationship between HAART and coronary atherosclerosis in HIV(+)patients.ResultsThere was no significant difference between the HAART group(group A)and the non-HAART group(group B)in gender,age and other demographic characteristics,as well as cardiovascular risk factors such as hypertension and diabetes(P>0.05).The incidence of total coronary plaque,non-calcified plaque and mixed plaque in group A was 69.05%,54.76%,30.16%,and that in group B was 46.88%,34.38%,and 12.50%,respectively.The differences between groups were statistically significant(P<0.05).The prevalence of coronary artery calcification plaque was 41.27% for group A and 34.38% for group B.The average Agatston score for group A was 127.93±63.75,and that for group B was 104.16±33.19,which was no longer statistically significant between the two groups(P>0.05).The mean number of total coronary plaque,non-calcified plaque and mixed plaque involved segments in each patient was statistically different between the two groups,but there was no significant difference in the number of calcified plaque involved segments between the two groups.The incidence of obvious coronary artery stenosis(stenosis degree>50%)was 31.75% in group A and 18.75% in group B,with no statistical difference(P=0.148).According to the duration of HAART,our patients were divided into three groups: group A1(less than 3 years),group A2(3-8 years),and group A3(more than 8 years).The incidence of total coronary plaque,calcified plaque,non-calcified plaque and mixed plaque in group A1 was 54.05%,27.03%,35.14%,21.62%,in group A2 was 68.42%,39.47%,55.26%,34.21%,and 80.39%,52.94%,68.63%,33.33% in group A3 respectively,and the difference between groups was statistically significant(P<0.05).The mean Agatston score was 167.0±69.4 in group A1,135.1±69.9 in group A2,and 109.5±52.0 in group A3,with statistically significant difference(P<0.05).The mean number of segments involved in total coronary plaque,calcified plaque and non-calcified plaque was statistically different between groups,but there was no significant difference in the number of segments involved in mixed plaques between groups.The incidence of obvious coronary artery stenosis(stenosis degree>50%)was 21.62% in group A1,28.95 in group A2,and 41.18 in group A3,with no statistical difference(P=0.137).After adjusting for demographic characteristics such as gender and age,as well as cardiovascular risk factors such as hypertension and diabetes,multivariate Logistic regression analysis showed that the duration of HAART was independently correlated with the presence of total coronary plaque and non-calcified plaque.ConclusionOur study demonstrates that compared with the patients who did not receive HAART,the incidence of coronary atherosclerosis was higher in HIV(+)patients received HAART.With the prolonged exposure of HAART,the incidence of total coronary artery plaques,calcified plaques and non-calcified plaques increased,but the calcification score reflecting the degree of calcification decreased.HAART may be an independent risk factor for coronary heart disease(CHD)in HIV(+)patients,and has an independent correlation with the presence of total plaque and non-calcified plaque.