| Part I:Assessment of coronary plaque and stenosis in HIV-infected individualsObjectiveTo analyze the differences of coronary artery calcium scores,the characteristics of plaque and the stenosis of coronary artery between the HIV-infected and HIV-uninfected patients.Materials and methodsPatients(53 HIV-infected,53 HIV-uninfected)were enrolled in this study,whose informations were collected from June 2016 to September 2017.Inclusion and exclusion factors were identical for both groups with the exception of HIV serostatus.Eligibility criteria for this study included being an active participant,age40 to 80 years,weighing less than 120 kg,and without a history of cardiac surgery or percutaneous coronary intervention as these procedures could interfere with the measurement of coronary atherosclerosis.All eligible CTA participants had an estimated GFR>60 ml/min/m~2 within one month of CTA.The patients had no history of non-iodine contrast allergy.The patients did not have atrial fibrillation at the time of the scan.Participants receiving antiretroviral therapy were on stable therapy for>3 months.The informed consent was provided by all participants.Coronary images were analyzed,respectively.We compared demographic and clinical characteristics between HIV-infected and HIV-uninfected participants,using the two sample test,chisquare tests,Wilcoxon rank sum test or Fisher exact test depending on the distribution of the variables.The statistical results were tested by two-sided test.Statistical tests with two-tailed p<0.05 were considered significant.ResultsThere were 106 patients(53 HIV-infected and 53 HIV-uninfected)in the study,and the proportion of females in both groups was 27/53(50.94%).The average age of the two groups was 56.60±8.98 and 56.65±11.07,respectively.Each segment was analyzed using the modified 15-segment model of the American Heart Association,and the total coronary segments of the two groups were 749 and 732,respectively.The proportion of segment number with plaque in HIV-infected and HIV-uninfected patients was 110/749(14.69%)and 61/732(8.33%),respectively;the ratio of the segment number with plaque was higher in HIV+patients than in HIV-patients(?~2=14.63,P<0.005).The proportion of segments with non-calcified plaque in HIV+and HIV-patients was 38/110(34.55%)and 39/61(63.93%),respectively;the proportion of segments with non-calcified plaque in HIV+patients was lower than that of HIV-patients(?~2=13.69,P<0.005).The proportion of segments with calcified plaque in HIV+and HIV-patients was 58/110(52.73%)and 19/61(31.15%),respectively;the proportion of segments with calcified plaque was higher among HIV+compared to HIV-patients(?~2=7.38,P<0.01).The proportion of segments with mixed plaque among HIV+and HIV-patients was 60/110(54.55%)and22/61(36.07%),respectively;the proportion of segments with mixed plaque was higher in HIV+patients(?~2=5.37,P<0.025).The number of segments with positive remodeling(PR)in HIV+and HIV-positive patients was 57 and 21,respectively.HIV+patients with PR were more(?~2=4.78,P<0.05).Plaque size is graded as 0=no plaque,1=mild,2=moderate,or 3=severe.The total scores of the plaque size in HIV-infected and HIV-uninfected patients were 207 and 93,respectively,and the difference was statistically significant(P<0.001).The proportion of segments with stenosis?50%in HIV+and HIV-patients was 28/110(25.45%)and 12/61(19.67%),respectively,and the difference of segments with significant stenosis in HIV-infecteed patients compared to HIV-uninfected was not statistically significant(?~2=0.73,P>0.25).The ratio of patients with plaque in the proximal and middle segments among the two groups were 82.73%(91/110)and 86.89%(53/61),respectively;the difference was not statistically significant(?~2=0.51,P>0.25).The plaque was mainly located in the proximal and middle segments.There were 27 patients with coronary artery calcium score>0 in HIV+patients and 23 patients in HIV-patients.There was no significant difference in the incidence of calcification between HIV+and HIV-patients(?~2=0.18,P>0.05).The proportion of patients with plaque in HIV+and HIV-patients was 33/53(62.26%)and37/53(69.81%),respectively;there were more people with plaques in the HIV-group than in the HIV+group(?~2=0.57,P<0.0025).Among the patients with the different plaques,the proportion of patients with non-calcified,calcified and mixed plaque in HIV+patients were 22/33(66.67%),16/33(48.48%)and 23/33(69.70%),respectively.The proportion of patients with non-calcified,calcified and mixed plaque in HIV-patients was 27/37(72.97%),12/37(32.43%)and 14/37(37.84%),respectively.The proportion of patients with mixed plaque wre only higher(P<0.01).The proportion of patients with PR in HIV+and HIV-patients was 23/33(69.70%)and20/37(54.05%),respectively;there was no significant difference(?~2=1.80,P>0.05).The proportion of patients with single vessel disease in HIV+and HIV-patients was12/33(36.36%)and 23/37(62.16%),respectively.The proportion of patients with two vessels disease was 12/33(36.36%)and 8/37(21.62%),respectively.There were lesser patients with single vessel disease in HIV+compared to HIV-group(?~2=4.64,P<0.05).The proportion of patients with significant stenosis in the HIV+and HIV-groups was 7/33(21.21%)and 8/37(21.62%),respectively;the difference was not statistically significant(?~2=0.002,P>0.05).ConclusionsThe number of segments with any plaque,calcified plaque and mixed plaque is more in HIV+patients.There are more segments with PR and larger total score with plaques in HIV+patients.Part II: Effect of Coronary Plaque in HIV-infected PatientsObjectiveTo explore the influencing factors of coronary plaque(PR)in HIV-infected patients,and to reduce the occurrence of acute coronary syndrome.Materials and methodsWe gathered 53 HIV+ patients from June 2016 to September 2017,which were suspected of having coronary artery disease.The inclusion criteria was the same as the first part.Data were collected regarding demographic,HIV clinical parameters from the clinical medical records prior to the CT measurements.The informed consent was provided by all participants.The HIV+ patients were divided into two groups: plaques and non-plaques;the differences of the influencing factors between the two groups were compared.The related factors of the segments with coronary positive remodeling in the plaque group were analyzed.To compare variables,we used the chi-square or Wilcoxon rank sum test depending on the distribution of the variables.To compare the correlation,we used the Spearman correlation analysis.Multivariate logistic regression modeling was performed to examine the effects of coronary plaque.The statistical results were tested by two-sided test.Statistical tests with two-tailed p < 0.05 were considered significant.ResultsHypertension was correlated with coronary plaque formation in HIV+ patients.There is no correlation between coronary plaques and the other factors.Smoking is independently associated with coronary positive remodeling.ConclusionHypertension is a risk factor for coronary plaque formation.Smoking is related to coronary PR. |
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