Coronary Aging in HIV-Infected Patients

Background. Human immunodeficiency virus (HIV)-infected patients often demonstrate accelerated aging processes. We investigated whether the vascular age of a cohort of stable HIV-infected patients receiving antiretroviral therapy (ART) was increased and sought out predictors of increased vascular age. Methods. In this cross-sectional study, 400 HIV-infected patients (mean age, 48 years) attending a cardiometabolic clinic underwent cardiac computed tomography imaging to identify coronary artery calcium (CAC). Vascular age was estimated on the basis of the extent of CAC by means of previously published equations. Results. Increased vascular age was observed in 162 patients (40.5%), with an average increase of 15 years (range, 1-43 years) over the chronological age. In univariable analyses, chronological age, male sex, systolic blood pressure, duration of ART, fasting glucose level, fasting serum triglyceride level, total cholesterol level, low-density and high-density lipoprotein cholesterol levels, hypertension, and the presence of the metabolic syndrome were associated with increased vascular age. In multivariable linear regression analyses, current CD4(+) cell count was the only predictor of increased vascular age (beta = 0.51; P = .005). Conclusions. Increased vascular age is frequent among HIV-infected patients and appears to be associated with CD4(+) cell count. If these findings were to be confirmed in prospective trials, a positive response to ART with an increase in CD4(+) cell count may become a marker of increased risk of atherosclerosis development.