HIV Infection and Subclinical Coronary Atherosclerosis

Wendy S. Post; Richard T. George; Matthew Budoff

doi:10.7326/L14-5033-2

Letters |16 December 2014

HIV Infection and Subclinical Coronary Atherosclerosis

Wendy S. Post, MD, MS; Richard T. George, MD; Matthew Budoff, MD

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IN RESPONSE:

We thank Dr. Chartrand-Lefebvre and colleagues for their insightful comments about our article, which showed that HIV-infected men had a greater prevalence of and more extensive noncalcified plaque than uninfected men in MACS (Multicenter AIDS Cohort Study). We agree that the noninvasive assessment plaque vulnerability with CT scanning may further elucidate potential mechanisms that place HIV-infected persons at increased risk for acute myocardial infarction. Before plaque rupture, the degree of luminal stenosis is frequently less than 50% and therefore would not lead to symptoms or abnormal results on stress testing (1). Recent advances in the analysis of coronary CT scans have led to the ability to identify potentially high-risk, vulnerable plaques among asymptomatic persons (2). Plaque characteristics identified on coronary CT angiography that have been associated with acute coronary syndromes include low attenuation (<30 Hounsfield units), spotty calcification, and outward remodeling (expansion of arterial diameter with plaque growing outward rather than only encroaching on the lumen) (3).

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Letters |16 December 2014

HIV Infection and Subclinical Coronary Atherosclerosis

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Letters |16 December 2014

HIV Infection and Subclinical Coronary Atherosclerosis

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