Current HIV Research, 2008, 6, 59-64 59 1570-162X/08 $55.00+.00 © 2008 Bentham Science Publishers Ltd. Coronary Artery Bypass Graft in HIV-Infected Patients: A Multicenter Case Control Study F. Boccara *,1 , A. Cohen 1 , E. Di Angelantonio 1 , C. Meuleman 1 , S. Ederhy 1 , G. Dufaitre 1 , G. Odi 1 , E. Teiger 2 , G. Barbarini 3 , G. Barbaro 4 , and on Behalf the French Italian Study on Coronary Artery Disease in AIDS Patients (FRISCA-2) 1 Department of Cardiology, Saint Antoine University Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris VI, Paris, France; 2 Department of Physiopathology, Henri Mondor University Hospital, Assistance Publique- Hôpitaux de Paris and Université Paris XII, Creteil, France; 3 Department of Infectious and Parasitic Diseases, University of Pavia, Italy; 4 Department of Medical Pathophysiology, University La Sapienza, Rome, Italy Abstract: Coronary artery disease (CAD) is an emerging complication in HIV-infected patients treated with highly active antiretroviral therapy. Immediate results and long-term outcome after coronary artery bypass graft (CABG) have not been yet evaluated in this population. Between January 1997 and December 2005, we compared baseline characteristics, immediate results and clinical outcome [Major Adverse Cardiac Events (MACE): death for cardiac cause, myocardial infarction (MI), coronary revascularization] at 41 months in 27 consecutive HIV-infected (HIV+) patients and 54 HIV- uninfected (HIV-) controls matched for age and gender (mean age of the cohort, 49±8 years; 96% male) who underwent CABG. Cardiovascular risk factors were well-balanced and nearly identical in both groups. In HIV+ group, mean preoperative CD4 was 502±192/mm 3 compared with 426.2±152.6/mm 3 postoperatively (p=0.004) without clinical manifestations at follow-up. At 30-day, the rate of post-operative death, MI, stroke, mediastinitis, re-intervention was identical in both groups. At follow-up [median: 41-months (range: 34-60)], rate of occurrence of 1 st MACE was higher in HIV+ group compared with HIV- group (11, 42% versus 13, 25%, p=0.03), mostly due to the need of repeated revascularization using percutaneous coronary intervention of the native coronary arteries but not of the grafts in the HIV+ group [9 (35%) versus 6 (11%), p=0.02]. CABG is a feasible and safe revascularization procedure in HIV+ patients with multivessel CAD. Immediate postoperative outcome was similar compared to controls. However, long-term follow- up was significantly different, due to an increased rate of repeated revascularization procedure in the native coronary arteries of HIV+ patients. Keywords: Coronary artery disease, Coronary artery bypass graft, Coronary revascularization, HIV infection, Highly active antiretroviral treatment. INTRODUCTION The advent of highly active antiretroviral therapy (HAART) in 1996 dramatically reduced HIV-associated morbidity and mortality. During HAART, long-term side effects such as severe metabolic disorders and related cardiovascular complications including acute coronary syndromes, peripheral vascular disease, and stroke have been reported [1-3]. Prevention and treatment of cardio-vascular complications in HIV-infected (HIV+) patients are emerging challenges for physicians involved in HIV infection care because of the prolongation of survival and long-term complications of HAART. There is a trend for an increased incidence of acute myocardial infarction (MI) in HIV+ patients tending to be higher than in the general population particularly in those under HAART including protease inhibitors [4-7]. The relation between coronary artery disease and the use of protease inhibitors in HIV+ patients is still under debate [8]. *Address correspondence to this author at the Department of Cardiology, Saint Antoine University Hospital. Assistance Publique-Hôpitaux de Paris and Université Paris VI. 184, rue du faubourg Saint-Antoine, 75571 Paris Cedex 12, France; Tel: +33.1.49.28.24.49; Fax: +33.1.49.28.26.83; E-mail: franck.boccara@sat.aphp.fr Few data are available regarding the results of conven- tional treatment, i.e. coronary revascularization [percut- aneous coronary intervention (PCI) and coronary artery bypass graft (CABG)] in HIV+ patient [9, 10]. In acute coro- nary syndromes (ACS), previous studies reported a higher rate of Major Adverse Cardiac Events (MACE) and target vessel revascularization (TVR) in HIV+ patients [11, 12]. Whether extracoporeal circulation (ECC) altered imunocom- petence in HIV+ undergoing CABG have been discussed [13-17]. The aim of this study was to compare the immediate results and long-term event-rate after CABG in HIV+ and HIV uninfected (HIV-) patients. MATERIALS AND METHODS Study Population We conducted a retrospective case-control (ratio1: 2) study and clinical outcome analysis in 27 consecutive HIV+ patients undergoing CABG over a eight-year period (January 1997 to December 2005) from 3 Cardiology Departments in France and Italy. Participants were recruited from the French Italian Study on Coronary artery disease in AIDS patients (FRISCA), a study aimed at evaluating the prognosis of