Research paper High-risk coronary plaque, invasive coronary procedures, and cardiac events among HIV-positive individuals and matched controls James Nadel a, b, * , Eoin O'Dwyer b , Sam Emmanuel a, b , Justyn Huang b , Sarat Cheruvu b , Neville Sammel a, b , Bruce Brew b, d , James Otton b, c , Cameron J. Holloway a, b, c a University of Notre Dame, Sydney, Australia b St. Vincent's Hospital, Sydney, Australia c Victor Chang Cardiac Research Institute, Sydney, Australia d Peter Duncan Neurosciences Unit St Vincent's Centre for Applied Medical Research University of New South Wales, Sydney, Australia article info Article history: Received 6 June 2016 Accepted 28 July 2016 Available online xxx Keywords: HIV CT coronary angiography Coronary artery disease Acute coronary syndrome abstract Background: Human immunodeficiency virus (HIV) infection is considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). We analyzed the utility of coronary CTA in the assessment of CAD among HIV patients and explored whether HIV patients are at greater risk of associated morbidity and mortality compared to HIV-negative controls. Methods: In a retrospective, single center cohort study 97 males without history of previous coronary artery disease who had undergone coronary CTA between 2011 and 2014 was analyzed, including 32 HIV positive patients and 65 matched HIV negative controls. Presence and composition of coronary plaque was determined by coronary CTA. Data on subsequent coronary events and coronary intervention was collected. Results: Patients with HIV had higher rates of non-calcified plaque (0.8 ± 1.5 versus 0.3 ± 0.7, p ¼ 0.03) compared to negative controls. At a median follow-up of 38 months, patients with HIV were at greater risk of non-ST elevation acute coronary syndrome (16% versus 3%, p < 0.04), although there was no difference in the combined endpoint of all acute coronary syndromes (19% versus 6%, p ¼ 0.08). Following baseline coronary TCA, there was a higher rate of coronary intervention in patients without HIV (mean time to event 9.9 ± 3.3 versus 20.6 ± 4.9 months, p < 0.04). Conclusion: Patients with HIV more pronounces coronary atherosclerosis on coronary CTA and higher rates of non-ST elevation acute coronary syndromes compared to negative controls. © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved. 1. Introduction Human immunodeficiency virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) affect over 33 million people globally and are responsible for almost 2 million deaths per year. 1 The advent of antiretroviral therapy (ART) has improved morbidity and mortality to a point where HIV is now considered a treatable chronic disease. 2 Life expectancy among treated in- dividuals is comparable to the general population. 3 This extension in expected survival has resulted in the emergence of chronic age related diseases including coronary artery disease (CAD). 4 The increased risk of CAD in patients with HIV has been associated with the inflammatory sequelae of the infection, the greater prevalence of cardiac risk factors in HIV-positive populations, and the side effects of life-prolonging antiretroviral therapies. 5À7 Even though almost half of all fatal myocardial infarctions occur in previously asymptomatic individuals, 8 controversy surrounds the role of screening and early management of CAD in patients with HIV. Similar to the general population, both the modality of screening and timing for when to screen at-risk asymptomatic in- dividuals remain unclear. 9 Screening high-risk patients with treated HIV may be advantageous to improve outcomes, 10,11 however, no studies have shown a correlation between screening for CAD and such an improvement. Independent of traditional cardiovascular risk factors, coronary plaque, especially non-calcified plaque, has been found to be more prevalent and extensive in HIV positive individuals compared to * Corresponding author. St Vincent's Hospital, Victoria St, Darlinghurst, 2010, Sydney, Australia. E-mail address: james.r.nadel@gmail.com (J. Nadel). Contents lists available at ScienceDirect Journal of Cardiovascular Computed Tomography journal homepage: www.JournalofCardiovascularCT.com http://dx.doi.org/10.1016/j.jcct.2016.07.018 1934-5925/© 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved. Journal of Cardiovascular Computed Tomography xxx (2016) 1e7 Please cite this article in press as: Nadel J, et al., High-risk coronary plaque, invasive coronary procedures, and cardiac events among HIV- positive individuals and matched controls, Journal of Cardiovascular Computed Tomography (2016), http://dx.doi.org/10.1016/j.jcct.2016.07.018