ART May Not Prevent Coronary Artery Inflammation in HIV Patients

Researchers found that 80% of HIV-positive patients had increased aortic inflammation after starting antiretroviral therapy.

In a recent study, researchers found that administering antiretroviral therapy (ART) soon after diagnosis with HIV did not prevent significant arterial inflammation.

"Our previous studies have found that persistent arterial inflammation may predispose people living with HIV to the development of high-risk coronary artery plaques that are potentially more likely to rupture and cause a heart attack," said study lead author Markella Zanni, MD. "Our findings suggest that additional strategies geared toward reducing arterial inflammation among HIV-infected patients receiving ART may be needed."

The study, published in JAMA Cardiology, included 12 HIV-infected men previously untreated and about to begin ART. The control group included 12 uninfected, age-matched patients.

With HIV-positive patients, researchers initially, and after 6 months, conducted PET scans with FDG that accumulates at the sites of inflammation in order to image the aortas, hearts, underarm lymph nodes, spleens, and bone marrow.

HIV-positive patients also had CT angiograms to find coronary artery plaques and blood tests to that analyzed lipids, immune system factors, and HIV viral loads, according to the study.

Over the 6-month period, researchers found that 80% of HIV-positive patients developed increased inflammation of the aorta. They also found that inflammation significantly decreased in lymph nodes and somewhat decreased in the spleen.

In 25% of HIV-positive patients, there was some level of coronary artery plaque found and after 6 months, this plaque increased. There was 1 patient who developed a new plaque.

"Further research is needed to better understand the relationship between persistent immune activation, arterial inflammation and plaque development in HIV infection," concluded senior author of the study Steven Grinspoon, MD. "We need to compare the effects of different antiretroviral therapy regimens on arterial inflammation over time. Moreover, we need to investigate the important question of whether administering immune-modulatory strategies along with ART can help suppress arterial inflammation, stabilize coronary plaques and reduce cardiovascular risk in HIV-infected patients."