Coronary artery disease outcomes

As discussed above, people with HIV infection experience coronary artery disease at approximately 1.5 times the rates seen in the general population. While initially thought to occur not only at higher rates but also prematurely [55], recent analyses have shown that coronary artery disease occurs at similar ages in people with HIV infection and the general population (adjusted mean difference in age at time of CVD diagnosis of -0.11 years  [95%CI -0.59 – 0.37]) [56].

People with HIV infection have an increased incidence of subclinical coronary artery disease and a higher plaque burden when compared to appropriately matched controls [57]. Notably, people with HIV infection have a greater burden of non-calcified (or ‘vulnerable’) plaque which has been shown to correlate with a higher risk of subsequent rupture and acute coronary events [58]. They are also more likely to present with an ST-elevation acute myocardial infarction compared to a non-ST-elevation infarction or angina [59], and experience re-infarction and re-stenosis at higher rates [60]. There is a trend towards increased in-hospital cardiovascular mortality and re-hospitalization with heart failure compared with the general community [61,62]. These observations would argue for close monitoring following the diagnosis of coronary artery disease, and attention to secondary prevention strategies, including consideration of modifiable risk factors in accordance with standard guidelines.