Subclinical Coronary Atherosclerosis in HIV-Infected Patients

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DESCRIPTION (provided by applicant): , Worldwide, HIV-infected patients are living longer with anti-retroviral therapy. Metabolic and cardiovascular complications associated with HIV infection and its treatment are becoming more evident as this patient population ages with chronic viral infection. Metabolic changes in HIV-infected patients including dyslipidemia, insulin resistance, and fat redistribution as well as increased inflammation associated with chronic infection may increase their cardiovascular risk. In the proposed grant, we will prospectively investigate the prevalence of subclinical coronary atherosclerosis in HIV-infected individuals without previously diagnosed cardiovascular disease. We also propose to study the potential metabolic, inflammatory, and genetic factors that may contribute to ; atherosclerosis in HIV-infected patients. In the proposed cross-sectional cohort study, we will obtain preliminary data and identify risk factors that will inform the design of future longitudinal studies using 64-row multidetector computed tomography (MDCT) and CT angiography to detect subclinical coronary disease in the HIV population in comparison to age-matched non-HIV infected control subjects. We hypothesize that evidence of coronary artery calcification and coronary plaque lesions as seen by MDCT will be present in individuals with HIV more than control subjects. We also plan to evaluate the metabolic and inflammatory factors associated with coronary artery disease in HIV-infected individuals. We hypothesize that dyslipidemia, increased secretion of inflammatory markers, insulin resistance, decreased adiponectin and certain polymorphisms in monocyte chemokines and chemokine receptors will be associated with coronary artery disease in HIV-infected individuals. We also hypothesize that : dyslipidemia and increased inflammation will be associated with increased coronary plaque formation : independent of other risk factors in this patient population. Characterization of the atherosclerotic disease burden as well as identification of risk factors associated with atherosclerotic disease in HIV will be instrumental to guide the future design of appropriate prevention strategies for the HIV patient population.