Presentation Abstract

Session: 019-Opportunistic Infections and Co-Morbid Conditions in HIV-I
Sunday, Sep 09, 2012, 11:30 AM - 1:30 PM
Presentation Title: H-229 - Early Onset and Late Diagnosis of CAD in HIV+ Persons
Location: Halls A-C
Presentation Number: H-229
Pres. Time: Sunday, Sep 09, 2012, 11:30 AM - 1:30 PM
Category: H1
Keywords: HIV Infection; mortality-morbidity; CAD
Author(s): C. Kaiser, MD - Medical Resident 1, T. Chin, MS - Research Assistant 1, S. Napravnik, Ph.D. - Associate Professor 2, L. Yang, M.S. - Professor 1, M. Tipton, M.S. - Research Assistant 2, J. Eron, MD - Professor 2, C. Hicks, MD (Doctor of Medicine) - Professor1;
1Duke Uni Med Ctr, Durham, NC, 2UNC, Chapel Hill, NC.
Financial Disclosures:  C. Kaiser, None..
T. Chin, None..
S. Napravnik, None..
L. Yang, None..
M. Tipton, None..
J. Eron, None..
C. Hicks, None.
Abstract: Background: Delays in catheterization (cath) in HIV-infected persons may worsen cardiac morbidity resulting in more significant coronary artery disease (CAD) at diagnosis. Methods: Data were collected on HIV+ patients from academic medical center HIV specialty clinics undergoing first cath for chest pain (CP) or suspected CAD and compared to a control population of randomly selected HIV - persons of similar sex, age and socioeconomic background also undergoing first cath for CP/CAD. Outcome measures: significant CAD (≥50% lesion in ≥ 1 major vessel) and indication for cath. Differences between groups tested by Fisher’s exact, Wilcoxon, Kruskal-Wallis rank tests. Results: 96 HIV+ patients were identified and compared to 41 HIV- controls. ESRD was significantly more common among HIV+ patients; DM more prevalent among HIV- patients. Tobacco use/male gender trended towards being more common in HIV+ patients. HIV+ patients were significantly more likely to have cath done urgently [unstable angina (UA) or myocardial infarction (MI)]. Prevalence of significant CAD was similar between groups, as was subsequent management. Conclusions: Significant CAD was very common in HIV+ patients going for cath (63%) despite the young median age of 49 years. In contrast, it was very difficult to find HIV-uninfected controls of comparable age/sex with suspected CAD. The high proportion of HIV+ caths for MI or UA suggests health care providers may not consider CAD early enough in younger HIV+ patients. Earlier recognition of CAD in HIV-infected patients may help improve outcomes.
Baseline Characteristics
HIV+ (n=96)HIV- (n=41)p-value
Median Age (IQR)49 (44, 53)50 (47, 52)0.48
Male (%)72 (75%)24 (59%)0.07
African-American (%)62 (65%)29 (71%)0.56
Tobacco Use (%)49 (51%)15 (37%)0.14
Cocaine Use (%)16 (17%)4 (10%)0.43
DM (%)22 (23%)17 (42%)0.04
ESRD (%)14 (15%)00.01

Catheterization Data
HIV+ (n=96)HIV- (n=41)p-value
Catheterization done for Unstable Angina or MI52 (54%)14 (34%)0.04
Significant CAD60 (63%)22 (54%)0.35
Intervention for CAD0.90
Medical Management18 (30%)7 (32%)
PCI31 (52%)10 (46%)
CABG11 (18%)5 (23%)

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