Global Health & Medicine 2020;2(6):367-373.
Unexpected high prevalence of severe coronary artery stenosis in Japanese hemophiliacs living with HIV-1
Nagai R, Kubota S, Ogata M, Yamamoto M, Tanuma J, Gatanaga H, Hara H, Oka S, Hiroi Y
To determine the prevalence of coronary artery stenosis (CAS) in Japanese hemophiliacs living with HIV- 1 (JHLH), a prospective study at AIDS Clinical Center, Tokyo, which provides care and treatment to nearly 10% of the JHLH was conducted. The study subjects were 76 JHLH who visited our clinic and received coronary computed tomography angiography (CCTA) between January through December 2019. CCTA with radiographic contrast media was used for CAS screening. Coronary artery calcium score (CACS) by CCTA, pulse wave velocity (PWV), electrocardiography, echocardiography, and chest radiography were also included to the screening process. Stenosis of 50% or more by CCTA was defined as moderate to severe CAS. All patients diagnosed with moderate to severe CAS were recommended to undergo coronary angiography (CAG). Among the 76 JHLH, 19 were excluded. Among the enrolled 57 patients, only 5 had complained of chest symptoms. Their median age was 47 years (interquartile range: 44-55 years), prevalence of hypertension 42.1%, diabetes mellitus 14.0%, dyslipidemia 38.6%, and smoking history 52.6%. Moderate to severe CAS was diagnosed in 14 patients by CCTA (24.6% of CCTA tested). Twelve patients agreed to undergo CAG. Seven patients were diagnosed as severe CAS by CAG (12.3% of CCTA received), although only 2 (28.6%) had chest symptoms. PWV and CACS were useful and significant non-invasive markers of moderate to severe CAS (p = 0.016, p < 0.001, respectively). In conclusions, our study identified high prevalence of severe CAS among JHLH. We recommend screening of all HIV-1-infected hemophiliacs with PWV and CACS, regardless of chest symptoms.