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Background:  Premature coronary heart disease (CHD), secondary to endothelial dysfunction, thrombophilia, and metabolic abnormalities associated with HIV or its treatment, has been postulated. Our objective was to test the hypothesis that HIV-infected Mexican patients were more likely to have abnormal myocardial perfusion than age- and gender-matched HIV-negative individuals.

Methods:  Using radionuclide imaging, we compared 2 groups:  a sample of 105 HIV⁺ patients randomly selected from those attending an HIV clinic in Mexico City, and a community sample of 105 HIV^– subjects. All individuals were assessed for myocardial perfusion (blinded interpretation of a Tc99m sestamibi SPECT); smoking, alcohol consumption, physical activity, and dietary habits; blood pressure; body composition; and fasting plasma glucose, lipid profile including apolipoproteins, C-reactive protein (hs-CRP), homocysteine, and fibrinogen. Time of exposure to combination ART and CD4 count and HIV viremia history were reviewed in the HIV⁺ patients. We calculated 95% confidence intervals (95% CI) of proportions (binomial distribution); and confounders-adjusted odds ratio (OR) and its 95% CI estimated with logistic regression analysis.

Results:  An abnormal SPECT was found in 4.8% (95% CI = 1.5 to 10.8) of HIV⁺ patients and in 7.6% (95% CI = 3.3 to 14.5) of HIV^–  subjects:  OR = 0.61 (95% CI = 0.19 to 1.92). Severity of SPECT abnormalities was similar between both groups. Median time since HIV diagnosis was 55.8 months. In the HIV⁺ group:  91% had received combination ART (100% a nucleoside reverse transcriptase inhibitor, 72% a protease inhibitor, and 70% a non-nucleoside reverse transcriptase inhibitor). Median time (months) of exposure to them was:  41.7, 36.5, and 19.3, respectively. In the HIV⁺ group:  32% were current smokers; 22% had abnormal fasting plasma glucose or diabetes; 17%, hypertension; 73%, HDL cholesterol < 40 mg/dL; 76% triglycerides ³ 150 mg/dL; 39%, apolipoprotein B > 90th percentile for Mexican adults; 10%, abdominal obesity; and and 66%, hs-CRP > 1.5 mg/L.

Conclusions:  In these Mexican HIV⁺ patients, despite a long time of infection and of exposure to diverse combined ART regimens and other known risk factors for CHD, no evidence of increased risk for severe abnormal coronary blood flow was found.

Keywords: coronary heart disease; radionuclide perfusion imaging; asymptomatic