Prevalence of incidental premature cardiac calcifications in an HIV-infected South African population using conventional computed tomography chest radiography

Abstract

Background International literature reported an increased prevalence of cardiovascular disease in persons living with HIV (PLWH), inferring an association with accelerated coronary atherosclerosis and plaque formation. Few local studies of HIV-related cardiac disease have confirmed this. Early identification of cardiac plaques would assist clinicians with risk stratification and implementation of treatment strategies to reduce morbidity and mortality. In resource-limited settings the use of conventional computed tomography (CT) may have a role in identifying at-risk individuals. Objectives This hypothesis-generating study was aimed at determining the contribution of HIV to accelerated vascular aging by assessing cardiac calcifications, incidentally detected on conventional CT chest imaging, in a young HIV-positive population. Method A retrospective quantitative analysis was performed at a tertiary hospital in KwaZulu-Natal, South Africa, over a 5-year period. Young patients (18–45 years) who underwent CT chest imaging for varied indications were included, further sub-categorised by immune status, the presence, absence and location of calcifications. Patients with unknown HIV statuses were excluded. Results An increased probability of cardiac calcification with increasing age, independent of the HIV status, was established. No statistically significant difference could be demonstrated between the cohorts. In the pre-contrasted subcategory, a lower P-value suggested an ‘imminent’ statistical significance. Contrast may have obscured some calcifications. The failure to record the immune status in a large number of patients resulted in their exclusion and limited the study. Conclusion The increased prevalence of incidentally detected cardiac calcifications in young HIV-infected individuals warrants further evaluation and cardiovascular risk stratification.