Acute Coronary Syndromes in Treatment‐Naïve Black South Africans with Human Immunodeficiency Virus Infection

Abstract

Background: HIV patients on protease inhibitors have greater risk of acute coronary syndromes (ACS) but little is known about treatment‐naïve patients. Methods and Results: Authors conducted a prospective single‐center study from Soweto, South Africa, comparing the clinical and angiographic features of treatment‐naïve HIV positive and negative patients with ACS. Between March 2004 and February 2008, 30 consecutive treatment‐naïve HIV patients with ACS were compared to the next HIV‐negative patient as a 1:1 control. HIV patients were younger (43 ± 7 vs. 54 ± 13, P = 0.004) and, besides smoking (73% vs. 33%, P = 0.002), had fewer risk factors than the control group with less hypertension (23% vs. 77%, P = 0.0001), diabetes (3% vs. 23%, P = 0.05), LDL hyperlipidemia (2.2 ± 0.9 vs. 3.0 ± 1.2, P = 0.006), and other coronary risk factors (7% vs. 53%, P = 0.0001). HDL was lower in the HIV group (0.8 ± 0.3 vs. 1.1 ± 0.4, P = 0.001). Atherosclerotic burden was lower in the HIV group with more normal infarct‐related arteries (47% vs. 13%, P = 0.005) but a higher degree of large thrombus burden (43% vs. 17%, P = 0.02). Stents were used to a similar degree in HIV and control patients (30% vs. 37%, P = 0.78) with more target lesion revascularization in the HIV group (56% vs. 0%, P = 0.008). Conclusion: Treatment‐naïve HIV patients with ACS are younger and have fewer traditional risk factors than HIV‐negative patients. HIV patients have less atherosclerotic but higher thrombotic burden which may imply a prothrombotic state in the pathogenesis of ACS in these patients. (J Interven Cardiol 2010;23:70–77)