Date of Award

2016

Degree Name

Master of Medicine / Surgery (Thesis)

First Supervisor

Cameron Holloway

Second Supervisor

Neville Sammel

Abstract

Background

Human immunodeficiency virus (HIV) infection is now considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). Screening of this at-risk population for CAD remains contentious. The aim of this thesis is to provide some guidance into the management of cardiovascular disease in HIV and examine the utility of screening CTCA in this population group.

Methods

We set out to disseminate our generated results via publications. The first paper was a literature review that sought to provide insight into the management of this complex population, in particular focusing on the risk assessment and screening of this population group. The second paper was original research; a retrospective single centre analysis that compared the CTCA findings and clinical endpoints of a group (n=32) of HIV patients to their uninfected counterparts (n=65), in an effort to appraise the efficacy of CTCA in the screening and prediction of adverse cardiac outcomes.

Results

Regarding the literature review we provided a formulaic approach to the risk assessment and screening of CAD in HIV. In our research article, patients with HIV were shown to have higher prevalence of non-calcified, high risk plaque (0.8±1.5 versus 0.3±0.7, p=0.03), experience greater rates of non-ST elevation acute coronary syndromes (ACS) (16% (5) versus 3% (2), p

Conclusion

Currently there are no guidelines pertaining to the screening and further management of HIV patients at risk of CAD. Our literature review outlines a proposed approach for assessing and managing CAD in HIV patients. In our clinical research we demonstrated that HIV patients screened with CTCA were susceptible to developing at-risk coronary plaques and had higher rates of adverse cardiac events despite less frequent invasive coronary intervention compared to HIV negative controls. This thesis provides early evidence for the use of CTCA in the screening of HIV patients and highlights a need for further investigation to establish appropriate screening and risk assessment protocols as well as more rigorous examination of why HIV patients may be less aggressively managed following adverse cardiac events.

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