Prognosis

The prognosis of CAD in HIV-infected patients has been evaluated in few series [57-61]. Matetzky et al. [57] compared the characteristics and long-term course of 24 HIV-infected patients with acute myocar­dial infarction with matched non-HIV patients.

Hsue et al. [58], in a case-control study, reported a higher rate of coronary resteno­sis after percutaneous coronary interven­tion (PCI) in HIV-infected patients com­pared with non-HIV-infected patients with acute coronary syndrome-52% (15/22 patients) vs. 14% (3/21 patients), p = 0.032. There was no significative difference in the subgroup of patients who had stenting (50 vs. 18%, p=0.078). Ambrose et al. [59] reported the outcome of 51 HIV-infected patients with acute coronary syndrome. Forty-five had coronary angiography and 25 had PCI with an excellent initial result and no hospital death in the PCI subgroup. Our group reported the results of a case­control study [61], comparing baseline characteristics, rate of procedural success and clinical outcome at 20-months (major adverse cardiac events: death from cardiac cause, myocardial infarction, target lesion or vessel revascularization) between 50 consecutive HIV+ and 50 HIV-patients matched for age and gender who under­went PCI. Procedural success rate was achieved in 98% of cases with a high rate of stenting (76 vs. 96%, p=0.004). In-hospi­tal course was uneventful in both groups. Clinical restenosis including revasculariza­tion of the entire target vessel was not sig­nificantly different between HIV+ and HIV-patients (14 vs. 16%, p=0.78) at follow­up (20 months). Rates of occurrence of first MACE and MI at 20 months were similar in both groups (20 vs. 16%, p=0.64 and 8 vs. 0%, p=0.12). We concluded that PCI repre­sents an adequate and safe therapeutic strategy of coronary revascularization in HIV+ patients without significant differ­ences in term of clinical restenosis and MACE compared with control population. The prognosis of coronary revasculariza­tion in HIV-infected patients needs to be compared with a large cohort of HIV-nega­tive subjects [62].