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Coexistence of HIV, Hemophilia May Lead to Increased Presence of Coronary Artery Stenosis

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In patients living with HIV, the cardiovascular risk factors that come with infection may lead to an increased prevalence of coronary artery stenosis, especially in those who also have hemophilia.

Japanese individuals who have hemophilia and HIV-1 (JHLH) were observed to have a significantly higher prevalence of coronary artery stenosis (CAS) compared with people living with HIV-1 (PLWH) without hemophilia, suggesting a synergistic effect that contributes to higher risk for cardiovascular disease (CVD), according to the results of a study published in Global Health & Medicine.1

In a previous study, the investigators found that among 57 asymptomatic JHLH, 7 patients (12.2%) had severe CAS that necessitated urgent health interventions.2 Overall, the prevalence of CAS in this cohort of patients was high, which was unexpected and suggested an unknown cause of CAS in these patients.

Due to the strong possibility that hemophilia contributed to the higher prevalence of CAS found in JHLH, the investigators aimed to compare this group with PLWH without hemophilia, with the hypothesis that JHLH have more severe coronary e lesions and high levels of inflammatory markers, such as (IL-6)-6 and D-dimer.

Sixty-nine male PLWH without hemophilia participated in the study; they had no evidence of ischemic heart disease, and they proceeded through the CAS screening process. The same 57 JHLH population from the previous study also participated. The screening process was performed by utilizing coronary CT angiography (CCTA).

Among the 69 PLWH without hemophilia who underwent CCTA screening, 6 patients (8.7%) had moderate to severe CAS. Among these 6 patients, 4 underwent a coronary angiography (CAG) and severe stenosis was found in 1 patient (1.4%).

Image of heart disease | Image Credit:Henadzy - stock.adobe.com

In the present study, the investigators looked at coagulation factors and inflammatory markers in groups of patients living with HIV-1 who did or did not have comorbid hemophilia | Image Credit:Henadzy - stock.adobe.com

These results were compared with the JHLH population, in which 14 of the 57 participants (24.6%) who were treated with CCTA had moderate to severe CAS, the investigators found. Additionally, 12 of the 15 underwent CAG, and 7 had stenosis that required treatment.

Furthermore, the investigators analyzed the patient demographics of each group. There were no significant differences regarding CAS risk factors such as family history or smoking. However, there was a significantly higher prevalence of hypertension and diabetes in the JHLH group, while dyslipidemia was found to be higher in the PLWH without hemophilia group, according to the investigators.

Coagulation factors and inflammatory markers were examined in both groups. There was no significant difference between the groups regarding levels of fibrinogen and D-dimer. Continuing, levels of IL-6 (P < .05) and ICAM-1 (P < .05) were higher in JHLH than in PLWH without hemophilia, which the investigators said indicates higher intravascular inflammation in JHLH.

Previous research indicates a higher risk of CVD in individuals who have HIV-1. Findings from a study published by Triant et al demonstrate significantly increased rates of acute myocardial infarction (AMI)—and risk factors associated with it—in PLWH compared with those who do not have HIV. In this study, there was an approximately 2-fold elevation in the rate of AMI events in the HIV cohort, which Triant et al noted was observed across multiple age ranges.3 The authors of the current study discussed the possibility that this was due to high intravascular inflammation in that population.

Overall, the investigators speculated that the coexistence of hemophilia and HIV-1 in the JHLH population could be responsible for the high prevalence of CAS. They noted that JHLH have higher coronary risks, including hypertension and diabetes, which could lead to an increased incidence of CAS.

Some limitations of the study were acknowledged, including the small group of participants and its status as a single-center study. Additionally, the participants in each group were different in some of their coronary risk factors and duration of HIV-1 infection, according to the investigators.

“Despite differences in some patient demographics in the age- and sex-matched studies, it has been suggested that the coexistence of hemophilia and HIV infection may have a synergistic effect, contributing to an increased prevalence of CVD,” the investigators concluded.

References

1. Nagai R, Kubota S, Ogata M, et al. Coronary artery stenosis In Japanese people living with HIV-1 with or without hemophilia. Glob Health Med. 2024;6(2):124-131. doi:10.35772/ghm.2023.01101

2. Nagai R, Kubota S, Ogata M, et al. Unexpected high prevalence of severe coronary artery stenosis in Japanese hemophiliacs living with HIV-1. Glob Health Med. 2020;2(6):367-373. doi:10.35772/ghm.2020.01080

3. Triant V, Lee H, Hadigan C, et al. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. Journ Clin Endo & Metabol. 2007;92(7);:2506-2512. doi:10.1210/jc.2006-2190

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