英国伦敦卫生与热带医学院Anoop S. V. Shah团队对基于先进心血管成像的心血管病理与HIV感染的相关性进行了系统回顾。该项研究成果发表在2022年9月13日出版的《美国医学会杂志》上。

HIV相关心血管疾病的发病率正在增加，但其机制仍不清楚。为了系统回顾来自先进心血管成像研究的数据，评估HIV感染者与未感染者的计算机断层冠状动脉造影、正电子发射断层扫描（PET）和心脏磁共振（MR），研究组在三个数据库和谷歌学术中搜索从开始至2022年2月11日，使用计算机断层冠状动脉造影、心脏MR、PET评估心血管病理学和HIV感染的研究。两位评审员选择关于HIV和心血管病理学的原创研究，不受任何设计、日期或语言限制。

数据由一名研究者提取，第二名研究者检查。从心血管病理学角度定性综合了HIV感染者和未感染者之间的患病率（PRs）和炎症差异。使用国家心脏、肺和血液研究所的观察性研究质量评估工具评估研究质量。主要结局是计算机断层冠状动脉造影定义的中度至重度（≥50%）冠状动脉狭窄、晚期钆增强确定的心脏MR定义的心肌纤维化以及PET定义的血管和心肌靶-背景比。与未感染者相比，HIV感染者报告了中重度冠状动脉疾病、心肌纤维化和PRs的患病率，以及血管靶-背景比的差异。

研究组共确定了45项研究，包括5218名HIV感染者（平均年龄48.5岁）和2414名未感染者（平均年龄49.1岁）。16项研究（5107名参与者）进行计算机断层冠状动脉造影评估；16项研究（ 1698名）进行心脏MRs评估；10项研究（681名）进行血管PET扫描；3项研究（146名）同时进行计算机断层冠状动脉造影和血管PET扫描。

没有来自低收入国家的研究。关于偏倚风险，22%被归类为低风险；47%为中等风险；31%为高风险。HIV感染者和非HIV感染者的中重度冠心病患病率分别为0%至52%和0%至27%，PRs为0.33至5.19。HIV感染者和非HIV感染者的心肌纤维化患病率分别为5%至84%和0%至68%，PRs为1.01至17.35。HIV感染者与未感染者之间血管靶-背景比的差异范围为0.06至0.37。

综上，在这项对先进心血管成像研究的系统回顾中，HIV与心血管疾病之间的相关性估计显示了大量异质性。调查结果总结了现有数据，但可能不代表所有HIV感染者，包括来自HIV流行率较高的低收入国家患者。

附：英文原文

Title: Association of HIV Infection With Cardiovascular Pathology Based on Advanced Cardiovascular Imaging: A Systematic Review

Author: Jonathan A. Hudson, Edith D. Majonga, Rashida A. Ferrand, Pablo Perel, Shirjel R. Alam, Anoop S. V. Shah

Issue&Volume: 2022/09/13

Abstract:

Importance  HIV-associated cardiovascular disease is increasing in prevalence, but its mechanisms remain poorly understood.

Objective  To systematically review data from advanced cardiovascular imaging studies evaluating computed tomographic coronary angiography, positron emission tomography (PET), and cardiac magnetic resonance (MR), in people living with HIV compared with uninfected individuals.

Data Sources  Three databases and Google Scholar were searched for studies assessing cardiovascular pathology using computed tomographic coronary angiography, cardiac MR, PET, and HIV from inception to February 11, 2022.

Study Selection  Two reviewers selected original studies without any restrictions on design, date, or language, investigating HIV and cardiovascular pathology.

Data Extraction and Synthesis  One investigator extracted data checked by a second investigator. Prevalence ratios (PRs) and differences in inflammation among people living with HIV and uninfected individuals were qualitatively synthesized in terms of cardiovascular pathology. Study quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tool for observational studies.

Main Outcomes and Measures  Primary outcomes were computed tomographic coronary angiography–defined moderate to severe (≥50%) coronary stenosis, cardiac MR–defined myocardial fibrosis identified by late gadolinium enhancement, and PET-defined vascular and myocardial target to background ratio. Prevalence of moderate to severe coronary disease, as well as myocardial fibrosis, and PRs compared with uninfected individuals were reported alongside difference in vascular target to background ratio.

Results  Forty-five studies including 5218 people living with HIV (mean age, 48.5 years) and 2414 uninfected individuals (mean age, 49.1 years) were identified. Sixteen studies (n=5107 participants) evaluated computed tomographic coronary angiography; 16 (n=1698), cardiac MRs; 10 (n=681), vascular PET scans; and 3 (n=146), both computed tomographic coronary angiography and vascular PET scans. No studies originated from low-income countries. Regarding risk of bias, 22% were classified as low; 47% moderate; and 31% high. Prevalence of moderate to severe coronary disease among those with vs without HIV ranged from 0% to 52% and 0% to 27%, respectively, with PRs ranging from 0.33 (95% CI, 0.01-15.90) to 5.19 (95% CI, 1.26-21.42). Prevalence of myocardial fibrosis among those with vs without HIV ranged from 5% to 84% and 0% to 68%, respectively, with PRs ranging from 1.01 (95% CI, 0.85-1.21) to 17.35 (95% CI, 1.10-274.28). Differences in vascular target to background ratio among those with vs without HIV ranged from 0.06 (95% CI, 0.01-0.11) to 0.37 (95% CI, 0.02-0.72).

Conclusions and Relevance  In this systematic review of studies of advanced cardiovascular imaging, the estimates of the associations between HIV and cardiovascular pathologies demonstrated large amounts of heterogeneity. The findings provide a summary of the available data but may not be representative of all individuals living with HIV, including those from low-income countries with higher HIV endemicity.

DOI: 10.1001/jama.2022.15078

Source: https://jamanetwork.com/journals/jama/article-abstract/2796250