Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis
Objectives People living with HIV (PLWH) were previously shown to have a higher prevalence of non-calcified coronary plaque with discrepant results for coronary stenosis and any plaque prevalence. This systematic review and meta-analysis summarise and estimate pooled effect sizes for observational s...
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| Format: | Article |
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/2/e092264.full |
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| author | Binh T Nguyen Edward Hulten Venkatesh L Murthy Tarin Phillips Gregory M Blake Jonathan A Aun Lisa M Conte Ritika Gadodia Aakash Tuli Sara L Robinson Travis E Harrell |
| author_facet | Binh T Nguyen Edward Hulten Venkatesh L Murthy Tarin Phillips Gregory M Blake Jonathan A Aun Lisa M Conte Ritika Gadodia Aakash Tuli Sara L Robinson Travis E Harrell |
| author_sort | Binh T Nguyen |
| collection | DOAJ |
| description | Objectives People living with HIV (PLWH) were previously shown to have a higher prevalence of non-calcified coronary plaque with discrepant results for coronary stenosis and any plaque prevalence. This systematic review and meta-analysis summarise and estimate pooled effect sizes for observational studies among PLWH using comprehensive coronary CT angiography (CTA).Design Preferred Reporting Items for Systematic Review and Meta-analysis reporting guidelines were used.Data sources PubMed, Embase, Web of Science, CINAHL, Cochrane Clinical Trials and EBM were searched from inception to 23 February 2024.Eligibility criteria We included studies evaluating coronary atherosclerosis in adult PLWH with controls and CTA results for plaque prevalence, extent, severity and high-degree stenosis.Data extraction and synthesis Two independent reviewers used standardised methods to screen for relevance by title, abstract and full-text review. Two unblinded independent reviewers manually extracted data and rated study quality using the Newcastle-Ottawa Scale. Meta-analysis was conducted using random effects models. A sensitivity analysis was performed with a fixed effects model. Publication bias was assessed by visual inspection of funnel plots and formal testing by Egger’s and Begg’s tests. Segment scores were evaluated using the difference of medians.Results PLWH showed a significantly higher prevalence of non-calcified plaque (34% (95% CI: 15% to 53%)) compared with controls (22% (95% CI: 6% to 38%)) with an OR of 1.61 (1.13–2.30, p=0.009). There was no significant difference in partially calcified plaque prevalence (OR=1.20, 0.96–1.49), stenosis prevalence (OR=1.34, 0.92–1.96) and median difference in Segment Involvement Score (SIS; 0.39, –0.01 to 0.79) in PLWH compared with controls who have a non-significant difference in calcified plaque (OR=0.80, 0.61–1.04). The prevalence of any plaque (OR=1.22, 0.93–1.61) and difference in median Segment Stenosis Score (−0.12, –0.60 to 0.35) did not differ between groups.Conclusion This study demonstrates a greater prevalence of non-calcified plaque in PLWH than controls. Additional research is needed to assess quantitative CTA measurements. Increased power may reveal a difference in the prevalence of high-degree stenosis and median SIS score in PWLH, while controls may have a greater prevalence of calcified plaque. |
| format | Article |
| id | doaj-art-547330c0bd864f5cb95b41fa37e1d93b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-547330c0bd864f5cb95b41fa37e1d93b2025-02-11T19:35:14ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115210.1136/bmjopen-2024-092264Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysisBinh T Nguyen0Edward Hulten1Venkatesh L Murthy2Tarin Phillips3Gregory M Blake4Jonathan A Aun5Lisa M Conte6Ritika Gadodia7Aakash Tuli8Sara L Robinson9Travis E Harrell107 Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA1 Department of Medicine, Cardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA3 Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA2 Navy Undersea Medical Institute, Groton, Connecticut, USA1 Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA3 Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA1 Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA5 Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA5 Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA3 Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA1 Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USAObjectives People living with HIV (PLWH) were previously shown to have a higher prevalence of non-calcified coronary plaque with discrepant results for coronary stenosis and any plaque prevalence. This systematic review and meta-analysis summarise and estimate pooled effect sizes for observational studies among PLWH using comprehensive coronary CT angiography (CTA).Design Preferred Reporting Items for Systematic Review and Meta-analysis reporting guidelines were used.Data sources PubMed, Embase, Web of Science, CINAHL, Cochrane Clinical Trials and EBM were searched from inception to 23 February 2024.Eligibility criteria We included studies evaluating coronary atherosclerosis in adult PLWH with controls and CTA results for plaque prevalence, extent, severity and high-degree stenosis.Data extraction and synthesis Two independent reviewers used standardised methods to screen for relevance by title, abstract and full-text review. Two unblinded independent reviewers manually extracted data and rated study quality using the Newcastle-Ottawa Scale. Meta-analysis was conducted using random effects models. A sensitivity analysis was performed with a fixed effects model. Publication bias was assessed by visual inspection of funnel plots and formal testing by Egger’s and Begg’s tests. Segment scores were evaluated using the difference of medians.Results PLWH showed a significantly higher prevalence of non-calcified plaque (34% (95% CI: 15% to 53%)) compared with controls (22% (95% CI: 6% to 38%)) with an OR of 1.61 (1.13–2.30, p=0.009). There was no significant difference in partially calcified plaque prevalence (OR=1.20, 0.96–1.49), stenosis prevalence (OR=1.34, 0.92–1.96) and median difference in Segment Involvement Score (SIS; 0.39, –0.01 to 0.79) in PLWH compared with controls who have a non-significant difference in calcified plaque (OR=0.80, 0.61–1.04). The prevalence of any plaque (OR=1.22, 0.93–1.61) and difference in median Segment Stenosis Score (−0.12, –0.60 to 0.35) did not differ between groups.Conclusion This study demonstrates a greater prevalence of non-calcified plaque in PLWH than controls. Additional research is needed to assess quantitative CTA measurements. Increased power may reveal a difference in the prevalence of high-degree stenosis and median SIS score in PWLH, while controls may have a greater prevalence of calcified plaque.https://bmjopen.bmj.com/content/15/2/e092264.full |
| spellingShingle | Binh T Nguyen Edward Hulten Venkatesh L Murthy Tarin Phillips Gregory M Blake Jonathan A Aun Lisa M Conte Ritika Gadodia Aakash Tuli Sara L Robinson Travis E Harrell Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis BMJ Open |
| title | Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis |
| title_full | Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis |
| title_fullStr | Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis |
| title_full_unstemmed | Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis |
| title_short | Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis |
| title_sort | comprehensive coronary ct angiography in people living with hiv a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/15/2/e092264.full |
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