Accelerated coronary atherosclerosis and arteriosclerosis in young human-immunodeficiency-virus-positive patients

Objective To determine the type of lesions observed in young patients infec ted with human immunodeficiency virus-1 (HIV-1), Design Examination of coronary networks in corpses of 13 men and two women who had died aged 23-32 years after having been infected with HIV-1 virus, having been seropositive for 2-5 years. Causes of death were infectious com plications (five cases), infection with cytomegalovirus leading to gastroin testinal haemorrhaging (one case), infection with cytomegalovirus and Kapos i's sarcoma (one case), overdoses of drugs (five cases) and sudden death (t hree cases). Methods The pathological analysis was carried out on the proximal and dista l coronary networks, In order to characterize the lesions better, the cells and the cytokines involved were characterized by immunohistochemistry. Results In all 15 cases we observed thickening of intima in the proximal ne twork at least as great as that of the media, caused by a proliferation of secreting cells, phenotypically identified as smooth muscle cells, with exa ggerated production of elastic fibres and in association with an increase i n the expression of tumor necrosis factor-alpha and interleukin-1 alpha. In nine cases, atherosclerosis had developed from and on the surface of this proliferation and in four cases arteriosclerosis had an unusual appearance, in the form of mamillated vegetations with endoluminal protrusions. A simi lar proliferation was found in the distal network in four cases, but with a significantly smaller proportion of elastic fibres Conclusions The lesions we examined in these young HIV-1-infected patients presented particular features and were intermediate between the lesions obs erved during common coronary atherosclerosis and atherosclerosis associated with chronic rejection of cardiac transplants, Coronary Artery Dis 11:41-4 6 (C) 2000 Lippincott Williams & Wilkins.