Excellent session at CROI Monday 4-6pm "Cardiovascular disease and other non-AIDS events: Epidemiology and Pathogenesis".

This session (which will be webcast) very successfully pulled together different presentations to give an update on the heart and vascular disease as well as other SNAEs (serious non AIDS events) in HIV.

The key messages were

1. Adjusted risk of myocardial infarct for HIV+ was 80% higher than HIV- controls (VACS - Veterans Aging Cohort Study of 68,000 HIV- and 31,000 HIV+) with similar mean age of incidence

2. Plaque formation in coronary arteries measured on CT was 80% higher in HIV+ (vs HIV- at risk) MACS cohort

3. HIV+ patients more likely to have plaque but also more likely to have "vulnerable plaque" - i.e. plaque which is soft, lipid rich, monocyte rich, subject to remodelling and less calcified (spotty calcification) - these plaques less stable, more likely to rupture and cause myocardial infarct or sudden cardiac death

4. Vulnerable plaque associated with inflammation and in HIV+ this is monocyte-mediated as measured by soluble CD163 (and CD16)

5. So, in HIV+, there is the traditional risk factor (smoking, lipids, hypertension) coronary artery disease as in the general population. Additionally there is an inflammatory monocyte driven process which could partially account for higher CVD in HIV.