Coronary artery stenosis in Japanese hemophiliacs living with HIV-1 progressed dramatically over two years

Patients with hemophilia living with HIV-1 are at increased risk for coronary artery disease (CAD) due to overlapping factors, including chronic vascular inflammation, antiretroviral therapy-associated dyslipidemia, and reduced physical activity from hemophilic arthropathy. However, longitudinal data on cardiovascular outcomes in this population have been scarce. In this two-year longitudinal follow-up study, 58 patients were evaluated. The cohort was stratified into three groups based on baseline CCTA findings and treatment history: 47 with normal-to-mild stenosis, 3 with prior PCI or CABG, and 8 with moderate-to-severe stenosis. Among the moderate stenosis group, 7 underwent repeat CCTA, and 4 showed progression of coronary lesions. Of these, 3 developed severe stenosis requiring percutaneous coronary intervention (PCI), despite improvement in LDL-C through pharmacologic and lifestyle interventions. Overall, LDL-C significantly decreased (<i>p</i> < 0.05); however, pulse wave velocity (PWV), an indicator of arterial stiffness, worsened in about half of patients. In the revascularization group, PWV deterioration was significant (<i>p</i> = 0.017). Our earlier cross-sectional analysis of this population demonstrated that a considerable proportion had moderate-to-severe stenosis requiring intervention, underscoring the need for longitudinal assessment. These findings suggest that even under guideline-based cardiovascular management, there remains a considerable risk for CAD progression in HIV-infected hemophilia patients with moderate or greater stenosis. Therefore, repeat CCTA at two-year follow-up could be considered to facilitate early detection and guide timely intervention. Continuous monitoring, including imaging, and early intervention targeting modifiable risk factors may be important to reduce long-term cardiac risk in this vulnerable population.