Assessment of atherosclerosis using carotid ultrasonography in a cohort of HIV-positive patients treated with protease inhibitors☆☆☆★

Seminari, Elena; Pan, Angelo; Voltini, Giuseppe; Carnevale, G; Maserati, Renato; Minoli, Lorenzo; Meneghetti, Grazia; Tinelli, Carmine; Testa, Sophie

doi:10.1016/s0021-9150(01)00736-5

Cited by 107 publications

(66 citation statements)

References 21 publications

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“…Previous observational studies that investigated the relationship between protease inhibitor and carotid plaques produced conflicting results [19,23,[29][30][31]. Maggi demonstrated that protease inhibitor exposure was associated with carotid plaques [29,30] while other observational studies failed to show this association [19,23,31]. Although protease inhibitor exposure was not significantly associated with abnormal carotid ultrasound in our analysis, we found that longer duration of antiretroviral therapy was associated with an abnormal result.…”

Section: Discussioncontrasting

confidence: 85%

“…After adjusting for serum lipid levels, the relative risk remained significant at 1.10, suggesting that protease inhibitors contribute to cardiovascular disease through different mechanisms. Previous observational studies that investigated the relationship between protease inhibitor and carotid plaques produced conflicting results [19,23,[29][30][31]. Maggi demonstrated that protease inhibitor exposure was associated with carotid plaques [29,30] while other observational studies failed to show this association [19,23,31].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

High Prevalence of Carotid Plaque Identified Using Standard Carotid Ultrasound Techniques in HIV-Positive Patients with Low to Moderate Vascular Risk

Stanek¹

2014

J AIDS Clin Res

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

High Prevalence of Carotid Plaque Identified Using Standard Carotid Ultrasound Techniques in HIV-Positive Patients with Low to Moderate Vascular Risk

Stanek¹

2014

J AIDS Clin Res

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“…15 Because carotid IMT measurements correlate satisfactorily with pathological measurements 16 and are potent predictors of myocardial infarction and stroke, even after adjustment for other risk factors, [17][18][19][20] carotid B-mode high-resolution ultrasound imaging has been used in several studies to evaluate cardiovascular risk in HIVinfected patients. 7,8,[21][22][23][24][25][26][27] Most but not all of these studies have in fact shown an increased prevalence of subclinical atherosclerosis in patients receiving CART. The main result of the present study was that CART exposure was the most powerful predictor of carotid atherosclerosis in HIV-infected patients after controlling for Framingham risk score.…”

Section: Discussionmentioning

confidence: 99%

Subclinical Carotid Atherosclerosis in HIV-Infected Patients

Jericó

Knobel

Calvo

et al. 2006

Stroke

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Background and Purpose-Whether or not combination antiretroviral therapy (CART) alone directly contributes to accelerating atherosclerosis in HIV-infected patients has not been studied in depth. This study aimed to ascertain the relationship between this therapy and subclinical carotid atherosclerosis according to cardiovascular risk. Methods-Sixty-eight HIV-infected patients with Յ1 cardiovascular risk factors and 64 with Ն2 risk factors completed the study protocol consisting of clinical, laboratory, and vascular evaluation by carotid high-resolution B-mode ultrasonography. Univariate and multivariate logistic regression analyses were performed with the presence of subclinical carotid atherosclerosis, defined by carotid intima-media thickness Ͼ0.8 mm or the presence of plaque being the dependent variable. Results-Among the 132 enrolled patients, 93 (70.5%) were on CART and 39 (29.5%) had never been on antiretroviral therapy. In accordance with cardiovascular risk stratification, subclinical carotid atherosclerosis was found in 26.6% (17 of 64 patients) of the very low-risk group (10-year coronary risk Ͻ5%), 35.3% (12 of 34 patients) of the low-risk group (10-year coronary risk between 5% and 9%) and 76.5% (26 of 34 patients) of the moderate/high-risk group (10-year coronary risk Ն10%). Thus, 55 (41.7%) of the 132 HIV-infected patients had subclinical carotid atherosclerosis, and independent variables associated with carotid atherosclerosis (odds ratio; 95% CI) were: CART exposure (10.5; 2.8 to 39) and 10-year coronary risk Ն10% (4.2; 1.5 to 12). In very low coronary risk patients (Ͻ5%), age (per 10-year increment: 4.01; 1.12 to 14.38), systolic blood pressure (per unit mm Hg 1.07; 1.01 to 1.14), and CART exposure (8.65; 1.54 to 48.54) were independently associated with subclinical carotid atherosclerosis. Conclusions-CART should be considered a strong, independent predictor for the development of subclinical atherosclerosis in HIV-infected patients, regardless of known major cardiovascular risk factors and atherogenic metabolic abnormalities induced by this therapy. (Stroke. 2006;37:812-817.)

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“…42 Neither of these studies reported carotid IMT. Seminari et al 43 found that carotid IMT was increased in 28 HIV patients receiving protease inhibitors compared with measurements in 15 protease inhibitornaive patients and 16 HIV-negative subjects. Chironi et al 44 reported that 36 HIV patients receiving protease inhibitors had carotid IMT equal to that of non-HIV subjects with similar lipid and glucose disturbances; both groups had increased carotid IMT compared with control subjects without lipid and glucose abnormalities.…”

Section: Previous Studiesmentioning

confidence: 99%

Progression of Atherosclerosis as Assessed by Carotid Intima-Media Thickness in Patients With HIV Infection

et al. 2004

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Background-HIV-infected patients may be at increased risk for coronary events. The purpose of this study was to identify predictors of carotid intima-media thickness (IMT) in HIV patients at baseline and to measure IMT progression over 1 year. Methods and Results-We measured blood lipids, inflammatory markers, and IMT in 148 HIV-infected adults (mean age, 45Ϯ8 years) and in 63 age-and sex-matched HIV-uninfected control subjects. The mean duration of HIV infection was 11 years, and the median duration of protease inhibitor treatment was 3.3 years. Mean baseline IMT was 0.91Ϯ0.33 mm in HIV patients and 0.74Ϯ0.17 mm in control subjects (Pϭ0.0001). Multivariable predictors of baseline IMT in HIV patients were age (PϽ0.001), LDL cholesterol (PϽ0.001), cigarette pack-years (Pϭ0.005), Latino race (Pϭ0.062), and hypertension (Pϭ0.074). When the control group was added to the analysis, HIV infection was an independent predictor of IMT (Pϭ0.001). The rate of progression among the 121 HIV patients with a repeated IMT measurement at 1 year was 0.074Ϯ0.13 mm, compared with Ϫ0.006Ϯ0.05 mm in 27 control subjects (Pϭ0.002). Age (PϽ0.001), Latino race (Pϭ0.02), and nadir CD4 count Յ200 (Pϭ0.082) were multivariable predictors of IMT progression. Conclusions-Carotid IMT is higher in HIV patients than in age-matched control subjects and progresses much more rapidly than previously reported rates in non-HIV cohorts. In HIV patients, carotid IMT is associated with classic coronary risk factors and with nadir CD4 count Յ200, suggesting that immunodeficiency and traditional coronary risk factors may contribute to atherosclerosis.

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Assessment of atherosclerosis using carotid ultrasonography in a cohort of HIV-positive patients treated with protease inhibitors☆☆☆★

Cited by 107 publications

References 21 publications

High Prevalence of Carotid Plaque Identified Using Standard Carotid Ultrasound Techniques in HIV-Positive Patients with Low to Moderate Vascular Risk

High Prevalence of Carotid Plaque Identified Using Standard Carotid Ultrasound Techniques in HIV-Positive Patients with Low to Moderate Vascular Risk

Subclinical Carotid Atherosclerosis in HIV-Infected Patients

Progression of Atherosclerosis as Assessed by Carotid Intima-Media Thickness in Patients With HIV Infection

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