Carotid Intima-Media Thickness in HIV-Infected Individuals: Relationship of Premature Atherosclerosis to Neuropsychological Deficits?

Abstract

Background: Intima-media thickness (IMT) measured by extracranial duplex sonography is a surrogate marker for atherosclerosis. It is well known that IMT is greater in HIV patients than in age-matched healthy controls due to HIV- induced endothelial damage and metabolic side-effects of antiretroviral therapy. However, it remains unclear whether atherosclerosis has an additional impact on cognitive function in HIV patients. Therefore, the objective of this study was to investigate the correlation between IMT and neuropsychological deficits in HIV patients. Methods: 47 HIV patients and 40 age-matched healthy controls were examined by extracranial ultrasound 2 and 3 cm before the flow divider to evaluate differences in IMT. Possible neuropsychological deficits in HIV patients were assessed using a battery of 10 neuropsychological tests. Results of neuropsychological tests and markers of disease severity were correlated with IMT in HIV patients. Results: IMT was significantly greater in patients than in healthy controls (p < 0.001). However, none of the neuropsychological tests correlated significantly with IMT measurements in HIV patients. There was only a weak correlation between deficits in attention and IMT in HIV patients (r = 0.44; p = 0.005), which was non-significant after correction for multiple comparisons. Markers of disease severity (CD4 cell count, HIV load in plasma, duration of HIV disease) did not correlate with IMT either. Conclusion: IMT was greater in HIV patients compared to age-matched controls but it appears that premature atherosclerosis has no additional impact on the evolution of neuropsychological deficits in HIV patients. IMT did not correlate with the severity of immunodeficiency.

Cardiovascular risk factors and carotid intima‐media thickness are associated with lower cognitive performance in HIV‐infected patients

“…Our results, together with observations from other populations [29][30][31][32][33]37], suggest the hypothesis that in the recent cART era the role of CV risk factors on the pathogenesis of cognitive impairment could be greater than that of traditional HIV-or cARTrelated variables, similar to findings obtained in HIVuninfected subjects. As a consequence, CV comorbidities should be adequately investigated at the time of neuropsychological examination, in order to better explore the aetiology of cognitive disorders in the HIV-positive population and to avoid classifying as affected by HAND those patients with prevalent vascular impairment.…”

HIV positivity, protease inhibitor exposure and subclinical atherosclerosis: a systematic review and meta-analysis of observational studies

“…Most studies showed a trend toward thicker CIMT among PI exposed patients, except four studies 12 21 24 32. The WMD for CIMT (fig 3) was not significantly different by PI exposure, WMD  = 0.02 mm (95% CI −0.01 to 0.06, p = 0.190); I2 = 93%, p<0.001).…”

“…Of 58 articles selected for detailed evaluation, 13 were excluded owing to missing data or comparison groups not relevant to our study question, 20 were duplicate data and 25 were included from the initial search 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32. After the addition of a study identified from the references of included articles a total of 26 articles were included 33.…”

“…Twenty-three (88%) controlled for age and at least one other important confounder; three studies did not control for confounding 19 28 30. Eleven studies (42%) stated there was blinded assessment of the study outcome (ultrasound or CAC result) 8 10 13 15 19 20 21 23 25 32 33. The median Newcastle–Ottawa score was 6.…”

“…CIMT, carotid plaque and CAC are well-established direct measures of subclinical atherosclerosis burden and predict the risk of future cardiovascular events 42 43. However, studies of subclinical atherosclerosis among patients with HIV have had disparate results with odds ratios ranging from protective to harmful 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32. Cohort studies that have quantified the risk of coronary events among patients with HIV and those exposed to PIs have similarly yielded inconsistencies 34 35 36 37 38 39 40 41…”