HIV Infection Is Not Associated with Carotid Intima-Media Thickness in Brazil: A Cross-Sectional Analysis from the INI/ELSA-Brasil Study

Abstract

BackgroundCarotid intima-media thickness (cIMT) has been used as an early marker of atherosclerotic disease in the general population. Recently its role among HIV-infected patients has been questioned. To date, no Brazilian study has compared cIMT in respect to HIV status.MethodsWe compared data from 535 patients actively followed in a prospective cohort in Rio de Janeiro (HIV group); 88 HIV-negative individuals who were nominated by patients (friend controls–FCs); and 10,943 participants of the ELSA-Brasil study. Linear regression models were used to study associations of the 3 groups and several covariables with cIMT. Propensity scores weighting (PSW) were also employed to balance data.ResultsMedian thickness in mm (IQR) were 0.54 (0.49,0.62); 0.58 (0.52,0.68); and 0.57 (0.49,0.70), HIV, FCs and ELSA-Brasil groups, respectively (p-value<0.001). The best linear model chosen did not include the group variables, after adjusting for all the variables chosen, showing no difference of cIMT across groups. Similar results were obtained with PSW. Several traditional CVD risk factors were also significantly associated with cIMT: female gender, higher education and higher HDL were negatively associated while risk factors were older age, current/former smoker, AMI/stroke family history, CVD history, hypertension, DM, higher BMI and total cholesterol.ConclusionsWe show for the first time in a middle-income setting that cIMT, is not different in HIV-infected patients in Rio de Janeiro compared with 2 different groups of non-HIV-infected individuals. Traditional CVD risk factors are associated with this outcome. Our results point out that high standards of care and prevention for CVD risk factors should always be sought both in the HIV-infected and non-infected populations to prevent CVD-related events.

Subclinical cardiovascular disease in patients starting contemporary protease inhibitors

“…This finding suggests that, in the population studied, even with a low risk for CVD, traditional risk factors may have a stronger impact on CIMT progression than HIV infection or antiretroviral treatment. Some observational studies have shown an increased CIMT in HIV‐infected patients relative to HIV‐uninfected individuals , although other studies have found a stronger association of CIMT with traditional cardiovascular risk factors than with HIV serostatus, consistent with our results. Most studies have been cross‐sectional; only a few have assessed longitudinal progression of CIMT .…”

“…Assessment of subclinical vascular progression may be more sensitive than diagnosing clinical CVD outcomes. Carotid artery intima-media thickness (CIMT) has been commonly used as an anatomical surrogate marker of CVD in the general and HIV-infected populations [9][10][11][12][13][14][15]. Different arterial stiffness and wave reflection measures have been proposed as functional vascular risk markers [16][17][18].…”

Subclinical atherosclerosis and associated risk factors among hiv-infected adults in Jos, North Central Nigeria: a cross-sectional study

“…Also, the prevalence of SCA of 18.2% obtained was higher than the rate in South Africa but similar to the Ugandan prevalence. In comparison to the findings in other continents, median (IQR) CIMT was slightly higher [0.57 (0.52-0.65)] than as observed in a Brazilian cohort of HIV-infected individuals [0.54 (0.49-0.62)] [ 29 ]. The prevalence rate obtained in this study was lower than reported among HIV-infected populations in European and Asian studies even at more stringent CIMT of between 0.80-0.90 mm.…”

Cardiovascular markers of inflammation and serum lipid levels in HIV-infected patients with undetectable viremia

“…CIMT has been used as an early marker of atherosclerosis 31 . Several studies suggested an association between HIV-infection and CIMT but opposing results have also been reported 23 , 32 , 33 . In our previous study, we reported subclinical atherosclerosis (CIMT ≥ 0.9 mm and/or the presence of ≥1 carotid plaque) more frequently in in older HIV-infected patients compared with HIV-negative controls 23 .…”