Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals

Abstract

BackgroundThe prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population.ObjectivesTo assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls.MethodsEighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant.ResultsAn IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]).ConclusionIn HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Evaluation of inflammatory biomarkers, carotid intima-media thickness and cardiovascular risk in HIV-1 treatment-naive patients

“…There was no association between cardiovascular biomarkers and carotid atherosclerosis, similar to other studies that did not find such an association 48 . We identified early changes in the intima-media thickness and the increase in the vascular age calculated in the majority of participants, similar to other studies 49 . This result points to the role of HIV itself in the pathogenesis of atherosclerotic disease since the population studied was young, most of them were without classical risk factors, and were all without previous ART exposure.…”

Progressione dell’aterosclerosi subclinica nei pazienti HIV-positivi naïve che iniziano una terapia antiretrovirale comprendente un inibitore dell’integrasi.

“…Dopo un follow-up di 6 anni, oltre ai fattori di rischio tradizionali (età, fumo, dislipidemia, diabete), anche un basso valore nadir dei linfociti T CD4+ e l'uso degli inibitori della proteasi sono risultati associati ad un maggiore incremento dell'IMT carotideo (13). Un altro studio osservazionale cross-sectional ha riscontrato in 80 pazienti HIV-positivi in terapia antiretrovirale una correlazione significativa tra aterosclerosi subclinica e trattamento con inibitori della proteasi (14). Una metaanalisi di 57 studi clinici ha analizzato la correlazione della malattia aterosclerotica con infezione da HIV, terapia antiretrovirale e uso degli inibitori della proteasi, dimostrando un valore medio più elevato di IMT carotideo nei pazienti HIV-positivi in terapia e, con particolare evidenza, in trattamento con la suddetta classe di farmaci (15).…”

Femoral Intima-media Thickness, Risk Factors, and Markers of Inflammation in Cardiovascular Disease

“…18 Lucatelli and associates reported 0.73 mm as the median value of f-IMT for CFA in a study involving individuals with no cardiovascular disease, but noticed an increase with age and the presence of risk factors. 19 Another study investigating the predictive value of f-IMT for cardiovascular events in patients with stable CAD, median values of f-IMT were 0.78 ± 0.26 mm in men and 0.71 ± 0.29 mm in women. 20 Age (years) r = 0.22, p = 0.35 r = 0.40, p = 0.03 Total cholesterol (mg/dL) r = -0.29, p = 0.23 r = 0.42, p = 0.02 LDL-cholesterol (mg/dL) r = 0.19, p = 0.43 r = 0.007, p = 0.69 HDL-cholesterol (mg/dL) r = 0.31, p = 0.19 r = -0.56, p = 0.0019 Triglyceride (mg/dL) r = -0.35, p = 0.14 r = 0.45, p = 0.01 Fasting glucose (mg/dL) r = 0.04, p = 0,86 r = 0.40, p = 0.03 Creatinine (mg/dL) r = 0.30, p = 0.21 r = 0.14, p = 0.46 GFR (ml/min/1.73 m 2 ) r = -0.11, p = 0.64 r = -0.31, p = 0.10 Uric acid (mg/dL) r = -0.48, p = 0.04 r = 0.32, p = 0.09 hsCRP (mg/L) r = -0.5316, p>0.99 r = 0.45, p = 0.01 Right ABI r = -0.7303, p = 0.0006 r = -0.17, p = 0.37 Left ABI r = 0.60, p = 0.007 r = -0.71, p<0.0001…”