Preclinical atherosclerosis due to HIV infection: carotid intima-medial thickness measurements from the FRAM study

Abstract

Background Cardiovascular disease (CVD) is an increasing cause of morbidity and mortality in HIV-infected patients. However, it is controversial whether HIV infection contributes to accelerated atherosclerosis independent of traditional CVD risk factors. Methods Cross-sectional study of HIV-infected and control subjects without pre-existing CVD from the study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM) and the Multi-Ethnic Study of Atherosclerosis (MESA). Pre-clinical atherosclerosis was assessed by carotid intima-medial thickness (IMT) measurements in the internal/bulb and common regions in HIV-infected and control subjects after adjusting for traditional CVD risk factors. Results For internal carotid, mean IMT was 1.17±0.50mm for HIV-infected participants and 1.06±0.58mm for controls (p<0.0001). After multivariable adjustment for demographic characteristics, the mean difference of HIV-infected vs. controls was +0.188mm (95%CI 0.113-0.263, p<0.0001). Further adjustment for traditional CVD risk factors modestly attenuated the HIV association (+0.148mm, 95%CI 0.072-0.224, p=0.0001). For the common carotid, HIV infection was independently associated with greater IMT (+0.033mm, 95%CI 0.010, 0.056, p=0.005). The association of HIV infection with IMT was similar to that of smoking which was also associated with greater IMT (internal +0.173mm, common +0.020mm). Conclusions Even after adjustment for traditional CVD risk factors, HIV infection was accompanied by more extensive atherosclerosis measured by IMT. The stronger association of HIV infection with IMT in the internal/bulb region compared to the common carotid may explain previous discrepancies in the literature. The association of HIV infection with IMT was similar to that of traditional CVD risk factors, such as smoking.

High prevalence at computed coronary tomography of non-calcified plaques in asymptomatic HIV patients treated with HAART: A meta-analysis

“…Some studies have found a higher prevalence of subclinical atherosclerosis in HIVpositive patients [13][14][15] but the results are not consistent. Consequently we performed a systematic review to understand the prevalence and the peculiarities of coronary plaques in asymptomatic HIV-positive patients.…”

“…evaluated quality of included studies on pre-specified forms. Modifying the MOOSE items to take into account the specific features of included studies, [15][16][17][18] we separately abstracted and appraised study design, setting, data source, as well as risk of analytical, selection, adjudication, detection, and attrition bias (expressed as low, moderate, or high risk of bias, as well as incomplete reporting leading to inability to ascertain the underlying risk of bias). For the quality assessment of the selected studies we used the Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analysis 19 .…”

Hepatitis C – Human Immunodeficiency Virus Coinfection and the Risk of Cerebro-Cardiovascular Diseases: Is There Enough Evidence to Draw Conclusion and Establish Guideline?

“…There is an interplay between infl ammation, HIV proteins, immune dysfunction, ART effect, malnutrition, and other factors in understanding the patophysiological basis of CVD among PLHIV. Studies using carotid intima-media thickness (CIMT) found that PLHIV asymptomatic had increased subclinical atherosclerosis [4,5]. Furthermore, study using coronary CT angiography (CCTA) confi rmed that PLHIV had increase coronary plaque even after controlling traditional CVD risk factors [6].…”

Neues bei HIV und Neuro-Aids

“…Zwischen 50 und 70 % der HIV-positiven Patienten hatten mindestens eine Komorbidität [65]. Hierbei ist besonders brisant, dass HIV-positive Patienten diese altersassoziierten, also "normalen" Alterserkrankungen zwischen 5 und 10 Jahre früher bekommen als eine alters-und geschlechtsgematchte Vergleichsgruppe aus der Allgemeinbevölkerung [66]. Auch wenn man Rauchen, Substanzgebrauch und andere "Life-style"-bedingte Risikofaktoren aus diesem Vergleich herausnimmt, haben HIV-positive Patienten ein deutlich erhöhtes Risiko früher einen Herzinfarkt oder Schlaganfall zu erleiden als ihre HIV-negativen Altersgenossen [66].…”

“…Hierbei ist besonders brisant, dass HIV-positive Patienten diese altersassoziierten, also "normalen" Alterserkrankungen zwischen 5 und 10 Jahre früher bekommen als eine alters-und geschlechtsgematchte Vergleichsgruppe aus der Allgemeinbevölkerung [66]. Auch wenn man Rauchen, Substanzgebrauch und andere "Life-style"-bedingte Risikofaktoren aus diesem Vergleich herausnimmt, haben HIV-positive Patienten ein deutlich erhöhtes Risiko früher einen Herzinfarkt oder Schlaganfall zu erleiden als ihre HIV-negativen Altersgenossen [66]. Eine aktuelle Metaanalyse über 5 Studien mit insgesamt 89 713 Teilnehmern zeigte, dass innerhalb von 5 Jahren Follow-up 1245 ischämische Schlaganfälle bei im Durchschnitt 46(46 -50)-jähri-gen, überwiegend (70 %) männlichen Patienten auftraten [67].…”