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

Abstract

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.

Is HIV-1 infection associated with endothelial dysfunction in a population of African ancestry in South Africa?

“…Endothelial dysfunction is also associated with a prothrombotic state,44 and studies which investigated the prothrombotic state in HIV-infected populations showed increased levels of PAI-1 activity and fibrinogen 4,45,46. However, in our study neither the PAI-1 activity nor fibrinogen levels were increased in the HIV-infected subjects, indicating no signs of a prothrombotic state.…”

“…Worldwide, various forms of cardiovascular involvement, such as endothelial dysfunction,3 accelerated atherosclerosis4 and coagulation disorders5 have been documented among HIV-infected individuals. In South Africa, atherosclerotic disease, historically not common in most black Africans, is increasing 6.…”

“…Recently it has been recommended that HIV infection per se should count as a coronary risk factor, similar to the traditional cardiovascular risk factors (smoking, hypertension, hypercholesterolaemia and diabetes) 4. Although data of Lorenz et al .…”

Association of non-HDL cholesterol with subclinical atherosclerosis in HIV-positive patients

“…Several classical CV risk factors including age, gender, body mass index (BMI), blood pressure, increased total cholesterol (TC) levels or tobacco consumption have been previously recognized in HIV+ patients 6 . Surprisingly, there are contradictory reports on the association between low density lipoprotein cholesterol (LDL-C), the most recognized lipid risk factor in non-HIV populations 7 , and CIMT in HIV+ populations [8][9][10][11] . -The fourth sentence was corrected by changing "formed" to "selected" as suggested.…”

“…We agree that the presence of lipo-accumulation influences the waist perimeter and so we 6 . Surprisingly, there are contradictory reports on the association between low density lipoprotein cholesterol (LDL-C), the most recognized lipid risk factor in non-HIV populations 7 , and CIMT in HIV+ populations [8][9][10][11] . Because classical risk factors do not account for all atherosclerosis risk in HIV+ patients, a search for non-classical could be of interest.…”