Risk factors for subclinical atherosclerosis in HIV-infected patients under and over 40 years: a case–control study

Abstract

BackgroundCardiovascular diseases (CVD) are a major cause of death in people with AIDS. Factors contributing to atherosclerosis include traditional risk factors, antiretrovirals and inflammatory factors related to HIV infection. This study set out to compare risk factors associated with subclinical atherosclerosis in individuals under and over 40 years of age.MethodsCase–control study with 697 HIV/AIDS individuals without HAART or who remain on their first antiretroviral regimen. Of the total, 351 individuals under 40 years and 346 over 40 years were analyzed separately. Subclinical atherosclerosis was assessed by carotid intima-media thickness, using B-mode ultrasound. Multivariate logistic regression was performed to find predictors of subclinical atherosclerosis in the entire group. Subsequent analysis excluded patients with major risk factors for CVD. Magnitudes of associations were expressed by odds ratio (OR) statistical significance, using a 95% confidence interval and p-value <0.05.ResultsIn the <40 years group subclinical atherosclerosis was associated with male gender (OR: 2.77, 95% CI: 1.43–5.34), nonwhite race (OR: 3.01, 95% CI: 1.23-6.53), obesity (OR: 5.13, 95% CI: 1.79–14.7) and metabolic syndrome (OR: 3.30, 95% CI: 1.44–7.58). In the group ≥40 years predictors of subclinical atherosclerosis were overweight and obesity (OR = 2.53, 95% CI, 0.85–7.54), current CD4 ≥350 cells/mL (OR: 2.81, 95% CI: 1.22–6.47) and NNRTI use ≥ 5 years (OR: 2.65, 95% CI: 1.10-6.37) or PI use >5 years (OR: 1.81, 95% CI: 0.38-8.59). In the multivariate model excluding patients with major risk factors for CVD, age, male sex and nonwhite race were associated with subclinical atherosclerosis in the <40 y group, while in the ≥40 y group, age, HIV viral load >10,000 copies and the use of NNRTI (OR: 7.60, 95% CI: 1.61-35.8) or PI ≥5 years (OR: 3.62, 95% CI: 0.48-26.8) were associated with subclinical atherosclerosis.ConclusionsIn young people the fight against obesity and metabolic syndrome is the main aim in the prevention of CVD. In individuals aged ≥40 y, the prevention of obesity is also of great importance. Moreover, the effects of uncontrolled viremia and the prolonged use of HAART appear to be more harmful in the older group.

Pre-clinical carotid atherosclerosis and sCD163 among virally suppressed HIV patients in Botswana compared with uninfected controls

“…Our final multivariate model highlighted the importance of the association between traditional CVD risk factors and cIMT. This same observation was made in a Brazilian cohort of 591 patients in whom traditional CVD risk factors predicted cIMT in multivariate analysis in those less than 40 years of age [6]. Findings of the Brazilian HIV cohort and the predominantly female HIV-infected clinical cohort in South Africa aligned with our findings and did not find an association between HIV-related factors and cIMT [7].…”

Comparison between potential risk factors for cardiovascular disease in people living with HIV/AIDS in areas of Brazil

“…Previous studies in the South indicated an association between fewer years of schooling and metabolic syndrome in men [19]. In the Northeast, an association between male sex and subclinical atherosclerosis [20] and higher velocity of pulse wave was observed, similar to the observations among HIVnegative individuals [21].…”

Subclinical atherosclerosis in low Framingham risk HIV patients

“…Given the restrictive inclusion criteria, we have found lower CIMT values than other studies , and only in three patients were above 0·8 mm, the usual cut‐off for the definition of ‘pathological’ CIMT. More surprising was the finding of a atherosclerotic plaque prevalence of 21% in these low‐risk patients.…”