Carotid artery intima-media thickness and HIV infection: traditional risk factors overshadow impact of protease inhibitor exposure.
BACKGROUND
The impact of HIV infection and exposure to antiretroviral therapy on the development of subclinical atherosclerosis is incompletely understood.


OBJECTIVE
To compare intima-media thickness (IMT) of the carotid artery between HIV-infected subjects receiving protease inhibitor-containing regimens and subjects not receiving these regimens and to compare differences in the IMT of the carotid artery between HIV-infected subjects and HIV-uninfected subjects.


METHODS
A prospective matched cohort study in university-based outpatient clinics. Groups of three individuals (triads) matched on the following characteristics were enrolled: age, sex, race/ethnicity, smoking status, blood pressure and menopausal status. Group 1, HIV-infected subjects with continuous use of protease inhibitor (PI) therapy for > or = 2 years; group 2, HIV-infected subjects without prior PI use; and group 3: HIV-uninfected. Ultrasonographers at six sites sent standardized ultrasound images to a central reading site for carotid IMT measurements. Carotid IMT was compared within the HIV-infected groups (1 and 2) and between the HIV-infected and uninfected groups in a matched analysis.


RESULTS
One hundred and thirty-four individuals were enrolled in 45 triads. The median IMT in groups 1, 2 and 3 was 0.690, 0.712 and 0.698 mm, respectively. There were no statistically significant differences in IMT between groups 1 and 2, or in the combined HIV groups compared with the HIV uninfected group. Significant predictors of carotid IMT in a multivariate model included high-density lipoprotein (HDL) cholesterol, the interaction of HDL cholesterol and triglycerides, age and body mass index.


CONCLUSIONS
We found no association between PI inhibitor exposure or HIV infection and carotid IMT.
Currier
Judith S
JS
Center for Clinical AIDS Research and Education, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA 90095, USA. jscurrier@mednet.ucla.edu
Kendall
Michelle A
MA
Zackin
Robert
R
Henry
W Keith
WK
Alston-Smith
Beverly
B
Torriani
Francesca J
FJ
Schouten
Jeff
J
Mickelberg
Keith
K
Li
Yanjie
Y
Hodis
Howard N
HN
D000328:Adult; D000886:Anthropometry; D015992:Body Mass Index; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology*; D008076:Cholesterol, HDL / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D014280:Triglycerides / Q000097:blood; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D014463:Ultrasonography
D008076:Cholesterol, HDL; D017320:HIV Protease Inhibitors; D014280:Triglycerides