Subclinical carotid atherosclerosis in HIV-infected patients: role of combination antiretroviral therapy.
OBJECTIVE
Whether or not combination antiretroviral therapy (CART) alone directly contributes to accelerating atherosclerosis in HIV-infected patients has not been studied in depth. This study aimed to ascertain the relationship between this therapy and subclinical carotid atherosclerosis according to cardiovascular risk.


METHODS
Sixty-eight HIV-infected patients with < or =1 cardiovascular risk factors and 64 with > or =2 risk factors completed the study protocol consisting of clinical, laboratory, and vascular evaluation by carotid high-resolution B-mode ultrasonography. Univariate and multivariate logistic regression analyses were performed with the presence of subclinical carotid atherosclerosis, defined by carotid intima-media thickness >0.8 mm or the presence of plaque being the dependent variable.


RESULTS
Among the 132 enrolled patients, 93 (70.5%) were on CART and 39 (29.5%) had never been on antiretroviral therapy. In accordance with cardiovascular risk stratification, subclinical carotid atherosclerosis was found in 26.6% (17 of 64 patients) of the very low-risk group (10-year coronary risk <5%), 35.3% (12 of 34 patients) of the low-risk group (10-year coronary risk between 5% and 9%) and 76.5% (26 of 34 patients) of the moderate/high-risk group (10-year coronary risk > or =10%). Thus, 55 (41.7%) of the 132 HIV-infected patients had subclinical carotid atherosclerosis, and independent variables associated with carotid atherosclerosis (odds ratio; 95% CI) were: CART exposure (10.5; 2.8 to 39) and 10-year coronary risk > or =10% (4.2; 1.5 to 12). In very low coronary risk patients (<5%), age (per 10-year increment: 4.01; 1.12 to 14.38), systolic blood pressure (per unit mm Hg 1.07; 1.01 to 1.14), and CART exposure (8.65; 1.54 to 48.54) were independently associated with subclinical carotid atherosclerosis.


CONCLUSIONS
CART should be considered a strong, independent predictor for the development of subclinical atherosclerosis in HIV-infected patients, regardless of known major cardiovascular risk factors and atherogenic metabolic abnormalities induced by this therapy.
Jericó
Carlos
C
Department of Medicine, Hospital del Mar, Barcelona, Spain.
Knobel
Hernando
H
Calvo
Nahum
N
Sorli
María L
ML
Guelar
Ana
A
Gimeno-Bayón
Juan L
JL
Saballs
Pere
P
López-Colomés
José L
JL
Pedro-Botet
Juan
J
D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D050197:Atherosclerosis; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000473:pathology; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis*; D002784:Cholesterol / Q000378:metabolism; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D006679:HIV Seropositivity / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D012306:Risk; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography
D044966:Anti-Retroviral Agents; D002784:Cholesterol