Functional and structural markers of atherosclerosis in human immunodeficiency virus-infected patients.
OBJECTIVE
We investigated functional and structural markers of atherosclerosis in human immunodeficiency virus (HIV)-infected patients in relation to the presence of the metabolic syndrome (MS).


BACKGROUND
Antiretroviral combination therapy in HIV has been associated with cardiovascular risk factors that cluster in the MS.


METHODS
Thirty-seven HIV-infected patients underwent assessment of flow-mediated vasodilation (FMD), aortic pulse-wave velocity (PWV), and carotid intima-media thickness (IMT). Age-matched type 2 diabetic patients (n = 13) and healthy controls (n = 14) served as reference groups.


RESULTS
Fifteen HIV-infected patients (41%) fulfilled the National Cholesterol Education Program criteria of the MS. The FMD was similarly impaired in HIV-infected patients without the MS (MS- group) and the diabetic patients (5.1 +/- 0.4% and 4.9 +/- 0.6%, respectively) compared with controls (8.8 +/- 0.7%). The HIV-infected patients with the MS (MS+ group) had even more impaired FMD (2.5 +/- 0.3%). Carotid IMT was similarly increased in the MS+ group and the diabetic patients compared with the other groups. Aortic PWV was increased in the diabetic patients only. In HIV-infected patients, FMD was related to metabolic parameters, whereas aortic PWV and IMT were related to parameters of HIV infection, time on antiretroviral combination therapy, inflammatory (C-reactive protein and leukocytes) and metabolic parameters.


CONCLUSIONS
The data of the present study suggest an increased cardiovascular risk in HIV-infected patients, even in the absence of clustering of metabolic risk variables. The presence of the MS in HIV is associated with even more advanced atherosclerotic changes. Presumably, both HIV infection and antiretroviral therapy may promote atherosclerosis through mechanisms involving endothelial cells, either directly or indirectly via metabolic risk factors.
Department of Internal Medicine and Infectious Disease, University Medical Center Utrecht, The Netherlands. jwijk3@hotmail.com
Jeroen P H
JP
van Wijk
Eelco J P
EJ
de Koning
Manuel Castro
MC
Cabezas
Jorge
J
Joven
Jos
J
op't Roodt
Ton J
TJ
Rabelink
Andy M
AM
Hoepelman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000886:Anthropometry; D023241:Antiretroviral Therapy, Highly Active; D050197:Atherosclerosis / Q000209:etiology*; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology*; D008875:Middle Aged; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology