High prevalence of peripheral arterial disease in HIV-infected persons.
BACKGROUND
Atherosclerosis has been assessed in human immunodeficiency virus (HIV)-infected persons by using various methods. Peripheral arterial disease (PAD) has not been evaluated, however. We studied the cross-sectional prevalence of lower limb PAD in an HIV-infected population.


METHODS
PAD was assessed using the Edinburgh Claudication Questionnaire and by measuring the systolic ankle-brachial blood pressure index (ABI) at rest and after exercise. Patients with PAD were further evaluated by duplex scan of lower limb arteries.


RESULTS
Ninety-two consecutive HIV-infected patients were evaluated (23.9% women; mean age, 49.5 years; 61.9% current smokers). Claudication was reported by 15.2% of the patients. PAD was found in 20.7% of the patients: 9.8% had an abnormal ABI (<0.90) at rest, and 10.9% had normal ABI at rest but a >25% decrease after exercise. Of the patients with PAD, 84.2% were investigated with duplex scan, all of whom had atherosclerotic occlusions or stenoses of the iliac or femoral arteries. Age, diabetes, smoking, and low CD4+ T lymphocyte counts were identified as independent predictors of PAD.


CONCLUSIONS
The prevalence of symptomatic and asymptomatic PAD is high in the HIV-infected population and is much higher than expected (prevalence in the general population, approximately 3% at 60 years). This study suggests the presence of an epidemic of PAD approximately 20 years earlier in the HIV-infected than in the general population. Larger epidemiological studies are needed to better define risk factors and to evaluate whether PAD is associated with increased mortality, as it is in the general population.
Periard
Daniel
D
Angiology, University Hospital, Lausanne, Switzerland. Daniel.Periard@chuv.ch
Cavassini
Matthias
M
Taffé
Patrick
P
Chevalley
Melanie
M
Senn
Laurence
L
Chapuis-Taillard
Caroline
C
de Vallière
Serge
S
Hayoz
Daniel
D
Tarr
Philip E
PE
D000328:Adult; D000367:Age Factors; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology; D001795:Blood Pressure Determination; D018791:CD4 Lymphocyte Count; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D011795:Surveys and Questionnaires; D014463:Ultrasonography