Human immunodeficiency virus per se exerts atherogenic effects.
OBJECTIVE
Premature atherosclerosis in HIV-infected patients has been attributed to highly active antiretroviral therapy (HAART) and the associated metabolic complications. Whether HIV per se plays a role is an unresolved issue. The purpose of this study was to evaluate whether HIV per se exerts atherogenic effects.


METHODS
We measured carotid intima-media thickness (IMT) and brachial endothelial-dependent (FMD) and endothelial-independent (NMD) vasodilation in 38 naïve untreated HIV-infected patients and 41 healthy control subjects.


RESULTS
Control subjects were selected as to match the HIV patients for metabolic risk factors. Mean carotid IMT was higher in HIV patients (0.85+/-0.2mm; p<0.001) than in controls (0.63+/-0.1mm). In a stepwise multiple regression model, the changes in carotid IMT were predicted by the duration of HIV infection (p<0.001) and CD4 T-cells (p=0.035). Brachial FMD was impaired in HIV patients (8.8+/-3% versus 12.2+/-3% in controls; p<0.001). In contrast, NMD values practically overlapped in the HIV patients and controls. Analysis of the data in relation to viral load showed that FMD was significantly more impaired in the subgroup of patients with viral load values above the median (p<0.001). In addition, there was a highly significant, inverse correlation between FMD and the HIV-RNA copies (p<0.001).


CONCLUSIONS
HIV infection causes functional and structural vascular alterations in a very early stage of the infection independent of HAART and metabolic factors. The data lend support to the viral infectious theory of atherosclerosis. Early assessment of the vascular status in HIV-infected patients is suggested.
Oliviero
Ugo
U
Department of Internal Medicine, University Federico II, Naples, Italy.
Bonadies
Giovanni
G
Apuzzi
Valentina
V
Foggia
Maria
M
Bosso
Giorgio
G
Nappa
Salvatore
S
Valvano
Antonio
A
Leonardi
Enrico
E
Borgia
Guglielmo
G
Castello
Giuseppe
G
Napoli
Raffaele
R
Saccà
Luigi
L
D000328:Adult; D001916:Brachial Artery / Q000503:physiopathology / Q000821:virology*; D018791:CD4 Lymphocyte Count; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000821:virology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000821:virology*; D016022:Case-Control Studies; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000276:immunology / Q000821:virology*; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000821:virology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000821:virology; D014463:Ultrasonography; D014664:Vasodilation; D019562:Viral Load
D012367:RNA, Viral; D014409:Tumor Necrosis Factor-alpha