Increase in carotid artery intima-media thickness and arterial stiffness but improvement in several markers of endothelial function after initiation of antiretroviral therapy.
BACKGROUND
The risk of cardiovascular disease in human immunodeficiency virus (HIV)-infected patients is an increasing concern. We studied the changes in vascular properties after the initiation of combination antiretroviral therapy (cART) as well as the contribution of different drug classes.


METHODS
cART-naive men were randomized to receive either lopinavir/ritonavir (LPV/r) plus zidovudine/lamivudine (ZDV/3TC) (n = 19) or LPV/r plus nevirapine (NVP) (n = 18). Carotid artery intima-media thickness (C-IMT), arterial stiffness (distensibility coefficients [DCs] and compliance coefficients [CCs] of the carotid, femoral, and brachial arteries; carotid elastic modulus; and augmentation index), and markers of endothelial function (soluble vascular cell adhesion molecule [sVCAM]-1, intercellular adhesion molecule [sICAM]-1, plasma von Willebrand factor (vWF) antigen, and plasminogen activator inhibitor-1 antigen) and inflammation (high-sensitivity C-reactive protein) were measured before the initiation of cART and after 3, 12, and 24 months of cART.


RESULTS
C-IMT increased by 0.061 +/- 0.016 mm (P < .001) in the ZDV/3TC/LPV/r arm and by 0.044 +/- 0.018 mm (P = .012) in the NVP/LPV/r arm (data are estimated means +/- SEs). Femoral artery DC (-1.66 +/- 0.78 x 10(-3)/kPa [P = .035]) and CC (-0.11 +/- 0.053 mm(2)/kPa [P = .43]) decreased in the ZDV/3TC/LPV/r arm and femoral DC decreased in the NVP/LPV/r arm (-1.72 +/- 0.85 x 10(-3)/kPa [P = .046]), with no significant difference in C-IMT or arterial stiffness between arms. sVCAM-1, sICAM-1, and vWF levels decreased significantly in both groups.


CONCLUSIONS
C-IMT and femoral artery stiffness increased after the initiation of cART, whereas several markers of endothelial function improved, regardless of the composition of cART. Trial registration. ClinicalTrials.gov identifier: NCT00122226 .
van Vonderen
Marit G A
MG
Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands. M.vVonderen@vumc.nl
Hassink
Elly A M
EA
van Agtmael
Michiel A
MA
Stehouwer
Coen D A
CD
Danner
Sven A
SA
Reiss
Peter
P
Smulders
Yvo
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000145:classification / Q000627:therapeutic use*; D001823:Body Composition; D001916:Brachial Artery / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000209:etiology; D002339:Carotid Arteries / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D003187:Compliance / Q000187:drug effects; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D005263:Femoral Artery / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017539:Tunica Intima / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D055815:Young Adult
D019380:Anti-HIV Agents