Lipodystrophy and anti-retroviral therapy as predictors of sub-clinical atherosclerosis in human immunodeficiency virus infected subjects.
OBJECTIVE
Although anti-retroviral therapy (ART) prolonged survival in HIV-infected persons, an increase in cardiovascular disease has also been observed. A frequent complication of ART is the development of lipodystrophy (LD) with its multiple phenotypes that may be associated with cardiovascular disease. We assessed the contribution of chronic HIV infection, ART use and LD to the presence of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging.


METHODS
Observational cross-sectional study of 372 HIV-infected patients receiving ART who attended a cardiometabolic clinic (48.2+/-8-year old; 74% men). All patients underwent CAC surveillance with computed tomography and the Agatston score was used to quantitate CAC. Presence of CAC was defined as a score >10. Multivariable logistic regression was used to evaluate associations between HIV clinical factors, ART and LD with the presence of CAC.


RESULTS
CAC was found in 134 patients (36%) with a median CAC score of 50 (range 10; 1243). Lipoatrophy alone (OR 3.82, 95% CI: 1.11; 13.1), fat accumulation alone (OR 7.65, 95% CI: 1.71; 37.17) and mixed lipodystrophy phenotypes (OR 4.36, 95% CI: 1.26; 15.01) were strongly associated with presence of CAC after adjusting for age, sex, hypertension and cumulative exposure to ART.


CONCLUSIONS
CAC is common among long-term ART users. The association between CAC and LD underscores the potential atherosclerosis risk inherent with ART and the need to undertake routine cardiovascular surveillance in patients treated with these drugs.
Guaraldi
Giovanni
G
Metabolic Clinic, Infectious and Tropical Disease Unit, Department of Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Stentarelli
Chiara
C
Zona
Stefano
S
Orlando
Gabriella
G
Carli
Federica
F
Ligabue
Guido
G
Lattanzi
Antonella
A
Zaccherini
Giacomo
G
Rossi
Rosario
R
Modena
Maria Grazia
MG
Alexopoulos
Nikolaos
N
Palella
Frank
F
Raggi
Paolo
P
D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D050197:Atherosclerosis / Q000209:etiology*; D002118:Calcium; D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008060:Lipodystrophy / Q000209:etiology*; D008297:Male; D008875:Middle Aged
D044966:Anti-Retroviral Agents; D002118:Calcium