Association between human immunodeficiency virus infection and stiffness of the common carotid artery.
OBJECTIVE
Individuals with human immunodeficiency virus (HIV) who use highly active antiretroviral therapy (HAART) may have an increased risk for cardiovascular-related events, although the underlying mechanism remains unclear. We tested the hypothesis that carotid arterial stiffness was higher among persons using HAART compared to HAART-naïve and HIV-uninfected persons.


METHODS
Between 2004 and 2006, we performed high-resolution B-mode ultrasound on 2789 HIV-infected and HIV-uninfected participants of the Women's Interagency HIV Study (1865 women) and the Multicenter AIDS Cohort Study (924 men) and determined carotid arterial distensibility, which is a direct measure of carotid arterial stiffness. We used generalized estimating equations to evaluate the association between distensibility and HIV infection, CD4(+) cell count, and exposure to HAART adjusted for demographic, behavioral, and clinical characteristics.


RESULTS
In multivariable analysis, distensibility was 4.3% lower (95% confidence interval, -7.4% to -1.1%) among HIV-infected vs uninfected participants. Among HIV-infected participants with <200 CD4(+) cells, distensibility was 10.5% lower (95% confidence interval, -14.5% to -6.2%) than that among HIV-uninfected participants, and this effect did not differ significantly by cohort or race. Concurrent HAART use was independently associated with lower distensibility among Multicenter AIDS Cohort Study participants but not among Women's Interagency HIV Study participants.


CONCLUSIONS
Our finding that advanced HIV-related immunosuppression was associated with increased carotid arterial stiffness independent from the effects of traditional atherosclerosis risk factors suggests that the etiologic mechanism underlying reports of an increased cardiovascular disease risk among HIV-infected individuals might involve HIV-related immunosuppression leading to vascular dysfunction and arterial stiffening.
Seaberg
Eric C
EC
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. eseaberg@jhsph.edu
Benning
Lorie
L
Sharrett
A Richey
AR
Lazar
Jason M
JM
Hodis
Howard N
HN
Mack
Wendy J
WJ
Siedner
Mark J
MJ
Phair
John P
JP
Kingsley
Lawrence A
LA
Kaplan
Robert C
RC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000821:virology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000821:virology*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D014463:Ultrasonography; D019562:Viral Load
J Acquir Immune Defic Syndr. 2008 Mar 1;47(3):338-41
18176330
Clin Diagn Lab Immunol. 2005 Sep;12(9):1013-9
16148165
N Engl J Med. 1998 Mar 26;338(13):853-60
9516219
AIDS. 2005 Jun 10;19(9):953-60
15905677
Am J Hypertens. 2002 May;15(5):445-52
12022247
Lancet. 1997 Sep 6;350(9079):713-4
9291911
N Engl J Med. 2005 Jan 6;352(1):48-62
15635112
Circulation. 2003 Jan 7;107(1):139-46
12515756
Arterioscler Thromb Vasc Biol. 2005 Nov;25(11):2381-5
16123321
AIDS. 2003 Nov 21;17(17):2529-31
14600526
AIDS. 2005 Jun 10;19(9):927-33
15905673
Circulation. 2001 Jul 17;104(3):257-62
11457741
Med Clin North Am. 2009 May;93(3):583-604, Table of Contents
19427493
Am J Epidemiol. 1995 Aug 1;142(3):323-30
7631636
N Engl J Med. 2007 Apr 26;356(17):1723-35
17460226
AIDS. 2004 Apr 30;18(7):1037-41
15096807
J Antimicrob Chemother. 2007 Oct;60(4):724-32
17715125
AIDS. 1998 May 7;12(7):F51-8
9619798
Ann Intern Med. 2001 Dec 4;135(11):939-53
11730394
J Am Coll Cardiol. 2008 Aug 12;52(7):569-76
18687253
Epidemiology. 1998 Mar;9(2):117-25
9504278
Am J Med. 1997 Mar;102(3):227-31
9217589
N Engl J Med. 2006 Nov 30;355(22):2283-96
17135583
Circulation. 2004 Apr 6;109(13):1603-8
15023877
Am J Hypertens. 2003 May;16(5 Pt 1):356-62
12745196
Curr Opin HIV AIDS. 2007 Jul;2(4):324-31
19372907
JAMA. 1998 Nov 4;280(17):1497-503
9809730
Am J Cardiol. 1994 Oct 1;74(7):691-5
7942527
AIDS. 2003 Nov 21;17(17):2479-86
14600519
Am J Epidemiol. 1987 Aug;126(2):310-8
3300281
AIDS. 2008 Aug 20;22(13):1615-24
18670221
Circulation. 1989 Jan;79(1):1-7
2642753
N Engl J Med. 2003 Nov 20;349(21):1993-2003
14627784
Ultrasound Med Biol. 1997;23(2):157-64
9140173
Hypertension. 2006 Mar;47(3):365-70
16432047
Ann Med. 2002;34(1):55-63
12014436
Lancet. 2002 Nov 30;360(9347):1747-8
12480430