Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study.
BACKGROUND
Psychological factors are known predictors of cardiovascular disease in many clinical settings, but data are lacking for HIV infection. We carried out a prospective cohort study to evaluate potential psychological predictors of preclinical and clinical vascular disease in HIV patients.


RESULTS
HIV patients were consecutively enrolled. Demographics, viral and immune parameters and traditional cardiovascular predictors were considered; Intima-Media Thickness (c-IMT, continuous measure) and Carotid Plaques (CPs, focal thickening ≥1.5 mm) were investigated by B-mode ultrasonography; depressive symptoms by the Beck Depression Inventory (BDI-II), Type D personality (Distressed Personality or Type D) by the DS14, alexithymia by the Toronto Alexithymia Scale (TAS-20). Vascular outcomes included transient ischemic attacks or stroke, acute coronary syndrome, myocardial or other organ infarction. We enrolled 232 HIV subjects, 73.9% males, aged 44.5±9.9 y, 38.2% with AIDS diagnosis, 18.3% untreated. Mean Nadir CD4 T-cell counts were 237.5±186.2/mmc. Of them, 224 (96.5%) attended IMT measurements; 201 (86.6%) attended both IMT assessment and psychological profiling. Mean follow-up was 782±308 days. Fifty-nine patients (29.4%) had CPs at baseline. Nineteen patients (9.5%) had ≥1 vascular event; 12 (6.0%) died due to such events (n = 4) or any cause. At baseline cross-sectional multivariate analysis, increasing age, total cholesterol, current smoking and Alexithymia score≥50 were significantly associated with both increased cIMT (linear regression) and CPs (logistic regression). At follow-up analysis, log-rank tests and Cox's regression revealed that only older age (p = 0.001), current smoking (p = 0.019) and alexithymia score≥50 (p = 0.013) were independently associated with vascular events.


CONCLUSIONS
In HIV-infected subjects, the Alexithymic trait emerges as a strong predictor of increased IMT, presence of CPs and vascular events. Such results are preliminary and require confirmation from studies with larger sample size and longer follow-up.
Unit of Infectious Diseases, Pescara General Hospital, Pescara, Italy. parruti@tin.it
Giustino
G
Parruti
Francesco
F
Vadini
Federica
F
Sozio
Elena
E
Mazzott
Tamara
T
Ursini
Ennio
E
Polill
Paola
P
Di Stefano
Monica
M
Tontodonati
Maria C
MC
Verrocchio
Mario
M
Fulcheri
Giulio
G
Calella
Francesca
F
Santilli
Lamberto
L
Manzoli
D000328:Adult; D000342:Affective Symptoms / Q000503:physiopathology* / Q000523:psychology; D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology; D015496:CD4-Positive T-Lymphocytes; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors