title: Risk factors for subclinical atherosclerosis in HIV-infected patients under and over 40 years: a case-control study.
abstract: BACKGROUND
  Cardiovascular diseases (CVD) are a major cause of death in people with AIDS. Factors contributing to atherosclerosis include traditional risk factors, antiretrovirals and inflammatory factors related to HIV infection. This study set out to compare risk factors associated with subclinical atherosclerosis in individuals under and over 40 years of age.
  
  
  METHODS
  Case-control study with 697 HIV/AIDS individuals without HAART or who remain on their first antiretroviral regimen. Of the total, 351 individuals under 40 years and 346 over 40 years were analyzed separately. Subclinical atherosclerosis was assessed by carotid intima-media thickness, using B-mode ultrasound. Multivariate logistic regression was performed to find predictors of subclinical atherosclerosis in the entire group. Subsequent analysis excluded patients with major risk factors for CVD. Magnitudes of associations were expressed by odds ratio (OR) statistical significance, using a 95% confidence interval and p-value <0.05.
  
  
  RESULTS
  In the <40 years group subclinical atherosclerosis was associated with male gender (OR: 2.77, 95% CI: 1.43-5.34), nonwhite race (OR: 3.01, 95% CI: 1.23-6.53), obesity (OR: 5.13, 95% CI: 1.79-14.7) and metabolic syndrome (OR: 3.30, 95% CI: 1.44-7.58). In the group ≥40 years predictors of subclinical atherosclerosis were overweight and obesity (OR = 2.53, 95% CI, 0.85-7.54), current CD4 ≥350 cells/mL (OR: 2.81, 95% CI: 1.22-6.47) and NNRTI use ≥ 5 years (OR: 2.65, 95% CI: 1.10-6.37) or PI use >5 years (OR: 1.81, 95% CI: 0.38-8.59). In the multivariate model excluding patients with major risk factors for CVD, age, male sex and nonwhite race were associated with subclinical atherosclerosis in the <40 y group, while in the ≥40 y group, age, HIV viral load >10,000 copies and the use of NNRTI (OR: 7.60, 95% CI: 1.61-35.8) or PI ≥5 years (OR: 3.62, 95% CI: 0.48-26.8) were associated with subclinical atherosclerosis.
  
  
  CONCLUSIONS
  In young people the fight against obesity and metabolic syndrome is the main aim in the prevention of CVD. In individuals aged ≥40 y, the prevention of obesity is also of great importance. Moreover, the effects of uncontrolled viremia and the prolonged use of HAART appear to be more harmful in the older group.
authors.affiliation: Department of Tropical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Valéria Maria Gonçalves
authors.initials: VM
authors.lastname: Albuquerque
authors.forename: Josefina Claudia
authors.initials: JC
authors.lastname: Zírpoli
authors.forename: Demócrito
authors.initials: D
authors.lastname: de Barros Miranda-Filho
authors.forename: Maria de Fátima Pessoa Militão
authors.initials: Mde F
authors.lastname: Albuquerque
authors.forename: Ulisses Ramos
authors.initials: UR
authors.lastname: Montarroyos
authors.forename: Ricardo Arraes
authors.initials: RA
authors.lastname: de Alencar Ximenes
authors.forename: Heloísa Ramos
authors.initials: HR
authors.lastname: Lacerda
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000821:virology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors