title: Long-term effects of an intensive intervention in HIV-infected patients with moderate-high atherosclerotic cardiovascular risk.
abstract: OBJECTIVE
  To evaluate the 5 year effects of an intensive intervention versus the standard-of-care intervention on cardiovascular risk factors in HIV-infected patients on antiretroviral therapy (ART).
  
  
  METHODS
  This was a longitudinal study including virologically suppressed patients with at least two cardiovascular risk factors or a Framingham risk score ≥10%. Intensive and standard-of-care interventions aimed for low-density lipoprotein cholesterol (LDL-C) <100 and <130 mg/dL, respectively, by using lipid-lowering drugs. In the intensive group, switching ART when needed to achieve the LDL-C target and low-dose aspirin were used. Achievement of LDL-C targets and changes in carotid intima-media thickness (cIMT) and cardiovascular biomarkers were compared between groups at different timepoints through a 5 year period.
  
  
  RESULTS
  Twenty-two and 25 patients in the intensive and standard intervention groups, respectively, were followed up. At 5 years, pre-specified LDL-C targets were achieved in 82% (intensive) and 81% (standard of care) of patients. The median (IQR) change in LDL-C in the intensive and standard intervention groups was -78 (-96/-39.7) and -49 (-72/-3) mg/dL, respectively (P = 0.04), and in the Framingham score was -4% (-8%/-1%) and 0% (-4%/6.5%), respectively (P = 0.01). There were no significant intra- or between-group changes in cIMT measurements. A significant decrease was observed in the intensive and standard groups in interleukin 6 (P = 0.001 and P = 0.002, respectively) and in tumour necrosis factor α (P = 0.023 and P = 0.052, respectively). Asymptomatic creatine phosphokinase elevations were observed in two patients assigned to the standard intervention group.
  
  
  CONCLUSIONS
  An intensive intervention on cardiovascular risk factors in HIV-infected patients on ART was feasible, safe and capable of achieving LDL-C targets in the long term. Both intensive and standard interventions were accompanied by antiatherosclerotic changes in inflammatory cytokines and lack of cIMT progression.
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain marmasiac@gmail.com.
authors.forename: Mar
authors.initials: M
authors.lastname: Masiá
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Bernal
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Robledano
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Padilla
authors.affiliation: Biochemistry Section, Hospital General Universitario de Elche, Elche, Alicante, Spain.
authors.forename: Natividad
authors.initials: N
authors.lastname: López
authors.affiliation: Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: Martínez
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Gutiérrez
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D050197:Atherosclerosis / Q000188:drug therapy / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors
chemical_list: D044966:Anti-Retroviral Agents
keywords: LDL cholesterol; cIMT; cardiovascular diseases; carotid intima-media thickness; inflammation biomarkers; lipid-lowering therapy; statins