Cardiovascular risk factors during hiv infection treated with antiretroviral therapy. An ultrasound assessment study of carotid atherosclerosis

Abstract

Background. There is controversy over whether or not HIV infection and antiretroviral therapy contribute to early atherosclerosis. Ultrasonographic evaluation of carotid intima-media thickness is considered a reliable surrogate marker of subclinical atherosclerosis and may be employed in the setting of a cardiovascular risk assessment in HIV-infected patients.Patients and methods. A cross-sectional study evaluating classical risk factors for cardiovascular diseases, parameters of HIV infection, antiretroviral therapy and subclinical atherosclerosis in HIV-positive subjects naïve or treated with antiretroviral agents was performed. The enrolled patients underwent ultrasonography of the epi-aortic vessels using a Philips HDI 5000 power color-Doppler with 7.5-MHz probes. The 10-year risk of coronary heart disease was calculated by the Framingham equation.Results. A total of 27 patients (19 males and 8 females; mean age 44 + 13 years; range 32-59 years) were enrolled into the study: 11 subjects were naïve to all antiretroviral agents (group A) and 16 patients were treated with antiretroviral therapy for >36 months (group B). Mean duration of known HIV infection was significantly longer in group B than in group A, such as frequence of dyslipidaemia and lipodystrophy syndrome. Prevalence of carotid plaques was significantly higher in group B than in group A (43.7% versus 0; p=0.012). In group B, patients with high 10-year risk of coronary heart disease (>10%) showed a significantly higher intima-media thickness and prevalence of carotid lesions than those with low risk (<10%). Moreover, carotid plaques presented structural features comparable to those of classical atherosclerotique plaques observed in general population, with iso-hyperechonegic aspects and irregular surfaces.Conclusions. Prevalence of carotid atherosclerosis is higher in HIV-infected experienced patients than in those naïve to antiretroviral therapy and seems mostly associa-ted with a longer duration of HIV infection, more severe lipid metabolism alterations, presence of lipodystrophy syndrome, and a more elevated 10-year risk of cardiovascular diseases.