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Rapid progression of carotid lesions in HAART-treated HIV-1 patients

Paolo Maggi1, Francesco Perilli, Antonio Lillo

  • 1Institute of Infectious Diseases, University of Bari, Italy. p_maggi@yahoo.com <p_maggi@yahoo.com>

Atherosclerosis
|June 22, 2006
PubMed

Insights

Patients on protease inhibitors (PIs) experienced faster carotid lesion development and worsening compared to those on non-nucleosidic reverse transcriptase inhibitors (NNRTIs). Shifting antiretroviral therapy regimens may reduce lesion progression.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Antiretroviral therapy is crucial for managing HIV.
  • Carotid lesions are a potential complication in HIV patients.
  • Understanding the impact of different antiretroviral drug classes on vascular health is important.

Purpose of the Study:

  • To compare the evolution of carotid lesions in HIV patients receiving protease inhibitors (PIs) versus non-nucleosidic reverse transcriptase inhibitors (NNRTIs).
  • To assess the impact of antiretroviral therapy regimens on the development and progression of carotid atherosclerosis.

Main Methods:

  • Prospective study of 133 HIV patients initiating their first antiretroviral regimen.
  • Patients were divided into two groups: 77 on PIs (Group A) and 56 on NNRTIs (Group B).
  • Carotid ultrasonography was performed at baseline and during a minimum 2-year follow-up period.

Main Results:

  • Group A (PIs) showed a significantly higher percentage of new carotid lesion development and worsening of pre-existing lesions compared to Group B (NNRTIs).
  • In Group A, 22.5% of patients with normal carotids developed lesions, and 46% of those with existing lesions experienced worsening.
  • In Group B, 12.7% of patients with normal carotids developed lesions, and 12.5% of those with existing lesions experienced worsening. Lesion disappearance was noted in both groups.

Conclusions:

  • Protease inhibitor-based antiretroviral therapy is associated with a more rapid onset and progression of carotid lesions compared to non-nucleosidic reverse transcriptase inhibitor-based therapy.
  • Switching from PIs to NNRTIs or triple nucleoside reverse transcriptase inhibitor (3 NRTI) regimens may be associated with a reduced rate of carotid lesion evolution.
  • Carotid lesion regression can occur in HIV patients on antiretroviral therapy, irrespective of the drug class used.

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