Carotid intima-media thickness among human immunodeficiency virus-infected patients without coronary calcium
Priscilla Y Hsue1, Karen Ordovas, Theodore Lee
1Division of Cardiology, San Francisco General Hospital, California, USA.
Insights
Human immunodeficiency virus (HIV) infection increases atherosclerosis risk. Carotid intima-media thickness (IMT) may be a more sensitive indicator of subclinical atherosclerosis in HIV patients than coronary artery calcium (CAC).
Area of Science:
- Cardiovascular disease research
- Infectious disease epidemiology
- Medical imaging and diagnostics
Background:
- Individuals with human immunodeficiency virus (HIV) exhibit an elevated risk of atherosclerosis.
- Carotid artery intima-media thickness (IMT) and coronary artery calcium (CAC) are established cardiovascular risk predictors in the general population.
- The comparative utility of IMT and CAC for atherosclerosis detection in HIV-infected individuals requires further definition.
Purpose of the Study:
- To compare the efficacy of IMT and CAC in identifying atherosclerosis among subjects with HIV.
- To evaluate the association of HIV-related and traditional risk factors with IMT and CAC.
- To compare IMT distributions in HIV-infected and uninfected individuals, with and without detectable CAC.
Main Methods:
- Measurement of CAC using computed tomography and IMT using ultrasound in 253 HIV-infected and 58 uninfected adults.
- Statistical analysis to assess associations between HIV status, risk factors, and atherosclerosis markers (CAC and IMT).
- Comparative analysis of IMT values based on CAC presence and severity.
Main Results:
- While detectable CAC rates were similar, absolute CAC scores were modestly higher in the HIV group (16% vs 5% with CAC >100, p=0.03).
- HIV-infected subjects demonstrated significantly higher IMT compared to controls (1.02 ± 0.34 mm vs 0.78 ± 0.12 mm, p <0.0001), even after adjusting for traditional risk factors.
- A substantial proportion of HIV-infected individuals (34%) exhibited markedly increased IMT (≥1 mm) even in the absence of detectable CAC, a finding not observed in controls.
Conclusions:
- Carotid IMT appears to be a more sensitive indicator of subclinical atherosclerosis in HIV-infected patients compared to CAC, particularly in the absence of significant coronary calcification.
- HIV-related factors were associated with IMT, suggesting a direct link between HIV infection and vascular changes.
- IMT may offer a valuable tool for assessing cardiovascular risk in HIV patients, complementing or potentially surpassing CAC in certain contexts.
Abstract:
Subjects infected with human immunodeficiency virus (HIV) have increased risk for atherosclerosis. Carotid artery intima-media thickness (IMT) assessed using ultrasound and coronary artery calcium (CAC) detected using computed tomography predict cardiovascular risk in the general population; however, their usefulness and comparability in patients with HIV are less well defined. The purpose of this study was to compare IMT and CAC in the detection of atherosclerosis in subjects with HIV. CAC and IMT were measured in 253 HIV-infected and 58 uninfected adults. Associations among HIV-related factors, traditional risk factors, and CAC and IMT were evaluated. The distribution of IMT among subjects with and without CAC was compared. Among the patients with HIV, 37% had detectable CAC compared to 28% of controls (p = 0.19); 16% of the patients with HIV had CAC >100 compared to 5% of controls (p = 0.03). With either detectable or undetectable CAC, HIV-infected subjects had higher IMT compared to controls (1.02 ± 0.34 vs 0.78 ± 0.12 mm, p <0.0001), even after adjustment for traditional risk factors. Among those with undetectable CAC, 34% of patients with HIV had markedly increased IMT (≥1 mm) compared to no controls (p <0.0001). HIV-related factors were associated with IMT but not with CAC. In conclusion, patients with HIV and controls had similar rates of detectable CAC, while absolute CAC scores were modestly higher in the HIV group. Conversely, carotid IMT detected advanced subclinical atherosclerosis in patients with HIV even in the absence of CAC. Thus, with HIV, IMT is associated with disease-related factors and may be a more sensitive indicator of subclinical atherosclerosis than CAC.
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