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Risk factors for subclinical atherosclerosis in HIV-infected patients under and over 40 years: a case-control study
Valéria Maria Gonçalves Albuquerque1, Josefina Claudia Zírpoli, Demócrito de Barros Miranda-Filho
1Department of Tropical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.
Insights
Subclinical atherosclerosis risk factors differ by age in people with HIV/AIDS. Younger individuals face risks from obesity and metabolic syndrome, while older individuals are affected by uncontrolled HIV viral load and long-term antiretroviral therapy.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular diseases (CVD) are a leading cause of mortality in individuals with acquired immunodeficiency syndrome (AIDS).
- Atherosclerosis in HIV/AIDS patients is influenced by traditional risk factors, antiretroviral drugs, and HIV-related inflammation.
- This study aimed to identify and compare risk factors for subclinical atherosclerosis in different age groups of HIV-infected individuals.
Purpose of the Study:
- To compare risk factors associated with subclinical atherosclerosis in HIV/AIDS individuals under 40 years versus those 40 years and older.
- To identify predictors of subclinical atherosclerosis in distinct age strata within the HIV/AIDS population.
- To inform targeted prevention strategies for CVD in people living with HIV/AIDS.
Main Methods:
- A case-control study involving 697 individuals with HIV/AIDS on their first antiretroviral regimen.
- Participants were divided into two groups: under 40 years (n=351) and 40 years and older (n=346).
- Subclinical atherosclerosis was assessed using carotid intima-media thickness via B-mode ultrasound; multivariate logistic regression identified predictors.
Main Results:
- In individuals <40 years, subclinical atherosclerosis was linked to male gender, nonwhite race, obesity, and metabolic syndrome.
- In individuals ≥40 years, predictors included overweight/obesity, higher CD4 counts, and prolonged use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors (PIs).
- After excluding major CVD risk factors, age, male sex, and nonwhite race remained associated in the <40 group, while age, high HIV viral load, and long-term NNRTI/PI use were associated in the ≥40 group.
Conclusions:
- For younger HIV/AIDS patients, managing obesity and metabolic syndrome is crucial for CVD prevention.
- In older HIV/AIDS patients (≥40 years), obesity prevention is important, alongside managing uncontrolled HIV viremia and prolonged use of highly active antiretroviral therapy (HAART).
- The long-term effects of HAART and uncontrolled viral load appear more detrimental in older HIV-infected individuals.
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.
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