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Frequency of Subclinical Atherosclerosis in Brazilian HIV-Infected Patients
Péricles Sidnei Salmazo1, Silméia Garcia Zanati Bazan1, Flávio Gobbis Shiraishi1
1Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil.
Insights
HIV-infected patients have a significantly higher risk of atherosclerosis, linked to traditional cardiovascular factors. Protease inhibitor treatment did not increase arterial plaque risk, suggesting the Framingham Risk Score may be unsuitable for this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Acquired Immunodeficiency Syndrome (AIDS) and atherosclerosis are major public health concerns.
- Increased cardiovascular events in HIV-infected individuals with longer survival are not fully understood.
Purpose of the Study:
- To determine the prevalence of subclinical atherosclerosis in HIV-infected patients compared to controls.
- To analyze associations between atherosclerosis and clinical/laboratory variables, cardiovascular risk factors, and the Framingham coronary heart disease risk score (FCRS).
Main Methods:
- A prospective, cross-sectional, case-control study involving 264 HIV-infected patients and 279 controls.
- Assessment included carotid artery ultrasound, arterial stiffness (PWV, AIx), blood tests, and FCRS.
- Statistical significance was set at p < 0.05.
Main Results:
- Atherosclerotic plaques were found in 37% of HIV patients versus 4% of controls (p < 0.001).
- HIV patients exhibited higher carotid intima-media thickness (p < 0.001).
- HIV presence, adjusted for confounders, increased atherosclerotic plaque risk nearly fivefold (OR: 4.9; p < 0.001).
- Protease inhibitor use showed no association with plaque frequency or arterial stiffness.
Conclusions:
- HIV-infected patients face elevated atherosclerosis risk, associated with conventional cardiovascular risk factors.
- Protease inhibitors do not appear to promote arterial dysfunction or increase plaque burden.
- The FCRS may be inadequate for assessing cardiovascular risk in HIV-infected populations.
Background:
AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated with increased number of cardiovascular events in this population, and this association is not fully understood.
Objectives:
To identify the frequency of subclinical atherosclerosis in HIV-infected patients compared to control subjects; to analyze associations between atherosclerosis and clinical and laboratory variables, cardiovascular risk factors, and the Framingham coronary heart disease risk score (FCRS).
Methods:
Prospective cross-sectional case-control study assessing the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 controls. Clinical evaluation included ultrasound examination of the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), laboratory analysis of peripheral blood, and cardiovascular risk according to FCRS criteria. The significance level adopted in the statistical analysis was p < 0.05.
Results:
Plaques were found in 37% of the HIV group and 4% of controls (p < 0.001). Furthermore, carotid intima-media thickness was higher in the HIV group than in controls (p < 0.001). Patients with carotid plaque had higher fasting glucose, total cholesterol, low-density lipoprotein cholesterol, and triglycerides than those without plaques. The presence of HIV, adjusted for age, overweight/obesity, and smoking increased by almost fivefold the risk of atherosclerotic carotid plaque (OR: 4.9; 95%CI: 2.5-9.9; p < 0.001). Exposure to protease inhibitors did not influence carotid intima-media thickness, was not associated with carotid plaque frequency, and did not alter the mechanical characteristics of the arterial system (PWV and AIx).
Conclusions:
HIV-infected patients are at increased risk of atherosclerosis in association with classical cardiovascular risk factors. Treatment with protease inhibitors does not promote functional changes in the arteries, and shows no association with increased frequency of atherosclerotic plaques in carotid arteries. The FCRS may be inappropriate for this population.
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