Atherosclerosis in subjects newly diagnosed with human immunodeficiency virus infection

Area of Science:

• Cardiovascular Disease Research
• Infectious Disease Epidemiology
• Immunology and Virology

Background:

• HIV infection is linked to a higher risk of cardiovascular disease (CVD), persisting even with combination antiretroviral therapy (cART).
• The precise mechanisms linking HIV, cART, and CVD pathogenesis remain incompletely understood and debated.
• Carotid intima-media thickness (CIMT) serves as a key surrogate marker for subclinical atherosclerosis.

Purpose of the Study:

• To investigate the impact of HIV infection and cART on the progression of atherosclerosis, measured by CIMT.
• To evaluate whether cART mitigates or reverses HIV-associated increases in CIMT.
• To identify early cardiovascular risk factors in newly diagnosed HIV-infected individuals.

Main Methods:

• A cohort of 109 newly diagnosed HIV-infected males and 109 age-matched uninfected male controls were recruited.
• Baseline cross-sectional analysis assessed traditional CVD risk factors and CIMT.
• A prospective arm followed a subset (37 HIV-infected, 23 controls) to measure CIMT changes over time.

Main Results:

• Baseline analysis revealed elevated triglycerides and reduced HDL in HIV-infected subjects, indicating early CVD risk factors.
• No significant difference in baseline CIMT was observed between HIV-infected and control groups.
• Prospective analysis showed a significantly greater increase in CIMT among HIV-infected individuals compared to controls (P=0.0063), irrespective of cART treatment status.

Conclusions:

• HIV infection accelerates atherosclerosis progression, as evidenced by increased CIMT, independent of cART treatment.
• cART does not appear to reverse the accelerated CIMT increase associated with HIV infection.
• HIV-infected individuals face a continued elevated risk of atherosclerosis development and progression, underscoring the need for vigilant cardiovascular risk management.