Published Online
on January 26, 2006

A more recent version of this article appeared on March 1, 2006

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Submitted on September 22, 2005
Revised on December 23, 2005
Accepted on January 5, 2006

Subclinical Carotid Atherosclerosis in HIV-Infected Patients. Role of Combination Antiretroviral Therapy

Carlos Jericó MD; Hernando Knobel MD; Nahum Calvo MD; María L. Sorli MD; Ana Guelar MD; Juan L. Gimeno-Bayón MD; Pere Saballs MD; José L. López-Colomés MD; and Juan Pedro-Botet MD^*

From the Departments of Medicine (C.J., H.K., M.L.S., A.G., J.L.G.-B., P.S., J.L.L.-C., J.P.-B.) and Radiology IDIMAS-CRC Mar (N.C.), Hospital del Mar, Barcelona, Spain; and the Universidad Autónoma de Barcelona (C.J., H.K., J.L.G.-B., P.S., J.L.L.-C., J.P.-B.), Spain.

^* To whom correspondence should be addressed. E-mail: 86620{at}imas.imim.es.

Background and Purpose--Whether or not combination antiretroviral therapy (CART) alone directly contributes to accelerating atherosclerosis in HIV-infected patients has not been studied in depth. This study aimed to ascertain the relationship between this therapy and subclinical carotid atherosclerosis according to cardiovascular risk.

Methods--Sixty-eight HIV-infected patients with 1 cardiovascular risk factors and 64 with 2 risk factors completed the study protocol consisting of clinical, laboratory, and vascular evaluation by carotid high-resolution B-mode ultrasonography. Univariate and multivariate logistic regression analyses were performed with the presence of subclinical carotid atherosclerosis, defined by carotid intima-media thickness >0.8 mm or the presence of plaque being the dependent variable.

Results--Among the 132 enrolled patients, 93 (70.5%) were on CART and 39 (29.5%) had never been on antiretroviral therapy. In accordance with cardiovascular risk stratification, subclinical carotid atherosclerosis was found in 26.6% (17 of 64 patients) of the very low-risk group (10-year coronary risk <5%), 35.3% (12 of 34 patients) of the low-risk group (10-year coronary risk between 5% and 9%) and 76.5% (26 of 34 patients) of the moderate/high-risk group (10-year coronary risk 10%). Thus, 55 (41.7%) of the 132 HIV-infected patients had subclinical carotid atherosclerosis, and independent variables associated with carotid atherosclerosis (odds ratio; 95% CI) were: CART exposure (10.5; 2.8 to 39) and 10-year coronary risk 10% (4.2; 1.5 to 12). In very low coronary risk patients (<5%), age (per 10-year increment: 4.01; 1.12 to 14.38), systolic blood pressure (per unit mm Hg 1.07; 1.01 to 1.14), and CART exposure (8.65; 1.54 to 48.54) were independently associated with subclinical carotid atherosclerosis.

Conclusions--CART should be considered a strong, independent predictor for the development of subclinical atherosclerosis in HIV-infected patients, regardless of known major cardiovascular risk factors and atherogenic metabolic abnormalities induced by this therapy.

Key words: arteriosclerosis • carotid arteries • HIV • risk factors • ultrasonography

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