Ultrasonographic measures of cardiovascular disease risk in antiretroviral treatment-naive individuals with HIV infection

Abstract

Objective To evaluate associations between traditional cardiovascular disease (CVD) risk factors, inflammatory markers, and markers of HIV disease activity with ultrasonographic measures of CVD risk in patients with HIV who are not receiving antiretroviral therapy (ART). Design Cross-sectional, baseline evaluation of ART-naïve HIV-infected individuals without known CVD or diabetes mellitus enrolled in a randomized ART treatment trial. Methods Prior to ART initiation, carotid artery intima-media thickness (CIMT) and brachial artery flow-mediated dilation (FMD) were measured. Additional parameters included CD4 cell count, HIV viral load, body composition, lipoproteins, and inflammatory markers. Associations with common CIMT, bifurcation CIMT, presence of carotid artery lesions, and brachial artery FMD were evaluated. Results The 331 enrolled subjects were a median (1st–3rd quartile) of 36 (28–45) years old. Common and bifurcation CIMT values were higher and lesions more prevalent with older age (p <0.001). FMD was lower with older age (p =0.009). Those with a Framingham Risk Score >6%/10 years (N =44) had higher common and bifurcation CIMT (p <0.001), carotid lesion prevalence (p <0.001), and lower FMD (p =0.035). Independent associations with common CIMT were identified for increasing age, height, weight, small LDL particles, and black race; these were similar for bifurcation CIMT. Presence of carotid artery lesions was associated with increasing age, presence of metabolic syndrome, interleukin-6, and lower HIV-1 RNA. Conclusions In a contemporary cohort of ART-naive HIV-infected individuals, ultrasonographic measures of CVD risk were more strongly associated with traditional risk factors than CD4 cell counts, HIV replication, or inflammatory markers.

Metabolic syndrome in HIV infected adults in Poland

“…In a study by Stein et al [29] ultrasonographic measures of CVD were used: carotid artery intima-media thickness and brachial artery flow-medicated vasodilation, to assess subclinical and functional atherosclerosis in treatment-naïve HIV-infected patients. They found that traditional CVD risk factors, such as aging, body size, and lipids levels, better predicted atherosclerosis than inflammatory markers, cytokines, CD4 cell count, and HIV viral load.…”

A prospective, randomized clinical trial of antiretroviral therapies on carotid wall thickness

“…Current use of statins, fish oil (>2 g/day), fibric acid derivatives, or niacin (>1000 mg/day) was exclusionary at enrolment. Detailed inclusion and exclusion criteria for the study were reported previously in our baseline, cross-sectional analysis [16]. …”

“…B-mode images of the distal right common carotid artery (CCA) and the right carotid artery bifurcation were acquired with a high-resolution linear array ultrasound transducer with simultaneous electrographic tracings before ART initiation, and then after 48, 96, and 112–144 weeks [16]. The right CCA was imaged in cross-section and the transducer moved laterally into the jugular vein so they were stacked with the vein displayed on top of the artery.…”

“…Paired ultrasound and phantom scans were obtained at baseline, but within group, coefficient of variants was paired at baseline CCA. The coefficients of variation for common carotid IMT scans and paired baseline carotid bifurcation IMT scans were 1.09 and 1.27%, respectively [16]. …”

HIV vasculopathy

“…Similarly, high-resolution ultrasound measures of carotid intima media thickness (CIMT) also predict CVD risk in the general population, particularly stroke[24, 25]. Traditional and non-traditional risk factors are associated with elevated CAC and CIMT in patients with HIV[8, 9, 22, 23, 26–29]. To date, transcriptional modulators that may explain these observations have not been identified.…”