Abstract 1186: Arterial Wall Properties and Endothelial Function in HIV Infected Patients
Background: A metabolic syndrome associated with atherosclerosis and cardiovascular disease has been seen in HIV (+) individuals receiving highly active antiretroviral therapy (HAART). Functional vascular changes can be non-invasively assessed and may precede the development of atherosclerosis.
Methods: We measured carotid artery intima media thickness (IMT) and brachial artery flow-mediated dilatation (FMD) by vascular ultrasonography in 61 HIV (+) patients (mean age 41.8 ± 13 yrs, 88.5 % male) attending a tertiary care center, in 30 patients with angiographically documented CAD (positive control) and in 30 healthy subjects. Both control groups had similar age, sex and atherosclerotic risk factors to HIV infected patients. Carotid to femoral pulse wave velocity (PWV-Complior apparatus) was also measured in HIV (+) patients.
Results: By ANOVA, HIV patients had higher IMT than healthy controls and similar IMT to matched CAD patients (0.64±0.2 vs. 0.54±0.05 vs .0.66±0.08 mm respectively, F=4.2, p=0.01) and lower FMD than healthy controls but higher FMD than matched CAD patients [5.5±2.8 vs. 7.0±3.7 vs. 2.8±2.7 % respectively, F=11.7, p=0.01]. HIV(+) patients on HAART [43 (70.5 %), treatment duration>12 months] had higher PWV values compared to naïve patients [8.3±1.5 vs 7.4±1.6 m/sec respectively, p =0.01)] but similar IMT and FMD values. In univariate regression analyses age, blood pressure, duration of HIV infection, HAART, BMI, cholesterol and triglycerides were associated with PWV and IMT (p < 0.05 for all associations). In multivariate regression analysis weighted for age, HAART and triglyceride levels were the most important predictors for increased PWV (regression coeficient b: 0.28 and b: 0.277, p<0.05) and diabetes, cholesterol and hypertension for increased IMT (b:0.61, b:0.39, b:0.41 respectively, p<0.01)
Conclusions: Compared to matched healthy subjects, HIV patients present an increased carotid intima media thickness, which is similar to that observed in matched CAD patients. Increased arterial stiffness is associated with antiretroviral treatment in HIV-infected patients.