Abstract 3901: Young Patients Infected with Human Immunodeficiency Virus Have Increased Prevalence of Peripheral Arterial Disease
Background: Human immunodeficiency virus (HIV) is associated with accelerated atherosclerosis and vasculopathy. Highly active antiretroviral therapy (HAART) has improved the survival of HIV-infected patients but increased their risk for atherosclerosis and cardiovascular events (CVE). The aim of this study was to determine the prevalence of peripheral arterial disease (PAD) in an urban, HIV-infected population and identify an association with unique and known cardiac risk factors.
Methods: We performed a prospective, cross sectional study. To identify the prevalence of PAD, ankle-brachial indices (ABIs) were measured using either the highest or lowest dorsalis pedis (DP) or posterior tibial (PT) artery pressure or the PT pressure alone. Four ABI categories were defined: ≤0.90 (abnormal), 0.91–0.99 (previously normal but now associated with an increased CVE rate), 1.00–1.30 (normal), and >1.30 (calcified blood vessels and associated with an increased CVE rate). Medical history and laboratory profiles were obtained including C-reactive protein, homocysteine, D-Dimer, and fibrinogen.
Results: In 102 patients (male/female: 58/44, mean age: 48 years old), the prevalence of PAD is shown below (Table⇓). Using conventional ABI (highest ankle pressure) measurements, menopause was an independent risk factor for ABIs: 0.91–0.99 (p=0.03). Male sex was an independent risk factor for ABIs: >1.30 (p=0.03). Compared to patients with normal ABIs: 1.00–1.30, patients with ABIs: 0.91–0.99 and >1.30 had significantly elevated plasma homocysteine levels (9.7 ± 3.4 μmol/l vs. 12.7 ± 5.0 μmol/l, p<0.02; and 9.7 ± 3.4 μmol/l vs. 14.3 ± 6.4 μmol/l, p<0.0003; respectively).
Conclusions: HIV-infected patients have a high prevalence of PAD. Menopause, male sex, and elevated plasma homocysteine levels are associated with abnormal ABIs. This is the first study to report the prevalence of PAD in HIV-infected patients and suggests that screening may be warranted.