Abstract 19369: High Prevalence of Peripheral Arterial Disease in HIV-Infected Patients With Normal Resting Ankle Brachial Index Reading.
Introduction: Atherosclerosis affects HIV-infected patients more severely and at younger ages. Peripheral Arterial Disease (PAD) is an important marker of atherosclerosis, which is commonly under diagnosed. Resting Ankle Brachial Index (r-ABI) is frequently used to diagnose PAD and has been found to correlate well with arterial stenosis ≥ 50%. However, it may miss those patients with milder disease. Post exercise Ankle Systolic Pressure (e-ASP) and post exercise ABI (e-ABI) measurements are helpful in identifying these patients with mild PAD, but they have not been studied well in the HIV population .
Hypothesis: We assessed the hypothesis that PAD is common in asymptomatic HIV patients with normal r-ABI readings.
Methods: Between November 2009 and January 2010, we prospectively enrolled the HIV-patients who have normal r-ABI readings (0.9 to 1.4). All participants performed either Treadmill walking Test (TT) or Pedal Plantarflexion Test (PFT). E-ASP and e-ABI were measured in both legs and were compared to resting measurements, which were done just before exercising. We used the common post-exercise cutoff values to define PAD (A drop by >0.15 in e-ABI or ≥ 20 mmHg in e-ASP). Patients were divided into two groups: PAD and No-PAD group. The two groups were compared with regard to the traditional cardiovascular disease risk factors, HIV-infection parameters, history of hepatitis, Intravenous Drug Use and Framingham Risk Score .
Results: 113 consecutive HIV-patients were included in the study (39% females). PAD was present in 30 subjects (26.5%), of whom 73% had no symptoms of intermittent claudication. Mean age was 46.7±10.2. Mean drop in e-ABI and e-ASP in legs with PAD were 0.22 ± 0.06 and 29±9 mmHg, respectively. The two groups did not differ significantly among the risk factors studied. Male gender was significantly associated with PAD. (RR:4.15; CI: 1.6 to 11.1: P<0.0008)
Conclusions: The prevalence of PAD, diagnosed by significant change in either e-ABI or e-ASP, in HIV-patients who have normal r-ABI measurement is high. Performing postexercise hemodynamic limb measurements (e-ABI and e-ASP) for HIV-males with normal r-ABI, regardless of the presence of PAD-symptoms, may help in identifying the high risk patients at earlier stages.
- © 2010 by American Heart Association, Inc.