HIV infection is associated with an increased risk of hardening of the arteries, researchers in the online edition of Clínica de Infectious Diseases. The North American study compared the changes in thickness in the carotid artery and the new formation of plaques between HIV positive and negative both in men and women with similar demographic characteristics and similar cardiovascular risk factors.
In general, HIV infection was not associated with changes in carotid artery thickness. However, people with HIV were more likely to have new plaque formation, even when their viral load is undetectable.
"We have shown that HIV-infected women like men had a 61% higher risk of forming new plaque in the focal carotid artery over seven years, compared to uninfected controls," comment the researchers. “The HIV-associated risk was greater than that associated with smoking. On the other hand, the high risk persisted among individuals treated with ART [antiretroviral therapy] - with persistent viral suppression of HIV, suggesting that sustained suppression of HIV RNA circulating below detectable limits does not eliminate excess CVD [risk of disease treatment] in HIV-infected population treatment. ”
More fortunately, people living with HIV whose CD4 cell count was above 500 cells / mm3, had a similar risk of new plaque formation in HIV-negative individuals.
Cardiovascular disease is now an important cause of morbidity and mortality in people with HIV. Researchers in the United States wanted to see if HIV was associated with the progression of subclinical arteriosclerosis - hardening of the arteries - over a seven-year follow-up period.
The study population consisted of 1011 women (74% HIV positive) enrolled in the Interdepartmental Women's HIV Study and approximately 811 men (65% HIV positive) in the multicenter AIDS Study Cohort Study. All had repeat carotid artery ultrasound investigations - thickness and new plaque formation - between the years 2003 and 2013. Two thirds of women with HIV and three quarters of men with HIV were taking ART.
Changes in carotid artery thickness do not differ according to the condition of HIV carriers in men or women. Factors associated with further thickening were black and Hispanic ethnicity and crack / cocaine use. Use of antihypertensive medications was associated with a reduction in carotid thickness.
The prevalence of carotid arteriosclerosis arterial plaques increased by 8 to 15% in women and 25 to 34% of men during the follow-up period. In general, people living with HIV were 61% more likely to experience new plaque formation compared to HIV negative individuals (OR = 1,61; 95% CI 1,12 -2,32). The association between HIV infection and plaque formation was present in both men and women.
Current smoking increased the risk of new plaque build-up by 42%. Other risk factors were higher total cholesterol and increasing age.
The researchers identified 199 people with HIV who were carrying art, with persistent viral suppression (16% of women with HIV; 29% of men with HIV). These patients had an increased risk of new plaque formation compared to HIV-negative group patients (RAR = 1,77; 95% CI 1,13 -2,77).
“Our finding that participants who remained suppressed by HIV still had an increased risk of new focal plaque formation suggests that surveillance for long-term adverse consequences of art remains warranted for all individuals infected with the HIV virus , ”Write the authors.
The relationship between immune status and plaque formation was then analyzed.
People living with HIV and who had a CD4 cell count line above 500 cells / mm3, had a comparable risk of new plaque formation for HIV-negative controls. The highest risk of new plaque build-up was seen in people with HIV who had a CD4 cell count below 200 cells / mm3 (RAR = 2,57; 95% CI 1,48 -4,46).
Longer duration of protease inhibitor therapy was a risk factor for plaque buildup among men with HIV (RAR = 1,12 per year of cumulative use; 95% CI, 1,01 -1.25) but not women with HIV .
“Our previous data support ART beginning, before CD 4 will decrease, which can mitigate HIV-associated cardiovascular risks,” conclude the authors. "A better understanding of these processes is needed, both to prevent or delay CVD development and strategies to improve treatment outcomes with the growing and increasingly older HIV-infected population."
Translated from the original English into Portuguese of Brazil By Cláudio Santos de Souza
The Original in English was published 06 May 2015 by Michel Carter
Hanna DB et al. HIV infection is associated with the progression of subclinical carotid arteriosclerosis. Clin infect Dis, online edition, by 2015