Aortic stiffness aging is influenced by past profound immunodeficiency in HIV-infected individuals: results from the EVAS-HIV (EValuation of Aortic Stiffness in HIV-infected individuals)

Objective: We compared aortic stiffness between HIV-infected and HIV-uninfected individuals and examined the determinants of vascular aging during HIV infection. Methods: Aortic stiffness using carotid-femoral pulse wave velocity ( cf-PWV) was evaluated cross-sectionally between HIV-infected individuals and uninfected controls frequency-matched for age and sex, and longitudinally in a subgroup of HIV-infected individuals. Determinants of elevated cf-PWV levels were assessed using logistic regression. Changes in cf-PWV levels during follow-up ( mixed-effect linear regression) and risk factors for achieving cf-PWV below ( Group 1) or above the median ( Group 2) at last follow-up visit were evaluated only in HIV-infected individuals. Results: A total of 133 HIV-infected and 135 HIV-uninfected individuals ( mean age: 47.7 +/- 8.9 years, 91% men) were enrolled. Median cf-PWV at baseline was similar between HIV-infected individuals and controls [ 7.5 m/s ( interquartile range = 6.7-8.4) vs. 7.5 m/s ( interquartile range = 6.6-8.4), respectively; P = 0.64]. In multivariable analysis, only mean arterial pressure showed significant association with elevated cf-PWV in the overall population ( P = 0.036). In HIV-infected individuals, elevated cf-PWV was associated with current smoking ( P = 0.042), and nadir CD4(+) T-cell count less than 200 cells/mu l ( P = 0.048). Ninety-one HIV-infected individuals were followed for a mean 7.6 +/- 2.0 years. cf-PWV progression was associated with age ( P = 0.018), mean arterial pressure ( P = 0.020), and nadir CD4(+) T-cell count ( P = 0.005). Patients from Group 2 had higher baseline waist circumference, pulse pressure, and nadir CD4(+) T-cell count less than 200 cells/mu l. Conclusion: We observed no difference in aortic stiffness between HIV-infected and controls. Moreover, aortic stiffness aging was independently associated with past severe immunodeficiency, along with other traditional risk factors. Our results call for early antiretroviral initiation.