Risk of cardiovascular disease in a cohort of HIV-Infected adults: A study using carotid intima-media thickness and coronary artery calcium score

Background. There is concern that human immunodeficiency virus (HIV) infection and the use of highly active antiretroviral therapy lead to accelerated atherosclerosis and increased risk of cardiovascular disease. We measured 2 surrogate markers of subclinical atherosclerosis, carotid intima-media thickness (c-IMT) and coronary artery calcium (CAC) scores, in HIV-infected adults. Methods. A cross-sectional analysis of 242 men and 85 women with HIV infection was used. Carotid ultrasonography and coronary computed tomography were performed, and their associations with cardiovascular risk factors were examined. Results. Among men, the mean (+/- standard deviation [SD]) common c-IMT was 0.62 +/- 0.2 mm, the mean (+/- SD) internal c-IMT was0.76 +/- 0.5 mm, and 136 patients (56.1%) had detectable CAC. Among women, the mean (+/- SD) common c-IMT was 0.59 +/- 0.02 mm, the mean (+/- SD) internal c-IMT was 0.66 +/- 0.4 mm, and 40 patients (47.1%) had detectable CAC. Neither the c-IMT nor the CAC score differed by antiretroviral therapy class or individual medications for either sex. For men, age and waist circumference independently predicted common c-IMT; age, systolic blood pressure, and high- sensitivity C-reactive protein level independently predicted internal c-IMT; and age, apolipoprotein B level, and high- sensitivity C-reactive protein level independently predicted CAC score. For women, age and body mass index independently predicted common c- IMT; age independently predicted internal c-IMT; and age and glucose level independently predicted CAC score. Conclusions. Our participants had more abnormal surrogate markers than expected at a relatively young age, but those were not associated with use of highly active antiretroviral therapy or protease inhibitors. At present, the positive associations were primarily with traditional and novel cardiovascular risk factors. Some HIV- specific (not treatment-specific) factors were observed; they may become more evident with prolonged HIV infection and treatment.