Peripheral arterial disease in antiretroviral therapy naive HIV infected patients - A single centre case control study from Eastern India

Background and Objectives: Human immunodeficiency virus (HIV)-induced endothelial dysfunction leads to premature atherosclerosis, which may manifest as peripheral arterial disease (PAD) of the lower limbs. Studies are not available on the prevalence of PAD among antiretroviral therapy (ART)-naive HIV-infected population. The objective was to explore the prevalence of PAD among HIV seropositive cases and to determine the relation of PAD with HIV infectivity and with CD4 count. Materials and Methods: This hospital-based case-control study included 100 newly diagnosed HIV seropositive ART naive cases (age 20-49 years) and 100 HIV seronegative frequency or group matched controls. Demographic, clinical and routine laboratory parameters, and ankle-brachial pressure index (ABI) were studied. PAD was diagnosed by Doppler study of lower limb arteries. Results: The prevalence of PAD was significantly more among HIV-infected cases (71%) in comparison to HIV-negative controls (P < 0.001). Abnormalities in ABI were present among 75% (53/71) of total PAD cases in our study. Among the cases of PAD, 53% (38/71) patients were asymptomatic. The mean CD4 count among the HIV-positive PAD cases was 220 cells/dl. HIV seropositivity was found to be significantly associated with the development of PAD. Male gender, concurrent tuberculosis, and low CD4 count came out to be individually associated with PAD among HIV seropositive cases in multivariate analysis. Conclusions: The prevalence of symptomatic and asymptomatic PAD was high among ART-naive HIV-infected cases of relatively younger age group. Future studies should validate the Doppler findings suggestive of PAD among HIV seropositive patients with different inflammatory markers. Prospective studies on Doppler evaluation of endothelial dysfunction among asymptomatic HIV patients should be undertaken to establish or disprove the role of ART.