7th Conference - Abstract 30

Noninvasive Morphological Analysis of Carotid and Femoral Arteries in Protease-Inhibitor-Treated HIV-Infected Individuals

M. DEPAIRON, S. CHESSEX*, A. TELENTI, P. SUDRE, J. P. CHAVE, R. DARIOLI, and V. MOOSER. Ctr. Hosp. Univ. Vaudois, Lausanne, Switzerland

The elevation in plasma lipid levels induced by protease inhibitors (PI) raises some major concern regarding the potential long-term cardiovascular toxicity of this type of therapy. Coronary vessels are not amenable to direct visualization. However, the presence of plaques and thickening of peripheral arteries can be used as surrogate markers for coronary artery lesions. Here, we performed a non-invasive analysis of both femoral and carotid arteries using high-resolution B-mode ultrasound imaging in 131 HIV-infected individuals aged 30 to 50 years (97M/34F, aged 39.2+/-0.5 years, mean+/-SEM) who had received PI-therapy for 27+/- 0.7 months (range 6-45 months). These subjects were compared to 20 nonPI-treated HIV-infected subjects (13M/7F, aged 39.4+/-1.4 years). Both groups were well-matched for the presence of smoking, obesity, positive family history and high blood pressure. The number of CD4 cells was higher in nonPI-treated subjects (341+/-40 cells/mm3 vs 217+/-12 cells/mm3, p = 0.06). Compared to nonPI-treated individuals, PI-treated subjects had higher plasma levels of total cholesterol (6.7+/-0.1 mmol/L vs 5.3+/-0.3 mmol/L, p < 0.01), LDL-cholesterol (4.2+/-0.1 mmol/L vs 3.4 +/-0.3 mmol/L, p < 0.05), triglycerides [2.2 mmol/L (median), vs 1.5 mmol/L, p < 0.05] and Lp(a) [9.9 mg/dL (median), vs 7.9 mg/dL, NS]. Plaques (defined as an intima-media thickness > 1.2 mm at any of the four sites examined) were observed in 74/131 PI-treated subjects (56%) and 9/20 nonPI-treated subjects (45%, NS). Multivariate logistic regression analysis identified age (p < 0.01) and cigarette smoking (p < 0.01), but not PI-therapy, as factors independently associated with the presence of plaques. In conclusion, this ongoing study reveals a high prevalence of plaques within femoral and carotid arteries in HIV-infected subjects. However, this prevalence does not seem to be increased by PIs. Duration of PI-therapy was short, however, and long-term follow-up of this cohort will be of importance.

Key Words: Atherosclerosis, Hyperlipidemia, Protease inhibitor