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Diagnosis and Determinants of Subclinical Arterial Disease in HIV1-Infected Patients on HAART N. CHEMINOT1, J. GARIEPY2, G. CHIRONI2, L. ESCAUT1, D. VITTECOQ*1, and A. SIMON2.
1Unité des Maladies Infectieuses et Tropicales, Hôpital Paul Brousse, Villejuif, France; and 2Ctr. de Médecine Préventive CardioVasculaire, Hôpital Broussais, Paris, France. Background: Metabolic disorders (insulinoresistance, lipid abnormalities, lipodystrophy) are common events in HIV infected patients. Cases of premature myocardial infarction have been reported.
Aim : To assess carotid intima media thickness (IMT), a powerful surrogate for cardiovascular disease, in HIV infected patients receiving HAART, with at least one major cardiovascular risk factor (hypertension, hypercholesterolemia, hypoHDLemia, diabetes mellitus, abdominal adiposity or current smoking).
Method: Far wall IMT was measured in right common carotid. Blood pressure, lipids, fasting and post prandial glycemia and insulin,abdominal adiposity and smoking were evaluated.
Results: 36 HIV patients (83% male) were assessed, of whom 88% received protease inhibitors. HIV patients had higher IMT (0.53+/-0.09 mm, p=0.03) than healthy volunteers (employees of an insurance company) matched for age, sex, BMI and smoking (0.48+/-0.08 mm). P-values of univariate, age adjusted (*), and multivariate significant association of IMT are shown in infected patients group in the table.
age waist circumference Chol/HDL
Univariate 0.02 0.02* 0.01*
Multivariate 0.01 0.05 0.03
No significant association existed with other cardiovascular risk factors (including insulin and smoking) or with CD4 cell counts and viral load,or with type and duration of antiretroviral therapy.
Conclusion: We showed that an early carotid wall thickening is present in HAART exposed patients and mainly mediated by certain but not all metabolic disturbances of insulinoresistance.
Key Words: cardiovascular risk, HAART, lypodystrophy
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