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Background:  Questions remain as to the estimate of atheromatous cardiovascular disease risk in HIV-infected patients and the means of to reduce it. It has been reported that among 102 HIV patients with lesions of the vascular wall, 52.7% had an increased median intima media thickness (1.2 mm) and a median percentage of stenosis of the vascular lumen estimated to 41.9%.

Methods:  In a single-center cross-sectionnal study, we investigated 152 successive HIV⁺ patients followed in the Aquitaine Cohort, southwestern France. We used the carotid echography upgraded with a plaque echogenicity and intima media thickness measure software. We collected clinical data, such as:  age, gender, body mass index, AIDS stage, smoking habits, alcohol consumption, arterial blood pressure, and cardiovascular disease history; echographic data:  prevalence of carotid atherosclerosis plaques, percentage of stenosis, intima media thickness, and PE; biological data:  total cholesterol, LDLc, HDLc, total cholesterol/HDL ratio, triglycerides, glycemia, CD4⁺ cell count, and viral load.

Results:  Mean age was 44.5 years (±8.7), 72.4% men, 30.9% AIDS stage, 55.9% active smokers, 6.6% increased blood pressure, 9.9% cardiovascular disease in the past. Lipodystrophy syndrome was found in 47.4% of cases with 55.6% of lipoatrophy. Mean body mass index was 22.7 kg/m² (±3.4). Patients treated by HAART were 79.7% with a mean viral load to 4.04 log₁₀ copies/mL (±4.57) (50.7% <50 copies/mL) and a CD4⁺ cell count to 508/mm³ (±338). Mean total cholesterol was 5.52 mmol/L (±1.28), LDL-c 3.22 mmol/L (±1.10), total cholesterol/HDL 4.42 (±1.17), triglycerides 2.37 mmol/L (±1.74). Median right intima media thickness was 0.53 mm (interquartile range [IR]:  0.39 to 0.85) and left intima media thickness was 0.54 mm (IR:  0.39 to 0.86). Prevalence of carotid atherosclerosis plaque was 17.1% (n = 26), 95% confidence interval (11.1 to 23.1). The mean percentage of stenosis was 24.2%. In the group presenting plaque, right intima media thickness was 0.60 mm compared with 0.53 mm without carotid atherosclerosis plaque (p = 0.004). Median echogenicity of plaques was 18.8 arbitrary units (IR:  5.21 to 60.3).

Conclusions:  Compared with the previous published data, our results show both a sharply lower prevalence of carotid atherosclerosis plaque and percentage of stenosis. We observe that carotid intima media thickness is well correlated with the carotid atherosclerosis plaque occuring (i.e. cardiovascular risk). Thus, carotid echography in search of carotid atherosclerosis plaque associated with intima media thickness measure is a safe, cheap and adapted investigation tool to estimate routinely the cardiovascular risk in HIV-treated patients.

Keywords: HIV; atheroslerosis; cardiovascular disease