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Background:  In previous reports within the PREVALEAT study (premature vascular lesions and ART), a higher than expected prevalence of premature carotid lesions was observed in HIV-1-infected patients treated with PI-including regimens compared to naive or NNRTI-treated patients with color doppler ultrasonograpy of the epiaortic vessels. In the present study, to obtain data on the evolution of the lesions, a subgroup of these pts was followed for a period of at least two years from the start of therapy.

Methods:  The group included 102 HIV-1-positive patients subjected to first line treatment, 51 of whom were being treated with PI-based regimens (group A) and another 51 with NNRTI-based regimens (group B). The patients were submitted to an initial color doppler ultrasonography after at least 12 months of therapy and to a second doppler after a further 12 months. Intima characteristics, pulsation, and resistance indexes, minimal, peak and mean speed were evaluated. Atherosclerotic plaques were described.

Results:  In group A, at baseline, 29 patients (56.8%) were normal while 22 (43.2%) showed lesions of the epiaortic vessels. At follow-up, among the previously normal patients, 7 (24%) developed lesions while 14 (48.2%) remained normal. The remaining 8 (27.6%) shifted to other regimens. Among the previously pathologic patients, 11 (50%) showed worsening of the lesions, 2 (9%) were stable, and in 2 (9%) the lesions had disappeared. The remaining 7 (32%) shifted to other regimens. In group B, at baseline 44 (86.2%) were normal and 7 (13.8%) had lesions. At follow-up, among the previously normal patients, 6 (13.6%) developed lesions while 37 (84%) remained unaltered. One patient (2.4%) shifted to PI. Among the previously pathologic patients, 1 (14.3%) worsened, the lesions reversed in 2 (28.5%), the lesions remained stable in 3 (42.8%) and 1 patient (14.3%) shifted to PI. When comparing the patients developing lesions in the 2 groups, no significant difference was found (χ² = 2.75; p = 0.05), while in group A the percentage of patients who worsened was significantly higher (χ² = 5.61; p = 0.05).

Conclusions:  These data evidence a high rate of patients developing new lesions in both groups  although, the patients treated with PI-including regimens showed a faster aggravation of vessel wall lesions. Interestingly, a disappearance of lesions was detected in both groups; this phenomenon, warranting further investigation, could be interpreted as a tendency to damage regression almost in the premature phase.

Keywords: color doppler ultrasonography; carotid; protease inhibitors