871    

Background:  An increased cardiovascular risk has been suggested in HIV-infected patients since the availability of highly active antiretroviral therapy (HAART). We wanted to evaluate the change in carotid intima-media thickness (IMT), a reliable marker of atherosclerosis, during a 36-month period in a cohort of HIV-infected patients.

Methods:  Patients were included successively from the Aquitaine cohort if they were seen in 1 of the 5 participating centers in Bordeaux, France, from September 1999 to April 2003. IMT evaluation was performed by B-mode ultrasonography at 3 planned visits:  at month 0 (baseline) and 12 months and 36 months later.

Results:  A total of 233 patients were included in the study with a median age of 44 years at baseline (interquartile range [IR] = 39 to 50), 57 (25%) were women, 138 (59%) were current smokers, and 74 (32%) at the AIDS stage. Of the total, 200 patients were treated by a HAART regimen, including a protease inhibitor (PI) for 55%. During the first 12 months, 16 patients were newly treated by statins (n = 8) or fibrates (n = 8) in relation to their dyslipidemia; 42 had their ART regimen changed to stop the PI; and 10 patients stopped smoking. During this period, serum triglycerides, HDL, and total cholesterol levels remained stable overall (p = 0.24, 0.75 and 0.78, respectively). Conversely, the IMT increased from 0.55 to 0.57 mm (p < 10^–4). In the following 24-month period, 52 patients switched from a PI-containing regimen to PI-free regimens, 30 patients were newly treated with anti-lipid drugs, and 14 stopped smoking, resulting in a point prevalence at month 36 of 17% for patients treated with fibrates or statins, 60% for PI-free ART and 51% for current smokers. During the same 2-year period, there was a significant decrease of total cholesterol (p < 10^–4), LDL cholesterol (p = 0.05), and median IMT, from 0.57 to 0.53 mm (p < 10^–4). In unadjusted analyses, there was a single significant association between smoking cessation and IMT decrease (p < 0.05) but this association disappeared after adjustment (p = 0.45).

Conclusions:  The potential beneficial consequences of interventions for cardiovascular risk prevention must be confirmed in larger study populations with clinical outcomes. The potential effect of smoking cessation in particular should encourage its active promotion in HIV medicine.

Keywords: intima media thickness; atherosclerosis; cardiovascular risk