Background:  Studies linking HIV infection and cardiovascular disease have been confounded by the presence of traditional cardiovascular risk factors, ART, and variable duration of infection. Increased arterial stiffness is a marker of subclinical atherosclerosis and is predictive of cardiovascular events. We hypothesized that HIV⁺ women would exhibit greater arterial stiffness than HIV^– women.

Methods:  Central augmentation index (AI), central pulse pressure (PP), and peripheral AI were measured using applanation tonometry with a commercial pulse wave analysis system in 276 HIV⁺ and 67 HIV^– participants in the Rwandan Women's Interassociation Study and Assessment, a population-based observational cohort study. Radial artery pressure waveforms were recorded and central aortic waveforms were derived by a validated transfer function.

Results:  HIV⁺ participants were younger (35±7 vs 41±10 years, p <0.0001) and had lower diastolic blood pressure (71±8 vs 74±12 mmHg, p = 0.019); 41% of the HIV⁺ women were taking ART for a median duration of 10 months. Mean central AI was significantly lower in the HIV⁺ than in control participants (20.3±12.0 vs 25.5±12.1, p = 0.002). Peripheral AI was also lower in the HIV⁺ group (74.6±18.8 vs 83.7±20.0, p<0.001). After age matching, there were no significant differences in central AI, central PP, or peripheral AI between the groups. In stepwise regression analysis, age, body mass index, heart rate, central systolic blood pressure, and peripheral diastolic blood pressure were independently associated with central AI (r ² = 0.36, p <0.0001). Among HIV⁺ women, current CD4 count was not significantly correlated with central AI (r = –0.01, p = 0.84), central PP (r = 0.09, p = 0.16), or peripheral AI (r = –0.01, p = 0.83).

Conclusions:  HIV infection was not associated with increased arterial stiffness in the absence of prolonged ART or other cardiovascular risk factors. Whether long-term ART increases measures of arterial stiffness remains unknown.