302 Impact of a systematic cardiovascular examination in HIV+ and AIDS patients

Abstract

HIV + patients have seen their survival improve with the emergence of poly antiviral therapies. However, it was recently shown that these therapies had an impact on lipid metabolism. We therefore wanted to determine what could be the impact of cardiological care systematically in this population. We have systematically proposed to all HIV + patients to go to a cardiological consultation followed by biological analysis, echocardiography, cervical Doppler with intima media measurement. Depending on the clinical and biological data it was then proposed diagnostic tests as arterial doppler of lower limbs and stress test. We then compared these data with those of literature studies on comparable populations in terms of age and sex. Of 97 patients regularly followed 77 were seen in consultation. The average age of our cohort was 49.05 5 years. 74% are active smoking on average at 15 PY, 54% are overweight (77.7 kg to 1.71 cm on average). The hip measurement is 97.3 cm. 15% have clinical lipodystrophies. 32% have hypertension (defined as PA> 140/95 on two occasions). 67% had dyslipidemia. The intima media thickness is 0.81 (Left) and right 0.82 mm for a standard 0.73 mm in our test cohort (p <0.05) and 0.75 mm as the threshold cut off in Canadian studies (p <0.05). The echocardiography proved normal in 80% of patients and in 100% of patients with BNP levels <30 pg / ml. After one year follow-up we found a lower limbs arteriopathy in 13% and an ischemic heart disease in 11% of patients which is significantly higher than expected and reported in literature. It seems appropriate to be able to propose to HIV + patients a cardiovascular consultation in view of their specific risk profile, due to a non detection of almost 24% of patients with atherosclerosis and of the increase of intima media size. However, echocardiography should not be systematic.