Carotid Intima-Media Thickness in African Patients with Critical Lower Limb Ischemia Infected with the Human Immunodeficiency Virus

Martin V

doi:10.4172/2155-6113.1000167

Abstract

Background: The extent to which Human Immunodeficiency Virus (HIV) is associated with increases in carotid Intima-Media Thickness (IMT) independent of conventional cardiovascular risk factors is unclear. Hence, we evaluated whether independent of conventional risk factors, an increased carotid IMT occurs in African HIV infected patients with chronic Critical Limb Ischemia (CLI). Methods: Carotid IMT was measured in 217 sequentially recruited patients with CLI, 25 of whom were HIV positive and in 430 randomly selected controls from a community sample. Results: As compared to HIV negative patients with CLI, HIV positive patients were younger (49 ± 10 vs. 64 ± 11 years, p<0.0001) and had a markedly lower prevalence of hypertension and diabetes mellitus (p<0.0001), but a similar proportion of patients smoked (76% vs 67%). However, as compared to patients with CLI who were HIV negative, HIV positive patients had a similar increase in carotid IMT (HIV positive= 0.75 ± 0.14 mm; HIV negative= 0.79 ± 0.14 mm; Controls= 0.64 ± 0.15, p < 0.0001 versus Controls) even after adjustments for age, sex and conventional risk factors (HIV positive= 0.75 ± 0.13 mm; HIV negative=0.73 ± 0.15 mm, Controls=0.66 ± 0.15, p < 0.005). IMT was similarly increased in HIV positive patients with CLI as compared to controls when assessed in men, smokers, and black African patients only (p < 0.05-0.0001), or in those who were receiving highly active antiretroviral therapy (n=12, 0.74 ± 0.10 mm) as compared to those not receiving therapy (0.75 ± 0.15 mm). As compared to controls, the age- sex- and conventional risk factor-adjusted odds of having an IMT ≥ 0.8 mm was similarly increased in patients with CLI who were HIV positive (odds ratio= 8.89, CI= 2.79-28.32, p= 0.0002) as those who were HIV negative (odds ratio= 2.70 CI= 1.51-4.81, p < 0.001). Conclusion: These results suggest that despite being of a younger age, with or without conventional risk factor adjustments, marked increases in carotid IMT in HIV in Africa are a risk factor for CLI.

Highlights

There is increasing evidence that infection with Human Immunodeficiency Virus (HIV) is associated with occlusive arterial disease including myocardial infarction [1,2,3] and Peripheral Arterial Disease (PAD) [4,5]
The measurement of carotid Intima-Media Thickness (IMT) may be useful at predicting cardiovascular risk beyond conventional risk factors in HIV infected patients
There is considerable uncertainty as to whether increases in carotid IMT occur in HIV independent of conventional risk factors

Summary

Introduction

There is increasing evidence that infection with Human Immunodeficiency Virus (HIV) is associated with occlusive arterial disease including myocardial infarction [1,2,3] and Peripheral Arterial Disease (PAD) [4,5]. The consequence may be endothelial dysfunction [7], and an enhanced degree of subclinical atherosclerosis as indexed by increases in carotid Intima-Media Thickness (IMT) [7,8,9]. Increases in carotid IMT in HIV infected patients may index the degree of atherosclerosis, and alternative large artery phenotypes [16]. There is considerable uncertainty as to whether increases in carotid IMT occur in HIV independent of conventional risk factors. The extent to which Human Immunodeficiency Virus (HIV) is associated with increases in carotid Intima-Media Thickness (IMT) independent of conventional cardiovascular risk factors is unclear. We evaluated whether independent of conventional risk factors, an increased carotid IMT occurs in African HIV infected patients with chronic Critical Limb Ischemia (CLI)

Objectives

Methods

Results