Does non-protease inhibitor based anti-retroviral therapy modify peripheral arterial disease? A vision from eastern India

Abstract

AimAssess the effects of ART on PAD over a follow up period of 12 months. BackgroundHIV induced endothelial dysfunction may manifest as peripheral arterial disease (PAD). Reports of follow up study showing the change of PAD in people living with HIV before and after initiation of non-protease inhibitor based ART (NPI-ART) are scarce. Materials and methodsART clinic based longitudinal study conducted at a tertiary care hospital in eastern India, 193 consecutive ART eligible HIV positive subjects of age between 18–49 years underwent ankle brachial pressure index (ABPI) measurement before ART initiation and after one year of receiving NPI-ART to examine the effect of ART on PAD. ABPI values of 0.90 or less were defined as PAD. ResultsProportion of subjects with PAD among treatment naive subjects was 30.57%. It dropped to 12.95% after 6 months and to 3.62% after 1 year of NPI-ART. Not a single new case of PAD was diagnosed during the study period. Traits like normal BMI and no alcoholism were found to be independently associated with PAD in ART naïve subjects. Interestingly significant improvement of PAD was also seen among normal BMI subjects and never alcoholics (p<0.05). ABPI improvement was also significant among people who were asymptomatic, belonged to urban population and never used tobacco (p value <0.05). ConclusionPrevalence of PAD decreased significantly after one year of ART. Routine ABPI measurement and early initiation of NPI-ART reduced PAD morbidity and improved quality of life.