Abstract
Background: People with HIV have an increased risk for developing atherosclerosis. The objective of our study was to measure the prevalence of carotid ultrasound abnormalities in HIV-positive patients receiving antiretroviral therapy using routine carotid ultrasound. We examined the association between abnormal carotid ultrasounds and traditional cardiovascular and HIV-related risk factors. Methods: A cross-sectional study was carried out on male HIV-positive patients with low-to-moderate cardiovascular risk attending the HIV Metabolic Clinic in Vancouver, British Columbia (BC). Carotid ultrasounds were performed between January 1, 2002 and June 30, 2012, and this information was used to establish patients overall cardiovascular risk. Patient's charts were reviewed to obtain clinical data for traditional and HIV-related risk factors. Antiretroviral treatment information was obtained from the provincial Drug Treatment Program (DTP) data-base. An abnormal carotid ultrasound was defined by the presence of carotid plaque(s) and was used as a surrogate marker for atherosclerotic cardiovascular disease. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation. Results: A total of 175 patients receiving antiretroviral therapy since 1996 were analyzed. The prevalence of carotid ultrasound abnormality was 47%. By multivariable analysis, the factors associated with carotid ultrasound abnormality included having history of high blood pressure (odds ratio 2.68, 95% confidence interval (CI): 1.17, 6.13) and a history of intravenous drug use (OR: 4.55, 95% CI: 1.40, 14.79). The odds ratios of carotid ultrasound abnormality for patients 46-55 years and ≥56 years old compared to ≤45 years old were 2.57 (95% CI: 1.08, 6.14) and 5.16 (95% CI: 2.02, 13.19), respectively. For every additional year on antiretroviral therapy, the odds ratio of abnormal carotid ultrasound increased by 1.10 (95% CI: 1.01, 1.19). Conclusion: Our study suggests that HIV-positive patients assessed as having low cardiovascular risk have a high prevalence of atherosclerotic vascular disease at younger ages. Some traditional factors and longer exposure to ARV's were associated with carotid ultrasound abnormalities.
Highlights
The introduction of highly active antiretroviral therapy (HAART) significantly improved the prognosis of people living with HIV [1]
Traditional risk factors such as hypertension, diabetes mellitus, dyslipidemia and smoking are highly prevalent among HIV-positive patients [4,5,6], which partly may explain the high rate of cardiovascular disease in this population
Another explanation relates to the fact that HAART may induce metabolic and anthropometric changes, which are risk factors for atherosclerotic cardiovascular disease [7,8]
Summary
The introduction of highly active antiretroviral therapy (HAART) significantly improved the prognosis of people living with HIV [1]. As HIV-positive patients are living longer, it is becoming evident that this population has a greater prevalence of atherosclerotic cardiovascular disease than the general population [2,3] Traditional risk factors such as hypertension, diabetes mellitus, dyslipidemia and smoking are highly prevalent among HIV-positive patients [4,5,6], which partly may explain the high rate of cardiovascular disease in this population. Another explanation relates to the fact that HAART may induce metabolic and anthropometric changes, which are risk factors for atherosclerotic cardiovascular disease [7,8]. We examined the association between abnormal carotid ultrasounds and traditional cardiovascular and HIV-related risk factors
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