P5337Neutrophil-lymphocyte ratio and peripheral arterial disease in HIV infection

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Abstract Background/Introduction While antiretroviral therapy has increased survival in HIV-infected patients, cardiovascular mortality is now their leading cause of death. Together with a high prevalence of traditional cardiovascular risk factors in HIV infection, chronic inflammation may be also responsible of an increased risk of cardiovascular diseases. Purpose To determine the association between a systemic inflammation-based biomarker, the neutrophil-lymphocyte ratio, and the occurrence of peripheral arterial disease in HIV infected patients. Methods In a case-control design, 41 patients with peripheral arterial disease and HIV infection were compared to 119 patients with HIV infection but no peripheral arterial disease. All patients were recruited at a Regional Hospital. The ankle-brachial index was measured in all subjects and peripheral arterial disease was defined as an ankle-brachial index >0.9. The neutrophil-lymphocyte ratio was assessed using neutrophil and lymphocyte levels in the complete blood count measurement, from routine hemograms performed six to twelve months before measurement of the ankle-brachial index. The cut-off of neutrophil-lymphocyte ratio >2 was used to categorize patients into low- and high- neutrophil-lymphocyte ratio groups. Odds ratios (OR) with 95% confidence intervals were used to estimate the strength of association. In order to control for potential confounders, a multiple logistic regression model was used. Results There was a significant association between elevated neutrophil-lymphocyte ratio and the presence of peripheral arterial disease (OR 7.25 [3.32–15.85], after adjustment for age (OR 1.07 [1.04–1.11]), smoking index (OR 1.12 [1.02–1.24]. Other considered variables did not contribute to the model (HDL-cholesterol, LDL-cholesterol, triglycerides, sex, diabetes, obesity and treatment). Conclusions The ankle-brachial index is a simple, cost-effective and validated method to assess peripheral arterial disease, which its presence increases the risk of cardiovascular disease morbidity and mortality. The neutrophil-lymphocyte ratio is a simple, rapid and novel inflammation parameter, that may help to identify HIV-infected patients with a higher risk of peripheral arterial disease.