Abstract
BackgroundPsychological factors are known predictors of cardiovascular disease in many clinical settings, but data are lacking for HIV infection. We carried out a prospective cohort study to evaluate potential psychological predictors of preclinical and clinical vascular disease in HIV patients.Methodology/Principal FindingsHIV patients were consecutively enrolled. Demographics, viral and immune parameters and traditional cardiovascular predictors were considered; Intima-Media Thickness (c-IMT, continuous measure) and Carotid Plaques (CPs, focal thickening ≥1.5 mm) were investigated by B-mode ultrasonography; depressive symptoms by the Beck Depression Inventory (BDI-II), Type D personality (Distressed Personality or Type D) by the DS14, alexithymia by the Toronto Alexithymia Scale (TAS-20). Vascular outcomes included transient ischemic attacks or stroke, acute coronary syndrome, myocardial or other organ infarction. We enrolled 232 HIV subjects, 73.9% males, aged 44.5±9.9 y, 38.2% with AIDS diagnosis, 18.3% untreated. Mean Nadir CD4 T-cell counts were 237.5±186.2/mmc. Of them, 224 (96.5%) attended IMT measurements; 201 (86.6%) attended both IMT assessment and psychological profiling. Mean follow-up was 782±308 days. Fifty-nine patients (29.4%) had CPs at baseline. Nineteen patients (9.5%) had ≥1 vascular event; 12 (6.0%) died due to such events (n = 4) or any cause. At baseline cross-sectional multivariate analysis, increasing age, total cholesterol, current smoking and Alexithymia score≥50 were significantly associated with both increased cIMT (linear regression) and CPs (logistic regression). At follow-up analysis, log-rank tests and Cox’s regression revealed that only older age (p = 0.001), current smoking (p = 0.019) and alexithymia score≥50 (p = 0.013) were independently associated with vascular events.Conclusions/SignificanceIn HIV-infected subjects, the Alexithymic trait emerges as a strong predictor of increased IMT, presence of CPs and vascular events. Such results are preliminary and require confirmation from studies with larger sample size and longer follow-up.
Highlights
HIV-infected individuals are known to be at higher risk of cardiovascular disease (CVD) than the general population [1,2]
Eight patients were excluded due to linguistic barriers; 11 patients were not included as they reported previous cardiovascular events; a priori refusal of the initial interview was expressed by 17 patients
Despite an association between CVD and depression was repeatedly documented, and several studies showed a role of immune parameters in such a relationship, making its investigation interesting in the setting of HIV infection [49,50], we observed a possible association between higher depression scores and the presence of Carotid Plaque(s) (CPs) in univariate models, but failed to demonstrate an independent association when contextually evaluating the other psychological constructs
Summary
HIV-infected individuals are known to be at higher risk of cardiovascular disease (CVD) than the general population [1,2]. Psychological factors may be related to atherosclerosis and other vascular events through their association with behavioral risk factors, such as smoking, physical activity, diet and abdominal obesity [22,23]. They may directly affect biological processes by multiple pathways, such as inflammation [24], cardiovascular reactivity [25], endothelial injury [26,27], platelet activation [28,29] and autonomic dysfunction [30,31], whereby psychological factors may play both a primary and a secondary pathogenetic role [32]. We carried out a prospective cohort study to evaluate potential psychological predictors of preclinical and clinical vascular disease in HIV patients
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