Abstract
BackgroundCardiovascular diseases (CVD) are a major cause of death in people with AIDS. Factors contributing to atherosclerosis include traditional risk factors, antiretrovirals and inflammatory factors related to HIV infection. This study set out to compare risk factors associated with subclinical atherosclerosis in individuals under and over 40 years of age.MethodsCase–control study with 697 HIV/AIDS individuals without HAART or who remain on their first antiretroviral regimen. Of the total, 351 individuals under 40 years and 346 over 40 years were analyzed separately. Subclinical atherosclerosis was assessed by carotid intima-media thickness, using B-mode ultrasound. Multivariate logistic regression was performed to find predictors of subclinical atherosclerosis in the entire group. Subsequent analysis excluded patients with major risk factors for CVD. Magnitudes of associations were expressed by odds ratio (OR) statistical significance, using a 95% confidence interval and p-value <0.05.ResultsIn the <40 years group subclinical atherosclerosis was associated with male gender (OR: 2.77, 95% CI: 1.43–5.34), nonwhite race (OR: 3.01, 95% CI: 1.23-6.53), obesity (OR: 5.13, 95% CI: 1.79–14.7) and metabolic syndrome (OR: 3.30, 95% CI: 1.44–7.58). In the group ≥40 years predictors of subclinical atherosclerosis were overweight and obesity (OR = 2.53, 95% CI, 0.85–7.54), current CD4 ≥350 cells/mL (OR: 2.81, 95% CI: 1.22–6.47) and NNRTI use ≥ 5 years (OR: 2.65, 95% CI: 1.10-6.37) or PI use >5 years (OR: 1.81, 95% CI: 0.38-8.59). In the multivariate model excluding patients with major risk factors for CVD, age, male sex and nonwhite race were associated with subclinical atherosclerosis in the <40 y group, while in the ≥40 y group, age, HIV viral load >10,000 copies and the use of NNRTI (OR: 7.60, 95% CI: 1.61-35.8) or PI ≥5 years (OR: 3.62, 95% CI: 0.48-26.8) were associated with subclinical atherosclerosis.ConclusionsIn young people the fight against obesity and metabolic syndrome is the main aim in the prevention of CVD. In individuals aged ≥40 y, the prevention of obesity is also of great importance. Moreover, the effects of uncontrolled viremia and the prolonged use of HAART appear to be more harmful in the older group.
Highlights
Cardiovascular diseases (CVD) are a major cause of death in people with AIDS
We measured the frequencies of subclinical atherosclerosis and sex, race, schooling, stable partner, traditional risk factors for coronary heart disease (CHD) (smoking, family history of early CHD, arterial hypertension defined according to VIIJC [14], hyperglycemia, metabolic syndrome, hypercholesterolemia (≥ 240 mg/ dL), low high density lipoprotein (HDL)-C (< 40 mg/dL in men and < 45 mg/dL in women) and increased low density lipoprotein (LDL)-C (≥ 130 mg/dL), lipodystrophy, hypertriglyceridemia (≥ 150 mg/dL), alcohol use, drug use, as well as the frequency of factors related to human immunodeficiency virus (HIV)/AIDS/HAART
The results of the multivariate Model A demonstrated that, in the
Summary
Cardiovascular diseases (CVD) are a major cause of death in people with AIDS. Factors contributing to atherosclerosis include traditional risk factors, antiretrovirals and inflammatory factors related to HIV infection. While the association of atherosclerosis and CHD in itself involves a complex inflammatory process, the acquisition of chronic infection with human immunodeficiency virus (HIV) in the same individual adds further complexity to this process. Factors potentially contributing to this increased risk include traditional CHD risk factors and antiretroviral medications, more recent data support a role for inflammatory and immunologic factors as central to a complex mechanism [8]. Decreasing CHD risk among HIV-infected patients is likely to involve the modification of inflammatory and immunologic factors through antiretroviral therapy or other novel strategies, as well as the targeted treatment of traditional CHD risk factors [8,9,10]
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