Vascular dysfunction in HIV‐infected patients

Abstract

Atherosclerotic cardiovascular disease is an increasing concern for patients with human immunodeficiency virus (HIV) infection. We investigated carotid intima‐media thickness (IMT), flow‐mediated dilation (FMD), pulse wave velocity (PWV) and the augmentation index (AIx), evaluated as indices of subclinical atherosclerosis, in HIV‐infected patients compared to uninfected subjects. We enrolled 80 HIV‐infected patients, 68 of whom treated with combined antiretroviral therapy (cART) and 12 therapy‐naïve, matched with 82 healthy subjects for age, systolic and diastolic blood pressure. We investigated IMT, FMD, PWV, AIx, viro‐immunological parameters, inflammatory markers, microalbuminuria and other biochemical parameters. Compared with uninfected subjects, HIV‐infected subjects had higher IMT, PWV and AIx values (all P=0.0001); and lower FMD (P=0.001). In the HIV+ group, naïve patients had statistically lower levels of IMT (P=0.02), and AIx (P=0.042) and higher FMD (P=0.032) compared with cART‐treated patients. In the HIV+group, IMT values was significantly related to the number of CD4+ (r=−0.31, P=0.008) and CD8+ cells (r=0.261, P=0.025), interleukin‐6 (r=0.284, P=0.015) and endothelin‐1 (r=0.302, P=0.009). Vascular dysfunction evaluated as IMT, FMD and arterial stiffness is increased in HIV‐infected subjects than in healthy subjects. Furthermore, cART‐treated patients showed higher IMT and AIx and lower FMD values than naïve patients. Our data support the hypothesis that both HIV infection and cART treatment are risk factors for accelerated arteriosclerosis.