Carotid Intima Media-Carotideo

ABC

Editorial

Frequency of Subclinical Atherosclerosis in HIV-infected Brazilians

The advances in the treatment of the Human Immunodeficiency Virus (HIV) infection have resulted in a significant reduction in the mortality related to the acquired immunodeficiency syndrome (AIDS). Most patients get infected between the ages of 19 and 39 years, receive medicines from the time of diagnosis onward, with no perspective of interruption. In the follow-up of those patients, chronic non-infectious diseases related to several risk factors, such as age and cardiovascular disease, emerge. Some studies have shown the direct action of the HIV on the vascular endothelium (chronic inflammatory process), in addition to the action of the antiretroviral therapy (ART) on the lipid metabolism.

The incidence of cardiovascular events among HIV-infected patients is low, being, thus, difficult to assess. Subclinical atherosclerosis is associated with an increased risk for events in the general population. It can be detected by use of non-invasive methods, such as carotid ultrasound, aimed at measuring the intimal medial thickness and at assessing the presence of atherosclerotic plaque, in addition to coronary computed tomography to calculate the calcium score. Coronary tomography angiography allows the assessment of the presence, composition and extension of coronary plaques, in addition to detecting stenosis.

[…]

Read Full Article

ABC

Original Article

Frequency of Subclinical Atherosclerosis in Brazilian HIV-Infected Patients

Péricles Sidnei Salmazo et al. Silméia Garcia Zanati Bazan Flávio Gobbis Shiraishi Rodrigo Bazan … Katashi Okoshi João Carlos Hueb

Abstract

Background:

AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated with increased number of cardiovascular events in this population, and this association is not fully understood.

Objectives:

To identify the frequency of subclinical atherosclerosis in HIV-infected patients compared to control subjects; to analyze associations between atherosclerosis and clinical and laboratory variables, cardiovascular risk factors, and the Framingham coronary heart disease risk score (FCRS).

Methods:

Prospective cross-sectional case-control study assessing the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 controls. Clinical evaluation included ultrasound examination of the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), laboratory analysis of peripheral blood, and cardiovascular risk according to FCRS criteria. The significance level adopted in the statistical analysis was p < 0.05.

Results:

Plaques were found in 37% of the HIV group and 4% of controls (p < 0.001). Furthermore, carotid intima-media thickness was higher in the HIV group than in controls (p < 0.001). Patients with carotid plaque had higher fasting glucose, total cholesterol, low-density lipoprotein cholesterol, and triglycerides than those without plaques. The presence of HIV, adjusted for age, overweight/obesity, and smoking increased by almost fivefold the risk of atherosclerotic carotid plaque (OR: 4.9; 95%CI: 2.5-9.9; p < 0.001). Exposure to protease inhibitors did not influence carotid intima-media thickness, was not associated with carotid plaque frequency, and did not alter the mechanical characteristics of the arterial system (PWV and AIx).

Conclusions:

HIV-infected patients are at increased risk of atherosclerosis in association with classical cardiovascular risk factors. Treatment with protease inhibitors does not promote functional changes in the arteries, and shows no association with increased frequency of atherosclerotic plaques in carotid arteries. The FCRS may be inappropriate for this population.