Carotid Intima-Media Thickness and Arterial Stiffness in HIV-Infected Patients: The Role of HIV, Antiretroviral Therapy, and Lipodystrophy

Abstract

Objectives: HIV-infected patients using combination antiretroviral therapy (ART) have an increased cardiovascular risk. We aimed to identify the effects of HIV, ART, and lipodystrophy (LD) on carotid artery intima-media thickness (C-IMT), a surrogate measure of atherosclerosis, and arterial stiffness, a marker of cardiovascular risk. Design: Case-control study of 77 HIV-infected men (55 exposed to ART, 22 ART naive, and 23 with LD) and 52 controls. Methods: C-IMT was measured ultrasonically, and arterial stiffness was estimated by distensibility (DC) and compliance (CC) coefficients of the carotid, femoral, and brachial arteries, by the carotid Young elastic modulus and pulse wave velocity. Results: After adjustment for cardiovascular risk factors, HIV-infected patients had a 0.067 mm (10.8%) greater C-IMT than controls, 13.6% and 29.5% lower DC, and 14.1% and 31% lower CC of the carotid and femoral arteries, respectively, but similar Young elastic modulus and pulse wave velocity. Patients exposed to ART had similar C-IMT compared with ART-naive patients but 25.9% lower DC and 21.7% lower CC of the femoral artery. Arterial properties did not differ between patients with and without LD. Conclusions: HIV infection is independently associated with C-IMT and generally increased arterial stiffness. ART use is associated with increased stiffness of the femoral artery.