Infection Sharply Increases Risk of Atherosclerosis, but Antiretroviral Therapy
Has a Minor Effect|
positive participants in the FRAM study had greater average intima-media thickness
-- an early indicator of atherosclerosis -- in 2 regions of the carotid artery,
even after adjusting for traditional cardiovascular risk factors, investigators
reported in the September
10, 2009 issue of AIDS.|
or loss of elasticity and build-up of plaque in the arteries, can restrict blood
supply to the heart, leading to myocardial infarction, and bits of plaque can
lodge in arteries in the brain, causing a stroke.
people with HIV live longer due to effective
combination antiretroviral therapy
disease has become an increasingly important cause of morbidity and mortality,
the study authors noted as background. But it remains controversial whether HIV
infection contributes to accelerated atherosclerosis independent of traditional
cardiovascular risk factors.
Grunfeld from the University of California at San Francisco and colleagues performed
a cross-sectional study of more than 400 HIV positive participants without pre-existing
cardiovascular disease in the FRAM (Fat
Redistribution and Metabolic
Change in HIV Infection) study, comparing them to HIV negative participants
in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort.
assessed preclinical atherosclerosis by measuring carotid intima-media thickness
(IMT), or thickness of the walls of the arteries in the neck that supply the brain.
They looked at IMT at 2 sites in the artery, known as the internal/bulb and common
intima-media thickness of the internal carotid was significantly greater in HIV
positive compared with HIV negative participants (1.17 vs 1.06 mm, respectively;
difference 0.11 mm; P < 0.0001). |
a multivariate analysis adjusting for demographic characteristics, the mean difference
in internal carotid IMT between HIV positive and HIV negative participants was
0.19 mm (P < 0.0001). |
further adjusting for traditional cardiovascular risk factors, the association
between HIV and carotid IMT was "modestly attenuated," but still significant
(0.15 mm; P = 0.0001). |
at the common carotid region, HIV infection was again independently associated
with greater intima-media thickness (0.03 mm; P = 0.005). |
association between HIV infection and intima-media thickness was similar to that
of smoking (internal carotid 0.17 mm, common carotid 0.02 mm). |
after adjustment for traditional cardiovascular disease risk factors, HIV infection
was accompanied by more extensive atherosclerosis measured by IMT," the investigators
concluded. "The association of HIV infection with IMT was similar to that
of traditional cardiovascular disease risk factors, such as smoking."
stronger association of HIV infection with IMT in the internal/bulb region compared
with the common carotid may explain previous discrepancies in the literature,"
impact of HIV infection on preclinical atherosclerosis overrides any small differences
related to antiretroviral therapy or specific drug classes, according to Grunfeld.
"The effect [of HIV] is so big that no drug or class of drugs stands out
as being an effective contributor," he said.
Service, Department of Veterans Affairs Medical Center, University of California,
San Francisco, CA.
Grunfeld, JA Delaney, C Wanke, and others. Preclinical atherosclerosis due to
HIV infection: carotid intima-medial thickness measurements from the FRAM study.
AIDS 23(14): 1841-1849. September 10, 2009. (Abstract).