Progression of Atherosclerosis as Assessed by Carotid Intima-Media Thickness in Patients With HIV Infection

Abstract

Background— HIV-infected patients may be at increased risk for coronary events. The purpose of this study was to identify predictors of carotid intima-media thickness (IMT) in HIV patients at baseline and to measure IMT progression over 1 year. Methods and Results— We measured blood lipids, inflammatory markers, and IMT in 148 HIV-infected adults (mean age, 45±8 years) and in 63 age- and sex-matched HIV-uninfected control subjects. The mean duration of HIV infection was 11 years, and the median duration of protease inhibitor treatment was 3.3 years. Mean baseline IMT was 0.91±0.33 mm in HIV patients and 0.74±0.17 mm in control subjects ( P =0.0001). Multivariable predictors of baseline IMT in HIV patients were age ( P <0.001), LDL cholesterol ( P <0.001), cigarette pack-years ( P =0.005), Latino race ( P =0.062), and hypertension ( P =0.074). When the control group was added to the analysis, HIV infection was an independent predictor of IMT ( P =0.001). The rate of progression among the 121 HIV patients with a repeated IMT measurement at 1 year was 0.074±0.13 mm, compared with −0.006±0.05 mm in 27 control subjects ( P =0.002). Age ( P <0.001), Latino race ( P =0.02), and nadir CD4 count ≤200 ( P =0.082) were multivariable predictors of IMT progression. Conclusions— Carotid IMT is higher in HIV patients than in age-matched control subjects and progresses much more rapidly than previously reported rates in non-HIV cohorts. In HIV patients, carotid IMT is associated with classic coronary risk factors and with nadir CD4 count ≤200, suggesting that immunodeficiency and traditional coronary risk factors may contribute to atherosclerosis.