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Keywords:

  • atherosclerosis;
  • cardiovascular risk factors;
  • carotid arteries;
  • CD4;
  • HIV infection

Objectives

HIV-infected patients are at risk of atherosclerosis and cardiovascular diseases. In a 12-month follow-up study, we aimed to investigate changes in carotid intima–media thickness (IMT), a surrogate marker of atherosclerosis, and its determinants in HIV-1-infected patients.

Methods

Our multicentre prospective longitudinal cohort study included 346 HIV-infected patients, for each of whom two IMT measurements were taken by B-mode ultrasonography at baseline (M0) and 1 year later (M12).

Results

We observed a significant but moderate increase in the common carotid artery (CCA) median IMT, from 0.54 to 0.56 mm (P<10−4), i.e. an increase of 0.020 mm (95% confidence interval 0.012–0.029). There was a significant association between cross-sectional CCA IMT measures at M12 and conventional cardiovascular risk factors (higher CCA IMT with older age, P<10−4; male gender, P=0.02; tobacco consumption, P=0.05), as well as higher CD4 cell count at M12 (>median 455 cells/μL, P=0.01). Only CD4 cell count at M0 was strongly and positively associated with the variation in IMT between M0 and M12 (P=4 × 10−3). IMT progression was +0.0020 mm for the lowest quartile of CD4 cell count distribution at M0, i.e. 3–253 cells/μL, +0.010 mm for 253–402 cells/μL, +0.043 mm for 402–590 cells/μL, and +0.028 mm for 590–2270 cells/μL. No association was found with type or duration of antiretroviral exposure.

Conclusions

Conventional cardiovascular risk factors are major determinants of IMT evolution. The link between immunological status and carotid IMT requires further study.