In a study published recently in HIV Medicine, Olalla et al. [1] measured ankle–brachial index (ABI) in 147 HIV-infected patients and found that 33 (22.4%) had an ‘altered’ ABI, according to the definition used by the authors (≤0.9 or ≥1.3). Thus, the prevalence of peripheral vascular disease (PAD) was much higher than in previous studies [2–4].

Whereas investigations validating ABI have found consistently that a decreased ABI (≤0.9) is a powerful predictor of death from cardiovascular causes in HIV-negative adults [5–8], the significance of high ABI (>1.40) as a predictor of atherosclerosis remains controversial, and additional non-invasive diagnostic testing is needed to diagnose PAD in that setting [6]. Although clinical validation of ABI in patients with HIV is lacking, when ABI measurements were compared to carotid intima-media thickness (IMT), a well-established marker of sub-clinical atherosclerosis, only patients with low ABI had a high carotid IMT [9].

Given the usual late onset of clinical events in the course of systemic atherosclerosis, HIV clinicians would welcome disease surrogate markers. ABI is a simple, non-invasive test that may become useful for this purpose, but it should be remembered that only a low ABI (≤0.9) is a reliable indicator of systemic atherosclerosis and PAD.


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  2. References
  • 1
    Olalla J, Salas D, Del Arco A et al. Ankle-branch index and HIV: the role of antiretrovirals. HIV Med 2009; 10: 15.
  • 2
    Bernal E, Masiá M, Padilla S, Hernández I, Gutiérrez F. Low prevalence of peripheral arterial disease in HIV-infected patients with multiple cardiovascular risk factors. J Acquir Immune Defic Syndr 2008; 47: 126127.
  • 3
    Sharma A, Holman S, Pitts R, Minkoff HL, Dehovitz JA, Lazar J. Peripheral arterial disease in HIV-infected and uninfected women. HIV Med 2007; 8: 555560.
  • 4
    Periard D, Cavassini M, Taffé P et al. High prevalence of peripheral arterial disease in HIV-infected persons. Clin Infect Dis 2008; 46: 761767.
  • 5
    Hirsch AT, Haskal ZJ, Hertzer NR et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, venal, mesenteric, and abdominal aortic). Circulation 2006; 113: e463e654.
  • 6
    Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA et al. for the TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007; 45 (Suppl): 567.
  • 7
    Doobay AV, Anand SS. Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: a systematic review. Arterioscler Thromb Vasc Biol 2005; 25: 14631469.
  • 8
    McDermott MM, Liu K, Criqui MH et al. Ankle-brachial index and sub-clinical cardiac and carotid disease: the multi-ethnic study of atherosclerosis. Am J Epidemiol 2005; 162: 3341.
  • 9
    Gutiérrez F, Bernal E, Padilla S, Hernández I, Masiá M. Relationship between ankle-brachial index and carotid intima-media thickness in HIV-infected patients. AIDS 2008; 22: 13691371.