Subclinical atherosclerosis in low Framingham risk HIV patients

• Published in: European journal of clinical investigation Vol. 47; no. 8; pp. 591 - 599
• Main Authors: León, Rafael, Reus, Sergio, López, Nicolás, Portilla, Irene, Sánchez‐Payá, José, Giner, Livia, Boix, Vicente, Merino, Esperanza, Torrús, Diego, Moreno‐Pérez, Óscar, Portilla, Joaquín
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.08.2017
• Subjects: Adult; Age; Age Factors; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Arteriosclerosis; Atherosclerosis; Bacteria; Biomarkers - metabolism; Body Mass Index; Cardiovascular diseases; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - virology; Carotid Intima-Media Thickness; Case-Control Studies; CD4 antigen; Cigarettes; Control methods; Deoxyribonucleic acid; Diabetes mellitus; Diagnosis; DNA; DNA, Ribosomal - metabolism; Dyslipidemia; Female; Health risk assessment; Health risks; Hip; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Hypertension; Infectious diseases; inflammation; Inflammatory diseases; Interleukin 6; Interleukin-6 - metabolism; intima‐media thickness; Lipopolysaccharide Receptors - metabolism; Male; microbial translocation; Multivariate analysis; Pathogenesis; Patients; Prophylaxis; Receiving; Risk analysis; Risk Factors; Smoking; Statins; subclinical atherosclerosis; Tumor necrosis factor; Ultrasound; Vascular diseases; Viral Load; intima-media thickness; microbial translocation; HIV; inflammation; subclinical atherosclerosis
• ISSN: 0014-2972; 1365-2362; 1365-2362
• DOI: 10.1111/eci.12780

Background Pathogenesis of atherosclerosis is complex, and differences between HIV‐infected patients and general population cannot be completely explained by the higher prevalence of traditional cardiovascular risk factors. We aimed to analyse the association between inflammation and subclinical atherosclerosis in HIV patients with low Framingham risk score. Materials and methods Case–control study. Setting: Outpatient Infectious Diseases clinic in a university hospital. Subjects: HIV‐1‐infected patients aged > 35 years receiving antiretroviral treatment with viral load < 50 copies/mL and Framingham risk score < 10%. Exclusion criteria: inflammatory diseases; dyslipidaemia requiring statins; smoking > 5 cigarettes/day; diabetes; hypertension; vascular diseases. Main outcome: subclinical atherosclerosis determined by ultrasonography: common carotid intima‐media thickness greater than 0·8 mm or carotid plaque presence. Explanatory variables: ribosomal bacterial DNA (rDNA), sCD14, interleukin‐6 (IL‐6) and TNF‐α. Results Eighty‐four patients were included, 75% male, mean age 42 years and mean CD4+ cells 657 ± 215/mm3. Median Framingham risk score was 1% at 10 years (percentile 25–75: 0·5–4%). Eighteen patients (21%) had subclinical atherosclerosis; the associated factors were older age (P = 0·001), waist–hip ratio (P = 0·01), time from HIV diagnosis (P = 0·02), rDNA (P = 0·04) and IL‐6 (P = 0·01). In multivariate analysis, OR for subclinical atherosclerosis was 7 (95% CI, 1.3–40, P = 0.02) and 9 (95% CI, 1.0–85, P = 0.04) for patients older than 44 years and IL‐6 > 6·6 pg/mL, respectively. Conclusions Well‐controlled HIV patients with low Framingham risk score have a high prevalence of subclinical carotid atherosclerosis, and the main risk factors are age and inflammation. These patients are not receiving primary prophylaxis for cardiovascular events according to current guidelines.