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HIV Infection and Low CD4 Count Associated with Arteriosclerosis

The HIV infection is associated with an increased risk of hardening of the arteries, researchers in the online edition of Clinical HeartInfectious Diseases. The US study made a comparison with the thickness changes in the carotid artery and the new plaque formation between positive and negative HIV in both men and women with similar demographic characteristics and similar cardiovascular risk factors.

In general, HIV infection was not associated with changes in the thickness of the carotid artery. However, people with HIV were more likely to have new plaque formation, even when their viral load is undetectable.

"We have shown that women infected with HIV as men had one 61% higher risk of new plaque formation in the carotid artery focal over seven years, compared with uninfected controls," the researchers comment. "HIV-associated risk was higher than that associated with smoking. Furthermore, the high risk persisted among individuals treated ART [antiretroviral therapy] - with persistent suppression of HIV virus, suggesting that sustained suppression of circulating HIV RNA to below detectable limits not eliminate the excess CVD [disease risk Cardiovascular] in treating HIV-infected population. "

More fortunately, people living with HIV whose CD4 cell count was above 500 cells / mm3, had a similar risk of new plaque formation in HIV-negative individuals.

Cardiovascular disease is currently a major cause of morbidity and mortality in people with HIV. US researchers wanted to see if HIV was associated with the progression of subclinical atherosclerosis - hardening of the arteries - over a period of seven years of follow-up.

The study population consisted of women 1011 (74% HIV positive) enrolled in the Interagency HIV Study of women and men about 811 (65% HIV positive) in the multicenter AIDS cohort study. Everyone had repeat ultrasound carotid artery investigations - thick and new plaque formation - between the years 2003 and 2013. Two Circulatory System-thirds of women with HIV and three-quarters of men with HIV were taking ART.

Changes in carotid artery thickness not differ according to the condition of people with HIV in men or women. Factors associated with greater thickening were black and Hispanic ethnicity and the use of crack / cocaine. Use of antihypertensive medications was associated with a reduction in carotid thickness.

The prevalence of carotid atherosclerosis arterial plaques increased from the 8 15% in women and 25 34% of the men during the monitoring period. In general, people living with HIV were 61% more likely to try new plaque formation as compared to HIV-negative individuals (OR = 1,61, 95 -1,12 IC2,32%). The association between HIV infection and plaque formation was present in both men and women.

Current smoking increased the risk of new plaque buildup in 42%. Other risk factors were higher total cholesterol and increasing age.

The researchers identified 199 people with HIV who were taking art with persistent viral suppression (16% of women with HIV; 29% of men with HIV). These patients had an increased risk of new plaque formation compared to HIV-negative patients group (ARR = 1,77, 95 -1,13 IC2,77%).

Blood Heart Health"Our finding that participants who remained HIV deletion also had an increased risk for new focal plaque formation suggests that monitoring with respect to long term adverse consequences art still guaranteed for all individuals infected with HIV , "write the authors.

The relationship between immune status and plaque formation was then analyzed.

People living with HIV and had a line CD4 cell count above 500 cells / mm3, had a comparable risk of new plaque formation for HIV-negative controls. The situation of higher risk of new plaque buildup was observed in people with HIV that they had a cell count below CD4 200 cells / mm3 (RAR = 2,57, 95 -1,48 IC4,46%).

Longer duration of therapy with protease inhibitor was a risk factor for plaque buildup between men with HIV (RAR = 1,12 per year of cumulative use; IC 95% 1,01 -1.25) but not women with HIV.

"Our data support previous ART early, before the 4 decrease CD, which can attenuate the cardiovascular HIV-associated increases the risk," the authors conclude. "A better understanding of these processes is necessary, either to prevent or retard the development CVD and strategies to improve the results of treatment with ascending and increasingly elderly population infected with HIV."

Claudius el guapissimoTranslated from the original English into Portuguese of Brazil By Cláudio Santos de Souza

The Original in EnglishIt was published 06 May 2015 by Michel Carter

Reference

DB Hanna et al.Infection with HIV is associated with the progression of subclinical carotid atherosclerosis. Clin infect Dis, online edition, up to 2015

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