HIV Infection and Low CD4 Count Associated with Arteriosclerosis

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

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

"We have shown that HIV-infected women like men had a 61% higher risk of forming new plaque in the focal carotid artery over seven years, compared to uninfected controls," comment the researchers. “The HIV-associated risk was greater than that associated with smoking. On the other hand, the high risk persisted among treated individuals ART [antiretroviral therapy] - with persistent viral suppression of HIV, suggesting that sustained suppression of HIV RNA circulating below detectable limits does not eliminate excess CVD [risk of cardiovascular disease] in treating HIV-infected populations. ”

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

Cardiovascular disease is today a major cause of morbidity and mortality in people with HIV. Researchers from the United States wanted to see if HIV was associated with the progression of subclinical arteriosclerosis - hardening of the arteries - over a seven-year follow-up.

The study population consisted of 1011 women (74% HIV positive) enrolled in the Interdepartmental Women's HIV Study and approximately 811 men (65% HIV positive) in the multicenter study. AIDS Cohort study. All had repeat carotid artery ultrasound investigations - thickness and new plaque formation - between the years 2003 and 2013. Two Circulatory Systemthirds of women with HIV and three quarters of men with HIV were taking ART.

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

The prevalence of carotid arteriosclerosis arterial plaques increased from 8 to 15% in women and 25 to 34% of men during the follow-up period. In general, people living with HIV were 61% more likely to experience new plaque formation compared to HIV negative individuals (OR = 1,61; IC95% 1,12 -2,32). 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 increased age.

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 showed an increased risk of plaque re-formation compared to HIV-negative patients group (RAR = 1,77; IC95% 1,13 -2,77).

Blood Heart Health“Our finding that participants who remained suppressed by HIV still had an increased risk of new focal plaque formation suggests that vigilance regarding long-term adverse art consequences remains warranted for all HIV-infected individuals. , ”Write the authors.

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

People living with HIV and who had a line count of CD4 cells above 500 cells / mm3, had a comparable risk of re-forming plaques for HIV-negative controls. The increased risk of new plaque accumulation was observed in people with HIV who had a CD4 cell count below 200 cells / mm3 (RAR = 2,57; IC95% 1,48 -4,46).

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

"Our previous data supporting early ART before CD 4 will decrease, which may attenuate HIV-associated cardiovascular risks," the authors conclude. "A better understanding of these processes is needed both to prevent or delay CVD development and strategies to improve treatment outcomes with the growing and increasingly older HIV-infected population."

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

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

Reference

Hanna DB et al. HIV infection is associated with progression of subclinical carotid arteriosclerosis. Clin infecting Dis, editing online, up to 2015

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