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Original Articles, Atherosclerosis/Endothelium/Vascular • Arq. Bras. Cardiol. 108 (1) • Jan 2017 • https://doi.org/10.5935/abc.20160197 copy

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population.

Objectives:

To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls.

Methods:

Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant.

Results:

An IMT > P₇₅ or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]).

Conclusion:

In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Keywords:
Carotid Artery Disease; Atherosclerosis; Carotid Intima-Media Thickness; HIV; Ankle Brachial Index

Atherosclerosis							OR (95%CI)^b b Reference group: HIV-negative subjects; p value (control x without PI)	OR (95%CI)^b b Reference group: HIV-negative subjects; valor de p (control x with PI)	p value (3 groups)
	HIV-negative subjects % (95%CI)	HIV-positive subjects % (95%CI)	HIV carriers			OR control x HIV (95%CI)^b b Reference group: HIV-negative subjects; P value
	HIV-negative subjects % (95%CI)	HIV-positive subjects % (95%CI)	Without PI % (95%CI)		With PI % (95%CI)
Intima-media thickness
Carotid
IMT	0.59 ± 0.11	0.70 ± 0.27	0.63 ± 0.11		0.71 ± 0.28	0.004	0.007	0.006	0.014
IMT >75P or presence of plaque	19.0% (9.1 - 29.0)	35.0% (24.3 - 45.7)	37.5% (21.8 - 53.2)		32.5% (17.3 47.7)	2.28 (1.05 - 4.98) p = 0.037	2.55 (1.04 - 6.25) p = 0.041	2.05 (0.82 -6.25) p = 0.124	0.095
IMT >0.8mm or presence of plaque	3.2% (0.0 - 7.6)	15.0% (7.0 - 23.0)	15.0% (3.4 - 26.6)		15.0% (3.4 - 26.6)	5.38 (1.16 - 25.1) p = 0.032	5.38 (1.03 - 28.1) p = 0.046	5.38 (1.03 - 28.1) p = 0.046	0.061
Femoral
IMT^d d Data with logarithmic transformation for normalization of distribution;	0.74 ± 0.30	0.79 ± 0.33	0.75 ± 0.27		0.82 ± 0.38	0.373	0.661	0.155	0.351
IMT >75P or presence of plaque	50.8% (38.1 -63.5)	65.0% (54.3 - 75.7)	60.0% (44.1 - 75.9)		70.0% (55.1 - 84.8)	1.80 (0.92 - 3.53) p = 0.088	1.45 (0.65 -3.24) p = 0.361	2.26 (0.98 -5.22) p = 0.056	0.153
IMT >0.8mm or presence of plaque	11.1% (3.1 - 19.1)	20.0% (11.0 - 29.0)	20.0% (7.0 32.9)		20.0% (7.0 - 32.9)	2.00 (0.77 - 5.21) p = 0.156	2.00 (0.66 - 6.03) p = 0.218	2.00 (0.66 - 6.03) p = 0.218	0.356
Changes in ABPI^c c IMT < 0.9 was not detected in the study group;
ABPI^e e Median (P25; P75) - Kruskal-Wallis test for between-group comparisons.	1.08 (1.07; 1.17)	1.15 (1.08; 1.2)	1.17 (1.08; 1.23)		1.08 (1.07; 1.17)	0.190	0.015	0.797	0.019^a a 75 Percentile of IMT of 0.66 mm in the study population;
Normal (0.9 – 1.3)	95.2% (92.0 - 100)	96.3% (92.0 - 100)	90.0% (80.3 - 99.9)		100% (-)	Reference	Reference	Reference	-
Incompressible (> 1,3)	4.8% (0.0 - 10.2)	5.0% (0.1 - 9.9)	10.0% (0.03 - 19.7)		0% (-)	1.05 (0.23 - 4.88) p = 0.948	2.22 (0.47 - 10.5) p = 0.314	Not calculated	0.116

Atherosclerosis risk factors	Groups			p value (control x without PI)	p value (control x with PI)	p value (3 groups)
	HIV-negative subjects (n = 63)	HIV-positive subjects
	HIV-negative subjects (n = 63)	Without PI (n = 40)	With PI (n = 40)
Age, years (mean ± SD)^b a ANOVA with Bonferroni post-test;	39.7 ± 9.7	42.2 ± 9.1	42.7 ± 8.8	0.550	0.351	0.215
Male sex (%)	37 (58.7%)	21 (52.5%)	26 (65.0%)	0.998	0.276	0.525
Years of school (%)
0 - 4 years	55 (87.3%)	33 (82.5%)	33 (82.5%)	0.501	0.501	0.732
5 - 7 years	8 (12.7%)	7 (17.5%)	7 (17.5%)
Skin color (%)
White	27 (42.9%)	8 (20.0%)	10 (25.0%)	0.017^a a ANOVA with Bonferroni post-test;	0.066	0.030^a a ANOVA with Bonferroni post-test;
Not white	36 (57.1%)	32 (80.0%)	30 (75.0%)
Smoking (%)	0 (0%)	4 (10.0%)	2 (5.0%)	Not calculated	Not calculated	0.046^a a ANOVA with Bonferroni post-test;
SAH (%)	0 (0%)	2 (5.0%)	5 (12.5%)	Not calculated	Not calculated	0.062
Hypercholesterolemia (%)	3 (4.8%)	3 (7.5%)	12 (30.0%)	0.563	<0.001^a a ANOVA with Bonferroni post-test;	<0.001^a a ANOVA with Bonferroni post-test;
Hypertriglyceridemia (%)	1 (1.6%)	2 (5.0%)	22 (55.0%)	0.315	<0.001^a a ANOVA with Bonferroni post-test;	<0.001^a a ANOVA with Bonferroni post-test;
Diabetes (%)	0 (0%)	1 (2.5%)	5 (12.5%)	Not calculated	Not calculated	0.007^a a ANOVA with Bonferroni post-test;
BMI, kg/m² (mean ± SD)^b a ANOVA with Bonferroni post-test;	26.2 ± 5.4	25.0 ± 3.6	24.7 ± 3.7	0.585	0.285	0.193
Overweight/obese (%)	36 (57.1%)	19 (47.5%)	19 (47.5%)	0.339	0.339	0.519

Factors	Without PI	With PI	p value
Laboratory^a a Thirty-six of 40 patients in the group without PI, and 20 of 40 patients without PI had available laboratory data;
Cholesterol (mg/dL)^b b Mean ± standard deviation; Student's t-test;	182.3 ± 32.9	188.0 ± 57.9	0.642
HDL cholesterol (mg/dl)^b b Mean ± standard deviation; Student's t-test;	52.5 ± 13.6	45.4 ± 10.6	0.071
LDL cholesterol (mg/dl)^b b Mean ± standard deviation; Student's t-test;	103.2 ± 31.0	81.8 ± 25.2	0.044
Triglycerides (mg/dL)^c c Median (P25; P75) - nonparametric Mann-Whitney test. HIV: human immunodeficiency virus; HDL: High Density Lipoprotein; LDL: Low Density Lipoprotein; HAART: highly active antiretroviral therapy.	95.7 (73.6; 143.5)	238.1 (140; 375.9)	<0.001
Related to HIV
Time of HIV infection (in years)^b b Mean ± standard deviation; Student's t-test;	7.27 ± 6.78	13.62 ± 6.20	<0.001
Time of HAART (in years)^b b Mean ± standard deviation; Student's t-test;	6.62 ± 6.65	12.1 ± 6.69	<0.001
CD4 count (%)
< 200 cells/mm³	2 (5.0%)	2 (5.0%)	0.599
200 - 500 cells/mm³	9 (22.5%)	13 (32.5%)
> 500 cells/mm³	29 (72.5%)	25 (62.5%)

	Carotid IMT^a a Atherosclerosis by the 75 percentile of IMT in the study population equal to or greater than 0.66 mm;		Statistics (95%CI)
	With atherosclerosis	Without atherosclerosis	Statistics (95%CI)
Femoral IMT^b b Atherosclerosis by the femoral IMT cutoff equal to or greater than 0.7 mm ,estimated by the ROC curve. PPV: positive predictive value; NPV: negative predictive value.
With atherosclerosis	29	55	Sensitivity: 72.5% (58.0 - 86.9)
Without atherosclerosis	11	48	Specificity: 46.6% (36.8 - 56.4)
Total	40	103	PPV: 34.5% (24.1 - 44.9)
			VPN: 18.6% (8.4 - 28.9)
			Area under the curve: 0.661 (0.563 - 0.760)
			Kappa: 14.3% (0.8 - 27.8)

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