HIV-infected have thicker carotid artery wall: predictor of heart attack & stroke

By Jeff Sheehy

With the advent of antiretroviral medication, HIV patients are living longer and facing yet another health challenge.

Carotid artery intima-media thickness (IMT)—a potent predictor of heart attack and stroke—is significantly higher in HIV-infected patients compared to uninfected controls, according to study results from UCSF researchers. In addition after one year of follow-up, carotid artery IMT progressed significantly faster in HIV-infected individuals.

“Our findings suggest that it would be reasonable to consider HIV infection a cardiac risk factor.  Other risk factors, such as high cholesterol and high blood pressure need to be aggressively treated in HIV patients—even it if means changes in their HIV medications.” said the study’s lead author, Priscilla Hsue, MD, assistant professor of medicine at UCSF.

The study, published in the April 6th issue of Circulation, found that HIV infection was an independent predictor of carotid artery IMT along with age, LDL-cholesterol levels, and cigarette smoking.  Duration of protease inhibitor therapy was not associated with thicker carotid IMT.

Carotid IMT progression over one year was greater among the 121 HIV patients with follow-up measurements.  IMT progression was associated with older age, Latino race, and a history of a low CD4 cell count.

In order to address cardiovascular issues in HIV patients, Hsue is opening one of the first cardiac sub-specialty clinics for HIV patients at the UCSF Positive Health Program based at San Francisco General Hospital Medical Center (SFGHMC).

“The greater rate of progression in arterial thickening among HIV patients is a cause for concern because it indicates that these patients could experience more vascular events in the future. Our primary motivation for starting a cardiac specialty clinic was to address cardiac issues and risk factors in HIV patients and to try and prevent cardiac complications before they occur,” said Hsue.

Study co-authors are Joan C. Lo, MD, UCSF assistant adjunct professor of medicine at the General Clinical Research Center; Arlana Franklin, RDMS, UCSF senior technologist; Ann F. Bolger, MD, UCSF associate professor of clinical medicine;  Steven G. Deeks, MD, UCSF associate professor of clinical medicine at the Positive Health Program; and David D. Waters, MD, UCSF professor of medicine, all at SFGHMC; and Jeffrey N. Martin, MD, MPH, UCSF assistant professor in the Department of Epidemiology and Biostatistics.

The study was conducted at the General Clinical Research Center at SFGHMC. It was funded by grants from the Doris Duke Charitable Foundation, the National Institutes of Health, the California AIDS Research Center, the UCSF Academic Senate, the UCSF/Gladstone Institute for Virology and Immunology Center for AIDS Research, and Astra Zeneca.