HIV positive patients treated with protease inhibitors have vascular changes resembling those observed in atherosclerotic cardiovascular disease

John Lekakis , Sotirios Tsiodras , Ignatios Ikonomidis (1) , John Palios , Garyfalia Poulakou , Loukianos Rallidis , Anastasia Antoniadou , Periklis Panagopoulos , Antonios Papadopoulos , Helen Giamarellou , Dimitrios T Kremastinos

1 Department of Cardiology, Heart Failure Unit, Athens University Hospital Attikon

A metabolic syndrome associated with atherosclerosis and cardiovascular disease has been described in HIV positive individuals. We investigated whether HIV individuals and CAD patients have similarities in their vascular function and structure. In a case-control study, we compared measurements of carotid artery intima media thickness (IMT) and brachial artery flow-mediated dilatation (FMD) in HIV individuals with age and sex-matched controls with similar risk factors and patients with established CAD. Seventy-one HIV patients age 42 ± 13.9 yrs, 91 % male) were compared to 29 CAD patients and 25 controls. HIV patients had higher IMT than controls and similar IMT with CAD patients (0.64±0.2 vs. 0.55±0.05 vs .0.66±0.08 mm respectively, F=4.2, p=0.01) Patients on protease inhibitors, had higher IMT (0.69±0.2 vs. 0.57±0.15 mm p=0.01), blood pressure, cholesterol and triglycerides than those without (p<0.05). In multiple regression analyses increasing blood pressure (b: 0.37, p=0.001), glucose (b: 0.26, p=0.016), cholesterol (b: 0.24, p=0.033), duration of HIV disease (b: 0.33, p=0.008) and use of protease inhibitors (b: 0.27, p=0.04) were the most important determinants of IMT respectively. FMD was associated only with triglyceride measurements. Patients with HIV present arterial changes resembling those found in patients with atherosclerotic cardiovascular disease. These vascular changes are closely related to protease inhibitor-induced changes of metabolic parameters. Thus, intensive treatment of metabolic parameters might retard atherosclerosis in HIV patients.

Mots clés: Medicine

John Lekakis, Sotirios Tsiodras, Ignatios Ikonomidis, John Palios, Garyfalia Poulakou, et al.. HIV positive patients treated with protease inhibitors have vascular changes resembling those observed in atherosclerotic cardiovascular disease. Clinical Science, 2008, 115 (6), pp.189-196. ⟨10.1042/CS20070353⟩. ⟨hal-00479406⟩