Revista de SIDA e investigación clínica

Carotid Intima-Media Thickness in African Patients with Critical Lower Limb Ischemia Infected with the Human Immunodeficiency Virus

Abstract

Martin Brand, Angela J Woodiwiss, Frederic Michel, Hendrik L Booysen, Olebogeng HI Majane, Muzi J Maseko, Martin G Veller and Gavin R Norton

Background: The extent to which Human Immunodeficiency Virus (HIV) is associated with increases in carotid Intima-Media Thickness (IMT) independent of conventional cardiovascular risk factors is unclear. Hence, we evaluated whether independent of conventional risk factors, an increased carotid IMT occurs in African HIV infected patients with chronic Critical Limb Ischemia (CLI). Methods: Carotid IMT was measured in 217 sequentially recruited patients with CLI, 25 of whom were HIV positive and in 430 randomly selected controls from a community sample. Results: As compared to HIV negative patients with CLI, HIV positive patients were younger (49 ± 10 vs. 64 ± 11 years, p<0.0001) and had a markedly lower prevalence of hypertension and diabetes mellitus (p<0.0001), but a similar proportion of patients smoked (76% vs 67%). However, as compared to patients with CLI who were HIV negative, HIV positive patients had a similar increase in carotid IMT (HIV positive= 0.75 ± 0.14 mm; HIV negative= 0.79 ± 0.14 mm; Controls= 0.64 ± 0.15, p < 0.0001 versus Controls) even after adjustments for age, sex and conventional risk factors (HIV positive= 0.75 ± 0.13 mm; HIV negative=0.73 ± 0.15 mm, Controls=0.66 ± 0.15, p < 0.005). IMT was similarly increased in HIV positive patients with CLI as compared to controls when assessed in men, smokers, and black African patients only (p < 0.05-0.0001), or in those who were receiving highly active antiretroviral therapy (n=12, 0.74 ± 0.10 mm) as compared to those not receiving therapy (0.75 ± 0.15 mm). As compared to controls, the age- sex- and conventional risk factor-adjusted odds of having an IMT ≥ 0.8 mm was similarly increased in patients with CLI who were HIV positive (odds ratio= 8.89, CI= 2.79-28.32, p= 0.0002) as those who were HIV negative (odds ratio= 2.70 CI= 1.51-4.81, p < 0.001). Conclusion: These results suggest that despite being of a younger age, with or without conventional risk factor adjustments, marked increases in carotid IMT in HIV in Africa are a risk factor for CLI.