Ultrasonographic measures of cardiovascular disease risk in antiretroviral treatment-naive individuals with HIV infection

Objective: To evaluate associations between traditional cardiovascular disease (CVD) risk factors, inflammatory markers and markers of HIV disease activity with ultrasonographic measures of CVD risk in patients with HIV who are not receiving antiretroviral therapy (ART). Design: Cross-sectional, baseline evaluation of ART-naive HIV-infected individuals without known CVD or diabetes mellitus enrolled in a randomized ART treatment trial. Methods: Prior to ART initiation, carotid artery intima-media thickness (CIMT) and brachial artery flow-mediated dilation (FMD) were measured. Additional parameters included CD4 cell count, HIV viral load, body composition, lipoproteins and inflammatory markers. Associations with common CIMT, bifurcation CIMT, presence of carotid artery lesions and brachial artery FMD were evaluated. Results: The 331 enrolled individuals were a median (first-third quartile) of 36 (28-45) years old. Common and bifurcation CIMT values were higher and lesions more prevalent with older age (P<0.001). FMD was lower with older age (P1/40.009). Those with a Framingham Risk Score of at least 6% per 10 years (N1/444) had higher common and bifurcation CIMT (P<0.001), carotid lesion prevalence (P<0.001) and lower FMD (P1/40.035). Independent associations with common CIMT were identified for increasing age, height, weight, small low-density lipoprotein (LDL) particles and black race; these were similar for bifurcation CIMT. Presence of carotid artery lesions was associated with increasing age, presence of metabolic syndrome, interleukin-6 and lower HIV-1 RNA. Conclusion: In a contemporary cohort of ART-naive HIV-infected individuals, ultrasonographic measures of CVD risk were more strongly associated with traditional risk factors than CD4 cell counts, HIV replication or inflammatory markers.