Protease inhibitor use not linked to atherosclerosis in middle-aged HIV patients

The peripheral atherosclerosis that often develops in middle-aged HIV-infected individuals is associated with “classic” cardiovascular risk factors such as smoking and hyperlipidaemia, and not with the use of protease inhibitor antiretroviral agents.

In a study reported in the February 16th issue of AIDS, Dr. Vincent Mooser, from CHUV University Hospital, in Lausanne, Switzerland, and colleagues used B-mode ultrasound to detect atherosclerotic plaques in the femoral and carotid arteries of 68 HIV-negative and 168 HIV-positive individuals.

Of the infected individuals, 136 had received protease inhibitor therapy for a mean of 26.8 months, the authors state.

The investigators found that the prevalence of plaques, cigarette smoking, and hyperlipidaemia was significantly higher in the HIV-infected group compared with the uninfected group. Age, male gender, plasma low-density lipoprotein cholesterol levels, and smoking were independently associated with plaque formation.

Univariate logistic regression analysis revealed that HIV infection was associated with an increased risk of plaque formation, but that among infected individuals protease inhibitor use had no bearing on this risk, the researchers point out.

“Our study provides evidence that atherosclerosis in HIV-infected patients is partly accounted for by modifiable risk factors such as smoking and hyperlipidaemia,” the authors state. “Vigorous interventions on the factors, similar to those recommended for patients suffering from other chronic diseases such as obesity or diabetes, would probably be equally beneficial to HIV-infected subjects.”