Objectives: To determine whether the reported increased atherosclerotic risk among HIV-infected individuals is related to antiretroviral therapy (ART) or HIV infection, whether this risk persists in never-smokers, and whether inflammatory profiles are associated with higher risk.
Design: Matched cross-sectional study.
Methods: A total of 100 HIV-infected patients (50 ART-treated >4 years, 50 ART-naive but HIV-infected >2 years) and 50 HIV-negative controls were recruited in age-matched never-smoking male triads (mean age 40.2 years). Carotid intima–media maximal thickness (c-IMT) was measured across 12 sites. Pro-inflammatory [highly sensitive C-reactive protein (hs-CRP), resistin, interleukin-6, interleukin-18, insulin, serum amyloid A, D-dimer) and anti-inflammatory (total and high molecular weight adiponectin, interleukin-27, interleukin-10) markers were dichotomized into high/low scores (based on median values). c-IMT was compared across HIV/treatment groups or inflammatory profiles using linear regression models adjusted for age, diabetes, hypertension, and, for HIV-infected patients, nadir CD4+ cell counts.
Results: Although adjusted c-IMT initially tended to be thicker in ART-exposed patients (P = 0.2), in post-hoc analyses stratifying by median HIV duration we observed significantly higher adjusted c-IMT in patients with longer (>7.9 years: 0.760 ± 0.008 mm) versus shorter prevalent duration of known HIV infection (<7.9 years: 0.731 ± 0.008 mm, P = 0.02), which remained significant after additionally adjusting for ART (P = 0.04). Individuals with low anti-inflammatory profile (<median versus >median score) had thicker c-IMT (0.754 ± 0.006 mm versus 0.722 ± 0.006 mm, P < 0.001), with anti-inflammatory markers declining as prevalent duration of HIV infection increased (P for linear trend <0.001).
Conclusion: Known HIV duration is related to thicker c-IMT, irrespective of ART, in these carefully selected age-matched never-smoking HIV-treated and ART-naive male individuals. Higher levels of anti-inflammatory markers appeared protective for atherosclerosis.