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Progression of Carotid Intima-Media Thickness and Coronary Artery Calcium Over 6 Years in an HIV-Infected Cohort

Volpe, Gretchen E. MD, MPH*,†; Tang, Alice M. PhD; Polak, Joseph F. MD, MPH; Mangili, Alexandra MD, MPH; Skinner, Sally C. MA; Wanke, Christine A. MD*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1st, 2013 - Volume 64 - Issue 1 - p 51–57
doi: 10.1097/QAI.0b013e31829ed726
Clinical Science

Objective: To evaluate changes in cardiovascular disease risk surrogate markers in a longitudinal cohort of HIV-infected adults over 6 years.

Design: Internal carotid artery (ICA) and common carotid artery (CCA) intima-media thickness (IMT), coronary artery calcium (CAC), vascular, and HIV risk factors were prospectively examined over 6 years in HIV-infected adults from 2002 to 2010.

Setting: Longitudinal cohort study with participants from urban center and surrounding communities.

Subjects/Participants: Three hundred forty-five HIV-infected participants were recruited from a longitudinal cohort study. Two hundred eleven participants completed the study and were included in this analysis.

Main Outcome Measures: Total and yearly ICA and CCA IMT change; CAC score progression.

Results: Participants were 27% female and 49% nonwhite; mean age at start was 45 ± 7 years. The median change in ICA and CCA over 6 years was 0.15 mm (0.08, 0.28) and 0.12 mm (0.09, 0.15), respectively. Age, baseline triglycerides ≥150 mg/dL, and pack-years smoking were associated with ICA IMT change; age, cholesterol, nadir CD4+ count, and protease inhibitor use were associated with CCA IMT change. Diabetes, HIV viral load, and highly active antiretroviral therapy duration were associated with CAC progression.

Conclusions: Carotid IMT and CAC progressed in this HIV-infected cohort. Some HIV-specific characteristics were associated with surrogate marker changes, but the majority of risk factors continue to be traditional. Aggressive identification and management of modifiable risk factors may reduce progression of cardiovascular disease risk in this population.

*Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA;

Nutrition/Infection Unit, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA; and

Department of Radiology, Tufts Medical Center, Boston, MA.

Correspondence to: Gretchen E. Volpe, MD, MPH, Department of Public Health and Community Medicine, Tufts University School of Medicine, 150 Harrison Ave, Rm 60B, Boston, MA 02111 (e-mail: gvolpe@tuftsmedicalcenter.org).

Financial and technical support, specifically for design and conduct of study, provided by Center for Drug Abuse and AIDS Research, center for AIDS Research, Tufts CTRC/CTSI 1UL1RR025752-03, NIH/NHLBI 5R01HL065947-10, and NIH/NIAID 5T32 AI007438-19.

Presented at the XIX International AIDS Conference, July 22-27, 2012, Washington DC.

A.M. is currently the Medical Director for HIV/Endocrinology at EMD Serono, Inc., but performed this work independently of this position through her affiliation with Tufts University. The remaining authors have no conflicts of interest to disclose.

Received March 13, 2013

Accepted June 01, 2013

© 2013 by Lippincott Williams & Wilkins