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Contributions of HIV, hepatitis C virus, and traditional vascular risk factors to peripheral artery disease in women

Cedarbaum, Emilya; Ma, Yifeia; Scherzer, Rebeccaa,b; Price, Jennifer C.a; Adimora, Adaora A.c; Bamman, Marcasd,e,f; Cohen, Mardgeg; Fischl, Margaret A.h; Matsushita, Kunihiroi; Ofotokun, Ighoj; Plankey, Michaelk; Seaberg, Eric C.i; Yin, Michael T.l; Grunfeld, Carla,b; Vartanian, Shantm; Sharma, Anjalin; Tien, Phyllis C.a,b

doi: 10.1097/QAD.0000000000002319

Objectives: HIV and hepatitis C virus (HCV) have been associated with cardiovascular disease (CVD), but it is unclear whether HIV and HCV are also associated with peripheral artery disease (PAD). We examined the association of HIV, HCV, and traditional CVD risk factors with PAD in the Women's Interagency HIV Study, a multicenter US cohort.

Methods: In this cross-sectional study, ankle–brachial index was estimated using Doppler ultrasound and manual sphygmomanometer in 1899 participants aged more than 40 years with HIV/HCV coinfection, HCV or HIV monoinfection, or neither infection. Multivariable logistic regression was used to estimate the odds of PAD (ankle–brachial index ≤0.9) after controlling for demographic, behavioral, and CVD risk factors.

Results: Over two-thirds were African-American, median age was 50 years, and PAD prevalence was 7.7% with little difference by infection status. After multivariable adjustment, neither HIV nor HCV infection was associated with greater odds of PAD. Factors associated with PAD included older age [adjusted odds ratio (aOR): 2.01 for age 61–70 vs. 40–50 years; 95% confidence interval (CI): 1.04, 3.87], Black race (aOR: 2.30; 95% CI: 1.15, 4.63), smoking (aOR: 1.27 per 10-pack-year increment; 95% CI: 1.09, 1.48), and higher SBP (aOR: 1.14 per 10 mmHg; 95% CI: 1.01, 1.28).

Conclusion: The high PAD prevalence in this nationally representative cohort of women with or at risk for HIV is on par with general population studies in individuals a decade older than our study's median age. HIV and HCV infection are not associated with greater PAD risk relative to uninfected women with similar risk factors. Modifiable traditional CVD risk factors may be important early intervention targets in women with and at risk for HIV.

aDepartment of Medicine, University of California, San Francisco

bMedical Service, Department of Veterans Affairs Medical Center, San Francisco, California

cDepartment of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

dDepartment of Cell, Developmental, and Integrative Biology

eDepartment of Medicine

fDepartment of Neurology, University of Alabama, Birmingham, Alabama

gDepartment of Medicine, Cook County Health and Hospitals System, Chicago, Illinois

hDepartment of Medicine, University of Miami, Miami, Florida

iDepartment of Epidemiology, Johns Hopkins University, Baltimore, Maryland

jDepartment of Medicine, Emory University, Atlanta, Georgia

kDepartment of Medicine, Georgetown University Medical Center, Washington, District of Columbia

lDepartment of Medicine, Columbia University, New York, New York

mDepartment of Surgery, University of California, San Francisco, San Francisco, California

nDepartment of Medicine, Albert Einstein College of Medicine, The Bronx, New York, USA.

Correspondence to Phyllis C. Tien, MD, Infectious Diseases Section, University of California, San Francisco, VAMC, 111W, 4150 Clement Street, San Francisco, CA 94121, USA. Tel: +1 415 221 4810x22577; fax: +1 415 379 5523; e-mail:

Received 27 February, 2019

Revised 28 May, 2019

Accepted 16 June, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.