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ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 50-55

Accelerated subclinical atherosclerosis in human immunodeficiency virus-infected patients on protease inhibitor regime


1 Department of Internal Medicine, Armed Forces Medical College, Pune, India
2 Department of Medicine, Armed Forces Medical College, Pune, India
3 Department of Internal Medicine, Armed Forces Medical College, Pune/Office of the DGAFMS, New Delhi, India
4 Department Internal Medicine and Neurology, Armed Forces Medical College and Command Hospital, Pune/Commandant AFSMD, Mumbai, India
5 Department of Internal Medicine, Armed Forces Medical College, Pune/Commandant MH Wellington, Nilgiris, India

Correspondence Address:
Gupta Salil
Department of Internal Medicine, Armed Forces Medical College, Sholapur Road, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-9157.159969

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Background: The life expectancy of human immunodeficiency virus (HIV) infected individuals has significantly increased following the introduction of combination antiretroviral therapy (cART). It is believed that because of their longevity these patients are more prone to atherosclerosis. This increased risk is not only linked to traditional risk factors for atherosclerosis, but also to HIV infection and cART. Objective: To identify the effects of HIV and cART (both protease inhibitor [PI] and non-PI based regimes) on carotid artery intima-media thickness (CIMT), a surrogate marker of subclinical atherosclerosis. Patients and Methods: Our cross-sectional study was done at a nodal HIV referral center. The study included 84 HIV-infected patients (24 exposed to PI-based cART, 30 to non-PI based cART, 30 not on cART) and 30 healthy age-matched controls. CIMT was measured ultrasonographically using high frequency B mode probe. The metabolic profile of the patients was also compared. Results: Using ANOVA the CIMT in patients on PI-based cART (0.82 + 0.17 mm) was significantly higher as compared to non-PI based cART (0.47 + 0.09 mm), HIV-infected patients not on ART (0.47 + 0.09 mm) and healthy control group (0.44 + 0.09 mm). When CIMT from non-PI based cART was compared with patients not on ART and healthy controls the difference was found not to be significant. Using linear regression analysis, the significant risk factors for this difference in CIMT in the PI-based regime included lower CD4 counts and higher total cholesterol. Conclusions: HIV-infected patients on PI-based cART are at risk for developing subclinical accelerated atherosclerosis. This will make them more prone to acute coronary syndromes, strokes, and peripheral vascular disease. Advanced HIV infection and high total cholesterol per se may also contribute to this risk of atherosclerosis. Screening using CIMT measurement and rigorous risk factor management is advocated for these patients.


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