Background
HIV-infected patients have an increased risk of cardiovascular disease. Measurement of carotid artery intima-media-thickness (c-IMT) with colour-doppler-ultrasonography is a well-accepted, non-invasive method to assess carotid atherosclerosis.
Purpose of the study
To investigate whether HCV infection could be involved in the development of carotid atherosclerosis beside the well-known risk factors.
Anzeige
Patients and methods
In this cohort study, 322 consecutive HIV+ subjects were identified and enrolled between May 2009 and May 2010. A total of 153 patients were HIV/HCV co-infected, whereas 169 were HIV+ mono-infected; 237 patients were treated with highly active antiretroviral therapy (HAART), and 85 subjects were HAART-naïve. All patients underwent at least one c-IMT measurement by the same examiner; an IMT of >0.9 mm was considered pathological.
Results
Overall, 112/322 (35%) patients showed c-IMT >0.9. Table 1 shows the correlation between c-IMT and the following risk factors: age, cigarette smoking, intravenous drug use, CD4 cell count <200/mmc, CDC stage C of HIV infection, PI-based regimens and HCV co-infection. A significant statistical association between all considered factors and increased c-IMT was found. In particular, HCV co-infection showed a greater association in addition to older age, dyslipidemia, stage C of HIV infection.
Table 1
c-IMT<0.9 | c-IMT> 0.9 | ||||
|---|---|---|---|---|---|
n. 210 | % | n. 112 | % | p | |
age >40 years | 121 | 57.6% | 105 | 93.8% | <0.0001 |
cigarette smoking | 42 | 20% | 70 | 63% | 0.03 |
IVDU | 79 | 37.6% | 56 | 50% | 0.03 |
Cholesterolemia >200 mg/dL | 50 | 23.8% | 51 | 45.5% | 0.0006 |
Triglyceridemia >170 mg/dL | 58 | 27.6% | 52 | 46.4% | 0.0006 |
CDC Stage C | 69 | 38.9% | 68 | 60.7% | <0.0001 |
HAART - PI exposure | 56 | 40.9% | 81 | 59.1% | 0.001 |
CD4 cell count <200/mmc | 36 | 17.1% | 36 | 32.1% | 0.002 |
HCV co-infection | 85 | 40.5% | 68 | 60.7% | 0.0005 |
Conclusions
In this cohort, several risk factors seem contribute to inflammatory damage and c-IMT development. Among them, HCV co-infection has been identified as a major determinant of carotid atherosclerosis. If the role of HCV infection will be confirmed in further studies, HIV-HCV co-infected patients should be strictly monitored for the vascular status.
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