Premature lesions of the carotid vessels in HIV-1-infected patients treated with protease inhibitors

Objectives: To evaluate the presence of premature atherosclerotic lesions o f epiaortic vessels in HIV-1-infected protease inhibitor-(PI) treated patie nts compared with PInaive patients and healthy individuals. Design: One-hundred and two HIV-1-positive patients, including 55 treated w ith PI for at least 12 months and 47 either naive or treated with PI-sparin g regimens, were subjected to epiaortic vessel ultrasonography. These data were compared with those obtained from 104 healthy individuals. Methods: Intima characteristics, pulsation and resistance indexes, and mini mal, peak and mean speed were evaluated using a colour power doppler. Ather osclerotic plaques were described. Independent risk: factors and values for glycaemia, cholesterolaemia and triglyceridaemia were considered. Statisti cal analysis included the chi-square test, Mantel-Haenszel test, odds ratio and logistic regression analysis. Results: Of the PI-treated patients, 29 out of 55 (52.7%) presented acquire d lesions of the vascular wall at ultrasonography, whereas similar lesions were found in seven out of 47 (14.9%) PI-naive patients. Of the 104 healthy individuals, seven cases (6.7%) of intimal medial thickness were noted. A slightly significant correlation was found between carotid lesions and age, male sex and hypercholesterolaemia, whereas cigarette smoking, hypertrigly ceridaemia and Centers for Disease Control and Prevention stage significant ly increased the risk of vascular lesions (P = 0.022, P = 0.017 and P = 0.0 79 respectively). However, the highest significance regarded use of PI (P = 0.011). These results were confirmed by logistic regression analysis. Conclusions: These data demonstrate a higher than expected prevalence of pr emature carotid lesions in the PI-treated compared with PI-naive patients. If confirmed, a periodic ultrasonographic study of the vascular wall should be included in the followup of HIV infected patients. (C) 2000 Lippincott Williams & Wilkins.