Premature atherosclerosis in HIV-infected individuals - focus on protease inhibitor therapy

Objective: Lipid disorders associated with the use of protease inhibitors m ay contribute to the premature development of atherosclerosis. The purpose of the present study was to determine whether the administration of a prote ase inhibitor-containing regimen to middle-aged (30-50 years) HIV-infected individuals for 6 months or longer is associated with an increased prevalen ce of atherosclerosis. Methods: High-resolution B-mode ultrasound imaging was used to Visualize th e femoral and carotid arteries of 68 HIV-negative and 168 HIV-infected indi viduals, including 136 patients who had received protease inhibitors for 26 .8 +/- 8.9 months (mean +/- SD). Atherogenic plaques were defined as a thic kening of the intima-media greater than or equal to 1200 mm. Results: The proportion of participants with one or more plaques was higher in the HIV-infected group in comparison with the HIV-negative group (55 ve rsus 38%; P = 0.02), and so was the prevalence of cigarette smoking (61 ver sus 46%; P = 0.03) and hyperlipidaemia (56 versus 24%; P < 0.001). The pres ence of plaque was independently associated with age, male gender, plasma l ow-density lipoprotein cholesterol levels and smoking. in univariate logist ic regression analysis, an association was also found with HIV infection. A mong HIV-infected subjects protease inhibitor therapy was not associated wi th the presence of plaque. Conclusions: A large proportion of the middle-aged HIV-infected individuals examined during this study had one or more atherosclerotic plaques within the femoral or carotid arteries. The presence of peripheral atherosclerosis within this population is not associated with the use of protease inhibito rs, but rather with 'classic' cardiovascular risk factors such as smoking a nd hyperlipidaemia, which are amenable to interventions. (C) 2001 Lippincot t Williams & Wilkins.