• Atherosclerosis · Jan 2010

    Lipodystrophy and anti-retroviral therapy as predictors of sub-clinical atherosclerosis in human immunodeficiency virus infected subjects.

    • Giovanni Guaraldi, Chiara Stentarelli, Stefano Zona, Gabriella Orlando, Federica Carli, Guido Ligabue, Antonella Lattanzi, Giacomo Zaccherini, Rosario Rossi, Maria Grazia Modena, Nikolaos Alexopoulos, Frank Palella, and Paolo Raggi.
    • Metabolic Clinic, Infectious and Tropical Disease Unit, Department of Medicine, University of Modena and Reggio Emilia, Modena, Italy.
    • Atherosclerosis. 2010 Jan 1; 208 (1): 222-7.

    Background And ObjectiveAlthough anti-retroviral therapy (ART) prolonged survival in HIV-infected persons, an increase in cardiovascular disease has also been observed. A frequent complication of ART is the development of lipodystrophy (LD) with its multiple phenotypes that may be associated with cardiovascular disease. We assessed the contribution of chronic HIV infection, ART use and LD to the presence of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging.MethodsObservational cross-sectional study of 372 HIV-infected patients receiving ART who attended a cardiometabolic clinic (48.2+/-8-year old; 74% men). All patients underwent CAC surveillance with computed tomography and the Agatston score was used to quantitate CAC. Presence of CAC was defined as a score >10. Multivariable logistic regression was used to evaluate associations between HIV clinical factors, ART and LD with the presence of CAC.FindingsCAC was found in 134 patients (36%) with a median CAC score of 50 (range 10; 1243). Lipoatrophy alone (OR 3.82, 95% CI: 1.11; 13.1), fat accumulation alone (OR 7.65, 95% CI: 1.71; 37.17) and mixed lipodystrophy phenotypes (OR 4.36, 95% CI: 1.26; 15.01) were strongly associated with presence of CAC after adjusting for age, sex, hypertension and cumulative exposure to ART.ConclusionCAC is common among long-term ART users. The association between CAC and LD underscores the potential atherosclerosis risk inherent with ART and the need to undertake routine cardiovascular surveillance in patients treated with these drugs.Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

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