Predictors of subclinical atherosclerosis in HIV

• Published in: BMC infectious diseases Vol. 23; no. 1; p. 17
• Main Authors: Fernández Soto, Julia, Romero-Jiménez, Manuel J, Alarcón García, José Carlos, Bonet Estruch, Elena, Sánchez Ramos, José Luís, Castaño López, Miguel Ángel
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10-01-2023; BioMed Central; BMC
• Subjects: Analysis; Antiviral agents; Atherosclerosis; Atherosclerosis - complications; Atherosclerosis - diagnostic imaging; Atherosclerosis - epidemiology; Cardiovascular Diseases - complications; Care and treatment; Carotid Intima-Media Thickness; CD4/CD8 ratio; Cholesterol, LDL; Complications and side effects; Diagnosis; Dosage and administration; Health aspects; HIV; HIV infection; HIV Infections - complications; HIV Infections - drug therapy; HIV patients; HIV testing; Humans; LDL-cholesterol; Measurement; Risk Factors; Subclinical atherosclerosis; Tobacco; Ultrasonography; Vascular mortality; Spain; LDL-cholesterol; Tobacco; Vascular mortality; Subclinical atherosclerosis; HIV; CD4/CD8 ratio
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-022-07976-1

Cardiovascular disease is a major cause of morbidity and mortality in people with HIV. The detection of subclinical atherosclerosis through vascular ultrasound allows us to identify patients at an increased risk of cardiovascular disease as a primary prevention strategy; this test is not routine. Our objective is to identify predictors of subclinical atherosclerosis in a population with HIV.
People with HIV infection were selected for primary prevention and underwent carotid and femoral ultrasound to detect atheromatous plaques. Logistic regression analysis including vascular risk factors was performed to predict the presence of atherosclerosis.
One hundred eighty-three patients were included, 54% of whom were smokers; the mean duration of HIV infection was 9.52 years, and all patients were undergoing antiretroviral treatment. Subclinical atherosclerosis was present in 62.29% of the patients; 83.32% had plaque in the carotid territory, 57.93% in the femoral territory and 25.6% in both vascular territories. Compared to those without atherosclerosis, patients with atherosclerosis were on average 5.35 years older (53.86 vs. 48.51, p < 0.001) and had a higher prevalence of smoking (63.23% vs. 39.12%, p = 0.020) and a CD4/CD8 ratio below 0.7 (44.23% vs. 29.02%, p = 0.043). A CD4/CD8 ratio lower than 0.3 was always associated with subclinical atherosclerosis (95% confidence interval (CI): 83.9-100%). The inclusion of smoking, the CD4/CD8 ratio and age in the logistic regression analysis led to a diagnostic yield of 72% measured by the area under the receiving operator characteristic (ROC) curve (95% CI: 64-80%).
Tobacco use, age and a CD4/CD8 ratio below 0.7 allow prediction of the presence of subclinical atherosclerosis in primary prevention. A CD4/CD8 ratio below 0.3 was a diagnostic indicator of atherosclerosis in HIV patients undergoing primary prevention in our sample.