Predictors of subclinical atherosclerosis in HIV

BMC Infectious Diseases

Research

Miguel Ángel Castaño López¹  Elena Bonet Estruch¹  José Carlos Alarcón García²  Manuel J. Romero-Jiménez³  Julia Fernández Soto³  José Luís Sánchez Ramos⁴ 

[1] Clinical Analysis Unit of the Infanta Elena Hospital, Huelva, Spain;Infectious Diseases Unit, Infanta Elena Hospital, Huelva, Spain;Internal Medicine Service, Lipid and Vascular Risk Unit, Infanta Elena Hospital, Doctor Pedro Naranjo S/N Street, 21007, Huelva, Spain;Nursing Department, University of Huelva, Huelva, Spain;

关键词: HIV;    CD4/CD8 ratio;    LDL-cholesterol;    Tobacco;    Subclinical atherosclerosis;    Vascular mortality;   

DOI  :  10.1186/s12879-022-07976-1

 received in 2022-08-30, accepted in 2022-12-28,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundCardiovascular 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.MethodsPeople 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.ResultsOne 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%).ConclusionsTobacco 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.

【 授权许可】

CC BY   
© The Author(s) 2023

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