Spanish find low prevalence of peripheral arterial disease in HIV-positive patients with heart disease risks

Spanish investigators have found a low prevalence of peripheral arterial disease in HIV-positive patients with multiple traditional risk factors for heart disease. The study is published in the January 1^st edition of the Journal of Acquired Immune Deficiency Syndromes and stands in contrast to a Swiss study presented to last year’s ICAAC that found that 20% of HIV-positive patients had peripheral arterial disease.

There is an increasing awareness that HIV-infected individuals have an increased risk of cardiovascular disease. Peripheral arterial disease is an indicator of hardening of the arteries and a strong predictor of an increased risk of death from heart disease. It is easy to detect peripheral arterial disease using an ankle-brachial index (ABI). This involves attaching a blood-pressure cuff to the ankle and comparing blood pressure at the ankle and at the normal measuring point on the upper arm (the brachial artery). An ABI of 0.9 or below indicates the presence of peripheral arterial disease.

Spanish investigators conducted a prospective study involving 91 HIV-positive patients with at least two traditional risk factors for heart disease. The study ran between January 2006 and January 2007.

The patients’ average age was 50 years, 80% were men, 36% had a history of injecting drug use, and 32% had progressed to AIDS. Antiretroviral therapy was being taken by 81% of patients and 63% of patients had experience of treatment with a protease inhibitor, the class of antiretrovirals most associated with a risk of heart disease. The median duration of antiretroviral therapy was seven years, 52% of patients had a viral load below 50 copies/ml and median CD4 cell count was 507 cells/mm³.

Lipodystrophy was present in 34% of patients, 69% had elevated lipids, 73% were smokers, 18% had diabetes, 57% high blood pressure and 20% a family history of heart disease.

A total of 33 patients (36%) had three or more risk factors for heart disease, and 26 (28%) four or more factors.

A low ABI was present in only four patients (4.39%). All four patients were men aged over 45 (median age, 55 years). Three of the patients were currently taking antiretroviral therapy, and all had some experience of protease inhibitor treatment. Lipodystrophy was present in three patients and two individuals had lipoatrophy. Three patients had three or more risk factors for heart disease.

Two patients had a heart attack within months of the study being conducted.

“Our results show a low prevalence of peripheral arterial damage in a cohort of HIV-infected patients with several cardiovascular risk factors”, write the investigators. They note that studies in the general population have found that between 5% - 30% (depending on age and risk factors) have this disease. The investigators expect the prevalence of peripheral arterial disease in patients with HIV to increase as the HIV-infected population ages.