Treatment with antiretroviral drugs can cause hardening of the arteries, Greek investigators report in the online edition of the American Journal of Hypertension. Traditional risk factors for hardening of the arteries, also known as atherosclerosis, such as cholesterol and high blood pressure, were also shown to be important.
Some anti-HIV drugs can cause side-effects that increase the long-term risk of cardiovascular disease. Antiretroviral therapy is lifelong and there is concern that patients taking HIV treatment may have an increased risk of developing hardening of the arteries.
Untreated HIV infection has also been associated with an increased risk of cardiovascular disease.
To gain a better understanding of the risk factors for atherosclerosis in HIV-positive patients, researchers in Athens monitored pulse wave velocity, an indicator of arterial stiffness, in 56 HIV-positive patients, with 28 individuals recently diagnosed with high blood pressure, a traditional risk factor for hardening of the arteries.
The patients with HIV were also matched with a further 28 HIV-negative individuals of the same age and sex.
Analysis of pulse wave velocity monitoring showed that HIV-positive patients had more hardening of the arteries than the HIV-negative controls (p = 0.03), but less than individuals with hypertension (p = 0.01).
These differences remained significant after adjusting for blood pressure.
Furthermore, individuals taking antiretroviral therapy were more likely to have atherosclerosis than HIV-positive patients who were not taking anti-HIV drugs (p = 0.03).
Individuals taking protease inhibitors had more evidence of hardening of the arteries than did individuals taking other antiretroviral drugs, as well as both groups of control patients.
Treatment with anti-HIV drugs was associated with higher blood pressure, cholesterol and triglycerides (all p
Statistical analysis showed that the following factors were associated with impaired pulse wave velocity in patients with HIV: age; blood pressure; cholesterol and triglyceride levels; use of and duration of antiretroviral therapy; and treatment with protease inhibitors or nucleoside reverse transcriptase inhibitors (NRTIs).
After adjusting these results to control for age and sex, the investigators found that the following factors were significant: longer duration of HIV infection; higher HIV viral load; a CD4 cell count below 200 copies/mm3 for at least six months; blood pressure; cholesterol and triglyceride levels; use of HIV treatment; and therapy with protease inhibitors and NRTIs.
In the final multivariate analysis, the only factors that remained significant were duration of antiretroviral treatment (p = 0.04), cholesterol levels (p = 0.04), and blood pressure (p
Lekakis J et al. Association of highly active antiretroviral therapy with increased arterial stiffness in patients infected with human immunodeficiency virus. American Journal of Hypertension (online edition), 2009.