ICAAC: Hardening of the arteries found in one in five patients in Swiss HIV cohort

A cross-sectional study of Swiss patients with HIV has found that one in five had peripheral vascular disease - hardening or narrowing of the arteries in the leg - compared with a prevalence of up to 4% in the general population.

The findings were presented as a poster this week at the 47^th Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago.

Atherosclerotic vascular disease (often called hardening of the arteries) has been observed in HIV-positive individuals taking a number of antiretroviral drugs. However, there are limited data concerning the prevalence of peripheral arterial disease in people with HIV.

Investigators from the University Hospital in Lausanne, Switzerland, therefore conducted a cross-sectional study involving 92 HIV-positive individuals aged 40 years and over.

Peripheral arterial disease was assessed using two measures. First, researchers used a resting ankle-brachial index (ABI: the ratio of ankle to brachial systolic blood pressure). An ABI ratio of below 0.9 at rest, or a greater than 25% decrease in ABI after exercise, suggested vascular disease. If hardening of the arteries was detected using this test, a second investigation, involving an ultrasound of the leg arteries, was employed.

The investigators noted that atherosclerotic vascular disease, using the ankle-brachial index, has been observed in between 0.6% and 4% of the general population aged between 40 and 59.

The mean age of patients in the study was 49.5 years, 24% were women and 62% were current smokers. Cramp-like pains in the leg, an indication of vascular disease, were reported by 14 patients.

Peripheral arterial disease was detected in 19 patients (20.7%) using the first test. Sixteen of these patients agreed to have an ultrasound investigation, and all these patients had obstructions or narrowing of the iliac or femoral arteries.

Smoking, age, diabetes, high levels of blood fats, and low CD4 cell count (below 200 cells/mm³) were all identified as significant predictors of peripheral arterial disease.

“The prevalence of symptomatic and asymptomatic peripheral arterial disease is high in this HIV-infected population and is much higher than expected … in the general population”, conclude the investigators. They add, “larger studies are needed to more precisely define peripheral arterial disease risk factors and to evaluate whether peripheral arterial disease is associated with an increase in mortality, as it is in the general population.”