Role of HCV infection in the development of carotid atherosclerosis in a cohort of HIV-infected patients

Background

HIV-infected patients have an increased risk of cardiovascular disease. Measurement of carotid artery intima-media-thickness (c-IMT) with colour-doppler-ultrasonography is a well-accepted, non-invasive method to assess carotid atherosclerosis.

Purpose of the study

To investigate whether HCV infection could be involved in the development of carotid atherosclerosis beside the well-known risk factors.

Patients and methods

In this cohort study, 322 consecutive HIV+ subjects were identified and enrolled between May 2009 and May 2010. A total of 153 patients were HIV/HCV co-infected, whereas 169 were HIV+ mono-infected; 237 patients were treated with highly active antiretroviral therapy (HAART), and 85 subjects were HAART-naïve. All patients underwent at least one c-IMT measurement by the same examiner; an IMT of >0.9 mm was considered pathological.

Results

Overall, 112/322 (35%) patients showed c-IMT >0.9. Table 1 shows the correlation between c-IMT and the following risk factors: age, cigarette smoking, intravenous drug use, CD4 cell count <200/mmc, CDC stage C of HIV infection, PI-based regimens and HCV co-infection. A significant statistical association between all considered factors and increased c-IMT was found. In particular, HCV co-infection showed a greater association in addition to older age, dyslipidemia, stage C of HIV infection.

Table 1

Conclusions

In this cohort, several risk factors seem contribute to inflammatory damage and c-IMT development. Among them, HCV co-infection has been identified as a major determinant of carotid atherosclerosis. If the role of HCV infection will be confirmed in further studies, HIV-HCV co-infected patients should be strictly monitored for the vascular status.