Maggi Paolo, Quirino Tiziana, Ricci Elena, De Socio Giuseppe Vittorio L, Gadaleta Aurora, Ingrassia Fabrizio, Perilli Francesco, Lillo Antonio, Bonfanti Paolo
Clinica delle Malattie Infettive, Università degli Studi di Bari-Policlinico, Bari, Italy . p_maggi_yahoo.com
AIDS Patient Care STDS. 2009 Oct;23(10):809-13. doi: 10.1089/apc.2009.0102.
Various studies have been conducted to evaluate the role of antiretroviral therapy in the onset of cardiovascular risk among HIV-1-infected patients, while fewer data are available regarding antiretroviral-naïve patients. Our objective was to evaluate the cardiovascular risk among naïve subjects examining traditional risk factors, immunovirologic parameters, assessing the Framingham risk score (FRS), and detecting the presence of subclinical carotid lesions by means of color Doppler ultrasonography. One hundred seventy-two antiretroviral-naïve patients underwent color Doppler ultrasonography. An intima-media thickness (IMT) greater than 0.9 mm and/or atherosclerotic plaques were considered pathologic findings. Demographic, immunovirologic data, and risk factors for cardiovascular disease were collected. The 10-year probability of acute coronary events was assessed by the FRS. The statistical analysis was performed using t test and chi(2), Fisher's test, and conditional multiple logistic. Thirty-six patients (20.9%) had lesions at ultrasonographic investigation. The presence of lesions was significantly related to male gender (p = 0.005), age (p = 0.003), sedentary life (p = 0.05), Centers for Disease Control and Prevention (CDC) group C or CD4(+) less than 150 cells/mm(3), and viral load (VL) > 100,000 copies per milliliter (p = 0.04). The presence of subclinical carotid lesions showed a highly significant direct association with the estimated FRS (p < 0.002). The presence of subclinical atheromasic lesion results was also high among antiretroviral-naïve patients. FRS is highly predictive of the lesions, but also an advanced stage of disease plays a significant role. Our data support the hypothesis that HIV infection per se is a risk factor for atherosclerosis. We recommend an ultrasonographic assessment both among patients with FRS 6% or more and among those in advanced stage of disease.
已经开展了各种研究来评估抗逆转录病毒疗法在HIV-1感染患者心血管风险发生中的作用，而关于未接受过抗逆转录病毒治疗的患者的数据较少。我们的目标是通过检查传统风险因素、免疫病毒学参数、评估弗雷明汉风险评分（FRS）以及通过彩色多普勒超声检测亚临床颈动脉病变的存在，来评估未接受过治疗的受试者的心血管风险。172例未接受过抗逆转录病毒治疗的患者接受了彩色多普勒超声检查。内膜中层厚度（IMT）大于0.9毫米和/或动脉粥样硬化斑块被视为病理结果。收集了人口统计学、免疫病毒学数据以及心血管疾病的风险因素。通过FRS评估急性冠状动脉事件的10年概率。使用t检验、卡方检验、费舍尔检验和条件多因素逻辑回归进行统计分析。36例患者（20.9%）在超声检查时有病变。病变的存在与男性性别（p = 0.005）、年龄（p = 0.003）、久坐不动的生活方式（p = 0.05）、美国疾病控制与预防中心（CDC）C组或CD4(+)细胞计数低于150个/立方毫米以及病毒载量（VL）>100,000拷贝/毫升（p = 0.04）显著相关。亚临床颈动脉病变的存在与估计的FRS呈高度显著的直接关联（p < 0.002）。在未接受过抗逆转录病毒治疗的患者中，亚临床动脉粥样硬化病变的发生率也很高。FRS对病变具有高度预测性，但疾病的晚期阶段也起着重要作用。我们的数据支持HIV感染本身是动脉粥样硬化危险因素这一假设。我们建议对FRS为6%或更高的患者以及疾病晚期患者都进行超声评估。
