University of Florida, Gainesville, USA.
AIDS. 2010 Sep 10;24(14):2201-9. doi: 10.1097/QAD.0b013e32833d2132.
Previous research has demonstrated an increase in carotid intima-media thickness (cIMT) in HIV-infected individuals compared to controls. However, the reason for this increased level of subclinical vascular disease is unknown.
To identify HIV-related risk factors for increased cIMT.
We evaluated the relationship between HIV-related characteristics (including markers of HIV disease severity and use of antiretroviral therapy) and cIMT measurements in the internal/bulb and common carotid regions among 538 HIV-infected participants from the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM). We used Bayesian model averaging to estimate the posterior probability of candidate HIV and non-HIV-related risk factors being true predictors of increased cIMT. Variables with a posterior probability of more than 50% were used to develop a selected regression model for each of the anatomic regions.
For common cIMT, the Bayesian model selection process identified age, African-American race, and systolic and diastolic blood pressure with probability more than 95%, HDL cholesterol with probability 85% and Hispanic ethnicity with probability 51%. Among the HIV-related factors included in the analysis, only tenofovir use was selected (51% probability). In the selected model, duration of tenofovir use was associated with lower common cIMT (-0.0094 mm/year of use; 95% confidence interval: -0.0177 to -0.0010). For internal cIMT, no HIV-related risk factors were above the 50% posterior probability threshold.
We observed an inverse association between duration of tenofovir use and common carotid cIMT. Whether this association is causal or due to confounding by indication needs further investigation.
与对照组相比，HIV 感染者的颈动脉内膜中层厚度（cIMT）增加。然而，这种亚临床血管疾病水平增加的原因尚不清楚。
确定与 HIV 相关的增加 cIMT 的危险因素。
我们评估了与 HIV 相关的特征（包括 HIV 疾病严重程度的标志物和抗逆转录病毒治疗的使用）与 538 名来自 HIV 感染脂肪再分布和代谢变化研究（FRAM）的参与者的内部/球部和颈总动脉区域的 cIMT 测量值之间的关系。我们使用贝叶斯模型平均来估计候选 HIV 和非 HIV 相关危险因素作为增加 cIMT 的真实预测因子的后验概率。后验概率超过 50%的变量用于为每个解剖区域开发一个选定的回归模型。
对于颈总 cIMT，贝叶斯模型选择过程确定了年龄、非裔美国人种族、收缩压和舒张压的概率超过 95%，高密度脂蛋白胆固醇的概率为 85%，西班牙裔的概率为 51%。在纳入分析的与 HIV 相关的因素中，只有替诺福韦的使用被选中（概率为 51%）。在选定的模型中，替诺福韦的使用时间与较低的颈总 cIMT 相关（使用时间每增加 0.0094 毫米/年；95%置信区间：-0.0177 至-0.0010）。对于内部 cIMT，没有与 HIV 相关的危险因素的后验概率超过 50%。
我们观察到替诺福韦使用时间与颈总动脉 cIMT 之间存在反比关系。这种关联是因果关系还是由于指示性混杂需要进一步研究。
