High Prevalence of Lower Extremity Medial Arterial Calcification in HIV-infected Patients with and without Chronic Renal Disease: A Vascular Ultrasound Cross-sectional Study

Background The association between HIV infection and increased risk of atherosclerotic peripheral artery disease (PAD) has been documented, but the relationship between HIV infection and lower extremity medial arterial calcification (MAC) is unknown. Objective We performed a cross-sectional study to compare the frequency of MAC diagnosed by vascular ultrasound in PAD-asymptomatic people living with HIV (PLWH) with and without chronic kidney disease (CKD) compared to HIV-uninfected participants as a control group. Methods MAC was defined as smooth, linear, and non-stenotic hyperechogenicity in the arterial wall as compared with the surrounding tissues. We studied 191 patients: 50 PLWH (25 with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73m2 and 25 with an eGFR <60 mL/min/1.73m2) and 141 HIV-uninfected patients (68 with eGFR<60 ml/min/1.73m2). Results MAC was most frequently found in PLWH with CKD (76%). The prevalence of MAC among PLWH was 54.0% (95% confidence interval [CI], 40.4-67.0%), whereas in HIV-uninfected it was 34.0% (95% CI, 26.7-42.2%, P=0.013). Age and CKD were consistently associated with MAC in our multivariable models, and there was also a sign that PLWH had higher odds of having MAC. Conclusion We found a higher prevalence of MAC in PAD-asymptomatic PLWH compared to HIV-uninfected ones, and provide evidence that HIV infection could be associated with MAC.