Sub-clinical atherosclerosis in HIV-infected patients: prevalence and risk factors

Introduction: Antiretroviral therapy has significantly improved the prognosis of human immuno-deficiency viruses (HIV) infection. Therefore, life expectancy of people living with HIV (PLHIV) has increased. However, this therapy may have some side effects. This study aimed to detect the prevalence of sub-clinical carotid and coronary atherosclerosis among asymptomatic patients living with HIV, free from known cardiovascular diseases, and to identify the factors associated with sub-clinical athe-rosclerosis. Material and methods: We conducted a cross-sectional prospective study over one year (between July 2018 and June 2019). We included 75 PLHIV, followed-up in the outpatient clinic of the Infectious Diseases Department of the University Hospital Fattouma Bourguiba in Monastir, Tunisia. Cardio-vascular assessment, including carotid doppler ultrasonography, electrocardiogram, exercise stress testing, and transthoracic echocardiography was proposed to all study participants. Results: The cardiovascular assessment revealed sub-clinical atherosclerosis in 9 PLHIV (12%): carotid atherosclerosis in 9 cases and coronary artery atherosclerosis in one case. One patient had presented both carotid and coronary atherosclerosis. After multivariate regression analysis, smoking (OR = 2.6; 95% CI: 1.08-6.62%; p = 0.03) and age >= 40 years (OR = 2.3; 95% CI: 1.02-5.22%; p = 0.04) were found to be independent risk factors of sub-clinical atherosclerosis in PLHIV. Conclusions: Our study revealed that sub-clinical atherosclerosis was present in 1 of 8 PLHIV. Therefore, screening for atherosclerosis using carotid ultrasound imaging, transthoracic echocardiography, and ex-ercise stress test should be suggested for all PLHIV under 40 years and/or smokers.