ABC | Volume 110, Nº5, May 2018

Original Article Salmazo et al Frequency of subclinical atherosclerosis in Brazilian HIV-infected patients Arq Bras Cardiol. 2018; 110(5):402-410 Figure 1 – Frequency of carotid artery plaque in HIV-infected patients and non-HIV-infected controls. 300 250 200 150 100 50 0 p < 0.001 37% 4% HIV Non-HIV-infected Study population Plaque - no Plaque - yes Table 2 – Clinical and laboratory variables of the patients treated or not with protease inhibitors Variables PI + (n=116) PI - (n=148) p Time since diagnosis (months) 140 (74;175) 72.5 (20;120) <0.001 Disease treatment duration (months) 124 (56;155) 44 (4;101) <0.001 LDL-c (mg/dL) 103.2 (80.8;132.4) 102 (83.4;132.8) 0.796 HDL-c (mg/dL) 42 (35;56) 45 (37;53) 0.626 TGL (mg/dL) 190 (119;280) 140 (100;188.5) <0.001 Fasting glucose (mg/dL) 83 (77;91) 83 (77;94) 0.764 Creatinine (mg/dL) 0.80 (0.70;1.0) 0.80 (0.70;0.90) 0.067 Hs-CRP (mg/dL) 0.50 (0.30;0.70) 0.50 (0.30;0.80) 0.344 PI +: in use of protease inhibitors; PI -: no use of protease inhibitors; LDL-c: low-density lipoprotein; HDL-c: high-density lipoprotein; TGL: triglycerides; hs‑CRP: high‑sensitivity C-reactive protein. By grouping patients into two subgroups, low-risk (207 patients) and moderate/high-risk subgroups (45 patients), the PL frequency was 62.8% in the moderate/high-risk and 18.2% in the low-risk (p<0.001) subgroup, as shown in Figure 4. Low-risk individuals were 11 years younger than their moderate/high-risk counterparts (52.5±10.3 years); p<0.001. Compared to the low-risk subgroup, the moderate/high-risk subgroup had higher CIMT [0.780 (0.710-0.935) vs. 0.605 (0.550-0.710) mm; p < 0.001], PWV [8.45 (7.15-10.05) vs. 6.90 (6.10-8.00) m/s; p < 0.001], TC [223 (188-253) vs. 182 (155-208) mg/dL; p < 0.001], LDL-c [130 (103-151) vs. 97.1 (79.6-126) mg/dL; p < 0.001], TGL [222 (160-309) vs. 143 (102-208) mg/dL; p < 0.001], fasting glucose [90 (80- 102) vs. 83 (76-90) mg/dL; p = 0.002], and serum creatinine [0.90 (0.70-1.10) vs. 0.80 (0.70-0.90) mg/dL; p < 0.001], and lower HDL-c [38 (32-45) vs. 46 (37-56) mg/dL; p = 0.002]. From the 207 low-risk individuals, 83 had LDL-c lower than 130 mg/dL and were not using PI, and, of those, 14 (16.9%) were diagnosed with carotid artery PL (p = 0.036). Discussion According to the Brazilian Ministry of Health data, the prevalence of overweight individuals in the general population is around 50%, while that of obesity is 12% to 17%. 33 In the HIV-infected population, some studies have reported a prevalence of fat distribution changes of around 50%, with highly variable lipodystrophy data (20-80%) and obesity in 4-14%. 34,35 In this study, BMI was lower in the HIV-group than in the control group (25.5 ± 4.5 vs. 27.4 ± 5.4 kg/m²). The overweight and obesity frequency was 51.1%, similar to that in the literature and lower than that found in the control group (63.1%). The literature shows a higher frequency of smoking among HIV-infected individuals, reaching approximately 50%, than in the general population. 36,37 We confirmed this in our series, finding active smoking in 43.6% of the patients and 16.1% of the control group (p < 0.001). Smoking had an effect on CIMT only in control subjects. This result could suggest that patients with HIV have other atherogenic factors that would neutralize the effects of smoking on intima-media thickness, with a tendency toward larger CIMT, independently of smoking. LDL-c was associated with age (R = 0.252, p < 0.001) and time since HIV diagnosis (R = 0.293; p = 0.041), in direct association with increased serum levels. These results suggest that atherosclerosis in the HIV population is influenced by other infection-related risk factors, in addition to presenting similar characteristics to the process classically described in other populations. 4-6,8,10,11 405