ABC | Volume 114, Nº1, January 2019

Original Article Inflammatory Biomarkers and Carotid Thickness in HIV Infected Patients under Antiretroviral Therapy, Undetectable HIV‑1 Viral Load, and Low Cardiovascular Risk Kaliene Maria Estevão Leite, 1 Gerson Gomes Santos Júnior, 1 Emmanuelle T. A. M Godoi, 1 Adriana Ferraz Vasconcelos, 1 Virgínia Maria Barros Lorena, 1 Paulo Sérgio Ramos Araújo, 1,2 Kledoaldo Oliveira Lima, 1 Heloisa Ramos Lacerda 1 Universidade Federal de Pernambuco - Pós-Graduação em Medicina Tropical, 1 Recife, PE – Brazil Instituto de Pesquisa Aggeu Magalhães, 2 Recife, PE – Brazil Mailing Address: Kledoaldo Oliveira Lima • Universidade Federal de Pernambuco - Av. Prof. Moraes Rego, s/n. Postal Code 50670-901, Cidade Universitária, Recife, PE – Brazil E-mail: kledoaldo@gmail.com Amnuscript received September 01, 2018, revised manuscript February 18, 2019, accepted March 10, 2019 DOI: 10.5935/abc.20190230 Abstract Background: People living with HIV are at increased risk of cardiovascular disease and carotid thickness, due to the inflammation caused by the virus, the antiretroviral therapy, and other risk factors. However, few studies have observed the occurrence of cardiovascular diseases and carotid thickness in HIV-positive population at low cardiovascular risk and with undetectable viral load. Objectives: To evaluate the association between levels of inflammatory markers and carotid thickness in people living with HIV, under antiretroviral therapy and at low cardiovascular risk. Methods: To determine low cardiovascular risk in both groups (HIV infected and non-infected individuals), the Framingham Risk Score was used. Inflammatory markers (IFN- γ , TNF- α , IL-1 β , IL-6, sVCAM-1, and sICAM-1) were assessed using flow cytometry. Carotid thickness (mm) was measured using Doppler ultrasound. Level of significance was p < 0.05. Results: In People living with HIV, age and smoking status were associated with carotid thickness alterations. In the non-HIV group, age, higher total cholesterol, and LDL levels were associated with increased carotid thickness. Using the multivariate analysis, a significant association between TNF- α and IL- 1 β levels, and a higher chance of atherosclerosis development in HIV group were observed. Conclusions: Both groups have a similar risk for developing cardiovascular disease, therefore our study demonstrates that HIV-positive individuals with undetectable viral load in antiretroviral therapy without protease inhibitors and with low cardiovascular risk do not present differences in carotid thickness in relation to uninfected individuals. (Arq Bras Cardiol. 2020; 114(1):90-97) Keywords: HIV; HIV Infections; Cardiovascular Diseases; Antiretroviral Therapy; Risk Factors; Caroti Artery Diseases; Atherosclerosis. Introduction Increased longevity in people living with HIV (PLHIV) due to effective highly active antiretroviral therapy (HAART) has increased the incidence of chronic diseases, such as cardiovascular disease. 1 According to some studies, the virus and antiretroviral therapy (ART) are factors that favor the increase of inflammatory makers and carotid thickness. 2,3 HIV-infected individuals have high levels of C-reactive protein, which is associated with atherosclerosis and myocardial infarction. Levels of interleukin-6 (IL-6), tumour necrosis factor alpha (TNF- α ), interferon gamma (IFN- γ ), interleukin-1 (IL-1), intracellular cell adhesion molecule (sICAM), and vascular cell adhesion molecule (sVCAM), which rise in the progression of cardiovascular disease, are also increased in this population. 4-6 Studies did not evaluate factors of cardiovascular disease progression in the population considered to be at low cardiovascular risk, without observing the true possible effect of the inflammation caused by the virus and the adverse effect of antiretrovirals without the interference of intrinsic factors affecting cardiovascular risk in these individuals. In addition, we have not yet studied a population in which all patients had undetectable HIV-1 RNA viral load and used only nucleoside reverse transcriptase inhibitor (NRTIs) analogues and non-nucleoside reverse transcriptase inhibitors (NNRTIs), since protease inhibitors (PIs) have high adverse effect on cardiovascular disorders. The present study evaluated the association of inflammatory markers IFN- γ , IL-1 β , IL-6, TNF- α , C-reactive protein, sVCAM-1, and sICAM-1 and carotid thickness in HIV infected peope, in use of NRTIs analogues and NNRTIs, and low cardiovascular risk. In addition, carotid intima-media thickness and inflammatory markers levels between HIV-infected and non-infected individuals stratified by age were compared. 90