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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:2381.)
© 2005 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Impact of Treatment With Protease Inhibitors on Aortic Stiffness in Adult Patients With Human Immunodeficiency Virus Infection

Giuseppe Schillaci; Giuseppe V.L. De Socio; Matteo Pirro; Gianluca Savarese; Massimo R. Mannarino; Franco Baldelli; Giuliano Stagni; Elmo Mannarino

From the Unit of Internal Medicine, Angiology, and Arteriosclerosis (G. Schillaci, M.P., G. Savarese, M.M., E.M.) and the Unit of Infectious Diseases (G.V.L.D.S., F.B., G. Stagni), University of Perugia, Italy.

Correspondence to Giuseppe Schillaci, MD, Medicina Interna, Angiologia e Malattie da Arteriosclerosi, Università degli Studi di Perugia, Ospedale "R. Silvestrini", via G. Dottori, 1-06132 Perugia, Italy. E-mail skill{at}unipg.it

Background— The role of antiretroviral therapy in acceleration of atherosclerosis in patients with human immunodeficiency virus (HIV) infection is controversial. We hypothesized that aortic stiffness, an early marker of arteriosclerosis, may be increased in HIV patients treated with protease inhibitors.

Methods and Results— In 32 HIV-infected patients treated with protease inhibitors and 32 age-, sex-, and blood pressure–matched HIV-uninfected control subjects, we obtained aortic pulse wave velocity and central aortic pressure waveform, from which aortic augmentation was calculated. HIV patients had a higher aortic pulse wave velocity (7.6±1.1 versus 6.8±1.2 mxs^–1, P=0.015) and aortic augmentation (6.8±5 versus 4.6±4 mm Hg, P=0.037) than control subjects. Age and HIV infection (both P<0.05) independently predicted aortic pulse wave velocity when a consistent number of cardiovascular risk factors was simultaneously controlled for. The cumulative duration of treatment was a predictor of aortic pulse wave velocity, each 5 years of treatment duration being independently related to a 1.35 mxs^–1 increase in pulse wave velocity.

Conclusions— Aortic stiffness is increased in HIV-positive individuals receiving antiretroviral therapy including a protease inhibitor. Pulse wave velocity increases with longer exposure to protease inhibitors. We hypothesize that arteriosclerosis is a side effect of antiretroviral treatment including a protease inhibitor.

Aortic stiffness was higher in HIV patients treated with protease inhibitors than in matched controls, also after adjustment for the effect of classic cardiovascular risk factors. Pulse wave velocity increased with longer exposure to treatment. We hypothesize that arteriosclerosis is a side effect of antiretroviral treatment including a protease inhibitor.

Key Words: acquired immunodeficiency syndrome • HIV • aortic stiffness • arteriosclerosis • protease inhibitors • cardiovascular diseases

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