Arterial stiffness in HIV-infected patients receiving highly active antiretroviral therapy

HIV-infected patients receiving highly active antiretroviral therapy (HAART) are at increased risk of cardiovascular events. Reported non-invasive techniques for assessment of blood pressure in this population have been limited to sphygmomanometry. The present cross-sectional study investigated the impact of antiretroviral therapy and the HAART-associated lipodystrophy on aortic blood pressure conditions and arterial stiffness in HAART-treated lipodystrophic (n=42) and non-lipodystrophic (n=17) patients. Pulse wave analysis, novel to this population, was used to evaluate measures of arterial stiffness, including the heart rate corrected augmentation index, AgIHR. Results indicated no significant difference between the study groups in peripheral or aortic blood pressure and AgIHR. Significant correlates of AgIHR included age (P=0.003), duration of antiretroviral therapy (P=0.020), lamivudine therapy (P=0.015) and ritonavir therapy (P=0.016) as well as cumulative exposure to protease inhibitors (P=0.030). Time since FIN diagnosis, severity of immunodeficiency or presence of HAART-associated lipodystrophy bore no relationship to AgIHR. In multivariate analysis, duration of antiretroviral therapy (P=0.046), cumulative exposure to nucleoside reverse transcriptase inhibitors (P=0.032) and to protease inhibitors (P=0.011) were identified as independent factors predicting AgIHR. Prolonged antiretroviral treatment, thus, delineates as a risk factor for systemic arterial stiffness and the associated cardiovascular mortality.