Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492012000200009
Jornal Vascular Brasileiro
Artigo Original

Efeito da terapia antirretroviral e dos níveis de carga viral no complexo médio-intimal e no índice tornozelo-braço em pacientes infectados pelo HIV

Antirretroviral therapy effect in the intima-medio complex and ankle-brachial index in patients infected by HIV

Emmanuelle Tenório Albuquerque Madruga Godoi; Carlos Teixeira Brandt; Jocelene Tenório Albuquerque Madruga Godoi; Heloísa Ramos Lacerda; Valéria Maria Gonçalves de Albuquerque; Josefina Cláudia Zirpoli; Juannicelle Tenório Albuquerque Madruga Godoi; Camila Sarteschi

http://dx.doi.org/10.1590/S1677-54492012000200009 J Vasc Bras, vol.11, n2, p.123-131, 2012
PDF Português
PDF English
SciELO
Downloads: 0
Views: 847

Resumo

OBJETIVOS: Identificar precocemente a prevalência de aterosclerose, por causa do espessamento do complexo médio-intimal das carótidas comuns e do índice tornozelo-braço. Essas medidas foram relacionadas com os fatores de risco clássicos de aterosclerose e os específicos dos infectados pelo HIV (tempo de doença, tempo de tratamento, tipo de tratamento, tipo de terapia antirretroviral utilizada, CD4 e carga viral). MÉTODOS: Setenta casos infectados com o HIV foram avaliados pela medida automática do complexo médio-intimal nas carótidas e do índice tornozelo-braço. Consideraram-se os fatores de risco clássicos de aterosclerose (idade, sexo, hipertensão arterial sistêmica, tabagismo, hipercolesterolemia, hipertrigliceridemia, obesidade e história familiar de evento cardiovascular), as medidas antropométricas e as variáveis relacionadas ao HIV. O nível de significância assumido foi de 5%. RESULTADOS: O tempo médio de diagnóstico do HIV foi de 104,9 meses e de tratamento foi de 97,9 meses. Quanto ao tipo de tratamento, 47 (67,1%) fizeram uso de inibidor de protease por mais de seis meses e 36 (51,4%) estão em uso atualmente. O índice tornozelo-braço estava aumentado em um único paciente (0,7%) e não se evidenciou espessamento do complexo médio-intimal em nenhum indivíduo. Não existiu associação significante da medida do complexo médio-intimal da carótida comum direita com nenhuma das variáveis analisadas. CONCLUSÕES: Indivíduos jovens, sob o uso de terapia antirretroviral por cinco anos ou mais, não apresentaram espessamento do complexo médio-intimal ou aumento do índice tornozelo-braço. Não houve diferença do espessamento do complexo médio-intimal associada ao tipo de esquema antirretroviral utilizado ou nível de carga viral.

Palavras-chave

aterosclerose, índice tornozelo-braço, anti-retrovirais

Abstract

OBJECTIVES: To precociously identify the prevalence of atherosclerosis caused by thickening of the intima-media complex of the common carotid arteries and of the ankle brachial index. These measurements were associated with the classical risk factors of atherosclerosis and the specific factors of those infected by HIV (duration of disease, length of treatment, kind of treatment, kind of antiretroviral therapy used, CD4 and viral load). METHODS: Seventy cases infected by HIV were assessed by automatic measurement of the intima-media complex in the carotids and of the ankle brachial index. The classical risk factors of atherosclerosis (age, gender, systemic arterial hypertension, smoking, hypercholesterolemia, hypertriglyceridemia, obesity, and family history of cardiovascular events), anthropometric measurements and the variables related to HIV were taken into consideration. The adopted level of significance was 5%. RESULTS: The mean time of HIV diagnosis was 104.9 months, mean duration of treatment was 97.9 months. As regard to the type of treatment, 47 (67.1%) used protease inhibitor for more than six months and 36 (51.4%) are using it recently. The ankle brachial index was increased in one patient (0.7%), and the intima-media complex was not thickened in any individual. There was no significant association of the measurement of the intima-media complex of the right common carotid with any of the variables analyzed. CONCLUSIONS: Young individuals under the use of antiretroviral therapy for five years or more did not show increase in thickness of the intima-media complex or increase in the ankle brachial index, and there was no difference in the intima-media complex thickness associated with the therapeutical scheme of antiretroviral used or the viral load level.

Keywords

atherosclerosis, ankle brachial index, anti-retroviral agent

References

Friis-Moler N, Weber R, Reiss P. Cardiovascular disease risk factors in HIV patients-association with antirretroviral therapy: Results from DAD study. AIDS. 2003;17:1179-93.

Bozkurt B. Cardiovascular toxicity with highly active antirretroviral therapy: review of clinical studies. Cardiovasc Toxicol. 2004;4:243-60.

Grover SA, Coupal L, Gilmore N, Mukherjee J. Impact of dyslipidemia associated with Highly Active Antirretroviral Therapy (HAART) on cardiovascular risk and life expectancy. Am J Cardiol. 2005;95:586-91.

Friis-Møller N, Reiss P. Class of antirretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356:1723-35.

Kung HC, Hoyert DL, Xu J, Murphy SL. Deaths: final data for 2005. Natl Vital Stat Rep. 2008;56:1-120.

Estatísticas Vitais. 2006.

Freire CM, Ribeiro AL, Barbosa FB. Comparison between automated and manual measurements of carotid intima-media thickness in clinical practice. Vasc Health Risk Manag. 2009;5:811-7.

Touboul PJ, Hennerici MG, Meairs S. Mannheim carotid intima-media thickness consensus (2004-2006). Cerebrovasc Dis. 2007;23:75-80.

Stein JH, Korcarz CE, Hurst RT. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21:93-111.

Kanter SD, Algra A, van Leeuwen MS, Banga JD. Reproducibility of in vivo carotid intima-media thickness measurements: a review. Stroke. 1997;28:665-71.

Godoi ETAM, Barbosa AD, Godoi JTAM. Envolvimento macrovascular e esclerose sistêmica. J Vasc Bras. 2009;8:65-75.

Palella FJ Jr, Delaney KM, Moorman AC. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection: HIV Outpatients Study Investigators. N Engl J Med. 1998;338:853-60.

Lewden C, Chene G, Morlat P. HIV-infected adults with a CD4 cell count greater than 500 cells/mm³ on long-term combination antirretroviral therapy reach same mortality rates as the general popul. . 2007;46:72-7.

Lima VD, Hogg RS, Harrigan PR. Continued improvement in survival among HIV-infected individuals with newer forms of highly active antirretroviral therapy. AIDS. 2007;21:685-92.

Olalla J, Salas D, de la Torre J, Del Arco A, Prada JL, García Alegría J. Ankle-brachial index in HIV infection. AIDS Res Ther. 2009;6(6).

Mulligan K, Grunfeld C, Tai VW. Hyperlipidemia and insulin resistance are induced by protease inhibitors independent of changes in body composition in patients with HIV infection. J Acquir Immune Defic Syndr. 2000;23:35-43.

Murata H, Hruz PW, Mueckler M. The mechanism of insulin resistance caused by HIV protease inhibitor therapy. J Biol Chem. 2000;275:20251-4.

Bernal E, Masiá M, Padilla S, Gutiérrez F. High-density lipoprotein cholesterol in HIV-infected patients: evidence for an association with HIV-1 viral load, antirretroviral therapy status, and regimen composition. AIDS Patient Care STDS. 2008;22:569-75.

Hsue PY, Hunt PW, Wu Y. Association of abacavir and HIV disease factors with endothelial function in patients on long-term suppressive ART. . .

Depairon M, Chessex S, Sudre P. Premature atherosclerosis in HIV-infected individuals-focus on protease inhibitor therapy. AIDS. 2001;15:329-34.

Martínez E, García-Viejo MA, Blanco JL. Impact of switching from human immunodeficiency virus type 1 protease inhibitors to efavirenz in successfully treated adults with lipodystrophy. Clin Infect Dis. 2000;31:1266-73.

Carr A. Cardiovascular risk factors in HIV-infected patients. JAIDS. 2003;34(^sSuppl):S73-8.

Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA. Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hiperlipidaemia, and diabetes mellitus: a cohort study. Lancet. 1999;353:2093-9.

Martínez E, Conget I, Lozano L, Casamitjana R, Gatell JM. Reversion of metabolic abnormalities after switching from HIV-1 protease inhibitors to nevirapine. AIDS. 1999;13:805-10.

Carr A, Miller J, Law M, Cooper DA. A syndrome of lipoatrophy, latic acidaemia and liver dysfunction associated with HIV nucleoside analogue therapy: cntribution to protease inhibitor-related lipodystrophy syndrome. AIDS. 2000;14:F25-32.

Lekakis JP, Papamichael CM, Cimponeriu AT. Atherosclerotic changes of extracoronary arteries are associated with the extent of coronary atherosclerosis. Am J Cardiol. 2000;85:949-52.

Maggi P, Lillo A, Perilli F, Maserati R, Chirianni A. Colour-Doppler ultrasonography of carotid vessels in patients treated with antirretroviral therapy: a comparative study. AIDS. 2004;18:1023-8.

Allison MA, Tiefenbrun J, Langer RD, Wright CM. Atherosclerotic calcification and intimal medial thickness of the carotid arteries. Int J Cardiol. 2005;103:98-104.

Currier JS, Kendall MA, Zackin R. Carotid artery intima-media thickness and HIV infection: traditional risk factors overshadow impact of prothease inhibitor exposure. AIDS. 2005;19:927-33.

Mercié P, Thiébaut R, Aurillac-Lavignolle V. Carotid intima-media thickness is slightly increased over time in HIV-1-infected patients. HIV Med. 2005;6:380-7.

Maggi P, Perilli F, Lillo A. An ultrasound-based comparative study on carotid plaques in HIV-positive patients vs. atherosclerotic and arteritis patients: atherosclerotic or inflammatory lesions?. Coron Artery Dis. 2007;18:23-9.

Maggi P, Perilli F, Lillo A. Rapid progression of carotid lesions in HAART-treated HIV-1 patients. Atherosclerosis. 2007;192:407-12.

Godoi ETAM, Barbosa AD, Godoi JTAM. Estudo da macrovasculatura por ultra-sonografia Doppler na esclerose sistêmica. Rev Bras Reumatol. 2008;48:86-93.

Leger P, Boccalon H. Bilan d'un artériopathie des membres inférieurs (AMI). Guide Pratique des Maladies Vasculaires. 2001:13-8.

Spácil J, Spácabilová J. The ankle-brachial blood pressure index as a risk indicator of generalized atherosclerosis. Semin Vasc Med. 2002;2:441-5.

Sarno F, Monteiro CA. Importância relativa do índice de massa corporal e da Circunferência Abdominal na predição da hipertensão Arterial. Rev Saúde Pública. 2007;41:788-96.

Guimarães ICB, Almeida AM, Santos AS, Barbosa DBV, Guimarães AC. Pressão arterial: efeito do índice de massa corporal e da circunferência abdominal em adolescentes. Arq Bras Cardiol. 2008;90(6):426-32.

Touboul PJ, Vicaut E, Labreuche J. Correlation between the Framingham risk score and intima media thickness: the paroi artérielle et risque cardio-vasculaire (PARC) study. Atherosclerosis. 2007;192:363-9.

Engelhorn CA, Engelhorn AL, Cassou MF. Espessamento médio-intimal na origem da artéria subclávia direita como marcador precoce de risco cardiovascular. Arq Bras Cardiol. 2006;87:609-14.

Labropoulos N, Ashraf Mansour M, Kang SS, Oh DS, Buckman J, Baker WH. Viscoelastic properties of normal and atherosclerotic carotid arteries. Eur J Vasc Endovasc Surg. 2000;19:221-5.

Maggi P, Maserati R, Antonelli G. Atherosclerosis in HIV patients: a new face for an old disease?. Aids Rev. 2006;8:204-9.

Hsue PY, Lo JC, Franklin A. Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation. 2004;109:1603-8.

Mercié P, Thiébaut R, Lavignolle V. Evaluation of cardiovascular risk factors in HIV-1 infected patients using carotid intima-media thickness measurement. Ann Med. 2002;34:55-63.

Periard D, Cavassini M, Taffé P. High prevalence of peripheral arterial disease in HIV-infected persons. Clin Infect Dis. 2008;46:761-7.

Bernal E, Masiá M, Padilla S, Hernández I, Gutiérrez F. Low prevalence of peripheral arterial disease in HIV-infected patients with multiple cardiovascular risk factors. J Acquir Immune Defic Syndr. 2008;47:126-7.

Palacios R, Alonso I, Hidalgo A. Peripheral arterial disease in HIV patients older than 50 years of age. AIDS Res Hum Retroviruses. 2008;24:1043-6.

Gutiérrez F, Bernal E, Padilla S, Hernández I, Masiá M. Relationship between ankle-brachial index and carotid intima-media thickness in HIV-infected patients. AIDS. 2008;22:1369-71.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddd35db0e882512071da3e9 jvb Articles
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections