Arterial stiffness in people with HIV: a cross-sectional, comparative study with echocardiographic outcomes in Tanzania

OBJECTIVES: Cardiovascular disease (CVD) is a growing cause of morbidity and mortality in people with HIV (PWH). Arterial stiffness may be an intermediary between HIV-infection and CVD, necessitating holistic assessment of arterial stiffness and correlation with cardiac outcomes. DESIGN: We conducted a cross-sectional study of PWH and HIV-uninfected community controls using multimodal assessment of arterial stiffness and echocardiographic outcomes. METHODS: We performed ankle-brachial index (ABI) and pulse wave velocity (PWV) to characterize arterial stiffness in a cohort of PWH and HIV-uninfected community controls in Tanzania. Regression analysis was used to determine differential risk factors for phenotypes of arterial stiffness and echocardiographic outcomes of these phenotypes. RESULTS: We enrolled 848 participants; 398/848 PWH (46.9%) and 450/848 community controls (53.1%). In multivariable models, elevated ABI was associated with HIV infection [3.29 (1.51, 7.21), P = 0.003] and male sex [2.33 (1.15, 4.71), P = 0.019], whereas elevated PWV was associated with age [1.11 (1.06, 1.17), P < 0.001], SBP [1.58 (1.24, 2.01), P < 0.001], and DBP [2.03 (1.38-2.98) P < 0.001]. ABI was independently associated with average E:e' [0.74 (0.18, 1.30), P = 0.010]. PWV was independently associated with left-ventricular mass index (LVMI) [10.73 (2.69-18.76), P = 0.009]. CONCLUSION: Differential associations between HIV and multiple measures of arterial stiffness suggest that HIV is associated with peripheral but not central arterial stiffness. Arterial stiffness was correlated with cardiac hypertrophy and impaired cardiac filling, suggesting a mechanistic pathway for HIV-related CVD that includes peripheral arterial stiffness. We identified a subpopulation of young, male PWH at risk for early vascular aging.