Echocardiography and carotid intima–media thickness among asymptomatic HIV-infected adolescents in Thailand

OBJECTIVES: To evaluate the carotid intima-media thickness (cIMT) in perinatally HIV-infected adolescents and factors associated with cardiovascular abnormalities. DESIGNS: A cross-sectional study was conducted in perinatally HIV-infected adolescents who had no known cardiovascular condition and healthy controls. METHODS: Transthoracic echocardiogram and cIMT measurements were taken by pediatric cardiologists. Serum lipid profiles, high-sensitivity C-reactive protein and N-terminal pro-brain natriuretic peptide were measured. RESULTS: Hundred HIV-infected and 50 healthy adolescents were enrolled. Echocardiograms revealed overall normal systolic function (median left-ventricular ejection fraction 66 vs. 66%; P = 0.825). The mean overall cIMTs of common carotid arteries and internal carotid arteries were not different between the groups (0.373 vs. 0.371; P = 0.744). Among the HIV-infected adolescents, those who had been receiving protease inhibitor-containing regimens had an increased cIMT (0.364 vs. 0.381 mm; P = 0.009). Hypertriglyceridemia was found in 52% of those who had received protease inhibitors for more than 6 months, but only in 21% of those who had never received protease inhibitors (odds ratio 4.0, 95% confidence interval 1.6-9.7, P = 0.002). Current HIV-RNA, CD4, BMI, sex, cholesterol and low-density lipoprotein-cholesterol were not associated with increased cIMT. Serum high-sensitivity C-reactive protein and N-terminal pro-brain natriuretic peptide were not different between the groups and not associated with cardiac abnormalities. CONCLUSIONS: Perinatally HIV-infected adolescents had comparable myocardial function and similar cIMT measurements to healthy adolescents. However, hypertriglyceridemia and increased cIMT were found in HIV-infected adolescents receiving protease inhibitor-based regimens. Longer-term follow-up is needed to evaluate HIV-associated cardiovascular disease risk in this population.