Key result
Age, tobacco, and low CD4/CD8 ratio detect subclinical atherosclerosis in HIV with ~72% diagnostic yield.
Why the study?
Cardiovascular disease is a major cause of morbidity and mortality in HIV patients, but predictors of subclinical atherosclerosis in this population are not well defined.
What are the clinical and immunological predictors of subclinical atherosclerosis in HIV patients?
Cross-Sectional (n=183)
Yes
What are the clinical and immunological predictors of subclinical atherosclerosis in HIV patients?
Effect estimate: AUC 0.72 (95% CI 64-80)
Tobacco use, older age, and a CD4/CD8 ratio <0.7 are significant predictors of subclinical atherosclerosis in HIV patients, with a ratio <0.3 being highly diagnostic.
May inform subclinical atherosclerosis screening in HIV but should not change practice; leaves open prospective validation of this model.
Background: Cardiovascular disease is a major cause of morbidity and mortality in HIV patients. The detection of subclinical atherosclerosis through vascular ultrasound allows us to identify patients at increased risk of cardiovascular disease as a primary prevention strategy; this test is not routine. Our objective is to determine predictors of subclinical atherosclerosis in a population with HIV. Methods: Patients with HIV infection were selected in primary prevention and underwent carotid and femoral ultrasound to detect atheromatous plaques. Logistic regression analysis was performed including vascular risk factors to predict the presence of atherosclerosis. Results: One hundred eighty-three patients were included. Subclinical atherosclerosis was present in 62.29% of the patients; 83.32% had plaque in the carotid territory, 57.93% in the femoral territory and 25.6% in both vascular territories. Compared to those without atherosclerosis, patients with atherosclerosis were on average 5.35 years older (53.86 vs. 48.51, p<0.001) and had a higher prevalence of smoking (63.23% vs. 39.12%, p=0.020) and a CD4/CD8 ratio below 0.7 (44.23% vs. 29.02%, p=0.043). A CD4/CD8 ratio lower than 0.3 was always associated with subclinical atherosclerosis (95% CI: 83.9-100%). Inclusion of smoking, CD4/CD8 ratio and age in the logistic regression analysis led to a diagnostic yield of 72% measured by the area under the ROC curve (95% CI: 64-80%). Conclusions: Tobacco use, age and a CD4/CD8 ratio lower than 0.7 allow prediction of the presence of subclinical atherosclerosis in primary prevention. A CD4/CD8 ratio below 0.3 was diagnostic of atherosclerosis in HIV patients in primary prevention. Trial registration Not applicable
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Soto et al. (2022) conducted a cross-sectional in HIV infection without a history of established cardiovascular disease (n=183). Risk factors (age, active smoking, CD4/CD8 ratio < 0.7) vs. Absence of these risk factors was evaluated on Presence of subclinical atherosclerosis (diagnostic yield of logistic regression model) (AUC 0.72, 95% CI 64-80). A predictive model including tobacco use, age, and a CD4/CD8 ratio lower than 0.7 identified the presence of subclinical atherosclerosis in HIV patients with a diagnostic yield of 72% (AUC 0.72).
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