[38] PRECOCIOUS LESIONS OF THE CAROTID VESSELS IN HIV-1-INFECTED PATIENTS TREATED WITH PROTEASE INHIBITORS

1st International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV

26–28 June 1999 - San Diego, CA, USA

PRECOCIOUS LESIONS OF THE CAROTID VESSELS IN HIV-1-INFECTED PATIENTS TREATED WITH PROTEASE INHIBITORS

Antiviral Therapy 1999; 4(Suppl. 2):54(abstract no. 38)

P Maggi¹, G Fiorentino¹, A Saracino¹, C Fico³, F Perilli², A Lillo², G Regina² and G Angarano¹
¹Institute of Infectious Disease; ²Chair of Vascular Surgery, University of Bari, Bari; and ³Department of Infectious Disease, Triggiano, Italy

BACKGROUND: The introduction of protease inhibitors (PI) in therapeutic combinations based on the use of three antiretroviral drugs determined an unprecedented decline in the morbidity and mortality of HIV-infected patients. However, these regimens have been found to have various adverse side effects. In particular, these drugs have been associated to the onset of hyperlipidaemia, insulin resistance and lipodystrophy. Moreover, some vascular complications have been recently described in patients subjected to prolonged treatment.

OBJECTIVES: To evaluate the presence of precocious atherosclerotic lesions, and changes in the flow and wall of the common and internal carotid arteries in patients treated with PI for at least 12 months.

DESIGN: Thirteen HIV-1-positive patients (median age 35 years) treated with PI (7 indinavir, 2 ritonavir, 1 saquinavir, 1 nelfinavir, 1 nelfinavir and saquinavir, 1 indinavir and ritonavir) for a median of 14 months were submitted to Doppler ultrasound of the epiaortic vessels; characteristics of the intima, pulsation index, resistance index, minimal speed, peak speed, mean speed, were evaluated; atherosclerotic plaques, if present, were described.

RESULTS: A thickening of the intima was evidenced in four patients (3 IVDA, 1 partner); one patient (IVDA) had various plaques determining a bilateral stenosis of the internal carotids, one patient (IVDA) had a congenital kinking of the left internal carotid. The other seven patients (1 homosexual, 1 partner, 4 IVDA) did not show any lesions.

CONCLUSIONS: This preliminary report showed an higher than expected prevalence of precocious lesions of the carotid vessels. Previous drug addiction could represent an important predisposing factor. Further studies are warranted to confirm these observations.

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Copyright © 1999 - International Medical Press Ltd. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Medical Editor, International Medical Press, 36 St Mary-at-Hill, London EC3R 8DU, United Kingdom.