AEGiS-15IAC: Determination of subclinical atherosclerosis in patients on long-term nevirapine, efavirenz, and protease inhibitor-based antiretroviral therapy by ultrasound measurement of carotid artery intima-media thickness and multislice cardiac CT measurement of coronary artery calcium.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Determination of subclinical atherosclerosis in patients on long-term nevirapine, efavirenz, and protease inhibitor-based antiretroviral therapy by ultrasound measurement of carotid artery intima-media thickness and multislice cardiac CT measurement of coronary artery calcium.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrB1355)

Pierone G, Cho N, Norconk J, Hatten P, Mieras J, Kantor C, Bulgin-Coleman D, Shearer J, Platt B
AIDS Research and Treatment Center of the Treasure Coast, Ft. Pierce, United States

BACKGROUND: Protease inhibitor (PI)-based HAART has been associated with higher rates of insulin resistance and hyperlipidemia than NNRTI-based therapy. A concern is PI-based therapy may accelerate the development of atherosclerosis. Carotid artery intima-media thickness (CIMT) and coronary artery calcium (CAC) measures reflect subclinical atherosclerosis and stratify the risk of CV events beyond known risk factors (RFs). We sought to determine if patients (pts) on nevirapine (NVP) or efavirenz (EFV) had less atherosclerosis than pts on PIs.

METHODS: Baseline results from prospective, single center study. 40 pts each on NVP, EFV, and PI-based HAART for >3 years enrolled. Fasting lipid profile, C-reactive protein (CRP), homocysteine, and lipoprotein A levels were obtained. Carotid ultrasound for CIMT and multislice cardiac CT for CAC scoring were done and interpreted by blinded personnel. Adjusted relationships between RFs and CAC were determined by multivariate logistic regression.

RESULTS: There were no significant differences in the NVP and EFV groups so they were combined. No significant differences in Framingham scores, age, family history (FH) of coronary artery disease (CAD), hypertension (HTN), diabetes, CRP, homocysteine lipoprotein A, and smoking were noted between the PI and NNRTI groups. The NNRTI group had more females, higher cholesterol levels, higher CD4 counts, and lower viral loads. The mean CIMT was 0.107cm in the NNRTI group and 0.096cm in the PI group (p=ns). The NNRTI group had 59/80 (74%) pts with CAC scores of 0 compared with 21/40 (52%) in PI group. PI group had a relative risk ratio (RRR) of 2.3 (p=0.013) for CAC of >0 and RRR of 8.2 (p=0.013) for CAC scores of >100. Other variables associated with CAC >0 were HTN, years living with HIV, and age.

CONCLUSIONS: 1. PI-treated pts had a higher rate of subclinical CAD based on CAC measurements than NNRTI-treated pts.2. No differences were found in CIMT in NNRTI and PI groups.

Keywords: AEGIS, Tunica Media, Tunica Intima, Nevirapine, Oxazines, Carotid Artery, Common, Carotid Arteries, Tomography, X-Ray Computed, Arteriosclerosis, Coronary Vessels, Coronary Arteriosclerosis, Protease Inhibitors, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, HIV Protease Inhibitors, Calcium, Risk Factors, C-Reactive Protein, Prospective Studies, efavirenz, Humans, Female, ultrasonography, therapy, radiography, drug therapy

040711
ThOrB1355