The Open Drug Safety Journal


ISSN: 1876-8180 ― Volume 4, 2013

HIV Disease, Antiretroviral Therapy Safety and the Cardiovascular System. Clinical-Instrumental Assessment of Antiretroviral-Naïve Versus Subjects Already Treated with Antiretroviral Agents

Roberto Manfredi*
Department of Internal Medicine, Ageing, and Nephrologic Sciences, Division of Infectious Diseases, “Alma Mater Studiorum” University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy



There is controversy over whether or not HIV infection and antiretroviral therapy contribute to early atherosclerosis. Ultrasonographic evaluation of carotid intima-media thickness is considered as a reliable surrogate marker of subclinical atherosclerosis and may be employed in the setting of a cardiovascular risk assessment in HIV-infected patients.

Patients and methods:

A cross-sectional study evaluating classical risk factors for cardiovascular diseases, parameters of HIV infection, antiretroviral therapy and subclinical atherosclerosis in HIV-positive subjects naïve or treated with antiretroviral agents was performed. The enrolled patients underwent ultrasonography of the epi-aortic vessels using a Philips HDI 5000 power color-Doppler with 7.5-MHz probes. The 10-year risk of coronary heart disease was calculated by the Framingham equation.


A total of 27 patients (19 males and 8 females; mean age 44 ± 13 years; range 32-59 years) was enrolled in the study: 11 subjects were naïve to all antiretroviral agents (group A) and 16 patients were treated with antiretroviral therapy for ≥36 months (group B). Mean duration of known HIV infection was significantly longer in group B than in group A, such as frequency of dyslipidemia and lipodystrophy syndrome. Prevalence of carotid plaques was significantly higher in group B than in group A (43.7% versus 0; p=0.012). In group B, patients with intermediate to high 10-year risk of coronary heart disease (≥10%) showed a significantly higher intima-media thickness and prevalence of carotid lesions than those with low risk (<10%). Moreover, carotid plaques presented structural features comparable to those of classical atherosclerotic plaques observed in general population, with iso-hyperechonegic aspects and irregular surfaces.


Prevalence of carotid atherosclerosis is higher in HIV-infected patients previously treated with antiretrovirals than in those naïve to antiretroviral therapy and seems mostly associated with a longer duration of HIV infection, more severe lipid metabolism alterations, presence of lipodystrophy syndrome, and a more elevated 10-year risk of cardiovascular diseases.

Keywords: HIV infection, antiretroviral therapy, atherosclerosis, carotid artery, ultrasonography.

Article Information

Identifiers and Pagination:

Year: 2011
Volume: 2
First Page: 1
Last Page: 8
Publisher Id: TODSJ-2-1
DOI: 10.2174/1876818001102010001

Article History:

Received Date: 1/9/2010
Revision Received Date: 27/9/2010
Acceptance Date: 2/11/2010
Electronic publication date: 13/1/2011
Collection year: 2011

© Roberto Manfredi; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Internal Medicine, Ageing, and Nephrologic Sciences, Division of Infectious Diseases, “Alma Mater Studiorum” University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy; Tel: +39 051 6363355; Fax: +39 051 343500; E-mail:

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