Several reports have suggested an increased risk of coronary disease in human immunodeficiency virus (HIV)-infected patients receiving protease inhibitors (PIs). Impaired endothelium-dependent vasodilation is a putative surrogate marker of coronary atherosclerotic disease.Methods
The present study evaluated the effect of HIV infection and antiretroviral treatment on endothelial vasomotor function, by assessing brachial artery flow-mediated dilation (FMD). A total of 75 HIV-infected patients were compared with 223 control subjects who were presumed to be HIV uninfected.Results
HIV-infected patients had significantly impaired FMD, compared with control subjects (mean ± SD, 7.3% ± 4.4% vs. 11.1% ± 6.3%; P < .0001). When adjustments were made for smoking status, sex, and body mass index, the difference between the 2 groups remained statistically significant (P < .01). In a cross-sectional analysis of the HIV-infected patients, we found significant associations between FMD and current injection drug use, hazardous drinking, HIV load, and α-high-density lipoprotein triglyceride levels, but not PI therapy. In a multivariate analysis, only current injection drug use and a lower α-high-density lipoprotein triglyceride level were significantly associated with FMD.Conclusions
HIV-infected patients have significant impairment of endothelial function, and this impairment is worse among those with elevated levels of HIV replication, particularly injection drug users.