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Ultrasonography in lesions of the carotid vessels in HIV positive patients

Valutazione ecografica delle lesioni vascolari carotidee nei pazienti HIV positivi

  • Vascular and Interventional Radiology / Radiologia Vascolare Ed Interventistica
  • Published:
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Abstract

Purpose

This study evaluated with ultrasonography (US) the presence of epiaortic vessel lesions in HIV-positive individuals receiving highly active antiretroviral therapy (HAART) and compared them with naïve patients and healthy individuals to highlight the differences among the different vascular damage patterns.

Materials and methods

A total of 222 HIV-infected patients receiving HAART, 64 HIV-infected patients naïve to antiretroviral therapy and 135 HIV-negative control patients underwent US of the carotid vessels. The morphological examination included grey-scale and colour and power Doppler imaging to better characterise lesions and intima media thickness. An automated computerised software package (Q LAB) was used to determine intima media thickness values. Independent risk factors for the development of carotid lesions and, in particular, cholesterolaemia and triglyceridaemia were considered. Atherosclerotic plaques and inflammatory-type lesions were reported. Statistical analysis included the chi-square test, the Fisher exact test for qualitative variables and the Kruskal-Wallis test to compare continuous variables.

Results

We observed a higher prevalence of carotid lesions in HIV-positive patients receiving HAART compared with HIV-positive naïve patients (p<0.0000001) and HIV-negative patients (p<0.0001). Findings consistent with inflammatory-type lesions rather than classic atheroma were depicted only in five patients receiving HAART (0.02%).

Conclusions

Our study confirms a higher prevalence of carotid lesions in HAART-treated HIV patients. In agreement with other authors, we identified carotid lesions that were consistent with arteritis rather than with classic atheroma, but the percentage was too small to suggest any robust hypothesis. Further studies are warranted to define the mechanism of onset of carotid lesions in HIV-positive individuals.

Riassunto

Obiettivo

Scopo dello studio è stato quello di valutare, mediante ecografia (US), la presenza di lesioni intimali nei vasi epiaortici di pazienti positivi al virus della immunodeficienza umana (HIV) trattati mediante terapia antiretrovirale altamente attiva (HAART), confrontando i risultati ottenuti con quelli provenienti dallo studio delle carotidi di pazienti HIV+ che non ricevevano HAART e di individui sani utilizzati come controllo. Abbiamo inoltre differenziato le lesioni intimali sulla base del quadro di presentazione, in placche aterosclerotiche classiche e lesioni di tipo infiammatorio, simili a quelle identificabili in corso di arterite.

Materiali e metodi

Abbiamo studiato con US le carotidi di 222 pazienti HIV-positivi trattati con HAART, di 64 HIV-positivi naïve per la terapia antiretrovirale e di 135 soggetti HIV-negativi, utilizzati come popolazione di controllo. Lo studio è stato effettuato in B-mode e mediante color e power Doppler, per meglio caratterizzare le lesioni e lo spessore intimale (IMT). Lo spessore intimale è stato valutato utilizzando un software dedicato (Q LAB). In ogni paziente sono stati considerati i fattori di rischio per l’insorgenza di lesioni delle carotidi e in particolare sono state considerate la colesterolemia e la trigliceridemia. L’analisi statistica è stata effettuata mediante test del chi-quadro, di Fischer, di Kruskall-Wallis.

Risultati

Abbiamo rilevato lesioni intimali carotidee in misura significativamente maggiore nei pazienti HIV-positivi trattati con HAART rispetto a quelli che non ricevano HAART (p<0,0000001), e ai controlli (p<0,0001). In cinque soggetti in terapia HAART abbiamo documentato la presenza di lesioni carotidee di tipo infiammatorio.

Conclusioni

Il nostro studio conferma un’elevata incidenza di lesioni carotidee nei soggetti HIV-positivi trattati con HAART. Come già segnalato da altri autori, abbiamo osservato lesioni carotidee compatibili con arterite piuttosto che con il classico ateroma, ma in una percentuale attualmente troppo esigua (0,02%) per supportare valide ipotesi diagnostiche. Ulteriori studi sono necessari per confermare quest’ultimo dato.

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Authors and Affiliations

  1. Diagnostic Department, Radiology, National Institute for Infectious Diseases “L. Spallanzani”, Via Portuense 292, 00149, Rome, Italy

    M. Cristofaro, E. Busi Rizzi, V. Schininà & C. Bibbolino

  2. Clinical Department, National Institute for Infectious Diseases “L. Spallanzani”, Via Portuense 292, 00149, Rome, Italy

    S. Cicalini & N. Petrosillo

Authors
  1. M. Cristofaro
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  2. S. Cicalini
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  3. E. Busi Rizzi
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  4. V. Schininà
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  5. N. Petrosillo
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  6. C. Bibbolino
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Correspondence to M. Cristofaro.

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Cristofaro, M., Cicalini, S., Busi Rizzi, E. et al. Ultrasonography in lesions of the carotid vessels in HIV positive patients. Radiol med 116, 61–70 (2011). https://doi.org/10.1007/s11547-010-0591-3

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  • DOI: https://doi.org/10.1007/s11547-010-0591-3

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