Increased carotid artery wall stiffness and plaque prevalence in HIV infected patients measured with ultrasound elastography



Assess carotid artery strain and motion in people living with HIV as markers of premature aging using ultrasound noninvasive vascular elastography (NIVE).


Seventy-four HIV-infected and 75 age-matched control subjects were recruited from a prospective, controlled cohort study from October 2015 to October 2017 (mean age 56 years ± 8 years; 128 men). NIVE applied to longitudinal ultrasound images of common and internal carotid arteries quantified the cumulated axial strain, cumulated shear strain, cumulated axial translation, and cumulated lateral translations. The presence of plaque was also assessed. An association between elastography biomarkers and HIV status was evaluated with Mann–Whitney tests and multivariable linear regression models.


A higher occurrence of carotid artery plaques was found in HIV-infected individuals (p = 0.011). Lower cumulated lateral translations were found in HIV-infected subjects on both common and internal carotid arteries (p = 0.037 and p = 0.026, respectively). These observations remained significant when considering multivariable models including common cardiovascular risk factors and clinical characteristics (p < 0.05). Lower cumulated axial strains were also observed in internal carotid arteries when considering both multivariable models (p < 0.05).


Lower translation and strain of the carotid artery wall in HIV-infected individuals indicates increased vessel wall stiffness. These new imaging biomarkers could be used to characterize premature atherosclerosis development.

Key Points

Noninvasive vascular elastography (NIVE) based on ultrasound imaging quantifies translations and strains of carotid arteries.

Lower translation and strain of the carotid artery wall found in HIV-infected individuals indicate premature arterial stiffening, compared with age-matched controls.

Carotid artery plaques were more prevalent in HIV-infected individuals than in control subjects.

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Fig. 1
Fig. 2



Antiretroviral therapy


Cumulated axial strain


Cumulated axial translation


Common carotid artery


Canadian HIV and Aging Cohort Study


Cumulated lateral translation


Cumulated axial shear magnitude


High-density lipoprotein cholesterol


Internal carotid artery


Intima-media thickness


Low-density lipoprotein cholesterol


Noninvasive vascular elastography


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This study was initiated through the support of the Canadian Institute of Health Research (CIHR, Canadian HIV and Aging Cohort Study, group grant no. 284512); it is now supported by CIHR group grant no. 398643 and project grant no. 399544.

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Correspondence to Guy Cloutier.

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The scientific guarantor of this publication is Dr. Guy Cloutier.

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The authors declare that they have no conflict of interest.

Statistics and biometry

Co-authors (MHRC, GS, and GC) have significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional review board approval was obtained.


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• cross-sectional study

• performed at one institution

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Roy Cardinal, MH., Durand, M., Chartrand-Lefebvre, C. et al. Increased carotid artery wall stiffness and plaque prevalence in HIV infected patients measured with ultrasound elastography. Eur Radiol 30, 3178–3187 (2020).

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  • HIV infections
  • Premature aging
  • Ultrasonography
  • Carotid arteries
  • Elasticity imaging techniques