Infraclinical Atherosclerosis (Intima-Media Thickness)

Progressive atherosclerosis has been assessed using carotid or femoral intima­media thickness (IMT) measurements, and the prevalence of arterial plaques and their percentage of lumen narrowing due to stenosis have been used to estimate periph­eral atherosclerosis dissemination and severity in HIV-infected patients, as shown in Figure 1.

The multicenter SUPRA study was con­ducted among 423 of the 2,744 HIV-infected patients in the Aquitaine Cohort [6]. Their median carotid IMT was 0.54 mm (range, 0.50-0.60). Lipodystrophy syndrome was diag­nosed in 161 (38.1%) of these patients. Ac­cording to univariate linear regression analy­sis, increased IMT was significantly associat­ed (pamount of calcification of the coro­nary arteries in HIV-infected patients is not well evaluated today. Echogenicity and MRI of the atherosclerotic plaques remain to be studied. The functional indication of the endothelium may be evaluated. The most promising test is the endothelium­dependent flow-mediated vasodilatation of the brachial artery (FMD). Abnormalities of the FMD are predictive of future cardio­vascular events and can be considered as a surrogate marker of the atherosclerosis pro­gression.