PURPOSE: Patients infected with HIV have an increased risk for accelerated atherosclerosis. Peripheral Arterial Disease (PAD) is a focal manifestation of atherosclerosis and is a predictor of cardiovascular outcomes. Prior studies have shown that prevalence of PAD is higher in HIV patients. We sought to determine whether the presence of PAD was directly proportional to the severity of HIV infection (low CD4 count).
METHODS: 70 consecutive HIV patients were enrolled from January 2009 to September 2009. Abnormal ABI (< 0.9, >1.3) was recorded in 24.3% (17/70) of HIV patients that formed the study group. The remaining 53 patients formed the control group. CD4 counts were recorded in both the groups and analyzed. The Edinburgh Claudication Questionnaire and Ankle Brachial Index (ABI) were used as study tools. Data were analyzed using Mann Whitney test.
RESULTS: The median CD4 count in HIV patients with abnormal ABI was found to be 819 (IQR-296, 1218) as opposed to 487 (IQR-259, 707) in HIV patients with normal ABI (P=0.04). Furthermore, median CD4 count was recorded to be 450 (253, 881) in PAD positive HIV patients while it was found to be 254 (90, 487) in PAD negative HIV patients (P= 0.02).
CONCLUSIONS: The presence of PAD or abnormal ABI does not have positive correlation with the severity of infection (low CD4 count) in patients with HIV. In fact, our study suggests that there might be a negative correlation among the two.
CLINICAL IMPLICATIONS: Ankle Brachial Index (ABI) is a reliable method to diagnose peripheral arterial disease. In addition, it may aid in early and aggressive treatment in asymptomatic HIV patients with peripheral arterial disease.
DISCLOSURE: The following authors have nothing to disclose: Manish Sharma, Nishant Gupta, Sharad Bajaj, Rupen Parikh, Mahesh Bikkina
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