Lipodystrophy and anti-retroviral therapy as predictors of sub-clinical atherosclerosis in human immunodeficiency virus infected subjects

Giovanni Guaraldi, Chiara Stentarelli, Stefano Zona, Gabriella Orlando, Federica Carli, Guido Ligabue, Antonella Lattanzi, Giacomo Zaccherini, Rosario Rossi, Maria Grazia Modena, Nikolaos Alexopoulos, Frank Palella, Paolo Raggi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


Background and objective: Although anti-retroviral therapy (ART) prolonged survival in HIV-infected persons, an increase in cardiovascular disease has also been observed. A frequent complication of ART is the development of lipodystrophy (LD) with its multiple phenotypes that may be associated with cardiovascular disease. We assessed the contribution of chronic HIV infection, ART use and LD to the presence of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging. Methods: Observational cross-sectional study of 372 HIV-infected patients receiving ART who attended a cardiometabolic clinic (48.2 ± 8-year old; 74% men). All patients underwent CAC surveillance with computed tomography and the Agatston score was used to quantitate CAC. Presence of CAC was defined as a score >10. Multivariable logistic regression was used to evaluate associations between HIV clinical factors, ART and LD with the presence of CAC. Findings: CAC was found in 134 patients (36%) with a median CAC score of 50 (range 10; 1243). Lipoatrophy alone (OR 3.82, 95% CI: 1.11; 13.1), fat accumulation alone (OR 7.65, 95% CI: 1.71; 37.17) and mixed lipodystrophy phenotypes (OR 4.36, 95% CI: 1.26; 15.01) were strongly associated with presence of CAC after adjusting for age, sex, hypertension and cumulative exposure to ART. Conclusion: CAC is common among long-term ART users. The association between CAC and LD underscores the potential atherosclerosis risk inherent with ART and the need to undertake routine cardiovascular surveillance in patients treated with these drugs.

Original languageEnglish (US)
Pages (from-to)222-227
Number of pages6
Issue number1
StatePublished - Jan 2010


  • Atherosclerosis
  • Coronary artery calcium
  • Human immunodeficiency virus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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