Other indicators of changes in risk of heart disease

A thickening of the wall of the carotid artery (the artery in the neck which supplies the brain with blood) is another sign of atherosclerosis. This intima media thickening (IMT) can serve as a risk indicator for coronary atherosclerosis.1 2

Two studies presented at the Tenth Retroviruses Conference in early 2003 showed conflicting findings. One found no evidence that protease inhibitor therapy was associated with IMT.3 Another found that a low CD4 cell count was a risk factor for thickening of the carotid artery in 106 HIV-positive people on HAART.4 Other research presented at previous conferences has shown some evidence of arterial damage and IMT among people on HAART, and elevated risk factors for coronary artery disease in people with HIV-related fat redistribution; however, not all of these studies took other cardiovascular risk factors into account. 5 6 7 8 9

An increased incidence of plaques in the carotid artery has also been identified in people treated with protease inhibitors. 10 A study published in mid-2002 has reported that protease inhibitors are associated with a thickening of parts of the heart, and that this may impact on heart function. 11

Coronary artery calcification occurs when calcium is deposited in arterial plaques. The degree of coronary calcification has been found to predict the risk of subsequent cardiovascular events in individuals with other risk factors. Significantly higher levels of coronary calcification have been found in individuals who receive protease inhibitor treatment compared with individuals who receive non-PI containing antiretroviral therapy.11

Thrombosis is the formation of a thrombus or blood clot within a blood vessel. Among HIV-infected individuals, age over 45 years and the presence of opportunistic illnesses, especially CMV, are associated with a greater risk of thrombosis. Drugs associated with thrombosis among HIV-infected individuals are indinavir and megestrol acetate. 12

A link between the protease inhibitor (PI) class of antiretroviral drugs and the risk of thrombosis has been found in a Swedish study of 363 HIV-positive individuals. The study found significantly higher levels of plasminogen activator inhibitor type 1 (PAI-1) in the treated patients. Plasminogen activator inhibitor type 1 (PAI-1) is a protein that inhibits the break down of blood clots, and high levels of PAI-1 will lead to increased clotting of the blood. A reduced tendency to break down blood clots, called hypercoagulability, leads to a higher risk of thrombosis. The only factor significantly associated with elevated PAI-1 levels was protease inhibitor therapy, regardless of prior medical history, age, duration of therapy, specific PI drug or AIDS diagnosis. 13

Silent myocardial ischemia (SMI), a painless condition which occurs when the supply of oxygen to the muscles of the heart is restricted, can be an early warning sign of heart disease and increased risk of heart attack or stroke. A French study of 99 patients with no prior history of cardiovascular disease showed no association between presence of SMI and duration of antiretroviral therapy. SMI was associated with elevated plasma glucose and total cholesterol, and central fat accumulation.14


  1. Ross AC et al. Relationship between inflammatory markers, endothelial activation markers and carotid intima-media thickness in HIV-infected patients receiving antiretroviral therapy. Clin Infect Dis 49(7): 1119-1126, 2009
  2. Maggi P et al. Cardiovascular risk assessment in antiretroviral-naive patients. AIDS Patient Care STDS 23(10): 809-813, 2009
  3. Currier J et al. Carotid intima-media thickness in HIV-infected and uninfected adults: ACTG 5078. Tenth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 131, 2003
  4. Hsue P et al. Increased atherosclerotic progression in patients with HIV: The role of traditional and immunological risk factors. Tenth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 139lb, 2003
  5. Seminari E et al. Haemostatic markers of cardiovascular risk in HIV patients treated and untreated with protease inhibitors. Thirteenth International AIDS Conference, Durban, abstract B760, 2000
  6. Mercie P et al. Evaluation of cardiovascular risk factors in HIV-1 infected patients using carotid intima-media thickness measurement. Annals of Medicine 34(1): 55-63, 2002
  7. Hadigan C et al. Acute inhibition of lipolysis improves insulin sensitivity in patients with HIV lipodystrophy and insulin resistance, and Increased rates of lipolysis among HIV-infected men with and without fat redistribution. Antivir Ther 6: S7, 2001b
  8. Maserati R et al. Intima media thickness as cardiovascular risk marker in HIV-positive patients treated and untreated with protease inhibitors. Antiviral Therapy 5 (Supp 5): 16, 2000
  9. Goebel FD et al. Cardiovascular dysregulation in HIV-infected individuals treated with HAART. Antiviral Therapy 5 (Supp 5):17, 2000
  10. Maggi P et al. Colour-Doppler ultrasonography of carotid vessels in patients treated with antiretroviral therapy: a comparative study. AIDS 18(7): 1023-8, 2004
  11. Meng Q et al. Use of HIV protease inhibitors is associated with left ventricular morphologic changes and diastolic dysfunction. Journal of Acquired Immune Deficiency Syndromes 30(3): 306-310, 2002
  12. Sullivan PS et al. Epidemiology of thrombosis in HIV-infected individuals. The Adult/Adolescent Spectrum of HIV Disease Project, 2000
  13. Koppel K et al. Hypofibrinolytic state in HIV-1-infected patients treated with protease inhibitor-containing highly active antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes 29(5): 441-449, 2002
  14. Duong M et al. Exercise stress testing for detection of silent myocardial ischemia in human immunodeficiency virus-infected patients receiving antiretroviral therapy. Clin Infect Dis 34: 523-528, 2002
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.