Prevalence and risk factors of peripheral arterial occlusive disease in adult Indian HIV positive patients The PAODH study.

Suraj S.; Edwin Stephen; Indrani Sen; Abel Rodger; Sukria Nayak; George M.Varghese; B. Antonisamy; Sunil Agarwal

Volume : VI, Issue : III, March - 2016

Prevalence and risk factors of peripheral arterial occlusive disease in adult Indian HIV positive patients The PAODH study.

Suraj S. , Edwin Stephen, Indrani Sen, Abel Rodger, Sukria Nayak, George M. Varghese, B. Antonisamy, Sunil Agarwal

Abstract :

 Introduction: HIV causes arterial occlusive disease by atherosclerotic and non–atherosclerotic mechanisms. There are only limited studies assessing the prevalence and risk factors of peripheral arterial occlusive disease (PAOD) in these patients: treatment parallels that of vascular disease due to other etiologies as a clear understanding of the pathophysiology in HIV disease is lacking. As patients with HIV infection has near normal life expectancy with the current antiretroviral therapy, management of vascular disease in HIV assumes clinical importance. This is the first study from the Indian subcontinent which analyses the prevalence of peripheral arterial occlusive disease in patients with HIV and identifies the risk factors for its occurrence. Methods: A prospective observational study was conducted in the department of Vascular Surgery and Infectious Diseases Retroviral Clinic in the Christian Medical College, Vellore from November 2012 to September 2014. Following a direct interview; demography, clinical features (assessed with help of Edinburgh Claudication Questionnaire), ankle achial pressure index and laboratory parameters assessing conventional risk were recorded in a proforma. The Ankle Brachial Pressure Index (ABPI), exercise ABPI and or Toe pressure (TP) was done to detect peripheral arterial disease in patients with HIV. Results: Four hundred and three HIV infected patients were recruited in to the study. Average age of study population was 41.45. There were 238 males and 165 females (59.1% Vs 40.1%). The prevalence of PAOD was 7.69% (31 patients); 26 were asymptomatic and 5 were symptomatic. Use of protease inhibitors and the duration of its use were identified to be risk factors for PAOD in this population whereas the traditional risk factors like diabetes mellitus, tobacco use including smoking, hypertension, and dyslipidaemia were not. Duration of HIV infection, overall duration of HIV treatment and CD4 count < 300 were also associated with a higher rate of PAOD but these did not attain statistical significance in multivariate analysis as risk factors. Conclusion: The prevalence of peripheral arterial occlusive disease in HIV positive patients is higher than in the general population. Protease inhibitor use and duration of its use can be strongly associated with development of PAOD. Traditional risk factors seem to be playing negligible role in the development of peripheral arterial occlusive disease in these patients.