Study Links Long-Term HIV Therapy to Cardiovascular Changes

A cross-sectional study published in AIDS Research and Therapy reports that long-term combination antiretroviral therapy (cART) is associated with increased carotid artery intima-media thickness, higher plaque incidence, and specific cardiac structural changes in HIV-infected patients. The research utilized multimodal ultrasound to evaluate these cardiovascular parameters alongside hemodynamic indicators and metabolic profiles. The study aimed to assess the effects of cART on carotid artery lesions, cardiac structure, and hemodynamics, while also exploring independent risk factors for cardiovascular comorbidities.

The study included 100 HIV-infected patients divided into two distinct groups. The cART-treated group consisted of 58 patients who had received standardized cART for at least three years. The untreated group comprised 42 patients who had not received antiretroviral therapy since their diagnosis. This design allowed for a direct comparison between those undergoing long-term treatment and those without such intervention. The researchers applied multimodal ultrasound to measure carotid intima-media thickness, plaque characteristics, vascular hemodynamic parameters, and cardiac structural and functional indicators.

Laboratory tests were conducted to complement the imaging data. These included lipid profiles, glucose metabolism indices, CD4+ T-cell counts, and HIV viral load measurements. Statistical analyses involved univariate and bivariate comparisons, as well as multivariate logistic regression. The regression models were adjusted for age and CD4+ T-cell count to control for variables that could independently influence cardiovascular health. A P-value of less than 0.05 was considered statistically significant for all reported comparisons.

Compared with the untreated group, the cART-treated group exhibited significantly higher carotid intima-media thickness, measuring 0.81 ± 0.03 mm versus 0.71 ± 0.03 mm. The incidence of carotid plaque was also higher in the treated group, at 37.9% compared to 14.3% in the untreated group. These findings suggest that long-term therapy may be associated with structural changes in the arterial walls and increased vascular resistance.

Cardiac structural and functional indicators also showed significant differences between the two groups. The cART-treated group had increased left ventricular end-diastolic diameter, interventricular septal thickness, and pulmonary artery systolic pressure. All these cardiac parameters showed statistically significant differences, with P-values less than 0.05. These observations point to potential cardiac remodeling and hemodynamic abnormalities associated with long-term cART use.

Metabolic abnormalities were also more prevalent in the cART-treated group. The incidence of dyslipidemia was significantly higher, at 56.9% compared to 26.2% in the untreated group. Similarly, the prevalence of fatty liver was higher in the treated group, at 55.2% versus 28.6% in the untreated group. Both of these metabolic conditions showed statistically significant differences, with P-values less than 0.01. Multivariate regression analysis identified fatty liver, increased body mass index, hyperglycemia, elevated LDL-C, older age, and decreased CD4+ T-cell count as independent risk factors for dyslipidemia. This suggests that metabolic factors play a significant role in the cardiovascular profile of patients on cART.

Subgroup analysis focused on specific antiretroviral agents, comparing regimens containing tenofovir disoproxil fumarate (TDF) with those containing tenofovir alafenamide (TAF). The TDF group had higher carotid intima-media thickness and pulmonary artery systolic pressure than the TAF group, with P-values less than 0.05. This finding suggests that TAF-based regimens may be associated with a more favorable cardiovascular profile compared to TDF-based regimens. The study concludes that long-term cART increases the risks of carotid atherosclerotic lesions, cardiac remodeling, and hemodynamic abnormalities, with dyslipidemia acting as a potential mediating factor.

The study highlights the importance of monitoring cardiovascular health in HIV-infected patients undergoing long-term cART. Multimodal ultrasound provides a non-invasive method for comprehensive assessment of carotid and cardiac parameters. The findings suggest that personalized clinical management, potentially involving the selection of specific antiretroviral agents like TAF, could help mitigate cardiovascular risks. However, as a cross-sectional study, the research cannot establish causality, and further longitudinal studies are needed to confirm these associations and their clinical implications.

Subject of Research: Cardiovascular effects of long-term combination antiretroviral therapy in HIV-infected patients

Article Title: The impact of cART on carotid artery function, cardiac structure, and hemodynamics in HIV-infected patients: a multimodal ultrasonic evaluation

Article References: Zhi, Z., Dou, W., Yilun, W., & Jianjian, L. (2026). The impact of cART on carotid artery function, cardiac structure, and hemodynamics in HIV-infected patients: a multimodal ultrasonic evaluation. AIDS Research and Therapy. https://doi.org/10.1186/s12981-026-00909-x

Image Credits: AI Generated

DOI: 10.1186/s12981-026-00909-x

Keywords: HIV, cART, cardiovascular, carotid artery, ultrasound, dyslipidemia, cardiac remodeling, tenofovir, cross-sectional study, AIDS Research and Therapy, impact, carotid