Ankle-brachial index in HIV infection

The generalised use of highly active antiretroviral therapy (HAART) in patients with the human immunodeficiency virus (HIV) has led to a spectacular increase in their survival rates [1-3]. At the same time, several cohort studies have noted an increase in the relative risk of major cardiovascular events, especially acute myocardial infarction and subclinical vascular disease [4-8]. Pathophysiological evidence exists that both HIV and HAART can affect the lipid profile [9,10], insulin resistance [11,12] and the vascular response to vasodilatation [13]. This has led to greater interest among physicians attending these patients in earlier diagnosis and treatment of the traditional cardiovascular risk factors, and recommendations have even been made for proactive changes in HAART, with a view to improving the profile of these risk factors [14].Cohort studies have revealed an increase in the relative risk of acute myocardial infarction and cardiovascular disease, which has not yet been reflected in a large number of cases because absolute levels of incidence remain low [15,16]. Nevertheless, the incidence observed is greater than that expected according to predictive techniques such as Framingham's equation [17]. Given the possibility that in a few years cardiovascular disease among HIV patients will become more significant than at present, it is of interest to make use of diagnostic tests that enable the early identification of groups of patients presenting high vascular risk, so that a closer control may be maintained of cardiovascular disease risk factors. Cardiovascular disease is the fourth cause of death among HIV patients, close behind non-AIDS-associated neoplasias [18]. Ideally, such tests should be cheap, comparable, innocuous and applicable at outpatient clinics. Techniques for the early diagnosis of atherosclerotic diseases in these patients would enable persons at high risk of cardiovascular events to receive more aggressive therapy for the management of the