Caracterização da saúde cardiovascular em pessoas vivendo com HIV: influência do tempo de infecção e uso de TARV

Abstract

Infection with the human immunodeficiency virus (HIV) remains a significant public health challenge. With the advent and expansion of access to antiretroviral therapy (ART), a substantial increase in the life expectancy of people living with HIV (PLHIV) has been observed. However, the chronicity of the infection, associated with persistent inflammation, the metabolic effects of ART, and the higher prevalence of traditional risk factors, has contributed to the increase in cardiovascular diseases in this population. Early identification of structural and functional changes in the vascular system, as well as the analysis of body composition, physical activity level, and functional capacity, are fundamental for a better understanding of this scenario. Objectives: To evaluate cardiovascular health in PLHIV, considering the influence of the duration of HIV infection and the use of ART. Specifically, to assess the presence of carotid atherosclerosis using Doppler ultrasound; to investigate vascular function by flow-mediated vasodilation (FMD); and to analyze body composition, functional capacity, and physical activity level. Methods: A cross-sectional study was conducted with PLHIV (people living with HIV), of both sexes, over 18 years of age, regularly using ART (antiretroviral therapy), recruited at the Dr. Heitor Vieira Dourado Tropical Medicine Foundation in Manaus-AM. Sociodemographic and clinical data were collected, the Framingham risk score was applied, and body composition assessments were performed using bioimpedance. Carotid atherosclerosis was determined by ultrasound, considering intima-media thickness greater than 1.0 mm or the presence of plaques. Endothelial function was measured by the FMD (flow-mediated vasodilation) of the brachial artery. Physical activity level was assessed using the IPAQ (short version), and functional capacity was assessed using the 1 minute sit-to-stand test. Analyses included descriptive statistics and association tests, adopting a significance level of 5%. Results: Sixty-seven participants were evaluated, predominantly men (68%), with a median age of 53 years and a median time since diagnosis of 14 years. The majority had an undetectable viral load (90%) and preserved CD4 count. Despite virological control, a significant presence of subclinical vascular alterations was observed. The median intima-media thickness was 0.96 mm, and carotid plaques were identified in a significant portion of the sample. Endothelial function was reduced, with a median FMD of 4.6%. Cardiovascular risk according to the Framingham score was predominantly classified as low tointermediate. No significant differences were observed in body composition parameters between participants with and without carotid plaques. The median number of repetitions in the 1-minute sit-to-stand test was 24. Conclusion: Even in individuals with viral suppression and good immune status, a high frequency of subclinical atherosclerosis and impaired endothelial function was observed. These findings reinforce the need for continuous cardiovascular monitoring in people living with HIV, beyond traditional risk indicators, contributing to earlier prevention and intervention strategies.