Open Access Research article

Carotid intima media thickness is associated with body fat abnormalities in HIV-infected patients

Paula Freitas1*, Davide Carvalho1, Ana Cristina Santos23, António José Madureira4, Esteban Martinez5, Jorge Pereira6, António Sarmento7 and José Luís Medina1

Author Affiliations

1 Endocrinology Department, Hospital de São João and University of Porto Medical School, Alameda Hernâni Monteiro, Porto 4200, Portugal

2 Hygiene and Epidemiology Department, University of Porto Medical School, Porto, Portugal

3 University of Porto Institute of Public Health, Porto, Portugal

4 Radiology Department, Hospital de São João and University of Porto Medical School, Porto, Portugal

5 Department of Infectious Diseases, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain

6 Nuclear Medicine Department, Hospital de São João l, Porto, Portugal

7 Infectious Disease Department, Hospital de São João and University of Porto Medical School, Porto, Portugal

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BMC Infectious Diseases 2014, 14:348  doi:10.1186/1471-2334-14-348

Published: 23 June 2014



HIV-infected patients may be at increased risk of cardiovascular (CV) events, and lipodystrophy is generally associated with proatherogenic metabolic disturbances. Carotid intima-media thickness (cIMT) has been used as a surrogate marker for atherosclerosis and it has been shown to be an independent risk factor for CV disease. Our objective was to evaluate cIMT in HIV-infected patients on combined anti-retroviral therapy (cART) with and without lipodystrophy defined by fat mass ratio (L-FMR), and to determine the association of lipodystrophy and visceral obesity [(visceral (VAT), subcutaneous adipose tissue (SAT) volume and VAT/SAT ratio, objectively evaluated by CT scan] with cIMT.


Cross-sectional study of 199 HIV-infected patients. Body composition by DXA and abdominal CT, lipids, blood pressure, inflammatory markers, and cIMT by ultrasonography were performed. L-FMR was defined as the ratio of the percentage of trunk fat mass to the percentage of lower limb fat mass by DXA. Categorical variables were compared using the chi-square or Fisher’s exact test. Spearman correlation coefficients were estimated to study the association between cIMT and clinical and metabolic characteristics. Means of cIMT, adjusted for age, were calculated, using generalized linear models.


L-FMR was present in 41.2% of patients and cIMT was higher in these patients [0.81 (0.24) vs. 0.76 (0.25); p = 0.037)]. Lipodystrophic patients had higher VAT and VAT/SAT ratio and lower SAT. cIMT was associated with lipodystrophy evaluated by FMR, trunk fat, total abdominal fat, VAT and VAT/SAT ratio. No association was observed between cIMT and leg fat mass. Using generalized linear models, cIMT means were adjusted for age and no significant differences remained after this adjustment. The adjusted mean of cIMT was 0.787 (95% CI: 0.751-0.823) in patients without lipodystrophy, and 0.775 (95% CI: 0.732-0.817) in those with lipodystrophy (p = 0.671).


HIV-infected patients on cART with lipodystrophy defined by FMR, had a significantly higher cIMT. Carotid IMT was also associated with classical cardiovascular risk factors. In these patients, visceral adipose tissue had a significant impact on cIMT, although age was the strongest associated factor.

Lipodystrophy; HIV; Carotid intima media thickness; Fat mass ratio; Body composition