NEW YORK (Reuters Health) Mar 10 - Use of combined antiretroviral therapy is a strong independent risk factor for the development of subclinical carotid atherosclerosis in HIV patients, Spanish researchers report in the March issue of Stroke.

Dr. Juan Pedro-Botet of Hospital del Mar, Barcelona and colleagues note that the long-term efficacy of anti-HIV regimens may be limited by adverse effects, including cardiovascular disease.

To investigate, the researchers studied 132 HIV patients of whom about half had no more than one cardiovascular risk factor. The remainder had two or more. In total, 92 of the subjects (70.5%) were on combination antiretroviral therapy and 39 had never received such treatment.

Subclinical atherosclerosis was seen in 55 (41.7%) of patients. The rate ranged from 26.6% in patients deemed at very low cardiovascular risk to 76.5% in those at moderate or high risk.

Moreover, only 2 of 32 antiretroviral-naive patients in the very low cardiovascular risk group (6.3%) had subclinical atherosclerosis versus 15 (46.9%) of the combined antiretroviral therapy-experienced patients.

The most significant risk factors for subclinical carotid atherosclerosis were combined antiretroviral therapy exposure (odds ratio, 10.5) and a 10-year coronary risk of 10% or more (odds ratio, 4.2).

The researchers thus observe that although conventional cardiovascular risk factors contribute to carotid atherosclerosis risk, antiretroviral therapy plays a major role.

In time, they conclude, "the need will arise to use different antiretroviral agents with potentially less cardiovascular toxicity."