Hyperbilirubinemia is associated with a decreased risk of carotid atherosclerosis in HIV-infected patients with virological suppression

Objectives: to investigate the association between total (TBIL), direct (DBIL) and indirect (IBIL) bilirubin and the presence of carotid lesions in a cohort of HIV-1 infected patients on virological suppression.
Methods: cross-sectional study on adult HIV-1 infected patients with a carotid ultrasound (CUS) examination, with HIV-RNA <50 copies/mL at CUS and no prior cardiovascular events. Intima media thickness (IMT) was measured at carotid common artery and bifurcation on left and right sides. Carotid lesion was defined as an IMT ≥1.5 mm in ≥1 region at CUS.
Patients were classified according to bilirubin trend prior CUS: normal, if all bilirubin values were below the upper normal limit (UNL); with hyperbilirubinemia if ≥1 bilirubin value was greater than UNL.
Multivariable logistic regression models were used to determine whether trend of bilirubin showed association with the presence of ≥1 carotid lesion, after adjusting for confounding factors. Results: 903 patients evaluated: 511 patients with ≥1 carotid lesion and 392 patients without it; median age 52, 14.7 years of ART, with 4.8 years of HIV-RNA20% in 11.6% (Framingham).
At multivariable analyses TBIL and IBIL hyperbilirubinemia were associated with a lower risk of carotid lesions.
Conclusion: among HIV-1 treated subjects with long exposure to ART, many patients had carotid lesions; the exposure to total or indirect hyperbilirubinemia was likely associated with less carotid atherosclerosis.

Camilla Muccini
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