Prevalence of Peripheral Artery Disease is Higher in Persons Living With HIV Compared With Uninfected Controls

Andreas D. Knudsen, MD; Marco Gelpi, MD; Shoaib Afzal, MD, PhD; Andreas Ronit, MD; Ashley Roen, MSc; Amanda Mocroft, MSc; Jens Lundgren, MD, DMSc; Børge Nordestgaard, MD, DMSc; Henrik Sillesen, MD, DMSc; Anne-Mette Lebech, MD, DMSc; Lars Køber, MD, DMSc; Klaus F. Kofoed, MD, DMSc; Susanne D. Nielsen, MD, DMSc


J Acquir Immune Defic Syndr. 2018;79(3):381-385. 

In This Article

Abstract and Introduction


Objective: Ankle–brachial index is an excellent tool for diagnosing peripheral artery disease (PAD). We aimed to determine the prevalence and risk factors for PAD in people living with HIV (PLWH) compared with uninfected controls. We hypothesized that prevalence of PAD would be higher among PLWH than among controls independent of traditional cardiovascular disease (CVD) risk factors.

Methods: PLWH aged 40 years and older were recruited from the Copenhagen comorbidity in HIV infection (COCOMO) study. Sex- and age-matched uninfected controls were recruited from the Copenhagen General Population Study. We defined PAD as ankle–brachial index ≤0.9 and assessed risk factors for PAD using logistic regression adjusting for age, sex, smoking status, dyslipidemia, diabetes, hypertension, and high-sensitivity C-reactive protein.

Results: Among 908 PLWH and 11,106 controls, PAD was detected in 112 [12% confidence interval: (95% 10 to 14)] and 623 [6% (95% 5 to 6)], respectively (P < 0.001), odds ratio = 2.4 (95% 1.9 to 2.9), and adjusted odds ratio = 1.8 (95% 1.3 to 2.3, P < 0.001). Traditional CVD risk factors, but not HIV-related variables, were associated with PAD. The strength of the association between PAD and HIV tended to be higher with older age (P = 0.052, adjusted test for interaction).

Conclusions: Prevalence of PAD is higher among PLWH compared with uninfected controls, especially among older persons, and remains so after adjusting for traditional CVD risk factors. Our findings expand the evidence base that PLWH have excess arterial disease to also include PAD. The exact biological mechanisms causing this excess risk remain to be elucidated. Until then, focus on management of modifiable traditional risk factors is important.


People living with HIV (PLWH) now have life expectancies approaching that of the general population and may be more prone to age-related comorbidities.[1,2] Among comorbidities, cardiovascular disease (CVD) with atherosclerotic lesions of the coronary and carotid vessels has received much attention as CVD is a leading cause of mortality in PLWH.[3]

Peripheral artery disease (PAD) is a manifestation of atherosclerosis that may lead to decreased blood supply and ischemic calf pain. With time, occlusive disease may lead to vascular ulcerations, gangrene, and ultimately amputation.[4] Although, PLWH are at higher risk of CVD in general, PAD has been comparatively less well-explored in this population.[2,5] Existing estimates of the prevalence of PAD in PLWH are conflicting, and studies report both higher and lower disease burden among PLWH compared with that of the uninfected population.[1,6–10] PAD can easily and safely be assessed by calculating the ratio of systolic blood pressure (SBP) measured at the ankle to the SBP of the brachial artery. Validated against gold standard angiography, the ankle–brachial index (ABI) has been found to be a sensitive and extremely specific marker for occlusive PAD.[11] Using ABI, we sought to investigate the prevalence and risk factors of PAD in a well-characterized population of PLWH compared with an uninfected population from the same geographical area matched on age and sex. We hypothesized that the prevalence of PAD was higher in PLWH than in uninfected, and that HIV is an independent risk factor for PAD.