Opthalmic artery resistance index is related to visceral fat distribution in HIV-1-infected patients receiving active antiretroviral therapy. Preliminary results.

Purpose. HIV-1 infected patients receiving antiretroviral therapy often develop changes in body fat distribution. Moreover, there is concern that human immunodeficiency virus (HIV) infection and the use of highly active antiretroviral therapy lead to accelerated atherosclerosis and increased risk of cardiovascular disease. Alteration of ocular blood flow may play a role in the pathophysiology of human HIV related endothelial damage secondary to altered fat distribution. Primary objective of our study was to evaluate wither peri-renal fat diameter (PRFD), a parameter of visceral obesity, is related to ophthalmic artery resistance index (RI), indexes of atherosclerosis. Methods. We enrolled 58 consecutive HIV-1-infected patients (42 men and 16 women) receiving active antiretroviral therapy (HAART) for more than twelve months, in a prospective cross-sectional study. Diagnosis of visceral obesity was based on ultrasound measured using a 7.5 mHz ultrasonographic linear probe scanning through the close eyelid. Results. A total of 24 patients were in the visceral obesity group and 34 were in control group. There were no differences between the two groups with regard to age, gender ratio, smoking status, risk factors, metabolic parameters, BMI, CD4 cells count, viral load and HAART duration. Protease inhibitors (PI) had been prescribed in 23 (39.65%) patients (8 with visceral obesity and 15 without obesity), without statistically significant difference between the two groups. All patients exposed to PIs received a ritonavir-boosted PI. Non-nucleoside reverse-trascriptase inhibitor (NNRI) had been prescribed in 35 (60.34%) patients (16 with visceral obesity and 19 without obesity). At baseline the mean of ophthalmic artery RI in HIV-1-patients with visceral obesity were considerably higher (0.74 ± 0.05 vs 0.68 ± 0.04) than that in patients without. We further found a positive correlation between ophthalmic artery RI and PRFD (r = 0.43; p = 0.0007). Using the average ophthalmic artery RI as the dependent variable in regression analysis, age and PRFD were independent factors associated to with ophthalmic artery RI. Conclusions. HIV-1 infected lipodystrophic patients with central fat distribution are at risk of increased ophthalmic artery RI, with positive correlation between ophthalmic artery RI and thickness of peri-renal adipose tissue. Our data demonstrated that ultrasonographic assessment of peri-renal fat diameter may have a potential to be a marker of increased endothelial damage HIV1 infected patients with specific involvement of ocular vascular district. As a consequence, a periodic screening for visceral obesity should be considered mandatory in the HIV-1-patients receiving highly active antiretroviral therapy and it could identify patients at major risk to develop an ocular damage.