Randomized trial of a multidisciplinary lifestyle intervention in HIV-infected patients with moderate-high cardiovascular risk


      • Population of study men, 50.5 years old and with a moderate-high cardiovascular risk.
      • Lifestyle intervention improved lipids the first two years and tobacco consumption.
      • Decrease in cardiovascular risk estimation was achieved with lifestyle intervention.
      • Most patients had subclinical atherosclerosis at baseline that worsened over the study.
      • A proinflammatory environment found at baseline did not improve over the study.



      To assess the impact of a multidisciplinary lifestyle intervention on cardiovascular risk and carotid intima-media thickness (c-IMT) in HIV-infected patients with Framingham scores (FS) > 10%.


      Randomized pilot study; follow-up 36 months.


      Virologically suppressed adult HIV-1-infected patients with FS >10% were randomized 1:1 to the intervention group (multidisciplinary lifestyle intervention) or control group (routine care). At baseline and months 12, 24 and 36, lipid parameters were analyzed and carotid ultrasound was performed to determine c-IMT and presence of plaques. Biomarkers were measured at baseline and month 36. The primary endpoints were lipid and FS changes at 36 months.


      Fifty-four patients were included, 27 in each arm. Median age was 50.5 years, all patients but one were men, and FS was 16.5%. Relative to controls, total and LDL cholesterol had significantly decreased in the intervention group at 24 months (p = 0.039, p = 0.011, respectively). However, no differences between groups were found at month 36 in lipid variables, neither in FS. Tobacco use decreased in the intervention group (p = 0.031). At baseline, 74.5% of patients had subclinical atherosclerosis, and at month 36, we observed a progression in c-IMT that was greater in the intervention group (p = 0.030). D-dimer increased (p = 0.027) and soluble intercellular adhesion molecule-1 decreased (p = 0.018) at 36 months.


      In this cohort of HIV-infected patients with FS>10% and a high percentage of subclinical atherosclerosis, a multidisciplinary lifestyle intervention resulted in a slight improvement in some cardiovascular risk factors and the FS during the first 2 years, but did not prevent c-IMT progression.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Guaraldi G.
        • et al.
        Premature age-related comorbidities among HIV-infected persons compared with the general population.
        Clin. Infect. Dis. 2011; 53: 1120-1126
        • Triant V.A.
        • et al.
        Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease.
        J. Clin. Endocrinol. Metab. 2007; 92: 2506-2512
        • Triant V.A.H.I.V.
        Infection and coronary heart disease: an intersection of epidemics.
        J. Infect. Dis. 2012; 3: S355-S361
        • Ross A.C.
        • et al.
        Relationship between inflammatory markers, endothelial activation markers, and carotid intima-media thickness in HIV-infected patients receiving antiretroviral therapy.
        Clin. Infect. Dis. 2009; 49: 1119-1127
        • Francisci D.
        • et al.
        HIV type 1 infection, and not short-term HAART, induces endothelial dysfunction.
        AIDS. 2009; 23: 589-596
        • Kristoffersen U.S.
        • et al.
        Reduction in circulating markers of endothelial dysfunction in HIV-infected patients during antiretroviral therapy.
        HIV Med. 2009; 10: 79-87
        • Malvestitto C.D.
        • Aberg J.A.
        Management of dyslipidemia in HIV-infected patients.
        Clin. Lipidol. 2011; 6: 447-462
        • National Cholesterol Education Program
        third report of the expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III).
        Circulation. 2002; 106: 3143-3421
        • Fitch K.V.
        • et al.
        Effects of a lifestyle modification program in HIV-infected patients with the metabolic syndrome.
        AIDS. 2006; 20: 1843-1850
        • Lazzaretti R.K.
        • et al.
        Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected individuals.
        J. Am. Coll. Cardiol. 2012; 59: 979-988
        • Fitch K.
        • et al.
        Effects of lifestyle modification and metformin on atherosclerotic indices among HIV-infected patients with metabolic syndrome.
        AIDS. 2012; 26: 587-597
        • Balasubramanyam A.
        • et al.
        Combination of niacin and fenofibrate with lifestyle changes improves dyslipidemia and hypoadiponectinemia in HIV patients on antiretroviral therapy: results of “Heart Positive” a randomized, controlled trial.
        J. Clin. Endocrinol. Metab. 2011; 96: 2236-2247
        • Wilson P.W.
        • et al.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • Vernet A.
        • et al.
        Automatic IMT measurements for carotid ultrasound images.
        in: Presented at: 8th World Congress on Computational Mechanics. 5th European Congress on Computational Methods in Applied Sciences and Engineering. Italy, Venice2008
        • Grau M.
        • et al.
        Grosor íntima-media carotídeo en población española: valores de referencia y asociación con los factores de riesgo cardiovascular.
        Rev. Esp. Cardiol. 2012; 65: 1086-1093
        • Stein J.H.
        • et al.
        Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography carotid Intima-Media thickness task Force. Endorsed by the Society for Vascular Medicine.
        J. Am. Soc. Echocardiogr. 2008; 21: 93-111
        • Nielsen T.
        • et al.
        Regression to the mean effect: when to be concerned and how to correct for it.
        Nord. Psychol. 2007; 59: 231-250
        • Aragonés G.
        • et al.
        The deleterious influence of tenofovir-based therapies on the progression of atherosclerosis in HIV-infected patients.
        Mediat. Inflamm. 2012; : 372305
      1. 2013 AHA/ACC Guideline on lifestyle management to reduce cardiovascular risk.
        Circulation. 2014; 1: S76-S99
        • Appel L.J.
        • et al.
        Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids.
        JAMA. 2005; 294: 2455-2464
        • Estruch R.
        • et al.
        Effects of a mediterranean-style diet on cardiovascular risk factors.
        Ann. Intern Med. 2006; 145: 1-11
        • Erlinger T.P.
        • et al.
        Inflammation modifies the effects of a reduced-fat low-cholesterol diet on lipids.
        Circulation. 2003; 108: 150-154
        • Corrado E.
        • et al.
        An update on the role of markers of inflammation in atheroclerosis.
        J. Atheroscler. Thromb. 2010; 17: 1-11
        • Danesh J.
        • et al.
        Fibrin D-dimer and coronary heart disease. Prospective study and meta-analysis.
        Circulation. 2001; 103: 2323-2327
        • Moadel A.B.
        • et al.
        A randomized controlled trial of a tailored group smoking cessation intervention for HIV-infected smokers.
        J. Acquir Immune Defic. Syndr. 2012; 61: 208-215
        • Jericó C.
        • et al.
        Subclinical carotid atherosclerosis in HIV-infected patients: role of combination antiretroviral therapy.
        Stroke. 2006; 37: 812-817
        • Hsue P.Y.
        • et al.
        Carotid intima-media thickness progression in HIV-infected adults occurs preferentially at the carotid bifurcation and is predicted by inflammation.
        J. Am. Heart Assoc. 2012; 1 (jah3-e000422)
        • Volpe G.E.
        • et al.
        Progression of carotid Intima-Media thickness and coronary artery calcium over 6 years in an HIV-infected cohort.
        J. Acquir Immune Defic. Syndr. 2013; 64: 51-57
        • Mangili A.
        • et al.
        HIV infection and progression of carotid and coronary atherosclerosis: the care Study.
        J. Acquir Immune Defic. Syndr. 2011; 58: 148-153
        • Masiá M.
        • et al.
        Long-term effects of an intensive intervention in HIV-infected patients with moderate-high atherosclerotic cardiovascular risk.
        J. Antimicrob. Chemother. 2014; 69: 3051-3056
        • Taylor A.J.
        • et al.
        Extended-release niacin or ezetemibe and carotid intima-media thickness.
        N. Engl. J. Med. 2009; 361: 2113-2122
        • Crouse J.R.
        • et al.
        Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis. METEOR Trial.
        JAMA. 2007; 297: 1344-1353
        • Kaplan R.C.
        • et al.
        Low CD4+ T-cell count as a major atherosclerosis risk factor in HIV-infected women and men.
        AIDS. 2008; 22: 1615-1624
        • Guaraldi G.
        • et al.
        Coronary aging in HIV-infected patients.
        Clin. Infect. Dis. 2009; 49: 1756-1762