A Color Doppler Ultrasound-based Comparative Study between Stavudine and Non-stavudine Regimens in the Onset of Vascular Lesions in HIV-1-positive Patients

Background:Thepresentstudyaimedtoinvestigate theroleofstavudineintheonsetofprematurevascularlesions using an ultrasound color Doppler evaluation of the carotid vessels. Patients and Methods: A total of 266 patients were evaluated:149weretreatedwithstavudine(groupI)and117 withoutstavudine(groupII).Results:Ofthepatientsingroup I, 41% exhibited vascular lesions vs. 26% in group II (p=0.0103). The two groups were further divided into subgroups Ia (stavudine and proteinase inhibitor, PI), Ib (stavudineand non-nucleotidicreversetranscriptaseinhibitor, NNRTI),IIa(PI,withoutstavudine)andIIb(NNRTIwithout stavudine).A higher prevalence of lesions emerged in group Ia,whilegroupIIawereathigherriskofdevelopingvascular lesionsthangroupsIbandIIb.Conclusion:Althoughstavudine per se d oes not seem to determine damage of the epiaortic vessels,theassociationofaPIwithstavudineisrelatedtoa significantlyhigherrateoflesions. Various studies have found stavudine to contribute to the development of lipoatrophy (1), hyperlactatemia (2) and dyslipidemia (3, 4). This evidence determined a progressive abandonment of this molecule as a part of antiretroviral combination therapies. Nevertheless, to date, there is no evidence of a direct involvement of the drug in the onset of vascular lesions, an emerging issue among HIV-infected patients. Color Doppler ultrasound is a well-established method for measuring the degree of atherosclerosis. Furthermore, the examination can be conducted early in the development of atherosclerosis and can be used to detect the progression of the lesions. In previous reports within the PREVALEAT study (premature vascular lesions and antiretroviral therapy), a higher than expected prevalence of premature carotid lesions on color Doppler ultrasonograpy of the epiaortic vessels was observed in HIV-1-infected patients, especially when treated with protease inhibitor (PI)-including regimens (5). The aim of the present study was the evaluation of the role of stavudine in the onset of these lesions.