Postmenopausal women with HIV show higher carotid plaque prevalence in Brazilian study

A cross-sectional study published in Menopause compared cardiovascular risk and subclinical atherosclerosis in 200 age-matched postmenopausal women aged 45–60 years in Manaus, Brazil: 100 with HIV and 100 HIV-negative controls. Researchers assessed cardiometabolic factors, carotid ultrasonography and estimated 10-year cardiovascular risk using Framingham scores, with D:A:D R10 scores additionally calculated for women with HIV.

Carotid plaque prevalence was higher among women with HIV (12% versus 3%; P=0.017), despite similar carotid intima–media thickness. Metabolic syndrome (55% versus 36%) and physical inactivity (81% versus 57%) were also more common. Mean Framingham scores were 10.5 versus 7.5 (P=0.007). After adjustment, HIV was associated with higher plaque odds (OR 4.65; 95% CI 1.06–20.4), while each year of later menopause was associated with lower odds (OR 0.92; 95% CI 0.85–0.99).

Among women with HIV, longer non-nucleoside reverse transcriptase inhibitor exposure was associated with lower plaque odds (OR 0.63 per year; P=0.005). D:A:D R10 had numerically better plaque discrimination than Framingham, but the difference was not statistically significant (area under the curve 0.69 versus 0.60; P=0.146).

The findings highlight cardiovascular risk assessment in postmenopausal women with HIV. However, the cross-sectional design, small number of plaque cases and wide confidence interval limit causal interpretation. These associations do not establish antiretroviral protection or superiority of either risk score, and plaque detection is not a clinical cardiovascular event outcome.