Background: The effect of human immunodeficiency virus (HIV) on the development of peripheral artery disease (PAD) remains unclear. We investigated whether HIV infection is associated with an increased risk of PAD after adjustment for traditional atherosclerotic risk factors in a large cohort of HIV-infected (HIV+) and demographically similar HIV-uninfected veterans.

Methods: We studied participants in the Veterans Aging Cohort Study from April 1, 2003 through December 31, 2014. We excluded participants with known prior PAD or prevalent cardiovascular disease (myocardial infarction, stroke, coronary heart disease, and congestive heart failure) and analyzed the effect of HIV status on the risk of incident PAD events after adjusting for demographics, PAD risk factors, substance use, CD4 cell count, HIV-1 ribonucleic acid, and antiretroviral therapy. The primary outcome is incident peripheral artery disease events. Secondary outcomes include mortality and amputation in subjects with incident PAD events by HIV infection status, viral load, and CD4 count.

Results: Among 91 953 participants, over a median follow up of 9.0 years, there were 7708 incident PAD events. Rates of incident PAD events per 1000 person-years were higher among HIV+ (11.9; 95% confidence interval [CI], 11.5–12.4) than uninfected veterans (9.9; 95% CI, 9.6–10.1). After adjustment for demographics, PAD risk factors, and other covariates, HIV+ veterans had an increased risk of incident PAD events compared with uninfected veterans (hazard ratio [HR], 1.19; 95% CI, 1.13–1.25). This risk was highest among those with time-updated HIV viral load >500 copies/mL (HR, 1.51; 95% CI, 1.38–1.65) and CD4 cell counts <200 cells/mm³ (HR, 1.91; 95% CI, 1.71–2.13). In contrast, HIV+ veterans with time updated CD4 cell count ≥500 cells/mm³ had no increased risk of PAD (HR, 1.03; 95% CI, 0.96–1.11). Mortality rates after incident PAD events are high regardless of HIV status. HIV infection did not affect rates of amputation after incident PAD events.

Conclusions: Infection with HIV is associated with a 19% increased risk of PAD beyond that explained by traditional atherosclerotic risk factors. However, for those with sustained CD4 cell counts <200 cells/mm³, the risk of incident PAD events is nearly 2-fold higher whereas for those with sustained CD4 cell counts ≥500 cells/mm³ there is no excess risk of incident PAD events compared with uninfected people.

背景：人类免疫缺陷病毒（HIV）对周围动脉疾病（PAD）发展的影响尚不清楚。我们在对大量受HIV感染（HIV +）和人口统计学上未受HIV感染的退伍军人进行传统动脉粥样硬化危险因素调整后，调查了HIV感染是否与PAD风险增加相关。

方法：我们研究了从2003年4月1日至2014年12月31日进行的退伍军人老龄化队列研究的参与者。我们排除了先前已知的PAD或流行的心血管疾病（心肌梗塞，中风，冠心病和充血性心力衰竭）的参与者，并进行了分析调整人口统计学，PAD危险因素，物质使用，CD4细胞计数，HIV-1核糖核酸和抗逆转录病毒疗法后，HIV状况对发生PAD事件风险的影响。主要结局是外周动脉疾病的突发事件。次要结果包括通过HIV感染状况，病毒载量和CD4计数而发生PAD事件的受试者的死亡率和截肢。

结果：在91 953名参与者中，平均随访9.0年，发生了7708起PAD事件。HIV +中每1000人年的PAD事件发生率（11.9； 95％置信区间[CI]，11.5-12.4）要高于未感染的退伍军人（9.9； 95％CI，9.6-10.1）。调整了人口统计学，PAD危险因素和其他协变量后，与未感染的退伍军人相比，HIV +退伍军人发生PAD事件的风险增加（危险比[HR]，1.19； 95％CI，1.13-1.25）。在HIV病毒更新时间> 500拷贝/mL（HR，1.51；95% CI，1.38–1.65）和CD4细胞计数<200细胞/ mm ³（HR，1.91； 95％CI， 1.71–2.13）。相反，HIV +退伍军人的CD4细胞计数随时间更新≥500个细胞/ mm ³没有增加PAD的风险（HR，1.03； 95％CI，0.96-1.11）。无论艾滋病毒感染状况如何，发生PAD事件后的死亡率很高。发生PAD事件后，HIV感染并未影响截肢率。

结论：与传统动脉粥样硬化危险因素所解释的相比，HIV感染使PAD危险增加19％。但是，对于那些持续CD4细胞计数小于200个细胞/ mm ^3的人，发生PAD事件的风险要高出将近2倍，而对于那些持续CD4细胞计数≥500细胞/ mm ^3的人，没有过多的事件发生PAD的危险。事件与未感染的人相比。