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. 2022 Dec 5;45(3):e1015.
doi: 10.23938/ASSN.1015.

[Capillaroscopy, microangiopathy, and HIV. Descriptive study of capillaroscopy findings in HIV positive patients]

[Article in Spanish]
Guillermo Verdejo-Muñoz  1 , César Gálvez-Barrón  2 , Borja Gracia Tello  3 , Sara Gamarra Calvo  4 , Isabel Sanjoaquín Conde  5 , Andrés Catena  6 , José Ramón Blanco Ramos  7
Affiliations

[Capillaroscopy, microangiopathy, and HIV. Descriptive study of capillaroscopy findings in HIV positive patients]

[Article in Spanish]
Guillermo Verdejo-Muñoz et al. An Sist Sanit Navar. .

Abstract
in English, Spanish

Background: In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population.

Methodology: Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries.

Results: One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD: 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuosity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension.

Conclusion: Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients.

Fundamento:: El objetivo de este estudio fue valorar la afectación microangiopática mediante capilaroscopia en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Apenas ha sido estudiada y podría constituir una herramienta de diagnóstico precoz de afectación cardiovascular en estos pacientes.

Material y métodos:: Estudio transversal que incluyó pacientes mayores de 18 años, diagnosticados de infección por VIH entre 2008 y 2018. Se recogieron variables demográficas (sexo, edad), analíticas (tiempo de infección, CD4, CD4/CD8, coinfección por otros virus), tratamiento antirretroviral y comorbilidades (tabaquismo, enolismo, hipertensión arterial, dislipemia, diabetes, cardiopatía). Se realizó una capilaroscopia y un análisis de sangre en el mismo acto. Las alteraciones capilaroscópicas evaluadas fueron: congestión, tortuosidades, hemorragias, dilataciones, pérdida capilar y megacapilares.

Resultados:: Se incluyeron 102 pacientes, 73,5% hombres, edad media 40 años (DE: 10) y tiempo medio de infección 4,5 años (DE: 3,1). Al diagnóstico, la media de CD4 fue 408 células/mm3 y la razón CD4/CD8 fue 0,4. El 14,7% presentaban coinfección por el virus de la hepatitis B, el 31,3% tabaquismo y el 13,7% enolismo. El 93,1% de pacientes mostró alguna alteración capilaroscópica. Se observaron, por orden de frecuencia, congestión (78,5%), tortuosidades (77,5%), hemorragias (13,8%), dilataciones (11,8%), pérdida capilar (5%) y megacapilares (1%). Las torutuosidades se asociaron a edad y tabaquismo, y las hemorragias a edad, CD4, tratamiento antirretroviral, e hipertensión.

Conclusiones:: Los pacientes con infección por VIH presentan una prevalencia importante de alteraciones capilaroscópicas, principalmente tortuosidades y congestión. Es la primera descripción de áreas de congestión como hallazgo capilaroscópico en este grupo de pacientes.

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Conflict of interest statement

Conflictos de intereses: Los autores declaran no tener conflictos de intereses.

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