The Association Between HIV Infection and Carotid Intima-Media Thickness in the Era of Antiretroviral Therapy: A Meta-Analysis

Abstract

Atherosclerosis remains a leading cause of mortality globally, and this is worse in people living with HIV (PLHIV). While the administration of antiretroviral therapy (ART) in this population has significant benefits, it is essential to acknowledge that it also has some undesired effects. This study investigated the impact of ART on carotid intima-media thickness (CIMT) in PLHIV as a marker of early atherosclerosis. A literature search was conducted on the PubMed, Scopus, and EBSCOhost databases from 1 January 1987 to 30 May 2025. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale. Data were analyzed using a meta-analysis web tool and reported as the mean difference (MD) and 95% confidence intervals (CIs). Twenty-seven studies, which included 3250 PLHIV on ART and 1542 who were ART-naive, were relevant. The mean age was 41.26 in ART and 39.91 years. The results showed a higher CIMT in PLHIV on ART compared to the ART-naive group, MD = 0.03 mm, 95% CI (0.02 mm to 0.04 mm), p < 0.0001; I² = 96.9%. Subgroup analysis showed that the inclusion of studies conducted on male participants only, those with a sample size of one hundred, and those with a moderate risk of bias contributed to heterogeneity. The results suggest there is an increased risk of atherosclerosis in PLHIV on ART.

Keywords: antiretroviral therapy; atherosclerosis; cardiovascular risk; carotid intima-media thickness; human immunodeficiency virus.

Figure 1

Preferred Items for Systematic Review and Meta-Analysis (PRISMA) flow diagram.

Figure 2

CIMT in PLHIV on ART versus ART-naive PLHIV. Data are reported as the mean difference and 95% confidence intervals [20,21,24,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61]. The gray box shows the weight of the study, the solid vertical line shows the line of no effect, the dashed vertical line shows the effect size, the horizontal line shows the confidence intervals, diamond plot shows the overall effect estimates.

Figure 3

Funnel plot showing assessment of publication bias.