Prevalence and risk of subclinical carotid atherosclerosis in the global population with HIV: a systematic review and meta-analysis

Int J STD AIDS. 2021 Apr;32(5):411-420. doi: 10.1177/0956462420972854. Epub 2021 Jan 25.


The current evidence regarding the prevalence of subclinical carotid atherosclerosis (SCA) for people living with HIV(PLWH) is inconsistent. In this study, we aimed to synthesize data on the prevalence and association of SCA patients with HIV infection. We searched PubMed, EMBASE, Web of Science, Medline, SinoMed, and CNKI from inception to March 2, 2020. The pooled proportion, odds ratio (OR) with 95% confidence intervals (CIs) were calculated. For inclusion, SCA was measured by carotid intima-media thickness (CIMT), with a B-mode ultrasound machine. Twenty-six studies consisting of 6590 participants were identified. The overall prevalence of SCA was 31.6% (95% CI 13.4-53.3; I2 = 99%; 4 studies) according to CIMT ≥ 0.78 mm criteria, and 32.3% (19.6-46.4; 97%; 10 studies) according to CIMT ≥ 0.90 mm criteria. SCA prevalence was higher in Europe, over 40 years old and male. What's more, PLWH have a higher likelihood of developing SCA comorbidity than HIV-negative controls (pooled OR 2.66, 95% CI 1.57-4.50, I2 = 74%; 9 studies), even after sensitivity analysis (pooled OR 2.58, 1.54-4.31, 73%). This study suggests a high prevalence and risk of SCA in the global population with HIV. As a result, subclinical carotid atherosclerosis deserves more attention from policymakers, HIV health-care providers, researchers, and stakeholders.

Keywords: HIV/AIDS; carotid intima‐media thickness; meta‐analysis; risk factors; subclinical atherosclerosis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Carotid Artery Diseases* / diagnostic imaging
  • Carotid Artery Diseases* / epidemiology
  • Carotid Intima-Media Thickness
  • HIV Infections* / complications
  • HIV Infections* / epidemiology
  • Humans
  • Male
  • Prevalence
  • Risk Factors