Alexithymia Predicts Carotid Atherosclerosis, Vascular Events, and All-Cause Mortality in Human Immunodeficiency Virus-Infected Patients: An Italian Multisite Prospective Cohort Study

• Published in: Open forum infectious diseases 2019-09, Vol.6 (9), p.ofz331-ofz331
• Main Authors: Vadini, Francesco, Sozio, Federica, Madeddu, Giordano, De Socio, Giuseppe, Maggi, Paolo, Nunnari, Giuseppe, Vichi, Francesca, Di Stefano, Paola, Tracanna, Elisa, Polilli, Ennio, Sciacca, Antonina, Zizi, Bernardetta, Lai, Vincenzo, Bartolozzi, Claudio, Flacco, Maria Elena, Bonfanti, Paolo, Santilli, Francesca, Manzoli, Lamberto, Parruti, Giustino
• Format: Article
• Language: English
• Subjects: Major
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofz331

Psychological factors (PFs) are known predictors of cardiovascular disease (CVD) in many clinical settings, but data are lacking for human immunodeficiency virus (HIV) infection. We carried out a prospective study to evaluate (1) psychological predictors of preclinical and clinical vascular disease and (2) all-cause mortality (ACM) in HIV patients. We conducted a cross-sectional analysis of baseline data to evaluate the predictors of carotid plaques (CPs) and a prospective analysis to explore predictors of vascular events (VEs) and ACM over 10 years. Human immunodeficiency virus patients monitored at the Infectious Disease Units of 6 Italian regions were consecutively enrolled. Traditional CVD risk factors, PFs (depressive symptoms, alexithymia, distress personality), and CPs were investigated. Vascular events and ACM after enrollment were censored at March 2018. A multicenter cohort of 712 HIV-positive patients (75.3% males, aged 46.1 ± 10.1 years) was recruited. One hundred seventy-five (31.6%) patients had CPs at baseline. At the cross-sectional analysis, alexithymia was independently associated with CPs (odds ratio, 4.93; 95% confidence interval [CI], 2.90-8.50; < .001), after adjustment for sociodemographic, clinical, and psychological variables. After an average follow-up of 4.4 ± 2.4 years, 54 (7.6%) patients developed a VE, whereas 41 (5.68%) died. Age, current smoking, hypertension, and alexithymia (hazard ratio [HR], 3.66; 95% CI, 1.80-7.44; < .001) were independent predictors of VE. Likewise, alexithymia was an independent predictor of ACM (HR, 3.93; 95% CI, 1.65-9.0; = .002), regardless of other clinical predictors. The present results validate our previous monocentric finding. Alexithymia may be an additional tool for the multifactorial assessment of cardiovascular risk in HIV.