High Prevalence of Lower Extremity Medial Arterial Calcification in HIV-infected Patients With and Without Chronic Renal Disease: A Vascular Ultrasound Cross-sectional Study

Klaudija Višković1, 2, Annibale Marinelli3, Katrin Nedeljko4, Petra Povalej Bržan5, 6, Nikolina Bogdanić2, *, Josip Begovac2, 7
1 Faculty of Health Sciences, University of Rijeka, Rijeka, Croatia
2 University Hospital for Infectious Diseases “Dr. Fran Mihaljević,” Zagreb, Croatia
3 Nephrology and Dialysis Department, Riuniti Hospital, Anzio, Roma, Italy
4 Ruđer Bošković Institute, Zagreb, Croatia
5 Faculty of Medicine University of Maribor, Maribor, Slovenia
6 Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
7 School of Medicine, University of Zagreb, Zagreb, Croatia

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© 2023 Višković et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the University Hospital for Infectious Diseases 10 000 Zagreb, Croatia; E-mail:



The association between HIV infection and increased risk of atherosclerotic peripheral artery disease (PAD) has been documented. Still, the relationship between HIV infection and lower extremity medial arterial calcification (MAC) is unknown.


We performed a cross-sectional study to compare the frequency of MAC diagnosed by vascular ultrasound in PAD-asymptomatic people living with HIV (PLWH) with and without chronic kidney disease (CKD) compared to HIV-uninfected participants as a control group.


MAC was defined as smooth, linear, and non-stenotic hyperechogenicity in the arterial wall compared to the surrounding tissues. We studied 191 patients: 50 PLWH (25 with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73m2 and 25 with an eGFR <60 mL/min/1.73m2) and 141 HIV-uninfected patients (68 with eGFR<60 ml/min/1.73m2).


MAC was most frequently found in PLWH with CKD (76%). The prevalence of MAC among PLWH was 54.0% (95% confidence interval [CI], 40.4-67.0%), whereas, in HIV-uninfected, it was 34.0% (95% CI, 26.7-42.2%, P=0.013). Age and CKD were consistently associated with MAC in our multivariable models, and there was also a sign that PLWH had higher odds of having MAC.


We found a higher prevalence of MAC in PAD-asymptomatic PLWH compared to HIV-uninfected ones and provided evidence that HIV infection could be associated with MAC.

Keywords: HIV infection, Medial arterial calcification, Chronic kidney disease, Peripheral artery disease, Chronic renal disease, Vascular ultrasound.