{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T08:19:30Z","timestamp":1761293970179,"version":"3.41.2"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,7,27]],"date-time":"2019-07-27T00:00:00Z","timestamp":1564185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A multicenter cohort of 712 HIV-positive patients (75.3% males, aged 46.1 \u00b1 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\u20138.50; P &amp;lt; .001), after adjustment for sociodemographic, clinical, and psychological variables. After an average follow-up of 4.4 \u00b1 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\u20137.44; P &amp;lt; .001) were independent predictors of VE. Likewise, alexithymia was an independent predictor of ACM (HR, 3.93; 95% CI, 1.65\u20139.0; P = .002), regardless of other clinical predictors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The present results validate our previous monocentric finding. Alexithymia may be an additional tool for the multifactorial assessment of cardiovascular risk in HIV.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofz331","type":"journal-article","created":{"date-parts":[[2019,8,7]],"date-time":"2019-08-07T18:47:27Z","timestamp":1565203647000},"source":"Crossref","is-referenced-by-count":9,"title":["Alexithymia Predicts Carotid Atherosclerosis, Vascular Events, and All-Cause Mortality in Human Immunodeficiency Virus-Infected Patients: An Italian Multisite Prospective Cohort Study"],"prefix":"10.1093","volume":"6","author":[{"given":"Francesco","family":"Vadini","sequence":"first","affiliation":[{"name":"Infectious Disease Unit, Pescara General Hospital, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Sozio","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Pescara General Hospital, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giordano","family":"Madeddu","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"De Socio","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Santa Maria Hospital, Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Maggi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinic, Policlinico Hospital, Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Nunnari","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Vichi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Di Stefano","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Pescara General Hospital, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Tracanna","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Pescara General Hospital, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ennio","family":"Polilli","sequence":"additional","affiliation":[{"name":"Clinical Pathology Laboratory, Pescara General Hospital, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonina","family":"Sciacca","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Pescara General Hospital, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernardetta","family":"Zizi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Bartolozzi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Elena","family":"Flacco","sequence":"additional","affiliation":[{"name":"Local Health Unit of Pescara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Bonfanti","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, A. Manzoni Hospital, Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Santilli","sequence":"additional","affiliation":[{"name":"Department of Medicine and Aging and Center of Aging Science and Translational Medicine, University of Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8129-9344","authenticated-orcid":false,"given":"Lamberto","family":"Manzoli","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giustino","family":"Parruti","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Pescara General Hospital, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,7,27]]},"reference":[{"key":"2020081004075934300_CIT0001","doi-asserted-by":"crossref","first-page":"2506","DOI":"10.1210\/jc.2006-2190","article-title":"Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease","volume":"92","author":"Triant","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"2020081004075934300_CIT0002","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1086\/518285","article-title":"Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study","volume":"44","author":"Obel","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2020081004075934300_CIT0003","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1001\/jamainternmed.2013.3728","article-title":"HIV infection and the risk of acute myocardial infarction","volume":"173","author":"Freiberg","year":"2013","journal-title":"JAMA Intern Med"},{"key":"2020081004075934300_CIT0004","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.amjcard.2015.10.030","article-title":"Patterns of cardiovascular mortality for HIV-infected adults in the United States: 1999 to 2013","volume":"117","author":"Feinstein","year":"2016","journal-title":"Am J Cardiol"},{"key":"2020081004075934300_CIT0005","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1093\/cid\/ciw470","article-title":"Trends in cardiovascular disease mortality among persons with HIV in New York City, 2001\u20132012","volume":"63","author":"Hanna","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2020081004075934300_CIT0006","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/S2213-8587(15)00388-5","article-title":"Pathophysiology and management of cardiovascular disease in HIV-infected patients","volume":"4","author":"Nou","year":"2016","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2020081004075934300_CIT0007","doi-asserted-by":"crossref","first-page":"2763","DOI":"10.1093\/eurheartj\/ehl338","article-title":"Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146,538 participants in 54 observational studies","volume":"27","author":"Nicholson","year":"2006","journal-title":"Eur Heart J"},{"key":"2020081004075934300_CIT0008","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/S0140-6736(04)17019-0","article-title":"Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study","volume":"364","author":"Rosengren","year":"2004","journal-title":"Lancet"},{"key":"2020081004075934300_CIT0009","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.2105\/AJPH.2009.172809","article-title":"Trajectories of change in obesity and symptoms of depression: the CARDIA study","volume":"100","author":"Needham","year":"2010","journal-title":"Am J Public Health"},{"key":"2020081004075934300_CIT0010","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1038\/nrcardio.2017.189","article-title":"Effects of stress on the development and progression of cardiovascular disease","volume":"15","author":"Kivim\u00e4ki","year":"2018","journal-title":"Nat Rev Cardiol"},{"key":"2020081004075934300_CIT0011","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1111\/psyp.12248","article-title":"A tale of two mechanisms: a meta-analytic approach toward understanding the autonomic basis of cardiovascular reactivity to acute psychological stress","volume":"51","author":"Brindle","year":"2014","journal-title":"Psychophysiology"},{"key":"2020081004075934300_CIT0012","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1093\/ajh\/hpw103","article-title":"Chronic stress and endothelial dysfunction: the multi-ethnic study of atherosclerosis (MESA)","volume":"30","author":"Kershaw","year":"2017","journal-title":"Am J Hypertens"},{"key":"2020081004075934300_CIT0013","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jad.2008.11.008","article-title":"Persistent versus transient depressive symptoms in relation to platelet hyperactivation: a longitudinal analysis of dementia caregivers","volume":"116","author":"Aschbacher","year":"2009","journal-title":"J Affect Disord"},{"key":"2020081004075934300_CIT0014","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/01.psy.0000162254.61556.d5","article-title":"Depression, the autonomic nervous system, and coronary heart disease","volume":"67","author":"Carney","year":"2005","journal-title":"Psychosom Med"},{"key":"2020081004075934300_CIT0015","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1093\/eurheartj\/eht462","article-title":"Depression and cardiovascular disease: a clinical review","volume":"35","author":"Hare","year":"2014","journal-title":"Eur Heart J"},{"key":"2020081004075934300_CIT0016","doi-asserted-by":"crossref","first-page":"e54555","DOI":"10.1371\/journal.pone.0054555","article-title":"Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study","volume":"8","author":"Parruti","year":"2013","journal-title":"PLoS One"},{"key":"2020081004075934300_CIT0017"},{"key":"2020081004075934300_CIT0018","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1177\/1741826710389925","article-title":"CUORE project: implementation of the 10-year risk score","volume":"18","author":"Palmieri","year":"2011","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"2020081004075934300_CIT0019"},{"key":"2020081004075934300_CIT0020"},{"key":"2020081004075934300_CIT0021","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jpsychores.2009.07.015","article-title":"Alexithymia, hypertension, and subclinical atherosclerosis in the general population","volume":"68","author":"Gabre","year":"2010","journal-title":"J Psychosom Res"},{"key":"2020081004075934300_CIT0022","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/PSY.0b013e3181c65d00","article-title":"Alexithymia is associated with increased cardiovascular mortality in middle-aged finnish men","volume":"72","author":"Tolmunen","year":"2010","journal-title":"Psychosom Med"},{"key":"2020081004075934300_CIT0023","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0140-6736(96)90007-0","article-title":"Personality as independent predictor of long-term mortality in patients with coronary heart disease","volume":"347","author":"Denollet","year":"1996","journal-title":"Lancet"},{"volume-title":"Manual for the Beck Depression Inventory-II","year":"1996","author":"Beck","key":"2020081004075934300_CIT0024"},{"key":"2020081004075934300_CIT0025","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1037\/pas0000040","article-title":"Psychometric validation of the BDI-II among HIV-positive CHARTER study participants","volume":"27","author":"Hobkirk","year":"2015","journal-title":"Psychol Assess"},{"key":"2020081004075934300_CIT0026","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S0022-3999(00)00177-X","article-title":"Type D personality. A potential risk factor refined","volume":"49","author":"Denollet","year":"2000","journal-title":"J Psychosom Res"},{"key":"2020081004075934300_CIT0027","first-page":"7","article-title":"[Type D personality, a relevant construct in cardiology. Preliminary validation study of the Italian questionnaire]","volume":"11","author":"Gremigni","year":"2005","journal-title":"Psicoterapia Cognitiva e Comportamentale"},{"key":"2020081004075934300_CIT0028","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S0033-3182(91)72086-0","article-title":"The alexithymia construct. A potential paradigm for psychosomatic medicine","volume":"32","author":"Taylor","year":"1991","journal-title":"Psychosomatics"},{"key":"2020081004075934300_CIT0029","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/S0022-3999(02)00601-3","article-title":"The 20-item Toronto alexithymia scale. IV. Reliability and factorial validity in different languages and cultures","volume":"55","author":"Taylor","year":"2003","journal-title":"J Psychosom Res"},{"key":"2020081004075934300_CIT0030","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.ijpsycho.2009.11.004","article-title":"The cognitive and affective alexithymia dimensions in the regulation of sympathetic responses","volume":"75","author":"Bermond","year":"2010","journal-title":"Int J Psychophysiol"},{"key":"2020081004075934300_CIT0031","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1159\/000327583","article-title":"Alexithymia and tissue inflammation","volume":"80","author":"Honkalampi","year":"2011","journal-title":"Psychother Psychosom"},{"key":"2020081004075934300_CIT0032","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.diabet.2010.06.004","article-title":"Alexithymia is associated with glycaemic control of children with type 1 diabetes","volume":"36","author":"Housiaux","year":"2010","journal-title":"Diabetes Metab"},{"key":"2020081004075934300_CIT0033","first-page":"4","article-title":"Gender, alexithymia and physical inactivity associated with abdominal obesity in type 1 diabetes mellitus: a cross sectional study at a secondary care hospital diabetes clinic","volume":"2","author":"Melin","year":"2017","journal-title":"BMC Obes"},{"key":"2020081004075934300_CIT0034","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.psychres.2015.12.034","article-title":"Is alexithymia associated with metabolic syndrome? A study in a healthy adult population","volume":"236","author":"Karukivi","year":"2016","journal-title":"Psychiatry Res"},{"key":"2020081004075934300_CIT0035","first-page":"149","article-title":"The association of alexithymia with all-cause mortality: prospective epidemiologic evidence","volume":"56","author":"Kauhanen","year":"1994","journal-title":"Psychosom Med"},{"key":"2020081004075934300_CIT0036","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/S0022-3999(96)00226-7","article-title":"Alexithymia and risk of death in middle-aged men","volume":"41","author":"Kauhanen","year":"1996","journal-title":"J Psychosom Res"},{"key":"2020081004075934300_CIT0037","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1176\/appi.psy.50.1.59","article-title":"Alexithymia and health-related quality of life in a general population","volume":"50","author":"Mattila","year":"2009","journal-title":"Psychosomatics"},{"key":"2020081004075934300_CIT0038","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.neuropsychologia.2009.12.033","article-title":"Neurocognitive correlates of alexithymia in asymptomatic individuals with HIV","volume":"48","author":"Bogdanova","year":"2010","journal-title":"Neuropsychologia"},{"key":"2020081004075934300_CIT0039","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.neuropsychologia.2015.03.003","article-title":"Facial emotion recognition impairments are associated with brain volume abnormalities in individuals with HIV","volume":"70","author":"Clark","year":"2015","journal-title":"Neuropsychologia"},{"key":"2020081004075934300_CIT0040","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1093\/scan\/nst058","article-title":"The association of interoceptive awareness and alexithymia with neurotransmitter concentrations in insula and anterior cingulate","volume":"9","author":"Ernst","year":"2014","journal-title":"Soc Cogn Affect Neurosci"},{"key":"2020081004075934300_CIT0041","doi-asserted-by":"crossref","first-page":"433","DOI":"10.31887\/DCNS.2010.12.4\/lpessoa","article-title":"Emergent processes in cognitive-emotional interactions","volume":"12","author":"Pessoa","year":"2010","journal-title":"Dialogues Clin Neurosci"},{"key":"2020081004075934300_CIT0042","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.comppsych.2010.09.007","article-title":"Stability of alexithymia in the general population: an 11-year follow-up","volume":"52","author":"Tolmunen","year":"2011","journal-title":"Compr Psychiatry"},{"key":"2020081004075934300_CIT0043","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jpsychores.2017.02.007","article-title":"An evaluation of the absolute and relative stability of alexithymia over 11 years in a Finnish general population","volume":"95","author":"Hiirola","year":"2017","journal-title":"J Psychosom Res"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofz331\/30051029\/ofz331.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/6\/9\/ofz331\/33576439\/ofz331.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/6\/9\/ofz331\/33576439\/ofz331.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,16]],"date-time":"2021-01-16T06:58:44Z","timestamp":1610780324000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofz331\/5539806"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,27]]},"references-count":43,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2019,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofz331","relation":{},"ISSN":["2328-8957"],"issn-type":[{"type":"electronic","value":"2328-8957"}],"subject":[],"published-other":{"date-parts":[[2019,9]]},"published":{"date-parts":[[2019,7,27]]},"article-number":"ofz331"}}