Peripheral artery disease and HIV


Key points

  • Peripheral artery disease (PAD) is caused when fatty deposits develop in your arteries, affecting the blood supply to your legs.
  • Symptoms include leg pain, changes to the skin on your legs, and cuts or sores on your feet that won’t heal.
  • People living with HIV who have a low CD4 count are at higher risk of developing PAD.

Peripheral artery disease (PAD) is a condition where the blood flow to your legs is affected by fatty substances building up in your arteries. It can cause pain in your legs and can also lead to more serious problems with your legs and heart. PAD is treated by making changes to your lifestyle and medication. Some people will need a medical procedure or surgery too.

You might also hear peripheral artery disease called peripheral arterial disease or peripheral vascular disease (PVD).

Your lifestyle and peripheral artery disease

You can reduce your risk of developing peripheral artery disease by making changes to your lifestyle. These changes will generally improve the health of your heart and blood vessels.

  • Don’t smoke. If you are a smoker, you can get support to stop smoking from your doctor. Smoking is one of the strongest risk factors for PAD.
  • Manage any health conditions, such as type 2 diabetes and high blood pressure, by taking any medications you are prescribed and following your doctor’s advice.
  • Eat a healthy, balanced diet that contains plenty of fruits, vegetables and whole grains such as brown rice.
  • Eat fewer foods that contain saturated fats, such as butter, cheese, and coconut oil. Instead, replace them with foods that contain unsaturated fats, such as vegetable oils and nuts.  
  • Avoid highly processed foods wherever possible as these tend to contain large amounts of salt, sugar, and trans fats.
  • Eat less than 6g of salt a day (about 1 teaspoon). Try to cut down or remove salt when you’re cooking from scratch and check the labels of the foods you’re buying.
  • Get regular exercise. Try to aim for 150 minutes of moderate-intensity exercise, such as cycling or brisk walking, each week. If you find exercise painful, speak to your doctor about how you can increase your activity levels.
  • Limit your intake of alcohol. In the UK, the recommended limit is no more than 14 units a week.
  • Limit your intake of caffeine. Try and avoid drinks and foods that contain a lot of caffeine such as coffee, Coca-Cola, and Red Bull.
  • Find ways to manage or cope with stress. This might involve exercise, mindfulness, or making time to do the things you enjoy.

Who is at risk?

There are also some things which increase your risk of peripheral artery disease which you can’t change, including:

  • being older, because the risk of developing PAD increases as you age
  • being a man or a post-menopausal woman
  • having a health condition such as diabetes and kidney disease
  • having smoked in the past
  • having fatty deposits in other arteries, such as those in your heart (coronary heart disease) or in your neck (which can cause stroke).

Peripheral artery disease in people living with HIV

People living with HIV who have a low CD4 count (below 500) or a detectable viral load have a higher risk of developing PAD. For people living with HIV who have CD4 counts above 500, or an undetectable viral load, it’s not known for sure if the risk of developing PAD is higher. This is because some studies have found an increased risk and others haven’t.

It’s thought that having a low CD4 might increase your risk of PAD because HIV can cause inflammation – when your immune system overreacts to the virus. Inflammation can cause fatty substances to build up in your arteries, including the arteries affected by PAD.

There isn’t enough information to know if there are links between specific anti-HIV medications and PAD. However, some anti-HIV medications have been linked to changes in the amount of fats (lipids) in your blood. Over time this might increase your risk of fatty deposits building up in your arteries. There is more information about these medications in our page Coronary heart disease and HIV.

Symptoms of peripheral artery disease

Many people don’t have any symptoms of PAD. If you do get symptoms these might include:

  • pain in your legs
  • pain in your leg muscles that only happens when you walk – this is called intermittent claudication
  • numbness or coldness in your feet
  • weakness in your legs
  • having cuts or sores on your feet and legs that won’t heal
  • changes to the skin on your legs, such as a change in colour, losing leg hair, or the skin becoming smoother.



Any perceptible, subjective change in the body or its functions that signals the presence of a disease or condition, as reported by the patient.



Fat or fat-like substances found in the blood and body tissues. Lipids serve as building blocks for cells and as a source of energy for the body. Cholesterol and triglycerides are types of lipids.


A group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.


The determination that a patient has a particular disease or condition, through evaluation of their medical history, clinical symptoms and/or laboratory test results.

detectable viral load

When viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners.

Some people with PAD also experience erectile dysfunction.

Diagnosis and monitoring

If your doctor thinks you might have PAD they will ask you about any symptoms and will look at your feet and legs. They will probably also measure the blood pressure in your legs and arms. This is called the ankle-brachial pressure index (ABPI) test.

They will do this using a cuff which is filled with air until it’s tight. The air is then let out of the cuff slowly and a blood pressure reading is taken. The doctor will use a calculation to work out the difference between the two blood pressure readings. If you have lower blood pressure in your legs compared to your arms then it’s a sign you might have PAD.  

If your doctor thinks you might have PAD, you might have more tests, such as ultrasound, MRI, or CT scans.

You won’t usually be tested for PAD at your HIV clinic appointments. However, you should have your blood fats (lipids) tested each year. This can help your doctor understand how healthy your heart and blood vessels are and whether you need to make any lifestyle changes or take lipid-lowering medication.

If you have diabetes, you should be examined and monitored for the development of PAD. This includes regular foot examinations for cuts and sores.

Treatment and management

If you’re diagnosed with PAD you should make lifestyle changes to improve the health of your heart and blood vessels. If you smoke, one of the most important things you can do is stop smoking. More information about lifestyle changes is in the section 'Your lifestyle and peripheral artery disease' further up this page.


Exercise can help manage PAD and reduce your symptoms. Your doctor might be able to recommend you a supervised exercise programme. This is usually two to three sessions of specific exercises every week for three months. These exercises help to build extra blood vessels and strengthen your muscles. This will allow you to walk further and more comfortably. If you aren’t able to go to a supervised exercise programme, your doctor should be able to work out an exercise plan with you to help you increase how active you are.


Having PAD means you’re at risk of other problems with your blood vessels and heart. Your doctor might prescribe you medication to reduce your cholesterol, reduce your blood pressure, or change the way that your blood clots.

If you have pain when you exercise (claudication) you might be prescribed naftidrofuryl oxalate to help with your symptoms. This is a medication that opens up your blood vessels which means that blood can flow more easily. Naftidrofuryl oxalate doesn’t interact with any anti-HIV medications.  

You might also be prescribed painkillers to deal with any pain.


If you have intermittent claudication and lifestyle changes haven’t worked well enough for you, you might be offered a medical procedure or surgery to help.

  • Angioplasty. A balloon is inserted into your artery to make it wider.
  • Stenting. A thin tube is put into your artery at the same time as you are having an angioplasty. This tube is called a stent. A stent keeps your artery open to allow blood to flow more easily.
  • An artery bypass graft. A blood vessel from somewhere else in your body is used to divert blood around a blockage in your artery.

If your PAD isn’t treated with lifestyle changes, medication, or surgery, then it will usually get worse. There is more information about possible complications in the ‘Symptoms of peripheral artery disease’ section above. In its most advanced stages, peripheral artery disease can cause damage to your legs, which can sometimes lead to amputation.

If you have peripheral artery disease you will be at higher risk of other health problems that affect your heart and blood vessels such as:

Other sources of information

You may find the British Heart Foundation helpful. Visit their website or call their helpline (from the UK) on 0300 330 3311.

Next review date

Thanks to Dr Eric Secemsky and Dr Katherine Kentoffio for their advice.