Infectious Disease

Irritation predicts vascular illness in handled HIV with “vital” gender variations

March 08, 2021

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Schnittman SR et al. Abstract 98. Presented at: Conference on Retroviruses and Opportunistic Infections; 6-10 March 2021 (virtual meeting).

Disclosure:
Schnittman does not report any relevant financial information.

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According to study results presented at the conference on retroviruses and opportunistic infections, there are different pathways of inflammation that predict vascular disease in patients treated for HIV.

The researchers also uncovered “important biological sex differences” in the study of nearly 1,000 people, including that women with HIV had higher levels of inflammation than men with HIV, and that inflammation “tended to predict several diseases more often in women than in men” . said Samuel Schnittman, MD, a research fellow in the Department of Medicine at the University of California at San Francisco.

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“Our study expands knowledge about the specific inflammatory pathways that predict vascular disease,” Schnittman told Healio. “Ultimately, we need a clinical study that proves that an intervention reduces the disease.”

Schnittman and colleagues examined a random subgroup of 979 HIV patients after 1 year of ART with available blood plasma and all patients (also suppressed for 1 year or more) diagnosed with ischemic stroke of type 1 or 2MI (T1MI, T2MI) or venous Thromboembolism (VTE). They analyzed the relationship between plasma biomarkers and gender and the risk for these events.

Of the patients, 76 had T1MI, 56 had T2MI, 30 had ischemic stroke, 80 had VTE, and 70 died. Women had 1.3 to 2.7 times higher C-reactive protein (CRP) in the interquartile range (IQR) and a total of 11 of 13 measured inflammatory markers compared to men (P <0.04), and the differences were at older women even bigger. Higher CRP, IL-6, LPS binding protein (LBP), kynurenine tryptophan (KT) ratio, suPAR, sTNFR1 and CMV IgG titers were associated with T1MI (P <0.03). Higher CRP, IL-6, LBP, suPAR, sTNFR1, and CMV IgG titers were associated with VTE (P <0.03). Almost all biomarkers were associated with a higher risk of T2MI and death. Overall, biomarkers were more frequently associated with cardiovascular disease in women than in men. However, the opposite effect was seen with VTE events, where the biomarkers were more predictive in men than in women, possibly related to the sex hormone effects on clotting, according to Schnittman.

“We need an ‘atlas’ of pathways that predict certain diseases for a rational clinical trial design, and this study contributes to that goal,” said Schnittman.

Schnittman said the study also highlights that inflammation is a “major problem for women, especially postmenopausal women with treated HIV”.

“While there are more men than women living with HIV in the US worldwide, more women than men worldwide have HIV,” he said. “Yet women are generally underrepresented in clinical trials of immune-based interventions. Our area simply needs to do better to enroll women in clinical trials. “

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Conference on Retroviruses and Opportunistic Infections (CROI)

Conference on Retroviruses and Opportunistic Infections (CROI)

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