Infectious Disease

The connection between HIV severity and endothelial perform can predict extra danger of CVD

17th December 2020

2 min read

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The relationship between HIV and arterial endothelial function may imply a risk of CVD in infected patients, especially if they also have kidney disease, according to a study published in Atherosclerosis, Thrombosis, and Vascular Biology.

“People living with HIV infection have endothelial dysfunction, which suggests that HIV infection increases the risk of CV beyond the associated risk factors.” James H. Stein, MDRobert Turell, professor of cardiovascular research, vice chairman of faculty development, department of medicine at the University of Wisconsin Medical School, and Madison public health, told Healio. “The effect of HIV-positive serostatus on endothelial function is influenced by even slight reductions in kidney function, which had a greater effect in people with HIV infection than in people without HIV disease. These results suggest that endothelial function associated with even mild kidney disease may play a role in HIV-associated CVD risk. “

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Using participant-level data from nine studies with 2,533 patients (986 with HIV) [mean age, 44 years];; 1,547 without HIV [mean age, 43 years]), the researchers examined the influence of HIV serostatus, disease severity and CVD risk factors on endothelial function. The dilation mediated by the brachial artery flow was measured using a standardized ultrasound imaging protocol with central reading.

HIV, risk factors, and endothelial function

The effect of HIV serostatus on flow-mediated dilation was not statistically significant even after adjustment (beta = 0.22; P = 0.558).

Researchers observed that larger brachial artery diameter, larger age, larger female gender, and lower BMI were the strongest factors associated with flow-mediated dilation (P for all <0.0001).

After adjusting creatinine levels, HIV-positive serostatus was associated with lower flow-mediated dilation (beta = 0.89%; 95% CI, 1.61 to 0.17; P = 0.015) and the association persisted Adaptation for the use of antihypertensive agents strong. Lipid lowering and antiglycemic drugs, lipoprotein particle sizes, and interleukin-6 levels.

According to the study, the subsequent adjustment with the addition of the C-reactive protein level further strengthened the association between HIV-positivity and lower flow-mediated dilation (beta = 1.2%; 95% CI, 1.85 to 0.55; P <0.0001).

“Identifying contributors to CVD in people with HIV infection has been challenging because the HIV epidemic has evolved in ways over the past 30 years that affect CVD risk,” Stein said in an interview. “Today, people with HIV infection are diagnosed younger, treated earlier, used antiretroviral therapies with fewer metabolic toxicities, live longer and older, use more lipid-lowering drugs, and have a lower prevalence of cigarette smoking.”

Kidney function, HIV and endothelial function

According to the study, creatinine levels were higher in HIV patients than in HIV-negative participants (P <0.001), and the inverse association between creatinine levels and flow-mediated dilation was greater (r = 0.14) in HIV patients Compared to those without (r = 0.05).

“We expected the risk of HIV in cardiovascular disease to vary based on age, severity of the HIV disease, and use of antiretroviral therapies,” Stein told Healio. “We were surprised that the effects of HIV infection and kidney disease on arterial function were not changed by these factors.”

In analyzes that included HIV serostatus, age, race, and creatinine, the researchers found that only HIV serostatus (beta = 1.25; P = 0.001) and creatinine (beta = 0.72; P = 0.024) were independent were associated with flow mediated dilation.

In addition, the association of creatinine and HIV-positive serostatus with the flow-mediated dilation in the highest tertile of creatinine was strong and relatively unaffected by the subsequent adjustment (1 mg / dl; beta = 1.59%; 95% CI, 2nd , 58 to 0.6; P = 0.002).

“What about kidney disease that increases the risk of CVD, especially in people with HIV infection?” Stein said areas remained for further research. “Is the relationship between HIV infection, CVD and kidney disease affected by antiretroviral therapy?”

For more informations:

James H. Stein, MDcan be reached at jhs@medicine.wisc.edu.

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