HIV Infections – ABC CARDIOL

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Editorial

Cardiovascular Conditions of Patients on HIV Therapy

Successful anti-infective therapy of patients submitted to contemporary HIV treatment decreased mortality between 2007 and 2017 by 51% in association with a decrease in of 17% in incidence; decrease in mortality associated with a smaller decrease in incidence means more people living with HIV disease. In Brazil, annualised rate of change in mortality was -1.2% (-1.4% to -1.0%). In many countries the survival rate of patients increased. Therefore, other non-infectious ailments such as prevalent cardiovascular diseases came to the attention of physicians in charge for the patients.

Prevention is a mainstay in the health care of patients. Patients on successful HIV treatment may incur in either asymptomatic or symptomatic conditions that may be risk factors for cardiovascular diseases or demonstrate metabolic abnormalities that need medical attention. Further, new technologies were studied in order to investigate in more depth vascular health either as screening, or a diagnostic tool or treatment strategies.

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Original Article

Inflammatory Biomarkers and Carotid Thickness in HIV Infected Patients under Antiretroviral Therapy, Undetectable HIV-1 Viral Load, and Low Cardiovascular Risk

Kaliene Maria Estevão Leite et al. Gerson Gomes Santos Júnior Emmanuelle T. A. M Godoi Adriana Ferraz Vasconcelos … Virgínia Maria Barros Lorena Paulo Sérgio Ramos Araújo Kledoaldo Oliveira Lima Heloisa Ramos Lacerda

Abstract

Background:

People living with HIV are at increased risk of cardiovascular disease and carotid thickness, due to the inflammation caused by the virus, the antiretroviral therapy, and other risk factors. However, few studies have observed the occurrence of cardiovascular diseases and carotid thickness in HIV-positive population at low cardiovascular risk and with undetectable viral load.

Objectives:

To evaluate the association between levels of inflammatory markers and carotid thickness in people living with HIV, under antiretroviral therapy and at low cardiovascular risk.

Methods:

To determine low cardiovascular risk in both groups (HIV infected and non-infected individuals), the Framingham Risk Score was used. Inflammatory markers (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1, and sICAM-1) were assessed using flow cytometry. Carotid thickness (mm) was measured using Doppler ultrasound. Level of significance was p < 0.05.

Results:

In People living with HIV, age and smoking status were associated with carotid thickness alterations. In the non-HIV group, age, higher total cholesterol, and LDL levels were associated with increased carotid thickness. Using the multivariate analysis, a significant association between TNF-α and IL- 1( levels, and a higher chance of atherosclerosis development in HIV group were observed.

Conclusions:

Both groups have a similar risk for developing cardiovascular disease, therefore our study demonstrates that HIV-positive individuals with undetectable viral load in antiretroviral therapy without protease inhibitors and with low cardiovascular risk do not present differences in carotid thickness in relation to uninfected individuals.

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Artigo Original

Potent antiretroviral therapy for human immunodeficiency virus infection increases aortic stiffness

Margareth Eira et al. Isabela M. Bensenor Egidio Lima Dorea Roberto Sá Cunha … José Geraldo Mill Paulo A. Lotufo

BACKGROUND: Highly active antiretroviral therapy for AIDS is known to increase cardiovascular risk, but the effects of potent antiretroviral agents according to gender are unknown. OBJECTIVE: The present study evaluated the impact of HIV infection treatment on aortic stiffness according to gender. METHODS: From university-affiliated hospitals, we recruited 28 AIDS patients undergoing highly active antiretroviral treatment (HAART), 28 treatment-naïve HIV-infected patients, 44 patients with type 2 diabetes, and 30 controls. Aortic stiffness was determined by measuring pulse wave velocity (PWV) using a validated and non-invasive automatic device. RESULTS: The crude mean PWV values and 95% confidence intervals (95% CI) for HAART, diabetics, and controls were 9.77 m/s (95% CI 9.17-10.36), , 9.00 m/s (95% CI 8.37-9.63), 9.90 m/s (95% CI 9.32-10.49), and 9.28 m/s (95% CI 8.61-9.95), respectively, for men (P-value for trend = 0.14), and 9.61 m/s (95% CI 8.56-10.66), 8.45 m/s (95% CI 7.51-9.39), 9.83 (95% CI 9.21-10.44), and 7.79 m/s (95% CI 6.99-8.58), respectively, for women (P-value for trend <0.001). Post-hoc analysis revealed a significant difference between the mean PWV values in the HAART group and controls in women (P-value <0.01). After adjusting for other potential covariates, including systolic blood pressure and diabetes, these results did not change. The findings indicate that the impact of HAART treatment on aortic stiffness was amplified in women with hypertension, dyslipidemia, and metabolic syndrome. CONCLUSION: Potent anti-retroviral agents used in the treatment of HIV infection increases aortic stiffness, mainly among women with higher cardiovascular risk.

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Cardiovascular Conditions of Patients on HIV Therapy

Inflammatory Biomarkers and Carotid Thickness in HIV Infected Patients under Antiretroviral Therapy, Undetectable HIV-1 Viral Load, and Low Cardiovascular Risk

Abstract

Background:

Objectives:

Methods:

Results:

Conclusions:

Potent antiretroviral therapy for human immunodeficiency virus infection increases aortic stiffness

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