Aortic stiffness and central hemodynamics in treatment-naïve HIV infection: a cross-sectional study

Abstract

Background Human immunodeficiency virus (HIV) infection is associated with a greater risk of cardiovascular disease (CVD). HIV infection causes a chronic inflammatory state and increases oxidative stress which can cause endothelial dysfunction and arterial stiffness. Aortic stiffness measured by carotid femoral-pulse wave velocity (cfPWV) and central hemodynamics are independent cardiovascular risk factors and have the prognostic ability for CVD. We assessed cfPWV and central hemodynamics in young individuals with recent HIV infection diagnosis and without antiretroviral therapy. We hypothesized that individuals living with HIV would present greater cfPWV and central hemodynamics (central systolic blood pressure and pulse pressure) compared to uninfected controls. Methods We recruited 51 treatment-naïve individuals living with HIV (HIV(+)) without previous CVD and 51 age- and sex-matched controls (HIV negative (−)). We evaluated traditional CVD risk factors including metabolic profile, blood pressure (BP), smoking, HIV viral load, and CD4+ T-cells count. Arterial stiffness and central hemodynamics were evaluated by cfPWV, central systolic BP, and central pulse pressure (cPP) via applanation tonometry. Results HIV(+) individuals presented a greater prevalence of smoking, reduced high-density lipoprotein cholesterol, and body mass index. 65.9% of HIV(+) individuals exhibited lymphocyte CD4+ T-cells count < 500 cells/μL. There was no difference in brachial or central BP between groups; however, HIV(+) individuals showed significantly lower cPP. We observed a greater cfPWV (mean difference = 0.5 m/s; p < 0.01) in HIV(+) compared to controls, even after adjusting for heart rate, mean arterial pressure and smoking. Conclusion In the early stages of infection, non-treated HIV individuals present a greater prevalence of traditional CVD risk factors, arterial stiffness, and normal or in some cases central hemodynamics.

The Effects of Acute Aerobic Exercise on Blood Pressure, Arterial Function, and Heart Rate Variability in Men Living With HIV

“…There is strong accumulated evidence indicating a decrease in arterial stiffness following acute aerobic exercise (Mutter et al, 2017;Pierce et al, 2018). Arterial stiffness depends on several factors, such as endothelial function, smooth muscular vascular tone, and structural features (Martinez-Ayala et al, 2020). It has been proposed that a relaxation of vascular smooth muscle transfers stress from the less extensive collagen fibers to elastin, which could partially account for decreases in arterial stiffness after exercise (Mutter et al, 2017).…”

“…It has been proposed that a relaxation of vascular smooth muscle transfers stress from the less extensive collagen fibers to elastin, which could partially account for decreases in arterial stiffness after exercise (Mutter et al, 2017). Evidence demonstrates that changes in immune activity due to HIV infection may increase the pulse wave velocity (Boccara et al, 2006;Rider et al, 2014), disrupting the activity of the matrix metalloproteinase (MMPs) (Misse et al, 2001) and degrading collagen, elastin, laminin, and fibrillin within the arterial wall (Martinez-Ayala et al, 2020). The consequent increasing in vascular resistance limits the vasodilation response during exercise.…”

Aortic Pressure Levels and Waveform Indexes in People Living With Human Immunodeficiency Virus: Impact of Calibration Method on the Differences With Respect to Non-HIV Subjects and Optimal Values

“…Taken together, reduced aoBP levels in the setting of similar baBP in PLWHIV would suggest that both HIV infection and/or highly active antiretroviral therapy play a role in hemodynamics, with differential effects on different locations of the vasculature (central vs. peripheral vessels). As was discussed by Martínez-Ayala et al ( 12 ) lower aoBP levels may be caused by a peripheral vasodilation of small and medium-sized arteries, possibly induced by prostaglandins and other inflammatory cytokines associated with the chronic HIV infection. The vasodilation effect on peripheral reflection sites (e.g., arterial bifurcations) might cause a reduced Pb and Pb/Pf, and a reduced contribution to aoSBP.…”

“…More precisely, there are scarce, and above all, controversial data on whether HIV infection is independently associated with aortic blood pressure (aoBP) levels and waveform-derived indexes. Previous studies have reported that both aoBP and some waveform-derived indexes were either elevated ( 9 , 10 ), unchanged ( 9 , 11 ), or even reduced ( 12 – 14 ) in PLWHIV compared to HIV- subjects.…”

Cardiovascular Profile of South African Adults with Low-Level Viremia during Antiretroviral Therapy

“…Studies from high-income settings have shown that PWH have less favorable carotid intima-media thickness, shear strain, presence of plaque, and pulse wave velocity parameters [ 25 , 26 ]. Higher pulse wave velocity and central pulse pressure measures are present in untreated PWH compared to HIV-negative adults [ 27 ]. Conversely, one South African study reported no differences in pulse wave velocity and carotid intima-media thickness between PWH and uninfected controls.…”