Aortic Stiffness in HIV Infection with and without Antiretroviral Therapy. A Meta-analysis of Observational Studies

Abstract

Keywords HIV infection cardiovascular risk pulse wave velocity aortic stiffness A B S T R A C TBackground: The risk of Cardiovascular (CV) events is higher in HIV-infected patients (HIV+) compared to HIV-uninfected persons (HIV−). Large artery stiffness, a well-documented predictor of adverse CV prognosis, may mediate this enhanced risk. It is usually assessed by measuring aortic Pulse Wave Velocity (aPWV). Studies examining arterial stiffness in HIV+ yielded inconsistent results. We performed a meta-analysis with the aim to evaluate the association of HIV infection and its therapy [Antiretroviral Therapy (ART)] with aPWV. Design and Method:The Standardized Mean Difference (SMD) and corresponding 95% confidence intervals were calculated for aPWV in different comparison groups. Statistical heterogeneity, assessed by Q-test and I 2 statistic, was observed in all these comparisons. Therefore, random effects model was implemented.Results: In a total of 12 studies, naive HIV+ (n = 547) showed increased aPWV compared to HIV− (n = 864): SMD = 0.333 (0.125-0.542), p < 0.002. A total of 22 studies were identified comparing HIV+ treated with ART (n = 3348) to HIV− (n = 2547) showing higher values of aPWV in the former than in latter: SMD = 0.391 (0.225-0.556), p < 0.001. In 10 studies, HIV+ treated with ART (n = 761) exhibited greater aPWV values than those of naive HIV+ (n = 457): SMD = 0.262 (0.006-0.518), p = 0.045. Conclusion:Our meta-analysis seems to suggest that HIV infection "per se" and ART may impair aortic distensibility. However, interpretation of our results needs caution due to between-study heterogeneity and some potential publication biases.

Treatment and comorbidity burden among people living with HIV: a review of systematic literature reviews

“…Among the 40 SLRs that covered comorbidities in PLWH, 21 articles focused on cardiovascular and metabolic diseases 15 , 18–21 , 23 , 25 , 27–29 , 32 , 36–39 , 43 , 44 , 46 , 47 , 53 , 55 , nine on mental health disorders 14 , 15 , 24 , 30 , 45 , 48 , 49 , 52 , 54 , five on bone and muscle diseases 14 , 15 , 31 , 34 , 40 , four on liver diseases 15 , 29 , 37 , 42 , four on renal diseases 15 , 26 , 29 , 41 , and six on other comorbidities 14 , 15 , 29 , 33 , 35 , 50 . Additionally, one SLR assessed hearing loss in children with HIV 22 , and another one assessed the economic burden of HIV management and comorbidities in the US 51 .…”

Pulse wave velocity in early-treated children living with perinatal HIV infection is similar to uninfected children

“…Children and adults with HIV are at substantial risk of cardiovascular events [1], driven by multiple factors including HIV-associated metabolic abnormalities [2], antiretroviral therapy (ART) exposure [3], and HIV infection itself [4,5]. For children living with perinatal HIV (CHIV), early ART initiation irrespective of CD4 þ cell count or clinical HIV disease is now standard-of-care globally.…”

Age-related differences in the vascular function and structure of South Africans living with HIV

“…17 Diabetes mellitus 18 and dysglycaemia, 19 as well as factors related to an unhealthy lifestyle, 20,21,22 also lead to acceleration of the vascular ageing process. 23 Vascular comorbidities, such as arterial stiffness and atherosclerosis, 5,6 as well as cardiometabolic disturbances, 24,25 become increasingly evident with the prolonged life expectancy of PLWH because of the effectiveness of antiretroviral treatment (ART). 26 Background: As the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities and early vascular ageing (EVA) also increases.…”

“…4 Multimorbidity adversely affects vascular health, causing acceleration in the vascular ageing process. 5 , 6 , 7 Physiological, vascular ageing occurs with the progression of age and is a gradual and continuous process, characterised by structural and/or mechanical changes within the vessel wall. 8 , 9 These mechanical and structural alterations that occur with vascular ageing may result in arterial stiffness and an increased carotid intima-media thickness (cIMT), 10 which can affect some individuals prematurely, a term coined early vascular ageing (EVA).…”