Arterial Disease in Patients With Human Immunodeficiency Virus Infection

Stein, James H.; Currier, Judith S.; Hsue, Priscilla Y.

doi:10.1016/j.jcmg.2013.08.019

Cited by 50 publications

(57 citation statements)

References 75 publications

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“…It is unclear whether differences in ART regimens or their metabolic effects influence CVD risk, in large part because few randomized clinical trials assessing ART have had a significant number of adverse CVD events due to the young age of the participants and short duration of follow-up [1]. Thus, evaluating the effects of ART on surrogate endpoints that predict adverse CVD events is necessary.…”

Section: Discussionmentioning

confidence: 99%

“…The relative contributions of antiretroviral therapy (ART), traditional cardiovascular disease (CVD) risk factors, inflammation, and immune activation on arterial injury and atherosclerosis progression in HIV-infected individuals are not known [1]. Previous observational studies, including studies of carotid intima-media thickness (IMT), have suggested that patients with HIV infection are at increased risk for CVD [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Previous observational studies, including studies of carotid intima-media thickness (IMT), have suggested that patients with HIV infection are at increased risk for CVD [1,2]. Some studies suggest that certain ART, including certain protease inhibitors and abacavir, may cause increased CVD risk in patients with HIV infection [3,4].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A prospective, randomized clinical trial of antiretroviral therapies on carotid wall thickness

Stein

Ribaudo

Hodis

et al. 2015

Aids

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Objective This article compares the effects of initiating three contemporary antiretroviral therapy (ART) regimens on progression of carotid artery intima-media thickness (IMT) over 3 years. Design Randomized clinical trial. Setting Multicenter (26 institutions). Patients ART-naïve HIV-infected individuals (n = 328) without known cardiovascular disease or diabetes mellitus. Intervention Random assignment to tenofovir/emtricitabine along with atazanavir/ritonavir (ATV/r), darunavir/ritonavir (DRV/r), or raltegravir (RAL). Main outcome measures Right-sided carotid IMT was evaluated by B-mode ultra-sonography before ART initiation, and then after 48, 96, and 144 weeks. Comparisons of yearly rates of change in carotid IMT used mixed-effects linear regression models that permitted not only evaluation of the effects of ART on carotid IMT progression but also how ART-associated changes in traditional risk factors, bilirubin, and markers of HIV infection were associated carotid IMT progression. Results HIV-1 RNA suppression rates were high in all arms (>85%) over 144 weeks. Modest increases in triglycerides and non-high-density lipoprotein cholesterol levels were observed in the protease inhibitor containing arms compared with decreases with RAL. In contrast, carotid IMT progressed more slowly on ATV/r [8.2, 95% confidence interval (5.6, 10.8) μm/year] than DRV/r [12.9 (10.3, 15.5) μm/year, P = 0.013]; changes with RAL were intermediate [10.7 (9.2, 12.2) μm/year, P = 0.15 vs. ATV/r; P = 0.31 vs. DRV/r]. Bilirubin and non-high-density lipoprotein cholesterol levels appeared to influence carotid IMT progression rates. Conclusion In ART-naïve HIV-infected individuals at low cardiovascular disease risk, carotid IMT progressed more slowly in participants initiating ATV/r than those initiating DRV/r, with intermediate changes associated with RAL. This effect may be due, in part, to hyperbilirubinemia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A prospective, randomized clinical trial of antiretroviral therapies on carotid wall thickness

Stein

Ribaudo

Hodis

et al. 2015

Aids

Self Cite

View full text Add to dashboard Cite

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“…19 A review by Stein et al suggested the increased use of non-invasive imaging studies including carotid ultrasound, CAC, arterial inflammatory imaging using PET, and brachial artery reactivity testing for monitoring of CHD risk in HIV-infected patients. 20 Mechanisms by which HIV increases cardiovascular risk include: ART metabolic dysfunction caused by ART, 3 and a chronic inflammatory state, particularly in the vasculature, caused by HIV. Individuals with HIV are also more likely to be smokers or have smoked cigarettes, and have higher rates of other traditional risk factors such as dyslipidemia and insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

HIV and coronary artery calcium score: comparison of the Hawaii Aging with HIV Cardiovascular Study and Multi-Ethnic Study of Atherosclerosis (MESA) cohorts

Chow

Young

Valcour

et al. 2015

HIV Clinical Trials

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Objectives To determine the association of HIV, immunologic, and inflammatory factors on coronary artery calcium (CAC), a marker of subclinical atherosclerosis. Methods Cross-sectional study comparing baseline data of males from Hawaii Aging with HIV –Cardiovascular Study (HAHCS) with the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. The cohorts were pooled to determine effects of HIV on CAC and explore immunologic and inflammatory factors that may explain development of CAC in HIV. Multivariable regression models compared CAC prevalence in HAHCS with MESA adjusting for coronary heart disease (CHD) risk profiles. Results We studied 100 men from HAHCS and 2733 men from MESA. Positive CAC was seen in 58% HAHCS participants and 57% MESA participants. Mean CAC was 260.8 in HAHCS and 306.5 in MESA. Using relative risk (RR) regression, HAHCS participants had a greater risk (RR=1.20, P<0.05) of having positive CAC than MESA when adjusting for age, smoking status, diabetes, antihypertensive therapy, BMI, systolic blood pressure, total cholesterol, and HDL cholesterol. Among participants with positive CAC, HIV infection was not associated with larger amounts of CAC. Among HAHCS participants, current HIV viral load, CD4, length of HIV, interleukin 6 (IL-6), fibrinogen, C-reactive protein (CRP), and D-dimer were not associated with the presence or amount of CAC. Discussion HIV was independently associated with a positive CAC in men with increased likelihood occurring between 45 and 50 years of age. Current HIV viral load, CD4 count, length of HIV, and inflammatory markers were unrelated to either presence or amount of CAC.

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“…The WG noted that HIV might alter and potentially accelerate the natural history of the fundamental processes underlying atherosclerosis, endothelial dysfunction, and thrombosis (34–45). The participants also observed that the mechanisms by which HIV and ART may modify these processes have still not been fully elucidated.…”

Section: Resultsmentioning

confidence: 99%

Stimulating High Impact HIV-Related Cardiovascular Research

Shah

Cook

Wong

et al. 2015

Journal of the American College of Cardiology

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The clinical challenges confronting patients with human immunodeficiency virus (HIV) have shifted from acquired immunodeficiency syndrome (AIDS)-related illnesses to chronic diseases, such as coronary artery disease, chronic lung disease, and chronic anemia. With the growing burden of HIV-related heart, lung, and blood (HLB) disease, the National Heart, Lung, and Blood Institute (NHLBI) recognizes it must stimulate and support HIV-related HLB research. Because HIV offers a natural, accelerated model of common pathological processes—such as inflammation—HIV-related HLB research may yield important breakthroughs for all patients with HLB disease. This paper summarizes the cardiovascular recommendations of an NHLBI Working Group, Advancing HIV/AIDS Research in Heart, Lung, and Blood Diseases, charged with identifying scientific priorities in HIV-related HLB disease and developing recommendations to promote multidisciplinary collaboration among HIV and HLB investigators. The working group included multidisciplinary sessions, as well as HLB breakout sessions for discussion of disease-specific issues, with common themes about scientific priorities and strategies to stimulate HLB research emerging in all 3 groups.

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Arterial Disease in Patients With Human Immunodeficiency Virus Infection

Cited by 50 publications

References 75 publications

A prospective, randomized clinical trial of antiretroviral therapies on carotid wall thickness

A prospective, randomized clinical trial of antiretroviral therapies on carotid wall thickness

HIV and coronary artery calcium score: comparison of the Hawaii Aging with HIV Cardiovascular Study and Multi-Ethnic Study of Atherosclerosis (MESA) cohorts

Stimulating High Impact HIV-Related Cardiovascular Research

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