Brachial and central blood pressure in HIV-infected subjects

Abstract

HIV infected subjects present an unfavorable cardiovascular (CV) risk profile that is determined by the infection itself, highly active anti-retroviral therapy (HAART) and other factors, such as chronic kidney disease (CKD). Information is scant and contradictory on whether these factors are associated with arterial stiffness and blood pressure (BP) alteration. Our study aimed to evaluate those parameters in HIV-positive subjects both with and without HAART and with and without CKD, which was defined as the presence of microalbuminuria with a normal glomerular filtration rate. We enrolled 94 HIV-infected subjects without known CV risk factors and compared them with 37 control subjects. We recorded brachial and central BP (pulse wave analysis) and pulse wave velocity ( SphygmoCor). HIV-positive subjects of similar ages and with similar BP values showed central pulse pressure values that were significantly greater than those of controls; this was also the case for the Aix value. Central systolic and pulse pressure values and Aix were significantly greater in HIV-positive subjects with HAART and CKD than in the other HIV-positive subgroups and control subjects. PWV was also superimposable between groups when the data were analyzed relative to the presence of HAART and CKD. Our study shows that the unfavorable CV risk profile associated with HIV infection includes an increase in both central BP and Aix. The central BP increase seems to be favored by renal damage, which apparently has a role in the early stages of the disease.

Aortic stiffness aging is influenced by past profound immunodeficiency in HIV-infected individuals

“…Conversely, several other studies found increased aortic stiffness in HIV-infected individuals [9][10][11]. Such discrepancies may be because of differences in study population characteristics, notably cART use, immunologic status, cardiovascular risk level, and variations in the methods used to evaluate aortic stiffness, particularly cardiac magnetic resonance [11], SphygmoCor [9,10,15,17,18] and Complior [12][13][14]16]. Our cross-sectional study provides additional information by observing that, among HIV-infected individuals, aortic stiffness is associated with both nadir CD4 þ T-cell count, a marker of past profound immunodeficiency, and traditional cardiovascular risk factors.…”

“…Certain studies found increased aortic stiffness among HIV-infected individuals when compared with controls [9][10][11], whereas others did not [12][13]. Contradictory results have also been reported concerning the effect of cART on aortic stiffness, observing either deleterious effects [14][15][16] or no association [17][18]. These discordant results may simply be because of population differences, differences in study design, or methodological approach.…”

“…Carotid-femoral pulse wave velocity (cf-PWV) is the gold standard for measuring aortic stiffness [8]. Several cross-sectional studies have previously addressed the effect of HIV infection [9][10][11][12][13] or cART [14][15][16][17] on aortic stiffness using different methods of evaluation, including cf-PWV, radial PWV, and cardiac magnetic resonance. Certain studies found increased aortic stiffness among HIV-infected individuals when compared with controls [9][10][11], whereas others did not [12][13].…”

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

“…This vasodilation effect on peripheral reflection sites (e.g., arterial bifurcations) might cause a decreased reflection of the backward wave and reduced contribution to cSBP [54]. However, Maloberti et al [55] found no difference in cPP between controls and HIV(+) receiving ART or treatment naïve. Only HIV individuals who received ART and presented chronic kidney disease had significantly greater cPP compared to HIV(-).…”

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

“…Moreover, aortic stiffness is associated with coronary artery disease [13,14]; and it is an independent predictor of coronary events [15]. However, there are contradictory ndings on aortic stiffness measured by carotid-femoral pulse wave velocity (cfPWV) in treatment-naïve individuals living with HIV; with some studies showing similar [16,17] and others increased cfPWV, compared to controls [18,19].…”