Cardiovascular markers of inflammation and serum lipid levels in HIV-infected patients with undetectable viremia

Višković, Klaudija; Lepej, Snježana Židovec; Gorenec, Ana; Grgić, Ivo; Lukas, Davorka; Zekan, Šime; Dragobratović, Anja; Trupković, Maja; Begovać, Josip

doi:10.1038/s41598-018-24446-4

Cited by 14 publications

(13 citation statements)

References 40 publications

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“…The most commonly measured biomarkers included IL-6 [29, 53, 56, 97–108], highly sensitive CRP [7, 28, 98, 99, 101–104, 106, 108, 109] and D-dimer levels [7, 28, 98, 99, 101–104, 106, 108, 109]. In addition, a number of studies measured markers of endothelial adhesion or activation, or both, including soluble intercellular adhesion molecule-1 and soluble vascular cell adhesion molecule-1 [7, 15, 17, 50, 97, 106–108, 110–112], monocyte activation (sCD163, sCD14, or changes in monocyte phenotype) [15, 28, 29, 50, 56, 96, 97, 100, 107–114], and platelet activation (expression of s- and p-selectin) [30, 33, 115]. Limitations exist in many studies examining biomarkers for CVD outcomes.…”

Section: Pathophysiological Mechanisms Associated With Development Ofmentioning

confidence: 99%

Good Fences Make Good Neighbors: Human Immunodeficiency Virus and Vascular Disease

Mayne

Louw

2019

Open Forum Infectious Diseases

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Cardiovascular disease, venous thrombosis, and microvascular disease in people with HIV (PWH) is predicted to increase in an aging HIV-infected population. Endothelial damage and dysfunction is a risk factor for cardiovascular events in PWH and is characterized by impaired vascular relaxation and decreased nitric oxide availability. Vascular disease has been attributed to direct viral effects, opportunistic infections, chronic inflammation, effects of antiretroviral therapy, and underlying comorbid conditions, like hypertension and use of tobacco. Although biomarkers have been examined to predict and prognosticate thrombotic and cardiovascular disease in this population, more comprehensive validation of risk factors is necessary to ensure patients are managed appropriately. This review examines the pathogenesis of vascular disease in PWH and summarizes the biomarkers used to predict vascular disease in this population.

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Section: Pathophysiological Mechanisms Associated With Development Ofmentioning

confidence: 99%

Good Fences Make Good Neighbors: Human Immunodeficiency Virus and Vascular Disease

Mayne

Louw

2019

Open Forum Infectious Diseases

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“…However, biomarkers of inflammation and immune activation such as CRP, microalbuminuria, cystatin C and soluble CD14 are elevated in HIV‐infected patients even when on cART , reflecting residual inflammatory/immune activation. Consistent with these findings, we did not find any correlation between the evaluated parameters and viral load or CD4 count, suggesting that, after viral suppression, the detrimental factors leading to atherothrombotic events are not completely normalized, and may reflect the excess CV risk observed in HIV‐infected patients even when successfully treated with ART .…”

Section: Discussionmentioning

confidence: 92%

Circulating CD40 ligand, Dickkopf‐1 and P‐selectin in HIV‐infected patients

et al. 2019

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Objectives The aim of this study was to evaluate the circulating levels of CD40 ligand (CD40 L), Dickkopf‐1 (DKK‐1) and P‐selectin, their relationships and their contributions to cardiovascular risk in subjects with HIV infection. Methods The study population included 80 HIV‐infected patients, 14 (17.5%) of whom had diabetes mellitus (DM) and 32 (40.0%) of whom had arterial hypertension (AH). The HIV‐infected patients were compared with a control group with similar demographic and clinical features. CD40L, DKK‐1 and P‐selectin levels were measured using an enzyme‐linked immunosorbent assay. Results The HIV‐infected patients showed higher levels of all the cardiovascular disease (CVD) markers. Both serum CD40L and DKK‐1 were significantly higher in HIV‐infected patients than in the HIV‐negative controls (P < 0.001), while soluble P‐selectin showed no significant between‐group difference (P = 0.133), reflecting the role of HIV infection in CVD. In the HIV‐infected group, patients with DM showed lower levels of CD40L and DKK‐1 in comparison with the nondiabetic patients and patients with AH (P < 0.05, with Bonferroni correction). In contrast, patients with AH showed higher levels of CD40L and DKK‐1 in comparison to patients without DM or AH (P < 0.05, with Bonferroni correction). Patients with AH showed higher levels of CD40L and DKK‐1 than patients with DM (P < 0.05, with Bonferroni correction). Conclusions In this study, we found that HIV‐infected patients displayed significantly higher circulating levels of both CD40L and DKK‐1, which were linearly and directly correlated, when compared to HIV‐negative patients. The presence of diabetes was associated with lower levels of both CD40L and DKK‐1, whereas the presence of hypertension was associated with higher levels of CD40L.

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“…This result emphasizes the additional effect of HIV related and individual components of MetS on the susceptibility to CVD mortality risk, at the absence of increased age. HIV infection, immune activation and inflammation are related to cardiovascular risk among the population, characterized by the complex interaction of systematic factors at all stages of HIV-infection progression [13, 16]. Likewise, both untreated HIV-infected and treated persons are adversely susceptible to CVD outcomes [19].…”

Section: Discussionmentioning

confidence: 99%

“…Islam et al [59] showed a yearly increasing CVD risk among treated HIV-infected patients, establishing that the duration of ART exposure is strongly associated with CVD outcome. Višković et al [13] analyzed the association between the presence of CVD biomarkers and related HIV-infected patient characteristics. The results of their study showed a positive correlation between the duration of HIV infection and ART and the presence of CVD markers, with a median of 8 and 6 years respectively [13].…”

Section: Discussionmentioning

confidence: 99%

“…Višković et al [13] analyzed the association between the presence of CVD biomarkers and related HIV-infected patient characteristics. The results of their study showed a positive correlation between the duration of HIV infection and ART and the presence of CVD markers, with a median of 8 and 6 years respectively [13]. Though in a Danish population, ageing, duration of ART initiation and HIV infection were not related with the risk of CVD [60].…”

Section: Discussionmentioning

confidence: 99%

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Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa

Todowede

Sartorius

Magula

et al. 2019

Diabetol Metab Syndr

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BackgroundSouth Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, based on their observed metabolic risk factor profile.MethodsWe extracted data from hospital medical charts for 384 randomly selected HIV-infected patients aged ≥ 30 years. We defined metabolic syndrome (MetS) subcomponents using the International Diabetes Federation definition. A validated non-laboratory-based model for predicting a 10-year CVD mortality risk was applied and categorised into five levels, with the thresholds ranging from very low-risk (< 5%) to very high-risk scores (> 30%).ResultsAmong the 384 patients, with a mean (± standard deviation) age of 42.90 ± 8.20 years, the proportion of patients that were overweight/obese was 53.3%, where 50.9% had low high-density lipoprotein (HDL) cholesterol and 21 (17.5%) had metabolic syndrome. A total of 144 patients with complete data allowed a definitive prediction of a 10-year CVD mortality risk. 52% (95% CI 44–60) of the patients were stratified to very low risk (< 5%) compared to 8% (95% CI 4–13) that were at a very high risk (> 30%) of 10-year CVD mortality. The CVD risk grows with increasing age (years), 57.82 ± 6.27 among very high risk and 37.52 ± 4.50; p < 0.001 in very low risk patients. Adjusting for age and analysing CVD risk mortality as a continuous risk score, increasing duration of HIV infection (p = 0.002) and ART (p = 0.007) were significantly associated with increased predicted 10 year CVD mortality risk. However, there was no association between these factors and categorised CVD mortality risk as per recommended scoring thresholds.ConclusionsApproximately 1 in 10 HIV-infected patients is at very high risk of predicted 10-year CVD mortality in our study population. Like uninfected individuals, our study found increased age as a major predictor of 10-year mortality risk and high prevalence of metabolic syndrome. Additional CVD mortality risk due to the duration of HIV infection and ART was seen in our population, further studies in larger and more representative study samples are encouraged. It recommends an urgent need for early planning, prevention and management of metabolic risk factors in HIV populations, at the point of ART initiation.

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Cardiovascular markers of inflammation and serum lipid levels in HIV-infected patients with undetectable viremia

Cited by 14 publications

References 40 publications

Good Fences Make Good Neighbors: Human Immunodeficiency Virus and Vascular Disease

Good Fences Make Good Neighbors: Human Immunodeficiency Virus and Vascular Disease

Circulating CD40 ligand, Dickkopf‐1 and P‐selectin in HIV‐infected patients

Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa

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