Functional and Structural Markers of Atherosclerosis in Human Immunodeficiency Virus-Infected Patients

Wijk, J.P.H. van; Koning, Eelco J.P. de; Cabezas, Manuel Castro; Joven, Jorge; Roodt, Jos Op ‘t; Rabelink, Ton J.; Hoepelman, Andy M.

doi:10.1016/j.jacc.2005.09.073

Cited by 98 publications

(88 citation statements)

References 37 publications

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“…The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) study reported that cumulative protease inhibitor exposure is an independent risk factor for MI [2], but the risk of specific protease inhibitors on MI incidence or surrogate measures of cardiovascular disease risk has not been well characterized. Although the HIV-infected subjects in the present study had considerable cumulative length of time on HAART, the brachial FMD was higher than in other crosssectional studies of HIV-infected persons [10][11][12][13] and similar to that of normal controls; CIMT was also similar in both groups. These findings may be due, in part, to the long-term use of modern, metabolically 'friendly' antiretroviral regimens [30].…”

Section: Discussioncontrasting

confidence: 69%

“…This study was cross-sectional and the number of subjects was low, but still higher compared with several other endothelial function studies in HIV [11][12][13]36]. In addition, several HIV-infected subjects were on statin therapy, which may have a positive effect on brachial FMD and CIMT.…”

Section: Discussionmentioning

confidence: 94%

“…Increased CIMT is a marker of underlying atherosclerosis and correlates well with traditional risk factors; however, endothelial dysfunction as measured by brachial artery FMD may occur earlier in the development of atherosclerosis, independent of other cardiac risk factors [7][8][9]. Several small studies [10][11][12][13] have assessed endothelial dysfunction in HIV-infected persons with varying results, including association with metabolic abnormalities, protease inhibitor use, behavioral factors, or uncontrolled HIV infection. Another study [14] that used CIMT as a surrogate for cardiovascular disease risk in HIV-infected patients on HAART found no significant difference compared with a matched seronegative cohort.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy

Mondy

Fuentes²,

Önen³

et al. 2008

Aids

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Objective-Cardiovascular disease risk among persons with HIV is likely multifactorial, thus testing a variety of available noninvasive vascular ultrasound and other surrogate tests may yield differing results. To address this issue, we assessed multiple metabolic and clinical predictors of endothelial function and carotid intima-media thickness in HIV-infected subjects and compared results with HIV-negative controls.Design-Prospective, cross-sectional study of 50 HIV-infected, healthy adults on stable highly active antiretroviral therapy matched to 50 HIV-negative controls by age, sex, race, and body mass index.Methods-Flow-mediated vasodilation of the brachial artery, carotid intima-media thickness, dual energy X-ray absorptiometry (HIV-infected subjects), and fasting insulin, lipids, and oral glucose tolerance tests were performed. Results were compared between HIV-infected and control groups.Results-Fifty percent of subjects were African-American with 34% women. Among HIVinfected, mean CD4 cell count was 547 cells/ µl; 90% had HIV RNA less than 50 copies/ml. There were no significant differences between HIV-infected and control subjects with regard to brachial artery flow-mediated vasodilation or carotid intima-media thickness. In multivariate analyses of the HIV cohort, independent predictors of endothelial dysfunction (lower flow-mediated vasodilation) were increasing insulin resistance, greater alcohol consumption, and higher baseline brachial artery diameter (P < 0.05); predictors of increased carotid intima-media thickness were hypertension, higher trunk/limb fat ratio, and insulin resistance (P < 0.05).Conclusion-In this HIV cohort on modern highly active antiretroviral therapy with well controlled HIV, there were no significant differences with regard to preclinical markers of cardiovascular disease. Insulin resistance was a strong predictor of impaired brachial artery flowmediated vasodilation and increased carotid intima-media thickness, and may be an important cardiovascular disease risk factor in the HIV population.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy

Mondy

Fuentes²,

Önen³

et al. 2008

Aids

View full text Add to dashboard Cite

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“…Using femoral PWV, previous studies showed increased aortic (central) stiffness in treated39 and untreated9 HIV-infected individuals. In our study, the peripheral cr-PWV did not differ between the HIV-infected participants and their age-, gender-, BMI- and locality-matched controls.…”

Section: Discussionmentioning

confidence: 99%

Is HIV-1 infection associated with endothelial dysfunction in a population of African ancestry in South Africa?

Fourie¹,

Rooyen²,

Pieters³

et al. 2011

CardioVascular Journal of Africa

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The chronic infection status suffered by HIV-infected individuals promotes chronic arterial inflammation and injury, which leads to dysfunction of the endothelium, atherosclerosis and thrombosis. Although HIV-1 subtype C is prevalent in South Africa and accounts for almost a third of the infections worldwide, this subtype differs genetically from HIV-1 subtype B on which the majority of studies have been done. The objective of this study was to assess whether newly identified, never-treated, HIV-1-infected South African participants showed signs of endothelial dysfunction, accelerated atherosclerosis and increased blood coagulation.We compared 300 newly diagnosed (never antiretroviral-treated) HIV-infected participants to 300 age-, gender-, body mass index- and locality-matched uninfected controls. Levels of high-density lipoprotein cholesterol (HDL-C), triglycerides, interleukin-6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), fibrinogen and plasminogen activator inhibitor-1 (PAI-1), and carotid radialis pulse wave velocity (cr-PWV) were determined. The HIV-infected participants showed lower HDL-C and higher IL-6, CRP, ICAM-1 and VCAM-1 levels compared to the uninfected controls. No differences in fibrinogen and PAI-1 levels were detected. A continuous positive trend of increasing age with cr-PWV was detected in the HIV-infected group.Our findings suggest inflammatory injury of the endothelium, pointing to endothelial dysfunction of never-treated HIV-1-infected South Africans of African ancestry. Although no indication of a prothrombotic state could be detected, there was an indication of accelerated vascular aging and probable early atherosclerosis in the older HIV-infected participants.

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“…Embora haja evidências de que os pacientes com HIV apresentem maior risco de infarto do miocárdio do que a população geral (15), não há dados sobre a associação de SM com o risco cardiovascular nesses pacientes. Um estudo mostrou que a espessura íntima-média da carótida, um marcador intermediário de risco cardiovascular, estava aumentada em pacientes infectados por HIV com SM, de maneira similar à observada em diabéticos não-infectados (33). Entretanto, estudos prospectivos ainda são necessários para esclarecer o impacto da SM sobre os desfechos clíni-cos (eventos cardiovasculares e morte) nessa população.…”

Section: Diehl Et Alunclassified

Prevalência da lipodistrofia associada ao HIV em pacientes ambulatoriais brasileiros: relação com síndrome metabólica e fatores de risco cardiovascular

Diehl¹,

Dias²,

Paes³

et al. 2008

Arq Bras Endocrinol Metab

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RESUMOA lipodistrofia associada ao HIV (LAHIV) acomete 40% a 50% dos pacientes infectados pelo vírus, mas sua prevalência no Brasil é desconhecida. O objetivo deste trabalho foi avaliar a prevalência de LAHIV entre adultos brasileiros infectados, bem como sua relação com fatores de risco cardiovascular e sín-drome metabólica (SM). Foram avaliados 180 pacientes maiores de 18 anos, infectados por HIV, atendidos no Ambulatório de Infectologia da Universidade Estadual de Londrina. Por meio de entrevista e revisão de prontuário, foram avaliados dados antropométricos, pressão arterial, antecedentes mór-bidos pessoais e familiares, duração da infecção por HIV e da aids, drogas anti-retrovirais utilizadas, CD4+, carga viral, glicemia e perfil lipídico. A LAHIV foi definida como a presença de alterações corporais percebidas pelo próprio paciente e confirmadas ao exame clínico. A SM foi diagnosticada usando os critérios do Adult Treatment Panel III (NCEP-ATPIII), revistos e atualizados pela American Heart Association (AHA/NHLBI). A prevalência observada de LAHIV foi de 55%. Os pacientes com LAHIV apresentaram maior duração da infecção por HIV, da aids e do uso de anti-retrovirais. Na análise multivariada, estiveram independentemente associados ao risco de LAHIV: sexo feminino (p = 0,006) e duração da aids 8 anos (p < 0,001). Quanto aos critérios para SM, hipertensão foi detectada em 32%, baixo HDL-colesterol em 68%, hipertrigliceridemia em 55%, cintura aumentada em 17% e glicemia aumentada e/ou diabetes em 23% dos indivíduos. A cintura aumentada e a hipertrigliceridemia foram mais comuns em portadores de LAHIV. A SM foi identificada em 36% dos pacientes. Na análise multivariada, estiveram associados à SM: IMC 25 kg/m 2 (p < 0,001), história familiar de obesidade (p = 0,01), uso de indinavir (p = 0,001) e idade 40 anos no diagnóstico do HIV (p = 0,002). A LAHIV apresentou tendência a ser mais comum em portadores de SM (65% versus 50%, p = 0,051). A prevalência de LAHIV que se observou neste grupo (55%) foi similar à descrita em estudos prévios de outros países. A prevalência de SM nestes pacientes parece ser diferente da descrita em adultos brasileiros não-infectados pelo HIV. (Arq Bras Endocrinol Metab 2008; 52/4:658-667) Descritores: Síndrome da lipodistrofia associada ao HIV; Síndrome X metabólica; Infecções por HIV; Prevalência; Brasil.

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Functional and Structural Markers of Atherosclerosis in Human Immunodeficiency Virus-Infected Patients

Cited by 98 publications

References 37 publications

Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy

Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy

Is HIV-1 infection associated with endothelial dysfunction in a population of African ancestry in South Africa?

Prevalência da lipodistrofia associada ao HIV em pacientes ambulatoriais brasileiros: relação com síndrome metabólica e fatores de risco cardiovascular

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