Atherosclerosis

2015

DOI: 10.1016/j.atherosclerosis.2015.06.059

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Is the atherosclerotic process accentuated under conditions of HIV infection, antiretroviral therapy, and protease inhibitor exposure? Meta-analysis of the markers of arterial structure and function

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Cardiac Function and Cardiovascular Disease Risk1

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Cited by 36 publications

(37 citation statements)

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“…However, TDF cannot completely normalize elevated TG caused by other ART or HIV infection drugs. Our study revealed that high BMI, high baseline TG and taking PIs were risk factors for hypertriglyceridemia, which is consistent with other research (Sun et al, 2015). Therefore, patients with these factors require close monitoring and further intervention after ART initiation.…”

Section: Discussionsupporting

confidence: 91%

Lipid profile and renal safety of tenofovir disoproxil fumarate-based anti-retroviral therapy in HIV-infected Chinese patients

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et al. 2019

International Journal of Infectious Diseases

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Background: Tenofovir disoproxil fumarate (TDF) is an important component of antiretroviral therapy (ART) that has been widely used. The aim of this study was to observe the long-term impact of TDF-based ART on lipid metabolism profiles and renal functions in Chinese patients. Methods: 414 and 124 HIV-infected, ART-naïve patients who initiated TDF-based regimens and non-TDF regimens respectively were retrospectively included. Demographic characteristics and clinical information of each patient was collected. Changes of lipid profiles and renal function, as well as the risk factors of hyperlipidemia and renal dysfunction were analyzed. Results: After 96 weeks of ART, HIV viral loads were undetectable in 97.34% (403/414) of patients exposed to TDF. The plasma total cholesterol (TCH) increased from 3.97 AE 0.83 mmol/L to 4.53 AE 0.87 mmol/L (P < 0.001), which did not show a significant difference comparing with non-TDF exposed group. By contrast, the plasma triglyceride (TG) levels increased, but were still lower than that in the non-TDF exposed group (0.26 AE 1.24 vs. 0.89 AE 1.78, P < 0.001). The mean estimated glomerular filtration rate (eGFR) decreased from 127.29 AE 24.04mlÁmin À1 Á1.73 m À2 at baseline to 118.84 AE 22.74 mlÁmin À1 Á1.73 m À2 (P < 0.001) in the TDF exposed group, while it increased in the non-TDF exposed group. In the TDF group, high body mass index (BMI) (OR = 1.13, P = 0.01), high baseline TG (OR = 2.33, P<0.001) and receiving protease inhibitors (PIs) (OR = 7.58, P < 0.001) were associated with hypertriglyceridemia after ART, while high baseline TCH predicted hypercholesterolemia (OR = 3.58, P < 0.001). MSM (OR = 0.22, P = 0.02) and baseline eGFR (OR = 0.90, P < 0.001) was associated with renal dysfunction after ART. Conclusions: TDF-based regimens are of good therapeutic effect among Chinese people. These regimens showed a better plasma lipid profile but mild renal dysfunction as compared to non-TDF based regimens. Patients with high BMI, high baseline TG, high baseline TCH and low baseline eGFR should be closely monitored when using TDF-based ART.

“…However, TDF cannot completely normalize elevated TG caused by other ART or HIV infection drugs. Our study revealed that high BMI, high baseline TG and taking PIs were risk factors for hypertriglyceridemia, which is consistent with other research (Sun et al, 2015). Therefore, patients with these factors require close monitoring and further intervention after ART initiation.…”

Section: Discussionsupporting

confidence: 91%

Lipid profile and renal safety of tenofovir disoproxil fumarate-based anti-retroviral therapy in HIV-infected Chinese patients

¹

,

²

,

³

et al. 2019

International Journal of Infectious Diseases

View full text Add to dashboard Cite

Background: Tenofovir disoproxil fumarate (TDF) is an important component of antiretroviral therapy (ART) that has been widely used. The aim of this study was to observe the long-term impact of TDF-based ART on lipid metabolism profiles and renal functions in Chinese patients. Methods: 414 and 124 HIV-infected, ART-naïve patients who initiated TDF-based regimens and non-TDF regimens respectively were retrospectively included. Demographic characteristics and clinical information of each patient was collected. Changes of lipid profiles and renal function, as well as the risk factors of hyperlipidemia and renal dysfunction were analyzed. Results: After 96 weeks of ART, HIV viral loads were undetectable in 97.34% (403/414) of patients exposed to TDF. The plasma total cholesterol (TCH) increased from 3.97 AE 0.83 mmol/L to 4.53 AE 0.87 mmol/L (P < 0.001), which did not show a significant difference comparing with non-TDF exposed group. By contrast, the plasma triglyceride (TG) levels increased, but were still lower than that in the non-TDF exposed group (0.26 AE 1.24 vs. 0.89 AE 1.78, P < 0.001). The mean estimated glomerular filtration rate (eGFR) decreased from 127.29 AE 24.04mlÁmin À1 Á1.73 m À2 at baseline to 118.84 AE 22.74 mlÁmin À1 Á1.73 m À2 (P < 0.001) in the TDF exposed group, while it increased in the non-TDF exposed group. In the TDF group, high body mass index (BMI) (OR = 1.13, P = 0.01), high baseline TG (OR = 2.33, P<0.001) and receiving protease inhibitors (PIs) (OR = 7.58, P < 0.001) were associated with hypertriglyceridemia after ART, while high baseline TCH predicted hypercholesterolemia (OR = 3.58, P < 0.001). MSM (OR = 0.22, P = 0.02) and baseline eGFR (OR = 0.90, P < 0.001) was associated with renal dysfunction after ART. Conclusions: TDF-based regimens are of good therapeutic effect among Chinese people. These regimens showed a better plasma lipid profile but mild renal dysfunction as compared to non-TDF based regimens. Patients with high BMI, high baseline TG, high baseline TCH and low baseline eGFR should be closely monitored when using TDF-based ART.

“…The second result of our meta-analysis, that is aPWV higher in HIV+ on ART than in control subjects, is in line with a previous meta-analysis on the same issue and with several studies showing that highly active antiretroviral therapy may have proatherogenic properties, caused by a derangement of lipid and glucose metabolism [30].…”

Section: Discussionsupporting

confidence: 91%

“…Several studies examined arterial stiffness in HIV+ with inconsistent results . In a previous meta-analysis, studies assessing aortic and peripheral PWV were pooled together [30]. This may be misleading, because aortic and peripheral stiffness have different clinical and prognostic significance [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

“…Within HIV-infected adults, higher PWV appears to be a reliable marker of subclinical vascular disease [41]. There has been only one published study to date investigating PWV in HIV-infected children [42].…”

Section: Cardiac Function and Cardiovascular Disease Riskmentioning

confidence: 99%

Complications of Treatment in Youth with HIV

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et al. 2016

Curr HIV/AIDS Rep

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While combination antiretroviral therapy allows HIV-infected patients to have life expectancies similar to that of the general population, it may also contribute to the development of co-morbidities, such as cardiovascular disease and osteoporosis. Such complications could compromise long-term quality of life, especially in HIV-infected youth whose lifetime cumulative exposure to antiretrovirals is likely to be many decades. Recent studies continue to demonstrate abnormalities associated with antiretroviral therapy, although clinical manifestations are rare in this younger population, especially with modern antiretrovirals. The purpose of this paper is to review the most recent literature on complications of treatment in youth with HIV.

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