Lipodystrophy and anti-retroviral therapy as predictors of sub-clinical atherosclerosis in human immunodeficiency virus infected subjects

Guaraldi, Giovanni; Stentarelli, Chiara; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Lattanzi, A; Zaccherini, Giacomo; Rossi, Rosario; Modena, Maria Grazia; Alexopoulos, Nikolaos; Palella, Frank J.; Raggi, Paolo

doi:10.1016/j.atherosclerosis.2009.06.011

Cited by 63 publications

(39 citation statements)

References 35 publications

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“…VAT is an excellent objective measure of abdominal adiposity and it is associated with cardiovascular disease. Furthermore, VAT is increased in HIV patients affected by dystrophic fat accumulations known as lipodystrophy syndromes [16]. Besides traditional risk factors, however, we also found that a high CD4?…”

Section: Discussionmentioning

confidence: 94%

Progression of coronary artery calcium in men affected by human immunodeficiency virus infection

Guaraldi

Zona

Orlando

et al. 2011

Int J Cardiovasc Imaging

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Cardiovascular risk is increased in HIV infected patients. We assessed progression of coronary artery calcium (CAC) in patients with HIV infection to identify factors that may help explain progression of atherosclerosis. Prospective, observational study of 132 HIV-infected men receiving chronic antiretroviral therapy (ART); we measured traditional atherosclerosis risk factors and assessed progression of CAC on sequential 64-slice CT scans at an average interval of 11 months (range 6-36). CAC score progression was defined as absolute and percentage change from baseline. During follow-up 45 patients (34%) showed absolute progression of CAC and 34 of them showed >15% yearly progression, a threshold previously associated with a high risk of myocardial infarction. Age, LDL cholesterol, visceral abdominal fat and current T-helper (CD4+) cell count were significantly associated with absolute CAC progression. Progression of subclinical atherosclerosis in HIV patients is associated with traditional coronary risk factors as well as HIV related factors such as the CD4+ cell count. Therefore, immunologic perturbations secondary to HIV infection may contribute to atherosclerosis progression.

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Section: Discussionmentioning

confidence: 94%

Progression of coronary artery calcium in men affected by human immunodeficiency virus infection

Guaraldi

Zona

Orlando

et al. 2011

Int J Cardiovasc Imaging

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“…1 However, drugs used in cART have been associated with manifestations of metabolic syndrome, 22,23 and there have been concerns regarding acceleration of atherosclerotic disease in HIV-infected patients. Patients with metabolic syndrome may have increased oxidative stress affecting their cardiovascular systems.…”

Section: Discussionmentioning

confidence: 99%

Plasma Klotho Levels Were Inversely Associated with Subclinical Carotid Atherosclerosis in HIV-Infected Patients Receiving Combined Antiretroviral Therapy

Jeong

Song

Kim

et al. 2013

AIDS Research and Human Retroviruses

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Combined antiretroviral therapy (cART) has significantly improved the survival rate in HIV-infected individuals, but it contributes to the development of various metabolic complications. Klotho is a novel antiaging gene that encodes a protein with pleiotropic functions, including an emerging role in cardiovascular disease (CVD). The protective effect of higher plasma klotho levels against CVD was recently observed in non-HIV-infected adults. We aimed to assess whether plasma-secreted α-klotho is associated with subclinical carotid atherosclerosis in HIV-infected patients receiving cART. We prospectively examined the association of circulating plasma α-klotho in 120 HIV-infected patients who had received cART for ≥6 months with intima-media thickness (IMT) in the carotid artery and other metabolic variables. The subclinical carotid atherosclerosis was defined as an increased mean IMT level of ≥75th percentile for the matched age, sex, and race and/or the presence of carotid plaque. Thirty-four (28.3%) of 120 had subclinical carotid atherosclerosis. The higher plasma levels of α-klotho had protective effect against subclinical carotid atherosclerosis (OR 0.006, p=0.034) in multivariate regression analysis. Plasma α-klotho levels had a significantly negative correlation with fasting glucose levels (r=-0.216, p=0.018) and mean IMT (r=-0.258, p=0.004) in multiple stepwise regression analyses. The optimal cutoff values of plasma α-klotho levels for the greatest sensitivity and specificity were calculated as 2.83 log10 [pg/ml] (sensitivity, 48.7%; specificity, 90.5%). These results show that plasma klotho levels were inversely associated with subclinical carotid atherosclerosis in HIV-infected patients receiving cART.

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“…Studies using this technique to identify early atherosclerosis in HIV-infected patients have revealed a higher burden of calcified coronary plaques than would be expected for their age when compared with the general population [102][103][104]. However, studies comparing CACS and other noninvasive methods suggest that the amount of coronary calcium may not fully reflect the total level of atherosclerotic disease.…”

Section: Coronary Artery Calcium Scoringmentioning

confidence: 94%

Cardiovascular Disease in Patients with HIV

et al. 2012

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The introduction of combination antiretroviral therapy (cART) has substantially decreased mortality among the HIV-infected population. In this setting, cardiovascular disease (CVD) has become a leading cause of morbidity and mortality. Compared with the general population, higher rates of myocardial infarction as well as a high prevalence of subclinical coronary atherosclerosis have been found in the HIV-infected population. It has been suggested that in HIV-infected patients, the atherosclerotic burden is not based solely on traditional cardiovascular risk factors. The interplay of other mechanisms such as chronic inflammation, effects of cART or immune activation after initiation of cART may predispose to accelerated and increased risk of CVD. Effective treatment are available today to reduce CVD in at-risk patients, and therefore early detection of subclinical coronary atherosclerosis is important. However, the mechanisms behind the development of CVD in HIV-infected patients may limit the usefulness of the traditional noninvasive screening tools for CVD used in the general population. This review will focus on the different plausible mechanisms behind the increased risk of CVD and the noninvasive methods by which atherosclerosis may be assessed in the HIV-infected population.

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Lipodystrophy and anti-retroviral therapy as predictors of sub-clinical atherosclerosis in human immunodeficiency virus infected subjects

Cited by 63 publications

References 35 publications

Progression of coronary artery calcium in men affected by human immunodeficiency virus infection

Progression of coronary artery calcium in men affected by human immunodeficiency virus infection

Plasma Klotho Levels Were Inversely Associated with Subclinical Carotid Atherosclerosis in HIV-Infected Patients Receiving Combined Antiretroviral Therapy

Cardiovascular Disease in Patients with HIV

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