Risk of myocardial infarction among people living with HIV: an updated systematic review and meta-analysis

Eyawo, Oghenowede; Brockman, Gwenyth; Goldsmith, Charles H.; Hull, Mark; Lear, Scott A.; Bennett, Matthew T.; Guillemi, Silvia; Franco‐Villalobos, Conrado; Adam, Ahmed; Mills, Edward J.; Montaner, Julio S. G.; Hogg, Robert S.

doi:10.1136/bmjopen-2018-025874

Cited by 53 publications

(59 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent meta-analysis of 86 randomized clinical trials (RCTs) including 162,796 participants showed that increasing PUFAs intake reduces plasma TG levels by 15% and slightly decreases the risk of coronary heart disease mortality (relative risk (RR) = 0.90, 95% CI: 0.81, 1.00) and coronary heart disease events (RR = 0.91, 95% CI: 0.85, 0.97) [28]. This is of particular interest in HIV-positive subjects, since the infection is associated with an increased risk of myocardial infarction compared with uninfected individuals (RR = 1.73; 95% CI: 1.44, 2.08), with HAART seeming to be a significant determinant of this risk [29]. Moreover, PUFAs could also have a positive impact on diseases other than cardiovascular ones [30], so our data support their use in HIV-positive patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Omega-3 Polyunsaturated Fatty Acids Treatment on Lipid Pattern of HIV Patients: A Meta-Analysis of Randomized Clinical Trials

et al. 2020

View full text Add to dashboard Cite

Even though omega-3 polyunsaturated fatty acids (PUFAs) seem to be effective in the treatment of human immunodeficiency virus (HIV)-associated dyslipidemia, their impact is still debated. For this reason, our aim was to perform a meta-analysis of the clinical evidence available to date. A systematic literature search was conducted in order to identify published clinical trials assessing the effect of PUFAs treatment on serum lipoproteins, and its safety profile. The effect sizes for lipid changes were expressed as mean difference (MD) and 95% confidence interval (CI). For safety analysis, odd ratios and the 95% CI were calculated with the Mantel–Haenszel method. Data were pooled from nine clinical studies comprising overall 578 HIV-affected subjects. Meta-analysis of the data suggested that omega-3 PUFAs significantly reduced triglycerides (TG) (MD = −1.04, 95% CI: −1.5, −0.58 mmol/L, p < 0.001), while increasing high-density lipoprotein cholesterol (MD = 0.36, 95% CI: 0.12, 0.61 mmol/L, p = 0.004), without affecting serum levels of total cholesterol, very-low- and low-density lipoprotein cholesterol, and apolipoprotein B and A1. Change in TG was significantly associated with eicosapentaenoic acid administered via daily dose. PUFA treatment did not lead to an increased risk of adverse events. In conclusion, PUFAs are safe and exert a significant plasma lipid improving effect in HIV-positive patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of Omega-3 Polyunsaturated Fatty Acids Treatment on Lipid Pattern of HIV Patients: A Meta-Analysis of Randomized Clinical Trials

et al. 2020

View full text Add to dashboard Cite

show abstract

“…ECG examination is a useful screening tool for CVDs, particularly in resource limited settings. This is particularly relevant for HIV patients who are expected to live much longer but with high probability of living with CVDs in the era of combination ART (19). Previous studies revealed that prolonged Q-T interval, a precursor to fatal cardiac arrhythmias, is the most prominent ECG manifestation among HIV patients (20).…”

Section: Discussionmentioning

confidence: 99%

“…results of three separate multivariable logistic regression analyses with adjustment of potential confounders to explore correlates of ST-T segment elevation, sinus tachycardia and any coded ECG abnormality, respectively. ST-T segment elevation was positively associated with higher baseline HIV viral load (≥ 4 log 10 copies/mL), (aOR = 2.08, 95% CI: 1 19. 3.63).…”

mentioning

confidence: 99%

Electrocardiographic abnormalities among people with HIV in Shanghai, China

Shen

Zhu

Ding

et al. 2020

BST

View full text Add to dashboard Cite

Wide access to highly effective combination antiretroviral therapy (ART) has ostensibly changed HIV infection status in many parts of the world from a fatal diagnosis to a chronic condition. However, extended life expectancy comes with long-term noninfectious comorbidities (NICMs), such as cardiovascular disease (CVD) (1). Prior studies have demonstrated that CVD is more common among the HIV-infected population than HIV-uninfected controls (2,3). This increased risk was partly explained by traditional risk factors of CVD such as smoking, diabetes, age, gender, as well as HIV infection itself, such as CD4 cell count and/or viral load, which is known to cause inflammation response by oxidative stress or coagulation disorders (4-6). However, the relative contributions of conventional cardiovascular risk factors, metabolic side effects of ART, and HIV infection itself on CVD risk are difficult to identify, as these factors frequently occur simultaneously (7). Due to its wide availability, low cost and the accumulating evidence that electrocardiographic (ECG) abnormalities are predictive of incident cardiovascular events in the general population (8), the 12-lead electrocardiogram is a very useful non-invasive tool for evaluation of cardiac disorders and risks in clinical settings. Several typical ECG parameters, including resting heart rate and markers of abnormal cardiac depolarization/repolarization, have been previously reported to be associated with increased risk of sudden cardiovascular death (SCD) (9,10). Cardiovascular involvement in HIV/AIDS was recognized as part of the pandemic and a wide spectrum of cardiovascular abnormalities including corrected QT (QTc) prolongation, widened spatial QRS-T angle, ST-segment depressions, T-wave changes, and resting heart rate have been widely reported (11-13). Moreover, the association between age, obesity, alcohol consumption, lower CD4 cell count and LV diastolic dysfunction and ECG abnormalities were documented among HIV-positive patients (14,15).

show abstract

“…Although not fully understood, the probable mechanism involves both chronic in ammation, CD4 cell depletion, endothelial dysfunction and atherosclerosis (22). It is undoubted that the worst lipid pro le (e.g.…”

Section: Discussionmentioning

confidence: 99%

A Comparison Between Different Anti-retroviral Therapy Regimes on Soluble Infammation Markers: a Pilot Study

Maritati

Trentini

Zanotta

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Although HIV-related deaths have decreased dramatically following the introduction of antiretroviral therapy (ART), HIV infection itself causes increased morbidity and mortality for both non-AIDS-related events or chronic inflammation and immune activation. The use of certain antiretroviral drugs can contribute to this process.Methods: We investigated 26 potential biomarkers in serum samples from HIV-1 infected patients virologically suppressed under ART. The main objective of our study was to evaluate if virological suppression achieved with a triple drug regimen containing tenofovir disoproxil fumarate co-formulated with emtricitabine (TDF/FTC) as backbone, could correlate with a better immunological and inflammatory profile in relation to the third class of antiretroviral drug administered. The eligible patients were then divided into 3 groups in relation to the third drug associated with TDF/FTC: nucleoside reverse transcriptase inhibitors (NNRTI) (Group 1, n=16), protease inhibitors (PI) (Group 2, n=17) and integrase inhibitors (INI) (Group 3, n=16).Results: Inflammatory cytokines and chemokines were more represented in Group 2 than in Group 3 (IL-1Ra, p=0.013; IL-12p70 p=0.039; TNF-α p=0.041; IL-8, p=0.027; MIP1 β, p=0.033). Eotaxin showed lower levels in Group 1 compared to Group 2 (p=0.010), while IP-10 was significantly lower in Group 1 compared to both Group 2 and Group 3 (p=0.003 and p=0.007, respectively).Conclusions: our results seem to discourage the administration of PI as a third drug in a virologically effective antiretroviral regimen, as its use is linked to the detection of higher levels of pro-inflammatory mediators in comparison with INI and NNRTI.

show abstract

Risk of myocardial infarction among people living with HIV: an updated systematic review and meta-analysis

Cited by 53 publications

References 80 publications

Effect of Omega-3 Polyunsaturated Fatty Acids Treatment on Lipid Pattern of HIV Patients: A Meta-Analysis of Randomized Clinical Trials

Effect of Omega-3 Polyunsaturated Fatty Acids Treatment on Lipid Pattern of HIV Patients: A Meta-Analysis of Randomized Clinical Trials

Electrocardiographic abnormalities among people with HIV in Shanghai, China

A Comparison Between Different Anti-retroviral Therapy Regimes on Soluble Infammation Markers: a Pilot Study

Contact Info

Product

Resources

About