Viral load of the human immunodeficiency virus could be an independent risk factor for endothelial dysfunction

Blum, Arnon; Hadas, Ron; Burke, Michael; Yust, Israel; Kessler, Ada

doi:10.1002/clc.4960280311

Cited by 73 publications

(55 citation statements)

References 20 publications

(22 reference statements)

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“…Our findings are consistent with recently reported data in HIV infected women showing a significant inverse association between viral load and serum cholesterol levels [24] and with results from another study [25] that showed an association between higher HIV RNA levels and lower HDL cholesterol in antiretroviral-naïve HIV infected inner city men and women and suggested that high viral replication has a direct effect on serum lipid levels. In addition, other investigators [14,26] have proposed a possible etiological link between inflammation caused by viruses and endothelial dysfunction, which may increase cardiovascular risk by eventually producing clinical atherosclerosis. Our findings also contribute to this hypothesis, as CRP, an independent predictor of CHD [27] and a marker of inflammation [28] , was significantly higher in participants with low HDL when compared to those with adequate HDL.…”

Section: Discussionmentioning

confidence: 99%

“…Estimate of 10-year coronary heart disease risk uses an algorithm that includes age, gender, blood pressure, total cholesterol and LDL cholesterol, high fasting glucose and smoking status [12] . While a number of studies have been published to demonstrate metabolic abnormalities and CHD risk in HIV seropositive cohorts [11,[13][14][15][16][17] , to our knowledge no reports focus on cohorts of HIV infected drug users and the contribution of illicit drugs to CHD risk. Moreover, the factors used to estimate CHD risk in the drug abusing population may not be accurate as the drug abuse itself significantly increases the risk [18] .…”

Section: Introductionmentioning

confidence: 99%

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Coronary Heart Disease (CHD) Risk Factors and Metabolic Syndrome in HIV-Positive Drug Users in Miami

Baum

Rafie²,

Lai³

et al. 2006

American J. of Infectious Diseases

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Abstract:The frequency of coronary heart disease (CHD) is increasing among HIV seropositive persons. This phenomenon may be related to HIV disease itself, the use of antiretroviral medications and increased length of survival, or the synergism of these factors. In this study we have calculated the 10-year CHD risk estimate and the prevalence of metabolic syndrome in a cohort of 118 HIV seropositive chronic drug users, including those who are on HAART with or without protease inhibitors (PI). The results showed that the 10-year coronary heart disease risk among the HIV seropositive drug users was 4.8 ± 5.7, which is within the range of results published for other HIV infected cohorts. The 10-year CHD risk was significantly higher in men (5.9±6.1, p<0.001) than in women (1.7±2.4), due to their gender and the pre-menopausal mean age of the women (39.4±7.3 years of age), despite a significantly higher rate of abdominal obesity (54.8% in women vs. 8.1% in men, p<0.001) and lower HDL (61.3% in women vs. 40% in men, p=0.042). The rate of metabolic syndrome among our female HIV seropositive drug users was significantly higher (29% vs 10.3%, p=0.013) compared to men (10.3%). Participants with metabolic syndrome had a significantly higher 10-year CHD risk (27.8% vs. 10.2%, p=0.041) and higher mean BMI (28.6 ± 4.1 vs. 24.2±4, p<0.001) than those without the syndrome. The predominant proportion of the cohort had a high viral load, suggesting that their use of illicit drugs has an influence on either adherence or effectiveness of antiretroviral medication. Increased viral load was significantly associated with metabolic syndrome (OR=2.23, 95% CI:1.12, 4.47; p=0.023), high fasting glucose (OR=1.61, 95% CI: 1.02, 2.55; p=0.042) and low HDL levels (OR=1.41, 95%CI: 1.01, 1.98; p=0.046), after controlling for age gender, smoking, PI exposure, BMI and CD4. HAART with or without PI did not significantly impact the 10-year CHD risk estimate or metabolic syndrome in this cohort. The estimated effect of PI, however, was positively and significantly related to triglyceride levels (effect estimate=95.81; 95% CI:39.40, 152.21; p<0.01) after controlling for age, gender, smoking, viral load, CD4 cell count and BMI. Heavy use of cigarettes and crack/cocaine was inversely associated with obesity (OR=0. 84, 95% CI:0.67, 0.99; p=0.049; OR=0.43, 95% CI:0.19, 0.98; p=0.044, respectively), while use of marijuana tended to be associated with increased central obesity (p=0.08). Heavy cigarette smoking was significantly associated with low HDL (OR=3.06, 95% CI:1.18; 7.95, p=0.02). The significant association of higher viral load with CHD risk indicates that controlling viral load may be important in reducing CHD risk in HIV infected drug users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Coronary Heart Disease (CHD) Risk Factors and Metabolic Syndrome in HIV-Positive Drug Users in Miami

Baum

Rafie²,

Lai³

et al. 2006

American J. of Infectious Diseases

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“…38 We did not identify any HIV-specific risk factors associated with FMD or any associations with ART, although HIV viral load was associated with endothelial dysfunction in several previous studies. 13,40 In a retrospective cohort study, soluble endothelial and platelet activation markers were higher in HIV-infected persons than in uninfected controls; initiation of ART decreased all markers except for P-selectin, while participants remaining ART naïve maintained higher concentrations of all markers. 41 ART-treated participants had lower FMD than both uninfected and ART-naïve participants in another trial, although the difference between ART-treated and ART-naïve subjects was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

High-Fat Meals Do Not Impair Postprandial Endothelial Function in HIV-Infected and Uninfected Men

Volpe

Wanke

Imai

et al. 2014

AIDS Research and Human Retroviruses

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Prior studies have demonstrated impaired endothelium-dependent flow-mediated dilation (FMD) in healthy subjects following a high-fat meal. Compared to uninfected individuals, HIV-infected persons have been shown to have impaired FMD. We examined the effect of two different high-fat meals on endothelial function in HIVinfected and uninfected men. We performed a randomized, parallel group crossover study comparing 47 white men [18 HIV-uninfected, 9 HIV-infected and antiretroviral therapy (ART)-naïve, and 20 HIV-infected men on ART]. Fasting participants consumed one of two randomly assigned high-fat meals of either saturated or polyunsaturated fat, followed at least 24 h later by the other meal. Brachial artery ultrasound measurements to assess vascular reactivity were performed before and 3 h after each dietary challenge.

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“…HIV envelope protein gp-120 has been linked to higher endothelin-1 concentrations [25]. The level of viremia and CD4 count are predictive of CVD [26][27][28]. CD4+ count nadir predicts subclinical carotid atherosclerosis as measured by CIMT.…”

Section: Role Of Inflammation and Viral Factorsmentioning

confidence: 99%

The Spectrum of Atherosclerotic Coronary Artery Disease in HIV Patients

Hakeem

Bhatti

Çilingiroğlu

2010

Curr Atheroscler Rep

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The incidence of HIV is on the rise. With the advent of antiretroviral therapy, the average life expectancy of HIV patients has increased by several decades, but the increasing life expectancy has shifted the spectrum of HIV-associated morbidity and mortality away from opportunistic infections and toward chronic medical conditions. In fact, coronary artery disease has become the leading cause of mortality in patients with HIV. The pathophysiology of atherosclerosis in patients with HIV is very complex, including direct endothelial damage from viremia, a heightened overall state of inflammation from immune activation, higher prevalence and contribution from traditional atherosclerotic risk factors, and direct effects from antiretroviral therapy itself. This review focuses on the patterns, predictors, and pathophysiology of atherosclerotic disease in patients with HIV. In addition, the risks and benefits of evidence-based highly active antiretroviral therapy are critically evaluated.

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Viral load of the human immunodeficiency virus could be an independent risk factor for endothelial dysfunction

Cited by 73 publications

References 20 publications

Coronary Heart Disease (CHD) Risk Factors and Metabolic Syndrome in HIV-Positive Drug Users in Miami

Coronary Heart Disease (CHD) Risk Factors and Metabolic Syndrome in HIV-Positive Drug Users in Miami

High-Fat Meals Do Not Impair Postprandial Endothelial Function in HIV-Infected and Uninfected Men

The Spectrum of Atherosclerotic Coronary Artery Disease in HIV Patients

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