Aortic stiffness aging is influenced by past profound immunodeficiency in HIV-infected individuals

Maia-Leite, L.; Catez, Emmanuel; Boyd, Anders; Haddour, Nabila; Curjol, Angélique; Lang, Sylvie; Nuernberg, M.; Duvivier, Claudine; Desvarieux, Moïse; Kirstetter, M.; Girard, Pierre‐Marie; Cohen, Ariel; Boccara, Franck

doi:10.1097/hjh.0000000000000957

Cited by 20 publications

(19 citation statements)

References 39 publications

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“…Although the absolute event rates remain low in the younger HIV infected, 3 the incidence and prevalence of CVD rise with age, 2 since HIV is accompanied by metabolic abnormalities, 4 endothelial dysfunction, 5 increased arterial stiffness, 6 and carotid wall thickness. 7 Furthermore, despite viral suppression by ART, premature CVD may result from a combination of viral injury, low-grade inflammation and abnormalities in immune activation.…”

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confidence: 99%

“…7 Furthermore, despite viral suppression by ART, premature CVD may result from a combination of viral injury, low-grade inflammation and abnormalities in immune activation. 3,8 Vascular alterations may be initiated by the direct effect of the virus on the vasculature, leading to altered endothelial function, inflammation and modification of the aortic smooth muscle cells and the extracellular matrix. 6 Although treatment may reduce endothelial activation, it does not seem to ameliorate the effects of HIV infection, thus endothelial dysfunction may persist and promote atherosclerosis, even among those with low viral loads.…”

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confidence: 99%

“…12 Ridker et al found that HIV infection independently predicts increased PWV, 6 but whether aortic stiffness and vascular aging are influenced by HIV remains a topic of debate. 3 Strategies implemented by health authorities to reduce CVD risk among HIV infected patients include anti-inflammatory medication, ART regimens known for the least adverse metabolic effects and potential immunomodulatory benefits, as well as careful management of traditional cardiovascular risk factors. 2,8 Early identification of subclinical atherosclerosis may therefore provide insight into the risk of developing overt CVD and may be central for both prevention and treatment of CVD development in the HIV infected population.…”

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confidence: 99%

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Early vascular aging in the HIV infected: Is arterial stiffness assessment the ideal tool?

Fourie

Schutte

2017

Virulence

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Early vascular aging in the HIV infected: Is arterial stiffness assessment the ideal tool?

Fourie

Schutte

2017

Virulence

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“…However, in our meta-regression analysis no relationship was observed between the effect size and the proportion of protease inhibitors (PI) used in 15 of the 22 studies included (Supplemental Digital Content, Table S5). On the other hand, in a recent prospective study, age, BP, nadir CD4+ count < 200/mm 3 , but not ART, were related to a worsening of aortic stiffness after 7 years of follow-up [14]. This finding, as well as other cross-sectional reports, suggest that the impact on vascular health of HIV infection severity or dysimmunity may be more important than the metabolic derangements related to ART.…”

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confidence: 57%

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

Mulè¹,

Mulè²,

Tranchida³

et al. 2020

Artery Res

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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.

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“…Individually, each of these “non-traditional” risk factors has been implicated in cardiovascular disease (CVD), 1–13 although with reports of null associations as well. 14–16 As combination antiretroviral therapy has substantially prolonged the life expectancy of HIV-infected persons, it is important to understand the traditional and non-traditional determinants of age-related comorbidities such as CVD.…”

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confidence: 99%

HIV, Cocaine Use, and Hepatitis C Virus

Lucas

Atta

Fine

et al. 2016

ATVB

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Objective We assessed cross-sectional and longitudinal associations of 3 non-traditional cardiovascular disease (CVD) risk factors - human immunodeficiency virus (HIV), cocaine use, and chronic hepatitis C virus (HCV) infection - with 3 validated markers of subclinical CVD: carotid artery plaque, albuminuria, and aortic pulse wave velocity (PWV) in a well-characterized cohort. Approach and Results We measured carotid plaque at baseline and after 24 months, urine albumin-creatinine ratio (ACR) every 6 months, and PWV annually for up to 36 months in a predominantly African-American cohort of 292 participants (100 HIV-negative and 192 HIV-positive). Thirty-nine percent had chronic HCV infection, and 20%, 28%, and 52% were never, past, and current cocaine users, respectively. Sixteen percent, 47%, and 64% of those with none, 1 or 2, or all 3 non-traditional risk factors had ≥2 abnormal CVD risk markers (P=0.001). In fully adjusted models that included all 3 non-traditional risk factors, HIV infection was independently associated with carotid plaque progression (increase in the number of anatomic segments with plaque), albuminuria (ACR >30mg/g), albuminuria progression (doubling of ACR from baseline to a value >30mg/g), and PWV. Cocaine use was associated with an approximately 3-fold higher odds of carotid plaque at baseline and HCV infection was significantly associated with a higher risk of carotid plaque progression. Conclusions These results suggest that HIV infection, cocaine use, and HCV infection are important non-traditional risk factors for CVD and highlight the need to understand the distinct and overlapping mechanisms of the associations.

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Aortic stiffness aging is influenced by past profound immunodeficiency in HIV-infected individuals

Abstract: We observed no difference in aortic stiffness between HIV-infected and controls. Moreover, aortic stiffness aging was independently associated with past severe immunodeficiency, along with other traditional risk factors. Our results call for early antiretroviral initiation.

Cited by 20 publications

References 39 publications

Early vascular aging in the HIV infected: Is arterial stiffness assessment the ideal tool?

Early vascular aging in the HIV infected: Is arterial stiffness assessment the ideal tool?

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

HIV, Cocaine Use, and Hepatitis C Virus

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