Association of increased CD8 + and persisting C-reactive protein levels with restenosis in HIV patients after coronary stenting

Schneider, Simon; Spinner, Christoph D.; Cassese, Salvatore; Promny, Dominik; Hapfelmeier, Alexander; Byrne, Robert A.; Baumann, Marcus; Jäger, H.; Steinlechner, Eva; Laugwitz, Karl‐Ludwig; Kastrati, Adnan

doi:10.1097/qad.0000000000001063

Cited by 14 publications

(12 citation statements)

References 33 publications

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“…In a study of HIV-infected patients undergoing percutaneous coronary intervention (PCI), CD8 T-cell level and persistent C-reactive protein (CRP) elevation at 6-months were significantly associated with angiographic restenosis. 75 …”

Section: Risk Factors For Ischemic Heart Disease In Hivmentioning

confidence: 99%

Epidemiology of ischemic heart disease in HIV

Triant

Grinspoon

2017

Current Opinion in HIV and AIDS

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Purpose of review The purpose of this review is to summarize and synthesize recent data on the risk of ischemic heart disease (IHD) in HIV-infected individuals. Recent findings Recent studies in the field demonstrate an increasing impact of cardiovascular disease (CVD) on morbidity and mortality in HIV relative to AIDS-related diagnoses. Studies continue to support an approximately 1.5 to 2-fold increased risk of IHD conferred by HIV, with specific risk varying by gender and virologic/immunologic status. Risk factors include both traditional CVD risk factors and novel, HIV-specific factors including inflammation and immune activation. Specific antiretroviral therapy (ART) drugs may increase CVD risk, yet the net effect of ART with viral suppression is beneficial with regards to CVD risk. Management of cardiovascular risk and prevention of CVD is complex, because current general population strategies target traditional CVD risk factors only. Extensive investigation is being directed at developing tailored CVD risk prediction algorithms and interventions to reduce CVD risk to HIV. Summary Increased IHD risk is a significant clinical and public health challenge in HIV. The development and application of HIV-specific interventions to manage CVD risk factors and reduce CVD risk will improve the long-term health of this aging population.

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Section: Risk Factors For Ischemic Heart Disease In Hivmentioning

confidence: 99%

Epidemiology of ischemic heart disease in HIV

Triant

Grinspoon

2017

Current Opinion in HIV and AIDS

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“…This in turn likely contributes to excess burden of other microbes (eg, cytomegalovirus, microbial translocation) and perhaps excess risk of malignancy . Persistent elevations in CD8+ T‐cell count during ART (often measured as a low CD4/CD8 ratio) are associated with chronic inflammation and have been consistent predictors of cardiovascular complications, non‐AIDS morbidity, and overall mortality . Expansion of CD8+ T cells are associated with T‐cell activation, senescence, and altered CD4/CD8 ratio in the gut mucosa .…”

Section: Discussionmentioning

confidence: 99%

“…48 Persistent elevations in CD8+ T-cell count during ART (often measured as a low CD4/CD8 ratio) are associated with chronic inflammation and have been consistent predictors of cardiovascular complications, non-AIDS morbidity, and overall mortality. 40,[49][50][51][52] Expansion of CD8+ T cells are associated with T-cell activation, senescence, and altered CD4/CD8 ratio in the gut mucosa. 40 Given these results, PD-1 inhibitors could be potential therapeutic targets for treatment of cardiovascular disease in chronic HIV infection.…”

Section: Discussionmentioning

confidence: 99%

Role of T‐Cell Dysfunction, Inflammation, and Coagulation in Microvascular Disease in HIV

Sinha

Scherzer

et al. 2016

JAHA

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BackgroundCompared to uninfected adults, HIV‐infected adults on antiretroviral therapy are at increased risk of cardiovascular disease. Given the increase in T‐cell dysfunction, inflammation, and coagulation in HIV infection, microvascular dysfunction is thought to contribute to this excess cardiovascular risk. However, the relationships between these variables remain undefined.Methods and ResultsThis was a cross‐sectional study of 358 HIV‐infected adults from the SCOPE cohort. Macrovascular endothelial function was assessed using flow‐mediated dilation of the brachial artery and microvascular function by reactive hyperemia. T‐cell phenotype was determined by flow cytometry. Plasma markers of inflammation (tumor necrosis factor‐α, interleukin‐6, high‐sensitivity C‐reactive protein, sCD14) and coagulation (fibrinogen, D‐dimer) were also measured. In all HIV+ subjects, markers of inflammation (tumor necrosis factor‐α, high‐sensitivity C‐reactive protein), coagulation (D‐dimer) and T‐cell activation (CD8+PD1+, CD4+interferon+cytomegalovirus‐specific) were associated with worse reactive hyperemia after adjusting for traditional cardiovascular risk factors and co‐infections. In treated and suppressed subjects, tumor necrosis factor‐α and CD8+PD1+ cells remained associated with worse reactive hyperemia after adjustment. Compared to the untreated subjects, CD8+PD1+ cells were increased in the virally suppressed group. Reactive hyperemia was predictive of flow‐mediated dilation.Conclusions CD8+PD1+ cells and tumor necrosis factor‐α were associated with microvascular dysfunction in all HIV+ subjects and the treated and suppressed group. Additionally, D‐dimer, high‐sensitivity C‐reactive protein, sCD‐14, and interleukin‐6 were associated with microvascular dysfunction in all HIV+ subjects. Although T‐cell dysfunction, inflammation, and microvascular dysfunction are thought to play a role in cardiovascular disease in HIV, this study is the first to look at which T‐cell and inflammatory markers are associated with microvascular dysfunction in HIV‐infected individuals.

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“…In this regard, a higher relative risk of developing cardiovascular events among HIV‐infected populations relative to HIV‐negative populations has been reported by several authors . Moreover, cardiovascular disease currently represents one of the main causes of morbidity and mortality in HIV‐infected patients .…”

Section: Nomenclature Of Targets and Ligandsmentioning

confidence: 99%

“…Several factors may contribute to the higher recurrence of coronary events in the HIV population. Among others, these include HIV RNA load, CD4+ T cell count, C‐reactive protein levels or the prothrombotic status that has been described in this population . Additionally, drug interactions between antiretroviral and antiplatelet treatments may also have a potential role in the worse prognosis of coronary disease observed in HIV‐infected patients.…”

Section: Nomenclature Of Targets and Ligandsmentioning

confidence: 99%

Recurrent coronary disease in HIV‐infected patients: role of drug–drug interactions

Bravo

Álvarez

Mariño

et al. 2018

Brit J Clinical Pharma

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Cardiovascular disease represents a leading comorbidity in HIV populations. Different factors may contribute to the recurrence of cardiovascular events in HIV‐infected patients. Here, we describe two patients with HIV infection and an acute coronary syndrome who developed in‐stent thrombosis after a percutaneous revascularization procedure. Also, we discuss the potential role of drug interactions between antiretroviral and antiplatelet treatments as a contributing factor for recurrent coronary disease in HIV‐infected patients.

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Association of increased CD8 + and persisting C-reactive protein levels with restenosis in HIV patients after coronary stenting

Abstract: Inflammation, represented by CD8 T-cell levels, and persistent C-reactive protein elevation are independent predictors of angiographic restenosis and should therefore be closely monitored in HIV patients undergoing PCI.

Cited by 14 publications

References 33 publications

Epidemiology of ischemic heart disease in HIV

Epidemiology of ischemic heart disease in HIV

Role of T‐Cell Dysfunction, Inflammation, and Coagulation in Microvascular Disease in HIV

Recurrent coronary disease in HIV‐infected patients: role of drug–drug interactions

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