HIV positivity, protease inhibitor exposure and subclinical atherosclerosis: a systematic review and meta-analysis of observational studies

Hulten, Edward; Mitchell, Joshua D.; Scally, John P.; Gibbs, Barnett T.; Villines, Todd C.

doi:10.1136/hrt.2009.177774

Cited by 108 publications

(108 citation statements)

References 59 publications

(137 reference statements)

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“…In addition, a recent published meta-analysis including 14 RCTs conducted in non-HIV smokers showed varenicline was associated with an elevated odds ratio of 1.72 (95% CI: 1.09-2.71) for any ischemic or arrhythmic cardiovascular event. 35 Given the existing concerns of ART-related cardiovascular events, 6,36,37 precautions and close monitor of serious cardiovascular AEs are needed in HIV-infected smokers using varenicline. (23) 69 ( FTND scores of 0-2 indicate very low nicotine dependence; 3-4, low; 5, medium; 6-7, high; and 8-10 very high.…”

Section: Discussionmentioning

confidence: 99%

Safety and Tolerability of Varenicline Tartrate (Champix^®/Chantix^®) for Smoking Cessation in HIV-Infected Subjects: A Pilot Open-Label Study

Cui

Robinson

Elston

et al. 2012

AIDS Patient Care and STDs

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Section: Discussionmentioning

confidence: 99%

Safety and Tolerability of Varenicline Tartrate (Champix^®/Chantix^®) for Smoking Cessation in HIV-Infected Subjects: A Pilot Open-Label Study

Cui

Robinson

Elston

et al. 2012

AIDS Patient Care and STDs

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“…[5][6][7][8][9] Cardiovascular magnetic resonance (CMR) imaging allows a comprehensive assessment of myocardial structure, function, and tissue characterization. We have previously reported, in a cohort of asymptomatic treated patients with HIV, findings of increased cardiac steatosis and myocardial regional fibrosis although these findings did not fully explain the extent of myocardial dysfunction.…”

Section: Ntusi Et Al Hiv-1-associated Cardiovascular Diseasementioning

confidence: 99%

HIV-1–Related Cardiovascular Disease Is Associated With Chronic Inflammation, Frequent Pericardial Effusions, and Probable Myocardial Edema

Ntusi

O'Dwyer

Dorrell

et al. 2016

Circ: Cardiovascular Imaging

101

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Background— Patients with treated HIV infection have clear survival benefits although with increased cardiac morbidity and mortality. Mechanisms of heart disease may be partly related to untreated chronic inflammation. Cardiovascular magnetic resonance imaging allows a comprehensive assessment of myocardial structure, function, and tissue characterization. We investigated, using cardiovascular magnetic resonance, subclinical inflammation and myocardial disease in asymptomatic HIV-infected individuals. Methods and Results— Myocardial structure and function were assessed using cardiovascular magnetic resonance at 1.5-T in treated HIV-infected individuals without known cardiovascular disease (n=103; mean age, 45±10 years) compared with healthy controls (n=92; mean age, 44±10 years). Assessments included left ventricular volumes, ejection fraction, strain, regional systolic, diastolic function, native T1 mapping, edema, and gadolinium enhancement. Compared with controls, subjects with HIV infection had 6% lower left ventricular ejection fraction ( P <0.001), 7% higher myocardial mass ( P =0.02), 29% lower peak diastolic strain rate ( P <0.001), 4% higher short-tau inversion recovery values ( P =0.02), and higher native T1 values (969 versus 956 ms in controls; P =0.01). Pericardial effusions and myocardial fibrosis were 3 and 4× more common, respectively, in subjects with HIV infection (both P <0.001). Conclusions— Treated HIV infection is associated with changes in myocardial structure and function in addition to higher rates of subclinical myocardial edema and fibrosis and frequent pericardial effusions. Chronic systemic inflammation in HIV, which involves the myocardium and pericardium, may explain the high rate of myocardial fibrosis and increased cardiac dysfunction in people living with HIV.

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“…Combination antiretroviral therapy (cART) has had a profound impact on HIVrelated morbidity and mortality, although long-term treatment is associated with metabolic sequelae and cardiovascular disease. 2,3 Although it is widely accepted that traditional risk factors play a major role in HIV-related cardiovascular disease, 4 the extent to which metabolic complications of therapy pose additional risk in the contemporary cART-treated patient remains controversial. Furthermore, myocardial disease was reported widely in the pre-cART era, in which a high incidence of cardiomyopathy with cardiac systolic and diastolic dysfunction was found, but comprehensive analysis of a contemporary cohort of patients receiving effective therapy is lacking.…”

mentioning

confidence: 99%

Comprehensive Cardiac Magnetic Resonance Imaging and Spectroscopy Reveal a High Burden of Myocardial Disease in HIV Patients

et al. 2013

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Background— HIV infection continues to be endemic worldwide. Although treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional, or biochemical cardiac abnormalities that may underlie their increased cardiac morbidity and mortality. The purpose of this study was to characterize myocardial abnormalities in a contemporary group of HIV-infected individuals undergoing combination antiretroviral therapy. Methods and Results— Volunteers with HIV who were undergoing combination antiretroviral therapy and age-matched control subjects without a history of cardiovascular disease underwent cardiac magnetic resonance imaging and spectroscopy for the determination of cardiac function, myocardial fibrosis, and myocardial lipid content. A total of 129 participants were included in this analysis. Compared with age-matched control subjects (n=39; 30.23%), HIV-infected subjects undergoing combination antiretroviral therapy (n=90; 69.77%) had 47% higher median myocardial lipid levels ( P <0.003) and 74% higher median plasma triglyceride levels (both P <0.001). Myocardial fibrosis, predominantly in the basal inferolateral wall of the left ventricle, was observed in 76% of HIV-infected subjects compared with 13% of control subjects ( P <0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals than in control subjects and remained statistically significant after adjustment for available confounders. Conclusions— Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function, and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects undergoing combination antiretroviral therapy. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.

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HIV positivity, protease inhibitor exposure and subclinical atherosclerosis: a systematic review and meta-analysis of observational studies

Abstract: HIV infection and PI exposure are not strong independent risk factors for subclinical atherosclerosis. Confounding may contribute to overestimation of the risk associated with HIV and PI exposure.

Cited by 108 publications

References 59 publications

Safety and Tolerability of Varenicline Tartrate (Champix^®/Chantix^®) for Smoking Cessation in HIV-Infected Subjects: A Pilot Open-Label Study

Safety and Tolerability of Varenicline Tartrate (Champix^®/Chantix^®) for Smoking Cessation in HIV-Infected Subjects: A Pilot Open-Label Study

HIV-1–Related Cardiovascular Disease Is Associated With Chronic Inflammation, Frequent Pericardial Effusions, and Probable Myocardial Edema

Comprehensive Cardiac Magnetic Resonance Imaging and Spectroscopy Reveal a High Burden of Myocardial Disease in HIV Patients

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HIV positivity, protease inhibitor exposure and subclinical atherosclerosis: a systematic review and meta-analysis of observational studies

Abstract: HIV infection and PI exposure are not strong independent risk factors for subclinical atherosclerosis. Confounding may contribute to overestimation of the risk associated with HIV and PI exposure.

Cited by 108 publications

References 59 publications

Safety and Tolerability of Varenicline Tartrate (Champix®/Chantix®) for Smoking Cessation in HIV-Infected Subjects: A Pilot Open-Label Study

Safety and Tolerability of Varenicline Tartrate (Champix®/Chantix®) for Smoking Cessation in HIV-Infected Subjects: A Pilot Open-Label Study

HIV-1–Related Cardiovascular Disease Is Associated With Chronic Inflammation, Frequent Pericardial Effusions, and Probable Myocardial Edema

Comprehensive Cardiac Magnetic Resonance Imaging and Spectroscopy Reveal a High Burden of Myocardial Disease in HIV Patients

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Safety and Tolerability of Varenicline Tartrate (Champix^®/Chantix^®) for Smoking Cessation in HIV-Infected Subjects: A Pilot Open-Label Study

Safety and Tolerability of Varenicline Tartrate (Champix^®/Chantix^®) for Smoking Cessation in HIV-Infected Subjects: A Pilot Open-Label Study