Effects of HIV Infection on Arterial Endothelial Function: Results From a Large Pooled Cohort Analysis.

Abstract

OBJECTIVE:

To determine the effects of HIV serostatus and disease severity on endothelial function in a large pooled cohort study of people living with HIV infection and HIV- controls. Approach and Results: We used participant-level data from 9 studies: 7 included people living with HIV (2 treatment-naïve) and 4 had HIV- controls. Brachial artery flow-mediated dilation (FMD) was measured using a standardized ultrasound imaging protocol with central reading. After data harmonization, multiple linear regression was used to examine the effects of HIV- serostatus, HIV disease severity measures, and cardiovascular disease risk factors on FMD. Of 2533 participants, 986 were people living with HIV (mean 44.4 [SD 11.8] years old) and 1547 were HIV- controls (42.9 [12.2] years old). The strongest and most consistent associates of FMD were brachial artery diameter, age, sex, and body mass index. The effect of HIV+ serostatus on FMD was strongly influenced by kidney function. In the highest tertile of creatinine (1.0 mg/dL), the effect of HIV+ serostatus was strong (β=-1.59% [95% CI, -2.58% to -0.60%], P=0.002), even after covariate adjustment (β=-1.36% [95% CI, -2.46% to -0.47%], P=0.003). In the lowest tertile (0.8 mg/dL), the effect of HIV+ serostatus was strong (β=-1.90% [95% CI, -2.58% to -1.21%], P<0.001), but disappeared after covariate adjustment. HIV RNA viremia, CD4+ T-cell count, and use of antiretroviral therapy were not meaningfully associated with FMD.

CONCLUSIONS:

The significant effect of HIV+ serostatus on FMD suggests that people living with HIV are at increased cardiovascular disease risk, especially if they have kidney disease.

• Authors: James H Stein, Noah Kime, Claudia E Korcarz, Heather Ribaudo, Judith S Currier, Joseph C Delaney
• Journal: Arteriosclerosis, thrombosis, and vascular biology (Arterioscler Thromb Vasc Biol) Vol. 41 Issue 1 Pg. 512-522 (01 2021) ISSN: 1524-4636 [Electronic] United States
• PMID: 33327750 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• AIDS Serodiagnosis
• AIDS-Associated Nephropathy (complications)
• Adolescent
• Adult
• Aged
• Brachial Artery (diagnostic imaging, physiopathology)
• Cardiovascular Diseases (diagnostic imaging, etiology, physiopathology)
• Case-Control Studies
• Endothelium, Vascular (physiopathology)
• Female
• HIV Infections (complications, diagnosis, virology)
• HIV Seronegativity
• HIV Seropositivity
• Heart Disease Risk Factors
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Risk Assessment
• Severity of Illness Index
• Vasodilation
• Young Adult