Traditional risk factors and D-dimer predict incident cardiovascular disease events in chronic HIV infection.

Abstract

OBJECTIVE:

Cardiovascular disease (CVD) contributes significantly to HIV-related morbidity and mortality. Chronic immune activation and inflammation are thought to augment the progression of atherosclerotic disease. In this retrospective, case-control study of HIV-infected individuals, we investigated the association of traditional cardiac risk factors, HIV-related disease, and inflammation with CVD events.

METHODS:

HIV-infected individuals who experienced an incident CVD event while enrolled in National Institutes of Health clinical protocols from 1995 to 2009 were matched 2: 1 to HIV-infected individuals without known CVD. Markers of inflammation and cell activation were measured in serum or plasma using ELISA-based assays and peripheral mononuclear cells by four-color flow cytometry.

RESULTS:

Fifty-two patients experienced an incident CVD event. Events were related to smoking, dyslipidemia, hyperglycemia, and family history as well as elevated D-dimer, soluble vascular cell adhesion molecule-1, tissue inhibitor of metalloproteinase-1, and soluble tissue factor, but not high-sensitivity C-reactive protein. No significant differences in antiviral therapy, CD4 T-cell count, or CD38 and human leukocyte antigen-DR expression were identified between patients and controls. In multivariable analysis, smoking, family history, D-dimer, and glucose were independently related to CVD risk.

CONCLUSION:

In this cohort, CVD risk was related to traditional CVD risk factors and markers of thrombosis and endothelial damage, but not to high-sensitivity C-reactive protein or markers of T-cell activation such as CD38/human leukocyte antigen-DR coexpression. D-dimer may help identify HIV-infected patients at elevated CVD risk.

• Authors: Emily S Ford, Jamieson H Greenwald, Aaron G Richterman, Adam Rupert, Lauren Dutcher, Yunden Badralmaa, Ven Natarajan, Catherine Rehm, Colleen Hadigan, Irini Sereti
• Journal: AIDS (London, England) (AIDS) Vol. 24 Issue 10 Pg. 1509-17 (Jun 19 2010) ISSN: 1473-5571 [Electronic] England
• PMID: 20505494 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural)

Chemical References

• Fibrin Fibrinogen Degradation Products
• Vascular Cell Adhesion Molecule-1
• fibrin fragment D

Topics

• Atherosclerosis (etiology, immunology)
• CD4 Lymphocyte Count
• Case-Control Studies
• Chronic Disease
• Disease Progression
• Enzyme-Linked Immunosorbent Assay
• Female
• Fibrin Fibrinogen Degradation Products (immunology)
• HIV Infections (complications, drug therapy, immunology)
• HIV-1 (immunology)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Vascular Cell Adhesion Molecule-1 (immunology)