Abstract
BackgroundAntiretroviral therapy (ART) has increased life expectancy and consequently the risk of cardiovascular disease (CVD) in adults living with HIV. We investigated the levels and predictors of arterial stiffness in young people (YP) living with perinatal HIV (PHIV) and HIV negative YP in the Adolescents and Adults Living with Perinatal HIV (AALPHI) study.MethodsAALPHI was a prospective study evaluating the impact of HIV infection and exposure to ART on YP living with PHIV (aged 13–21 years) who had known their HIV status for at least 6 months, and HIV negative YP (aged 13–23 years) who either had a sibling, friend or parent living with HIV. Participants were enrolled from HIV clinics and community services in England. Two hundred and thirteen PHIV and 65 HIV negative YP (42% siblings of PHIV) had pulse wave velocity (PWV) measurements taken (Vicorder software) from the supra-sternal notch to the middle of the thigh cuff, at their second interview in the study between 2015 and 2017. Average PWV was calculated from the three closest readings (≥3 and ≤ 12 m/s) within 0.6 m/s of each other. Linear regression examined predictors of higher (worse) PWV, including age, sex, HIV status and height as a priori, ethnicity, born outside UK/Ireland, alcohol/nicotine/drug use, weight, waist-to-hip-ratio, mean arterial pressure (MAP), caffeine 2 h before PWV and nicotine on day of PWV. A separate PHIV model included CD4, viral load, years taking ART and ART regimen.FindingsOne hundred and twenty eight (60%) PHIV and 45 (69%) HIV negative YP were female (p = 0.18), with median (IQR) age 18 (16, 20) and 18 (16, 21) years (p = 0.48) respectively. Most PHIV were taking a combination of three ART drugs from two classes. There was a trend toward higher (worse) mean PWV in the PHIV group than the HIV negative group [unvariable analysis 6.15 (SD 0.83) m/s vs. 5.93 (0.70) m/s, respectively, unadjusted p = 0.058], which was statistically significant in the multivariable analysis [adjusted p (ap) = 0.020]. In multivariable analysis being male (ap = 0.002), older age (ap < 0.001), higher MAP (ap < 0.001) and nicotine use on day of measurement (ap = 0.001) were also predictors of higher PWV. The predictors were the same in the PHIV model.InterpretationBy late adolescence PHIV had worse PWV in comparison to HIV negative peers, and traditional risk factors for CVD (higher arterial pressure, being male and older age) were associated with higher PWV values. Regular detailed monitoring of cardiovascular risk factors should become standard of care for every young person with PHIV worldwide.
Highlights
Combination antiretroviral therapy has turned human immunodeficiency virus (HIV) into a manageable chronic condition for the 38 million people living with HIV today, of whom about 1.7 million (5%) are young people aged 10–19 years [1, 2].an increased life expectancy has increased the incidence of non-communicable conditions
The underlying mechanisms are based on an interplay of an increased prevalence of traditional or conventional cardiovascular risk factors, adverse side effects of antiretroviral therapy (ART), “emerging” risk factors based on chronic inflammation and infection, as well as a changed immunology due to the HIV infection itself, that lead to a proinflammatory state promoting endothelial dysfunction and atherosclerotic changes to the vasculature [4]
This paper explores the levels and predictors of arterial stiffness in young people living with perinatal HIV (PHIV) and HIV negative young people, in the largest study measuring arterial stiffness in PHIV to date
Summary
Combination antiretroviral therapy has turned human immunodeficiency virus (HIV) into a manageable chronic condition for the 38 million people living with HIV today, of whom about 1.7 million (5%) are young people aged 10–19 years [1, 2].an increased life expectancy has increased the incidence of non-communicable conditions. Studies in adults living with HIV have shown an increased risk of cardiovascular disease (CVD) [3]. The underlying mechanisms are based on an interplay of an increased prevalence of traditional or conventional cardiovascular risk factors, adverse side effects of antiretroviral therapy (ART), “emerging” risk factors based on chronic inflammation and infection, as well as a changed immunology due to the HIV infection itself, that lead to a proinflammatory state promoting endothelial dysfunction and atherosclerotic changes to the vasculature [4]. While children and adolescents might not have signs of symptomatic atherosclerosis yet, precursors of atherosclerosis such as endothelial dysfunction as well as changes of the vascular wall and arterial stiffness have been shown as early as the first decade of life [5]. Antiretroviral therapy (ART) has increased life expectancy and the risk of cardiovascular disease (CVD) in adults living with HIV. We investigated the levels and predictors of arterial stiffness in young people (YP) living with perinatal HIV (PHIV) and HIV negative YP in the Adolescents and Adults Living with Perinatal HIV (AALPHI) study
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