Abstract
BackgroundEffective combined antiretroviral therapy (cART) has improved life expectancy among people living with HIV-1 infection. Treated HIV-1infection increases the prevalence of metabolic syndrome (MS). Despite sub-Saharan Africa having among the highest rates of HIV-1 infection, the effects of MS in HIV-1-infected individuals on cardiovascular risk is poorly explored. The aim of the study was to assess whether MS and/or HIV-1 treatment correlates with large elastic artery stiffness in HIV-1-infected patients treated with first-line cART.MethodsThe study sample comprised of 102 subjects free of cardiovascular disease and major risk factors divided into two groups based on HIV-1 infection, treatment, and MS status: HIV-1+/cART+/MS+ (n = 12); HIV-1+/cART−/MS+ (n = 16); HIV-1−/ MS+ (n = 10); HIV-1+/cART+/MS− (n = 42); HIV-1+/cART−/MS− (n = 32); HIV-1−/ MS− (n = 39). MS was established according the International Diabetes Federation definition. Large artery stiffness was measured using applanation tonometry to assess aortic pulse wave velocity (aPWV) and aortic augmentation index at heart rate of 75 bpm (AIx@HR75). cART included lamivudine/zidovudine and nevirapine or efavirenz.ResultsThe prevalence of MS in the HIV-1-infected patients was 28%. There were no significant differences in aPWV in the non-MS groups. However, in subjects with MS, aPWV was significantly higher in the HIV-1 cART patients (9.0 ± 1.9 m/s) compared with both controls (7.5 ± 1.8 m/s; P = 0.018) and untreated HIV-1 patients (7.7 ± 1.3 m/s; P = 0.023), and these differences remained after adjustment for blood pressure and sex. Aortic PWV was significantly elevated (P = 0.009) in HIV-1 cART patients with MS compared to their counterparts without MS. Untreated HIV-1 patients with MS also demonstrated increased aPWV compared to their counterparts without MS (P = 0.05). Aortic AIx@HR75 was, on average, ~ 5% higher in HIV-1 cART patients with MS (28.3 ± 62% compared with untreated HIV-1 patients with MS (23.5 ± 9%; P = 0.075). Sub-group multivariate analysis identified MS as an independent predictor of increased aPWV in HIV-1 cART patients.ConclusionsOur study established that presence of MS in HIV-1 patients on treatment was associated with increased aPWV and hence increased arterial stiffness in sub-Saharan African HIV-1 patients on first-line cART.
Highlights
Effective combined antiretroviral therapy has improved life expectancy among people living with RNA human Immuno-deficiency virus type 1Ribo-nucleic acid (HIV-1) infection
Despite immunological modulation, aging with HIV-1 infection is linked with an increased prevalence of metabolic syndrome (MS), both in the absence and presence of combined antiretroviral therapy (cART), which can accelerate the development of vascular abnormalities, endothelial dysfunction [2] and increased carotid-artery media thickness [3]
We have previously shown that first-line cART with non-nucleoside and nucleoside reverse transcriptase inhibitors and time since HIV-1 diagnosis were independent predictors of increased large elastic artery stiffness in sub-Saharan African HIV-1-infected patients [8], largely free of clustered cardiometabolic risk factors that comprise MS
Summary
Effective combined antiretroviral therapy (cART) has improved life expectancy among people living with HIV-1 infection. Effective use of combined antiretroviral therapy (cART) has improved life expectancy among people living with HIV-1infection [1]. Large elastic artery stiffness, a marker of heightened cardiovascular risk and an independent predictor of adverse vascular events [4], is elevated in HIV-1-infected patients in North America and Europe [5] and appears to be further increased the presence of cART [6, 7]. We have previously shown that first-line cART with non-nucleoside and nucleoside reverse transcriptase inhibitors and time since HIV-1 diagnosis were independent predictors of increased large elastic artery stiffness in sub-Saharan African HIV-1-infected patients [8], largely free of clustered cardiometabolic risk factors that comprise MS. Despite sub-Saharan Africa having the highest rates of HIV-1 infection [10], MS in relation to arterial stiffness in HIV-1-infected patients is poorly explored
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