Is the atherosclerotic process accentuated under conditions of HIV infection, antiretroviral therapy, and protease inhibitor exposure? Meta-analysis of the markers of arterial structure and function.

Abstract

To evaluate the apparent association of human immunodeficiency virus (HIV) infection, antiretroviral therapy (ART), and protease inhibitor (PI) exposure with the functional and structural markers of vasculature. A meta-analysis of the relationship between HIV infection, ART, and PI exposure and the functional and structural markers of vasculature. A systematic literature search was performed electronically using specific eligibility criteria. Weighted mean difference (WMD) and corresponding 95% confidence interval (CI) were calculated and combined appropriately. Fifty-seven articles were included with nine different outcomes. Compared with HIV-negative patients, HIV-positive patients demonstrated significant elevated intima-media thickness (IMT) (WMD (95% CI) = 0.042 (0.028-0.057)), increased pulse wave velocity (PWV) (0.538 (0.283-0.792)), and reduced flow-mediated vasodilation (FMD) (-2.049 (-2.806 to -1.293)). Elevated IMT was observed in HIV patients receiving ART when compared with those naïve to ART in the 20- to 40-year-old age group (0.078 (0.033-0.123)), the >40-year-old age group (0.038 (0.018-0.057)), and the group comprising >50% males (0.070 (0.041-0.099)). In addition, ART resulted in an increased PWV in HIV patients receiving ART in the group with >50% male proportion (0.628 (0.405-0.851)). HIV patients exposed to PI showed a significant trend toward elevated IMT (0.033 (0.007-0.058)) and increased PWV (0.264 (0.118-0.410)) compared with those without PI exposure. The atherosclerotic process was accentuated by elevated IMT, increased PWV, and reduced FMD under condition of HIV infection. Comparison of ART-receiving with ART-naïve patients showed a significant trend toward elevated IMT and increased PWV, especially under treatment with PI-containing drugs.