Pulse wave velocity demonstrates increased aortic stiffness in newly diagnosed, antiretroviral naïve HIV infected adults: A case-control study.
Pulse wave velocity demonstrates increased aortic stiffness in newly diagnosed, antiretroviral naïve HIV infected adults: A case-control study.
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DOI：
10.1097/md.0000000000029721
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发表时间：
2022-08-26
期刊：
影响因子：
1.6
通讯作者：
Herbst, Philip G.
中科院分区：
文献类型：
--
作者：
Robbertse, Pieter-Paul S.;Doubell, Anton F.;Innes, Steve;Lombard, Carl J.;Herbst, Philip G.
关键词：
主动脉僵硬度增加是心血管疾病（CVD）的重要预测指标。 HIV感染者在诊断HIV时主动脉僵硬度是否增加仍存在争议。一项探索性病例对照研究采用颈动脉-股动脉脉搏波速度 (PWV) 在新诊断、未接受过抗逆转录病毒治疗 (ART) 且基线心血管风险中等的队列中进行。我们从南非的医疗机构招募了 85 名新诊断的无已知 CVD 的成年人（43 名女性；平均年龄 33 岁）。 CD4 计数中位数为 285，IQR 156–393 个细胞/μL。从同一机构招募了 22 名未感染 HIV 的对照者（8 名女性；平均年龄 33 岁）。 PWV 使用 Vicorder 模块（Skidmore Medical，英国）测量，校正系数为 0.8。 HIV 感染组的平均 PWV 比对照组高 11%（5.88 vs 5.28 m/s；P = .02）。 HIV 感染者的中位主动脉扩张度比对照组低 18%（0.37 vs 0.45 mm Hg−1；P = .009）。多变量分析显示，在校正年龄、性别、平均血压和肾功能后，各组之间的 PWV 差异仍然显着（平均差 0.52 m/s；P = .01）。平均血压、估计肾小球滤过率、HIV 感染本身、年龄和男性性别与 PWV 增加有重要关系。我们的研究提供了证据，证明未接受过 ART 的成年人的主动脉僵硬度在 HIV 诊断时就已明显增加。由于该人群年龄较小，而且最近被诊断出艾滋病毒，因此动脉粥样硬化不太可能解释这种差异。需要进一步研究的替代的、可能可逆的解释包括血管舒缩张力异常和内皮功能障碍。
Increased aortic stiffness is an important predictor of cardiovascular disease (CVD). It remains controversial whether HIV infected persons have increased aortic stiffness at the time of HIV diagnosis. An explorative, case-control study was performed using carotid-femoral pulse wave velocity (PWV) in a newly diagnosed, antiretroviral treatment (ART)-naïve cohort with modest baseline cardiovascular risk. We recruited 85 newly diagnosed adults without known CVD from health care facilities in South Africa (43 female; mean age 33). Median CD4 count was 285, IQR 156–393 cells/µL. Twenty two HIV uninfected controls were recruited from the same facilities (8 female; mean age 33). PWV was measured using the Vicorder module (Skidmore Medical, United Kingdom) using a corrective factor of 0.8. The HIV infected group’s mean PWV measured 11% higher than controls (5.88 vs 5.28 m/s; P = .02). Median aortic distensibility in HIV infected persons was 18% lower than controls (0.37 vs 0.45 mm Hg−1; P = .009). Multivariate analysis revealed that the difference in PWV between groups remained significant when corrected for age, sex, mean blood pressure and kidney function (mean difference 0.52 m/s; P = .01). Mean blood pressure, estimated glomerular filtration rate, HIV infection per se, age and male sex were important associations with increased PWV. Our study provides evidence for increased aortic stiffness in ART naïve adults already demonstrable at the time of HIV diagnosis. The cohort’s young age and recent HIV diagnosis makes atherosclerosis a less likely explanation for the difference. Alternative, potentially reversible, explanations that require further research include vasomotor tone abnormalities and endothelial dysfunction.