Evaluation of Vascular Event Risk while on Long-term Antiretroviral Suppressive Treatment (EVERLAST)

长期抗逆转录病毒抑制治疗（EVERLAST）期间血管事件风险的评估

• 批准号: 9884509
• 负责人: BRUCE OVBIAGELE
• 金额: $ 0.8万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-11 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9884509
• 关键词: Evaluation; Vascular; Event; Risk; while

SUMMARY/ABSTRACT Two out of three individuals living with HIV/AIDS worldwide reside in sub-Saharan Africa (SSA). Fortunately, due to a massive roll-out of potent combination Antiretroviral Therapy (cART), global rates of morbidity and mortality from HIV infection have declined significantly over the past decade. However, while the initiation of cART has led to a global decline in deaths from AIDS related opportunistic infections and malignancies, there has correspondingly been a surge in deaths from cardiovascular disease (CVD) and non- AIDS related cancers. In North American cohorts up to 10% of all deaths among people with HIV/AIDS have been attributed to CVD. The greater frequency of CVD complications among HIV patients is thought to be possibly due to HIV-stimulated endothelial activation, vasculopathies, opportunistic infections, neoplasia, prothrombosis, and metabolic derangements or cART directly causing immune activation and metabolic dysfunction that can accelerate systemic atherosclerosis. There is a striking paucity of data on the nature and contributors to CVD among HIV patients in SSA. Beyond the potential contributions of the virus or cART to CVD risk in HIV patients, enhancements in the socio-economic status of general populations in SSA has led to an increasing adoption of Western diets and lifestyles resulting in a growing epidemic of key CVD risk factors such as hypertension, diabetes mellitus and dyslipidemia. Information on the prevalence and predictors of co-existing CVD among HIV patients in SSA could permit the development of unique strategies to reduce CVD burden in these patients encountered in resource-limited settings. Currently, HIV patients cared for in SSA are not routinely or systematically screened/treated for CVD because of socioeconomic obstacles, cultural barriers, under- diagnosis, and a dearth of scientific information to guide providers. The overall objective of the Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy (EVERLAST) study is to characterize the presence of CVD risk among 240 HIV subjects on cART in SSA (vs. 240 cART-naïve HIV patients and 240 HIV-uninfected subjects) and explore factors influencing it, while building sustainable capacity for a future intervention study across the lifespan in a resource-limited setting (Ghana). In EVERLAST, we will 1) assess the prevalence of CVD risk among HIV patients on cART for >1 year as defined by carotid intima media thickness, along with socio-econo-demographic factors, traditional CVD medical and lifestyle risk factors, HIV- related factors, and serologic indices; 2) we will obtain information and guidance about the barriers and facilitators influencing CVD risk management among HIV patients in SSA at the various levels of a social ecological model; and 3) based on data gathered from the earlier phases of the study, we will propose interventions at levels of the social ecological model to improve optimal CVD risk management of HIV patients on cART in SSA that can be tested in a future study.

摘要/摘要 全世界艾滋病毒/艾滋病感染者中有三分之二居住在撒哈拉以南非洲地区。 幸运的是，由于强有力的联合抗逆转录病毒疗法(CART)的大规模推出，全球的 在过去十年中，艾滋病毒感染的发病率和死亡率大幅下降。然而，虽然 启动抗逆转录病毒治疗导致全球艾滋病相关机会性感染死亡人数下降， 在恶性肿瘤方面，相应地，死于心血管疾病(CVD)和非 与艾滋病相关的癌症。在北美，艾滋病毒/艾滋病患者中高达10%的死亡病例 被归因于心血管疾病。艾滋病毒患者发生心血管并发症的频率较高 可能是由于艾滋病毒刺激的内皮激活，血管病变，机会性感染，肿瘤， 血栓前病变以及直接导致免疫激活和代谢的代谢紊乱或CART 会加速系统性动脉粥样硬化的功能障碍。关于自然和气候变化的数据惊人的缺乏 SSA地区HIV患者心血管疾病的影响因素。除了病毒或购物车对心血管疾病的潜在贡献之外 在艾滋病毒患者的风险方面，SSA普通人群的社会经济地位的增强导致了 越来越多地采用西方饮食和生活方式导致关键心血管疾病风险因素的流行，如 如高血压、糖尿病、血脂异常。关于共存的患病率和预测因素的信息 在SSA的艾滋病毒患者中的心血管疾病可以允许开发独特的战略来减少心血管疾病负担 这些患者是在资源有限的情况下遇到的。目前，在SSA接受治疗的艾滋病毒患者并不是常规的 或系统地筛查/治疗心血管疾病，因为社会经济障碍、文化障碍、 诊断，以及缺乏科学信息来指导提供者。评估的总体目标是 长期抗逆转录病毒抑制治疗(Everlast)研究中的血管事件风险 描述SSA中240名接受CART的HIV受试者心血管疾病风险的特征(与240名CART-NAIVE HIV相比 患者和240名未感染艾滋病毒的受试者)，并探索影响其的因素，同时建设可持续能力 在资源有限的情况下，进行未来寿命内的干预研究(加纳)。在永恒中，我们将1) 根据颈动脉内膜中层的定义，评估接受CART治疗1年的HIV患者心血管疾病风险的患病率 厚度，以及社会经济人口因素，传统的心血管疾病医疗和生活方式风险因素，艾滋病毒- 相关因素和血清学指标；2)我们将获得有关障碍和 在社会不同层面影响SSA艾滋病毒患者心血管风险管理的促进者 生态模型；以及3)基于从研究的早期阶段收集的数据，我们将提出 社会生态模型层面的干预措施，以改善艾滋病患者的最佳心血管疾病风险管理 可以在未来的研究中测试的SSA中的CART。