HIV and cardiovascular disease: the role of inflammation.
HIV and cardiovascular disease: the role of inflammation.
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DOI：
10.1097/coh.0000000000000755
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发表时间：
2022-09-01
影响因子：
4.1
通讯作者：
Funderburg, Nicholas
中科院分区：
文献类型：
--
作者：
Dirajlal-Fargo, Sahera;Funderburg, Nicholas
艾滋病毒和抗逆转录病毒治疗（ART）的使用与动脉粥样硬化性心血管疾病（ASCVD）的发病率增加有关。在接受art治疗的HIV （PWH）患者中，免疫激活持续存在，炎症标志物（即IL-6， c反应蛋白）预测这一人群的死亡率。本综述讨论了PWH中可能导致炎症和ASCVD发展的潜在机制。持续的炎症有助于加速HIV中的ASCVD，并且对PWH中慢性炎症的潜在免疫机制有了一些新的见解（例如克隆造血，训练免疫，脂质组学）。我们还将强调在包括妇女、少数民族和儿童在内的弱势群体中可能不同的潜在促炎机制。对PWH慢性炎症驱动因素的机制研究正在进行中，可能有助于制定有效的治疗策略，降低这一人群的ASCVD风险。重点还应包括导致艾滋病毒护理和合并症方面持续存在差异的因素，包括作为健康的生物因素和社会决定因素的性别。目前尚不清楚HIV的ASCVD进展是由独特的介质（HIV本身、ART、免疫缺陷）驱动的，还是在普通人群中看到的疾病进展的加速版本。
HIV and antiretroviral therapy (ART) use are linked to an increased incidence of atherosclerotic cardiovascular disease (ASCVD). Immune activation persists in ART-treated people with HIV (PWH), and markers of inflammation (i.e. IL-6, C-reactive protein) predict mortality in this population. This review discusses underlying mechanisms that likely contribute to inflammation and the development of ASCVD in PWH. Persistent inflammation contributes to accelerated ASCVD in HIV and several new insights into the underlying immunologic mechanisms of chronic inflammation in PWH have been made (e.g. clonal hematopoiesis, trained immunity, lipidomics). We will also highlight potential pro-inflammatory mechanisms that may differ in vulnerable populations including women, minorities and children. Mechanistic studies into the drivers of chronic inflammation in PWH are ongoing and may aid in tailoring effective therapeutic strategies that can reduce ASCVD risk in this population. Focus should also include factors that lead to persistent disparities in HIV care and co-morbidities, including sex as a biological factor and social determinants of health. It remains unclear if ASCVD progression in HIV is driven by unique mediators (HIV itself, ART, immunodeficiency), or if it is an accelerated version of disease progression seen in the general population.