Subclinical Coronary Atherosclerosis in HIV-Infected Patients

说明（由申请人提供）：在世界范围内，艾滋病毒感染者通过抗逆转录病毒治疗延长了寿命。随着慢性病毒感染患者年龄的增长，与HIV感染及其治疗相关的代谢和心血管并发症变得越来越明显。hiv感染患者的代谢变化，包括血脂异常、胰岛素抵抗和脂肪再分配，以及与慢性感染相关的炎症增加，都可能增加其心血管风险。在拟议的拨款中，我们将前瞻性地调查没有先前诊断出心血管疾病的hiv感染者的亚临床冠状动脉粥样硬化的患病率。我们还建议研究潜在的代谢、炎症和遗传因素可能导致；hiv感染患者的动脉粥样硬化在拟议的横断面队列研究中，我们将获得初步数据并确定危险因素，这些数据将为未来纵向研究的设计提供信息，使用64排多探测器计算机断层扫描（MDCT）和CT血管造影来检测HIV人群中的亚临床冠状动脉疾病，并与年龄匹配的非HIV感染对照受试者进行比较。我们假设MDCT显示的冠状动脉钙化和冠状动脉斑块病变的证据在HIV感染者中比在对照组中更多。我们还计划评估与hiv感染者冠状动脉疾病相关的代谢和炎症因素。我们假设血脂异常、炎症标志物分泌增加、胰岛素抵抗、脂联素降低以及单核细胞趋化因子和趋化因子受体的某些多态性与hiv感染者的冠状动脉疾病有关。我们还假设：血脂异常和炎症增加将与冠状动脉斑块形成增加有关：独立于该患者人群中的其他危险因素。动脉粥样硬化性疾病负担的表征以及与HIV中动脉粥样硬化性疾病相关的危险因素的识别将有助于指导未来针对HIV患者人群设计适当的预防策略。

DESCRIPTION (provided by applicant): , Worldwide, HIV-infected patients are living longer with anti-retroviral therapy. Metabolic and cardiovascular complications associated with HIV infection and its treatment are becoming more evident as this patient population ages with chronic viral infection. Metabolic changes in HIV-infected patients including dyslipidemia, insulin resistance, and fat redistribution as well as increased inflammation associated with chronic infection may increase their cardiovascular risk. In the proposed grant, we will prospectively investigate the prevalence of subclinical coronary atherosclerosis in HIV-infected individuals without previously diagnosed cardiovascular disease. We also propose to study the potential metabolic, inflammatory, and genetic factors that may contribute to ; atherosclerosis in HIV-infected patients. In the proposed cross-sectional cohort study, we will obtain preliminary data and identify risk factors that will inform the design of future longitudinal studies using 64-row multidetector computed tomography (MDCT) and CT angiography to detect subclinical coronary disease in the HIV population in comparison to age-matched non-HIV infected control subjects. We hypothesize that evidence of coronary artery calcification and coronary plaque lesions as seen by MDCT will be present in individuals with HIV more than control subjects. We also plan to evaluate the metabolic and inflammatory factors associated with coronary artery disease in HIV-infected individuals. We hypothesize that dyslipidemia, increased secretion of inflammatory markers, insulin resistance, decreased adiponectin and certain polymorphisms in monocyte chemokines and chemokine receptors will be associated with coronary artery disease in HIV-infected individuals. We also hypothesize that : dyslipidemia and increased inflammation will be associated with increased coronary plaque formation : independent of other risk factors in this patient population. Characterization of the atherosclerotic disease burden as well as identification of risk factors associated with atherosclerotic disease in HIV will be instrumental to guide the future design of appropriate prevention strategies for the HIV patient population.