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

总结/摘要 全世界三分之二的艾滋病毒/艾滋病感染者居住在撒哈拉以南非洲。 幸运的是，由于强效抗逆转录病毒疗法（cART）的大规模推广， 艾滋病毒感染的发病率和死亡率在过去十年中大幅下降。然而，虽然 cART的启动导致全球艾滋病相关机会性感染死亡率下降， 恶性肿瘤，相应地，死于心血管疾病（CVD）和非心血管疾病的人数激增。 与艾滋病有关的癌症在北美，艾滋病毒/艾滋病感染者中高达10%的死亡是由于 被认为是CVD。HIV患者中CVD并发症的发生率更高被认为是 可能是由于HIV刺激的内皮活化、血管病变、机会性感染、肿瘤形成， 促血栓形成和代谢紊乱或cART直接导致免疫激活和代谢紊乱。 会加速全身动脉粥样硬化的功能障碍。有一个惊人的缺乏数据的性质和 在SSA的HIV患者中CVD的贡献者。除了病毒或cART对CVD的潜在贡献之外 艾滋病毒感染者的风险，在SSA一般人群的社会经济地位的提高，导致了一个 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， 如高血压、糖尿病和血脂异常。关于同时存在的流行病和预测因素的信息 SSA中HIV患者的心血管疾病可以允许开发独特的策略来减少 这些患者在资源有限的环境中遇到。目前，在撒哈拉以南非洲接受治疗的艾滋病毒感染者并不经常 或由于社会经济障碍、文化障碍、 诊断，以及缺乏科学信息来指导供应商。评价的总体目标是： 长期抗逆转录病毒抑制治疗（EVERLAST）研究期间的血管事件风险是 描述SSA中接受cART的240例HIV受试者（vs. 240例cART初治HIV受试者）的CVD风险 患者和240名未感染艾滋病毒的受试者），并探讨影响因素，同时建立可持续的能力 在资源有限的环境中，未来进行一项贯穿整个生命周期的干预研究（加纳）。在永恒中，我们将1） 评估接受cART治疗>1年的HIV患者中CVD风险的患病率（根据颈动脉内膜中层定义） 厚度，沿着社会-经济-人口因素，传统的心血管疾病医学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的信息和指导， 在社会的各个层面上影响SSA中HIV患者CVD风险管理的促进者 生态模型; 3）根据研究早期阶段收集的数据，我们将提出 在社会生态模型层面采取干预措施，以改善艾滋病毒患者的最佳CVD风险管理， 可以在未来的研究中进行测试。

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.