Dubé Michael P, Shen Changyu, Mather Kieren J, Waltz Jeff, Greenwald Martha, Gupta Samir K
Department of Medicine and the Divisions of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA.
AIDS Res Hum Retroviruses. 2010 Aug;26(8):847-54. doi: 10.1089/aid.2010.0007.
Vascular endothelial dysfunction may contribute to the increase in cardiovascular events during HIV-1 infection and its treatment. Antiretroviral therapy (ART), metabolic factors, lipodystrophy, and HIV infection itself may be involved. Ninety-six HIV-infected subjects were evaluated for endothelial function by measurement of brachial artery flow-mediated dilation (FMD) by ultrasound, single-slice CT of the abdomen and mid-thigh, whole-body dual x-ray absorptiomety (DXA) scans, and metabolic evaluations in a cross-sectional study. The median age was 40 years; 28% were female, 38% black, 3% Hispanic, and 59% white. Forty-nine (51%) were receiving ART, which included a PI in 28 (57%) and was non-PI based in 21 (43%). FMD (+/-SD) in subjects not on ART was 5.5 +/- 4.3%, PI-ART 5.3 +/- 3.6%, and non-PI-ART 5.5 +/- 4.1% (p = 0.9). Age, race, CD4 cell count, and HIV RNA did not correlate significantly with FMD. Among ART-treated subjects in the lowest tertile of thigh subcutaneous fat area (range 3-31 cm(2)), FMD was 4.4 +/- 3.5% and in the highest tertile (range 67-237 cm(2)) FMD was 6.8 +/- 3.6% (p = 0.07, t-test). However, in multivariate analyses, no body composition measure showed a significant association with FMD for either the group as a whole or in ART-treated subjects. ART use, PI use, CD4 cell count, and HIV RNA levels were not associated with endothelial dysfunction by brachial FMD. A definitive association with measures of adiposity was not detected in multivariate analysis, suggesting that lipoatrophy may not be an important contributor to endothelial dysfunction in HIV-infected individuals on ART.
血管内皮功能障碍可能导致HIV-1感染及其治疗期间心血管事件的增加。抗逆转录病毒疗法（ART）、代谢因素、脂肪营养不良和HIV感染本身可能都与之相关。在一项横断面研究中，对96名HIV感染受试者进行了评估，通过超声测量肱动脉血流介导的血管舒张功能（FMD）、腹部和大腿中部的单层CT、全身双能X线吸收法（DXA）扫描以及代谢评估来评估内皮功能。中位年龄为40岁；28%为女性，38%为黑人，3%为西班牙裔，59%为白人。49名（51%）受试者正在接受ART治疗，其中28名（57%）使用蛋白酶抑制剂（PI），21名（43%）使用非PI类药物。未接受ART治疗的受试者的FMD（±标准差）为5.5±4.3%，接受PI-ART治疗的为5.3±3.6%，接受非PI-ART治疗的为5.5±4.1%（p = 0.9）。年龄、种族、CD4细胞计数和HIV RNA与FMD无显著相关性。在接受ART治疗且大腿皮下脂肪面积处于最低三分位数（范围3 - 31 cm²）的受试者中，FMD为4.4±3.5%，而在最高三分位数（范围67 - 237 cm²）的受试者中，FMD为6.8±3.6%（p = 0.07，t检验）。然而，在多变量分析中，无论是对于整个组还是接受ART治疗的受试者，没有任何身体成分测量指标显示与FMD有显著关联。使用ART、使用PI、CD4细胞计数和HIV RNA水平与肱动脉FMD所检测的内皮功能障碍无关。在多变量分析中未检测到与肥胖指标的明确关联，这表明脂肪萎缩可能不是接受ART治疗的HIV感染个体内皮功能障碍的重要因素。
