Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
AIDS. 2012 Jun 1;26(9):1115-20. doi: 10.1097/QAD.0b013e328352ce54.
HIV-infected individuals are at high risk of developing cardiovascular disease. Whether earlier initiation of HIV therapy at higher CD4 cell counts has any effect on cardiovascular risk as assessed by endothelial function is unknown.
Cross-sectional study of 74 antiretroviral-treated men with undetectable plasma HIV RNA levels.
Participants underwent noninvasive assessment of endothelial function using brachial artery flow-mediated dilation (FMD). The association of nadir and current CD4 T-cell count with FMD was assessed using multivariable linear regression.
The median age was 47 years [interquartile range (IQR) 42-55], median current CD4 T-cell count was 659 cells/μl (IQR 542-845), and nadir CD4 cell count was 314 cells/μl (IQR 150-490). Twenty-eight percent had hypertension, and 32% hyperlipidemia. Nadir CD4 T-cell count less than 350 cells/μl was associated with lower FMD in age-adjusted and race-adjusted analyses and remained an independent predictor of FMD after adjustment for cardiovascular risk factors (hypertension, diabetes, smoking, hyperlipidemia) and HIV-related characteristics (HIV duration, HAART duration). After multivariable adjustment, individuals with nadir CD4 T-cell count less than 350 cells/μl had a 1.22% lower FMD compared with those with higher T-cell counts [95% confidence interval (CI) -2.20 to -0.19, P=0.02]. Proximal CD4 T-cell count showed little association with FMD.
Among treated HIV-infected individuals, nadir CD4 T-cell count less than 350 cells/μl is independently associated with lower FMD, suggesting that delayed therapy results in sustained harm to endothelial function. Our data support future prospective studies evaluating cardiovascular effects of HAART initiation at higher CD4 cell counts.
感染 HIV 的个体患心血管疾病的风险很高。目前尚不清楚，以 CD4 细胞计数较高作为起始点尽早开始 HIV 治疗是否会对内皮功能评估的心血管风险产生影响。
对 74 名接受抗逆转录病毒治疗且血浆 HIV RNA 水平不可检测的男性进行了横断面研究。
使用肱动脉血流介导的舒张功能（FMD）对参与者进行内皮功能的非侵入性评估。使用多变量线性回归评估最低和当前 CD4 T 细胞计数与 FMD 的相关性。
中位年龄为 47 岁（四分位距 42-55 岁），中位当前 CD4 T 细胞计数为 659 个/μl（四分位距 542-845 个/μl），最低 CD4 细胞计数为 314 个/μl（四分位距 150-490 个/μl）。28%的人患有高血压，32%的人患有高血脂。在校正年龄和种族后，最低 CD4 T 细胞计数<350 个/μl 与 FMD 降低相关，在调整心血管危险因素（高血压、糖尿病、吸烟、高血脂）和 HIV 相关特征（HIV 持续时间、HAART 持续时间）后，仍然是 FMD 的独立预测因子。在多变量调整后，与 CD4 细胞计数较高的个体相比，最低 CD4 T 细胞计数<350 个/μl 的个体的 FMD 低 1.22%[95%置信区间（CI）-2.20 至-0.19，P=0.02]。CD4 细胞计数近端与 FMD 相关性不大。
在接受治疗的 HIV 感染者中，最低 CD4 T 细胞计数<350 个/μl 与 FMD 降低独立相关，这表明延迟治疗会导致内皮功能持续受损。我们的数据支持未来评估以较高 CD4 细胞计数开始 HAART 的心血管影响的前瞻性研究。
