Strijdom Hans, De Boever Patrick, Walzl Gerhard, Essop M Faadiel, Nawrot Tim S, Webster Ingrid, Westcott Corli, Mashele Nyiko, Everson Frans, Malherbe Stephanus T, Stanley Kim, Kessler Harald H, Stelzl Evelyn, Goswami Nandu
Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
Environmental Risk and Health Unit, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400, Mol, Belgium.
BMC Infect Dis. 2017 Jan 7;17(1):41. doi: 10.1186/s12879-016-2158-y.
There is growing evidence of an interaction between HIV-infection, anti-retroviral therapy (ART) and cardiovascular diseases (CVD). Epidemiological studies in Europe and North America have been observing a shift towards an increased incidence of coronary heart disease and acute myocardial infarctions in HIV-infected populations compared to the general population even after adjusting for traditional cardiovascular risk factors. Despite South Africa (and sub-Saharan Africa, SSA) being regarded as the epicentre of the global HIV epidemic, very little is known about the prevalence of cardiovascular risk factors and precursors of vascular disease in HIV-infected populations in this region. The knowledge gap is further widened by the paucity of data from prospective studies. We present the rationale, objectives and key methodological features of the EndoAfrica study, which aims to determine whether HIV-infection and ART are associated with altered cardiovascular risk and changes in vascular endothelial structure and function in adults living in the Western Cape Province of South Africa.
In this longitudinal study, comprehensive cardiovascular assessments of HIV-negative and HIV-positive (with and without ART) study participants are performed by clinical and biochemical screening for traditional cardiovascular risk factors and biomarkers of CVD. Vascular and endothelial function is determined by brachial artery flow-mediated dilatation (FMD), carotid-intima-thickness (IMT) measurements and quantitative retinal blood vessel analyses, complemented by vascular endothelial biomarker assays. Finally, we aim to statistically determine whether HIV-infection and/or ART are associated with increased cardiovascular risk and vascular endothelial dysfunction, and determine whether there is progression/regression in these endpoints 18 months after the baseline assessments.
The EndoAfrica study provides a unique opportunity to recruit a cohort of HIV-infected patients and HIV-negative controls who will be comprehensively and longitudinally assessed for cardiovascular risk and disease profile with vascular endothelial function as a potentially important intermediate cardiovascular phenotype. To our knowledge, it is the first time that such a systematic study has been established in the context of SSA and South Africa.
越来越多的证据表明，艾滋病毒感染、抗逆转录病毒疗法（ART）与心血管疾病（CVD）之间存在相互作用。欧洲和北美的流行病学研究发现，即使在对传统心血管危险因素进行调整之后，与普通人群相比，艾滋病毒感染人群中冠心病和急性心肌梗死的发病率仍呈上升趋势。尽管南非（以及撒哈拉以南非洲地区，即SSA）被视为全球艾滋病毒流行的中心，但对于该地区艾滋病毒感染人群中心血管危险因素的流行情况以及血管疾病的先兆，我们却知之甚少。前瞻性研究数据的匮乏进一步扩大了这一知识差距。我们介绍了EndoAfrica研究的基本原理、目标和关键方法学特征，该研究旨在确定艾滋病毒感染和抗逆转录病毒疗法是否与南非西开普省成年人心血管风险改变以及血管内皮结构和功能变化有关。
在这项纵向研究中，通过对传统心血管危险因素和心血管疾病生物标志物进行临床和生化筛查，对艾滋病毒阴性和艾滋病毒阳性（接受或未接受抗逆转录病毒疗法）的研究参与者进行全面的心血管评估。通过肱动脉血流介导的血管舒张（FMD）、颈动脉内膜厚度（IMT）测量和定量视网膜血管分析来确定血管和内皮功能，并辅以血管内皮生物标志物检测。最后，我们旨在通过统计学方法确定艾滋病毒感染和/或抗逆转录病毒疗法是否与心血管风险增加和血管内皮功能障碍有关，并确定在基线评估18个月后这些终点是否有进展/逆转。
EndoAfrica研究提供了一个独特的机会，可招募一组艾滋病毒感染患者和艾滋病毒阴性对照，对他们进行全面的纵向心血管风险和疾病特征评估，将血管内皮功能作为潜在重要的中间心血管表型。据我们所知，这是首次在撒哈拉以南非洲地区和南非开展此类系统性研究。
