HIV、丙型肝炎病毒和传统血管危险因素对女性外周动脉疾病的影响。
Contributions of HIV, hepatitis C virus, and traditional vascular risk factors to peripheral artery disease in women.
机构信息
aDepartment of Medicine, University of California, San Francisco bMedical Service, Department of Veterans Affairs Medical Center, San Francisco, California cDepartment of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina dDepartment of Cell, Developmental, and Integrative Biology eDepartment of Medicine fDepartment of Neurology, University of Alabama, Birmingham, Alabama gDepartment of Medicine, Cook County Health and Hospitals System, Chicago, Illinois hDepartment of Medicine, University of Miami, Miami, Florida iDepartment of Epidemiology, Johns Hopkins University, Baltimore, Maryland jDepartment of Medicine, Emory University, Atlanta, Georgia kDepartment of Medicine, Georgetown University Medical Center, Washington, District of Columbia lDepartment of Medicine, Columbia University, New York, New York mDepartment of Surgery, University of California, San Francisco, San Francisco, California nDepartment of Medicine, Albert Einstein College of Medicine, The Bronx, New York, USA.
出版信息
AIDS. 2019 Nov 1;33(13):2025-2033. doi: 10.1097/QAD.0000000000002319.
OBJECTIVES
HIV and hepatitis C virus (HCV) have been associated with cardiovascular disease (CVD), but it is unclear whether HIV and HCV are also associated with peripheral artery disease (PAD). We examined the association of HIV, HCV, and traditional CVD risk factors with PAD in the Women's Interagency HIV Study, a multicenter US cohort.
METHODS
In this cross-sectional study, ankle-brachial index was estimated using Doppler ultrasound and manual sphygmomanometer in 1899 participants aged more than 40 years with HIV/HCV coinfection, HCV or HIV monoinfection, or neither infection. Multivariable logistic regression was used to estimate the odds of PAD (ankle-brachial index ≤0.9) after controlling for demographic, behavioral, and CVD risk factors.
RESULTS
Over two-thirds were African-American, median age was 50 years, and PAD prevalence was 7.7% with little difference by infection status. After multivariable adjustment, neither HIV nor HCV infection was associated with greater odds of PAD. Factors associated with PAD included older age [adjusted odds ratio (aOR): 2.01 for age 61-70 vs. 40-50 years; 95% confidence interval (CI): 1.04, 3.87], Black race (aOR: 2.30; 95% CI: 1.15, 4.63), smoking (aOR: 1.27 per 10-pack-year increment; 95% CI: 1.09, 1.48), and higher SBP (aOR: 1.14 per 10 mmHg; 95% CI: 1.01, 1.28).
CONCLUSION
The high PAD prevalence in this nationally representative cohort of women with or at risk for HIV is on par with general population studies in individuals a decade older than our study's median age. HIV and HCV infection are not associated with greater PAD risk relative to uninfected women with similar risk factors. Modifiable traditional CVD risk factors may be important early intervention targets in women with and at risk for HIV.
目的
艾滋病毒（HIV）和丙型肝炎病毒（HCV）与心血管疾病（CVD）有关，但 HIV 和 HCV 是否也与外周动脉疾病（PAD）有关尚不清楚。我们在一个多中心的美国队列——妇女艾滋病联合研究中，研究了 HIV、HCV 以及传统 CVD 危险因素与 PAD 的关系。
方法
在这项横断面研究中，对 1899 名年龄在 40 岁以上、HIV/HCV 合并感染、HCV 或 HIV 单感染或无感染的参与者，使用多普勒超声和手动血压计来估计踝臂指数。多变量逻辑回归用于在控制人口统计学、行为和 CVD 危险因素后，估计 PAD（踝臂指数≤0.9）的几率。
结果
超过三分之二的参与者为非裔美国人，中位年龄为 50 岁，PAD 的患病率为 7.7%，不同感染状态下的差异很小。经多变量调整后，HIV 和 HCV 感染均与 PAD 的发生几率增加无关。与 PAD 相关的因素包括年龄较大（调整后的优势比[OR]：61-70 岁与 40-50 岁年龄组相比为 2.01；95%置信区间[CI]：1.04，3.87）、黑人种族（OR：2.30；95% CI：1.15，4.63）、吸烟（OR：每 10 包年增量增加 1.27；95% CI：1.09，1.48）和较高的 SBP（OR：每 10mmHg 增加 1.14；95% CI：1.01，1.28）。
结论
在这个具有代表性的、有或有感染 HIV 风险的女性队列中，PAD 的高患病率与我们研究的中位数年龄大十年的一般人群研究相当。与具有相似危险因素的未感染女性相比，HIV 和 HCV 感染与更大的 PAD 风险无关。可改变的传统 CVD 危险因素可能是 HIV 感染和有感染风险的女性的早期干预重要靶点。
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