HIV 感染者中的亚临床心血管疾病和长期非进展者人群。
Subclinical cardiovascular disease in HIV controller and long-term nonprogressor populations.
机构信息
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
出版信息
HIV Med. 2020 Apr;21(4):217-227. doi: 10.1111/hiv.12820. Epub 2019 Nov 14.
OBJECTIVES
Elite controllers (ECs), viraemic controllers (VCs), and long-term nonprogressors (LTNPs) control HIV viral replication or maintain CD4 T-cell counts without antiretroviral therapy, but may have increased cardiovascular disease (CVD) risk compared to HIV-uninfected persons. We evaluated subclinical carotid and coronary atherosclerosis and inflammatory biomarker levels among HIV controllers, LTNPs and noncontrollers and HIV-uninfected individuals in the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS).
METHODS
We measured carotid plaque presence and common carotid artery intima-media thickness (IMT) in 1729 women and 1308 men, and the presence of coronary artery calcium and plaque in a subgroup of men. Associations between HIV control category and carotid and coronary plaque prevalences were assessed by multivariable regression analyses adjusting for demographics and CVD risk factors. Serum inflammatory biomarker concentrations [soluble CD163 (sCD163), soluble CD14 (sCD14), galectin-3 (Gal-3), galectin-3 binding protein (Gal-3BP) and interleukin (IL)-6] were measured and associations with HIV control category assessed.
RESULTS
We included 135 HIV controllers (30 ECs) and 135 LTNPs in the study. Carotid plaque prevalence and carotid IMT were similar in HIV controllers, LTNPs and HIV-uninfected individuals. HIV controllers and LTNPs had lower prevalences of carotid plaque compared to viraemic HIV-infected individuals. The prevalence of coronary atherosclerosis was similar in HIV controllers/LTNPs compared to HIV-uninfected and viraemic HIV-infected men. Controllers and LTNPs had higher concentrations of sCD163 and sCD14 compared to HIV-uninfected persons.
CONCLUSIONS
Subclinical CVD was similar in HIV controllers, LTNPs and HIV-uninfected individuals despite elevated levels of some inflammatory biomarkers. Future studies of HIV controllers and LTNPs are needed to characterize the risk of CVD among HIV-infected persons.
目的
精英控制者（ECs）、病毒控制者（VCs）和长期非进展者（LTNPs）在没有抗逆转录病毒治疗的情况下控制 HIV 病毒复制或维持 CD4 T 细胞计数，但与 HIV 未感染者相比，他们可能有更高的心血管疾病（CVD）风险。我们在多中心艾滋病队列研究（MACS）和妇女艾滋病研究机构间研究（WIHS）中评估了 HIV 控制者、LTNPs 和非控制者以及 HIV 未感染者的亚临床颈动脉和冠状动脉粥样硬化以及炎症生物标志物水平。
方法
我们测量了 1729 名女性和 1308 名男性的颈动脉斑块存在情况和颈总动脉内膜中层厚度（IMT），并在男性亚组中测量了冠状动脉钙和斑块的存在情况。通过多变量回归分析调整人口统计学和 CVD 危险因素，评估了 HIV 控制类别与颈动脉和冠状动脉斑块患病率之间的关联。测量了血清炎症生物标志物浓度[可溶性 CD163（sCD163）、可溶性 CD14（sCD14）、半乳糖凝集素-3（Gal-3）、半乳糖凝集素-3 结合蛋白（Gal-3BP）和白细胞介素（IL）-6]，并评估了与 HIV 控制类别之间的关联。
结果
我们将 135 名 HIV 控制者（30 名 ECs）和 135 名 LTNPs 纳入了这项研究。HIV 控制者、LTNPs 和 HIV 未感染者的颈动脉斑块患病率和颈动脉 IMT 相似。与病毒载量的 HIV 感染者相比，HIV 控制者和 LTNPs 的颈动脉斑块患病率较低。与 HIV 未感染者和病毒载量的 HIV 感染者相比，HIV 控制者/ LTNPs 的冠状动脉粥样硬化患病率相似。与 HIV 未感染者相比，控制者和 LTNPs 的 sCD163 和 sCD14 浓度更高。
结论
尽管一些炎症生物标志物水平升高，但 HIV 控制者、LTNPs 和 HIV 未感染者的亚临床 CVD 相似。需要对 HIV 控制者和 LTNPs 进行进一步研究，以确定 HIV 感染者的 CVD 风险。
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