Calza Leonardo, Borderi Marco, Granozzi Bianca, Malosso Pietro, Pancaldi Livia, Bon Isabella, Re Maria Carla
Unit of Infectious Diseases, Department of Medical and Surgical Sciences, "Alma Mater Studiorum" University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
Unit of Microbiology, Department of Medical and Surgical Sciences, "Alma Mater Studiorum" University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
HIV Res Clin Pract. 2019 Dec;20(6):131-139. doi: 10.1080/25787489.2020.1724749. Epub 2020 Feb 17.
Vitamin D insufficiency has been associated with faster progression of atherosclerosis and increased cardiovascular disease risk, but limited data are available in HIV-infected people. So, we examined potential correlation between vitamin D status and atherosclerosis in people living with HIV. A cross-sectional study was performed including adult HIV-infected patients on stable antiretroviral therapy, aged 40-60 years, and with a recent carotid ultrasonography. Subclinical atherosclerosis was defined as a carotid intima-media thickness (IMT) ≥0.9 mm at any site. Patients with diabetes mellitus or atherosclerotic cardiovascular disease were excluded. On the whole, 188 patients were enrolled: 86.2% were men and the mean age was 49.1 years. The mean CD4 T lymphocyte count was 567 cells/mm, 176 (93.6%) had plasma HIV RNA <20 copies/mL, 51.1% were smoker, 29.2% had hypertension, 27.7% metabolic syndrome, and 44.7% LDL cholesterol >150 mg/dL. The mean serum concentration of vitamin D was 35.2 ng/mL, and 84 (44.6%) patients had a vitamin D insufficiency (<30 ng/mL). Subclinical atherosclerosis was reported in 105 (55.8%) and the mean vitamin D concentration was significantly lower among patients with subclinical atherosclerosis than among those without (18.2 vs 41.3 ng/mL, < 0.001). Moreover, the multivariate linear regression analysis adjusted by confounding factors showed an independent association between subclinical atherosclerosis and vitamin D insufficiency, age >50 years, smoking, hypertension, metabolic syndrome, higher BMI, higher LDL cholesterol, longer duration of HIV infection, lower nadir CD4 cell count, and longer exposure to boosted protease inhibitors. In our study, vitamin D insufficiency is significantly associated with subclinical atherosclerosis, so its role in HIV-associated cardiovascular disease should be further evaluated as a possible target for intervention.
维生素D不足与动脉粥样硬化进展加快及心血管疾病风险增加有关，但关于HIV感染者的数据有限。因此，我们研究了HIV感染者维生素D状态与动脉粥样硬化之间的潜在相关性。我们进行了一项横断面研究，纳入年龄在40 - 60岁、接受稳定抗逆转录病毒治疗且近期进行过颈动脉超声检查的成年HIV感染患者。亚临床动脉粥样硬化定义为任何部位的颈动脉内膜中层厚度（IMT）≥0.9毫米。排除患有糖尿病或动脉粥样硬化性心血管疾病的患者。总体上，共纳入188例患者：86.2%为男性，平均年龄为49.1岁。平均CD4 T淋巴细胞计数为567个/立方毫米，176例（93.6%）血浆HIV RNA <20拷贝/毫升，51.1%为吸烟者，29.2%患有高血压，27.7%患有代谢综合征，44.7%的低密度脂蛋白胆固醇>150毫克/分升。维生素D的平均血清浓度为35.2纳克/毫升，84例（44.6%）患者存在维生素D不足（<30纳克/毫升）。105例（55.8%）报告有亚临床动脉粥样硬化，亚临床动脉粥样硬化患者的维生素D平均浓度显著低于无亚临床动脉粥样硬化者（18.2对41.3纳克/毫升，P<0.001）。此外，经混杂因素调整的多变量线性回归分析显示，亚临床动脉粥样硬化与维生素D不足、年龄>50岁、吸烟、高血压、代谢综合征、较高的体重指数、较高的低密度脂蛋白胆固醇、较长的HIV感染病程、较低的最低CD4细胞计数以及较长时间使用增强型蛋白酶抑制剂之间存在独立关联。在我们的研究中，维生素D不足与亚临床动脉粥样硬化显著相关，因此其在HIV相关心血管疾病中的作用应作为可能的干预靶点进一步评估。
