Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Acquir Immune Defic Syndr. 2020 Oct 1;85(2):233-238. doi: 10.1097/QAI.0000000000002419.
Women with HIV (WHIV) on antiretroviral therapy (ART) face an increased risk of cardiovascular disease (CVD) in the context of heightened systemic immune activation. Aortic stiffness, a measure of vascular dysfunction and a robust predictor of CVD outcomes, is highly influenced by immune activation. We compared aortic stiffness among women with and without HIV and examined interrelationships between aortic stiffness and key indices of systemic immune activation.
Twenty WHIV on ART and 14 women without HIV group-matched on age and body mass index (BMI) were prospectively recruited and underwent cardiovascular magnetic resonance imaging, as well as metabolic and immune phenotyping.
Age and BMI did not differ significantly across groups (age: 52 ± 4 vs. 53 ± 6 years; BMI: 32 ± 7 vs. 32 ± 7 kg/m). Aortic pulse wave velocity (aPWV) was higher among WHIV (8.6 ± 1.3 vs. 6.5 ± 1.3 m/s, P < 0.0001), reflecting increased aortic stiffness. Among the whole group and among WHIV, aPWV related to sCD163 levels (whole group: R = 0.65, P < 0.0001; WHIV: R = 0.73, P = 0.0003) and to myocardial fibrosis (extracellular volume; whole group: R = 0.54, P = 0.001; WHIV: R = 0.47, P = 0.04). Both HIV status and sCD163 levels independently predicted aPWV, controlling for age, BMI, cigarette smoking status, and systolic blood pressure (HIV status: β-estimate = 0.69, 95% CI [0.1 to 1.3], P = 0.02; sCD163: β-estimate = 0.002, 95% CI [0.0006 to 0.004], P = 0.01). Among WHIV, sCD163 levels independently predicted aPWV, controlling for duration of HIV, CD4 count, and HIV viral load (sCD163: β-estimate = 0.004, 95% CI [0.002 to 0.005], P = 0.0005).
Asymptomatic WHIV on ART have increased aortic stiffness as compared to matched control subjects. Among WHIV, aPWV related to heightened monocyte activation (sCD163) and to downstream CVD pathology (myocardial fibrosis). CLINICALTRIALS.
NCT02874703.
接受抗逆转录病毒疗法（ART）的艾滋病毒（HIV）女性在全身免疫激活的情况下面临心血管疾病（CVD）风险增加。血管功能障碍的衡量指标主动脉僵硬，是 CVD 结果的有力预测指标，高度受免疫激活的影响。我们比较了有和没有 HIV 的女性之间的主动脉僵硬，并检查了主动脉僵硬与全身免疫激活关键指标之间的相互关系。
前瞻性招募了 20 名接受 ART 的 HIV 阳性女性（WHIV）和 14 名年龄和体重指数（BMI）匹配的无 HIV 女性，并进行了心血管磁共振成像以及代谢和免疫表型检查。
年龄和 BMI 在两组之间无显著差异（年龄：52 ± 4 岁 vs. 53 ± 6 岁；BMI：32 ± 7 公斤/平方米 vs. 32 ± 7 公斤/平方米）。WHIV 的主动脉脉搏波速度（aPWV）更高（8.6 ± 1.3 米/秒 vs. 6.5 ± 1.3 米/秒，P < 0.0001），反映出主动脉僵硬增加。在整个组和 WHIV 中，aPWV 与 sCD163 水平相关（整个组：R = 0.65，P < 0.0001；WHIV：R = 0.73，P = 0.0003）和心肌纤维化（细胞外体积；整个组：R = 0.54，P = 0.001；WHIV：R = 0.47，P = 0.04）。HIV 状态和 sCD163 水平独立预测 aPWV，控制年龄、BMI、吸烟状态和收缩压（HIV 状态：β估计值= 0.69，95%CI [0.1 至 1.3]，P = 0.02；sCD163：β估计值= 0.002，95%CI [0.0006 至 0.004]，P = 0.01）。在 WHIV 中，sCD163 水平独立预测 aPWV，控制 HIV 持续时间、CD4 计数和 HIV 病毒载量（sCD163：β估计值= 0.004，95%CI [0.002 至 0.005]，P = 0.0005）。
与匹配的对照组相比，接受 ART 的无症状 WHIV 主动脉僵硬增加。在 WHIV 中，aPWV 与单核细胞激活（sCD163）和下游 CVD 病理相关（心肌纤维化）。临床试验。
NCT02874703。
