Castaldi Biagio, Lanzoni Gloria, Rampon Osvalda, Donà Daniele, Di Candia Angela, Milanesi Ornella, Giaquinto Carlo, Di Salvo Giovanni
Department of Women's and Children's Health, University of Padua, 35126 Padua, Italy.
J Clin Med. 2021 Nov 22;10(22):5455. doi: 10.3390/jcm10225455.
HIV infection and lifelong cART are responsible of an increase in cardiovascular risk. The aim of this study was to describe the subclinical cardiovascular disease and to identify early markers of cardiovascular damage in adolescents and young adults vertically infected with HIV on cART, through an innovative multi-parametric approach.
We enrolled 52 patients vertically infected with HIV. Demographic records, traditional cardiovascular risk factors, laboratory findings and echocardiographic measurements were collected in a one-year routine follow up. The echocardiographic examination included measurements of the 2D and 3D ejection fraction (EF), E/A ratio, E/E' ratio, carotid intima media thickness (cIMT), flow-mediated dilation (FMD) and global longitudinal strain (GLS).
At the time of enrolment, all the patients were on cART therapy. The viral load was suppressed in 95% of them. EF was normal in 94.2% of patients (66 ± 7.2%), and GLS (mean value: -20.0 ± 2.5%) was reduced in 29% of patients. The cIMT mean value was higher than the 95th centile for sex and age in 73%, and FMD was impaired in 45% of patients. Clinically evident disease was found in three patients: dilative cardiomyopathy in one, thoracic-abdominal aneurysm Crawford type II with a bilateral carotid dilation in one and carotid plaque with 30% of stenosis in a third patient.
This study confirms the presence of clinical and subclinical cardiovascular disease in a very young population vertically infected with HIV, underlining the importance of an early, multi-parametric cardiovascular follow up.
HIV感染和终身抗逆转录病毒治疗（cART）会导致心血管疾病风险增加。本研究的目的是通过一种创新的多参数方法，描述接受cART治疗的垂直感染HIV的青少年和年轻成人的亚临床心血管疾病，并确定心血管损伤的早期标志物。
我们纳入了52例垂直感染HIV的患者。在为期一年的常规随访中收集了人口统计学记录、传统心血管危险因素、实验室检查结果和超声心动图测量数据。超声心动图检查包括二维和三维射血分数（EF）、E/A比值、E/E'比值、颈动脉内膜中层厚度（cIMT）、血流介导的血管舒张（FMD）和整体纵向应变（GLS）的测量。
入组时，所有患者均接受cART治疗。其中95%的患者病毒载量得到抑制。94.2%的患者EF正常（66±7.2%），29%的患者GLS降低（平均值：-20.0±2.5%）。73%患者的cIMT平均值高于性别和年龄的第95百分位数，45%的患者FMD受损。三名患者出现了临床明显疾病：一名患者为扩张型心肌病，一名患者为克劳福德II型胸腹主动脉瘤伴双侧颈动脉扩张，第三名患者为颈动脉斑块伴30%狭窄。
本研究证实了垂直感染HIV的非常年轻人群中存在临床和亚临床心血管疾病，强调了早期多参数心血管随访的重要性。
