Dobe Igor S, Mocumbi Ana O, Majid Noorjean, Ayele Birhanu, Browne Sara H, Innes Steve
Division Non-Communicable Diseases, Instituto Nacional de Saúde, Maputo, Mozambique.
Department of Internal Medicine, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.
South Afr J HIV Med. 2021 Oct 14;22(1):1282. doi: 10.4102/sajhivmed.v22i1.1282. eCollection 2021.
Cardiovascular disease is a major driver of morbidity and mortality in adults living with HIV. The drivers of cardiovascular disease in children living with perinatally acquired HIV (PHIV) with sustained HIV viral suppression are unclear.
We explored the contribution of HIV-specific risk factors to arterial stiffness independently of traditional risk factors (metabolic syndrome [MetS]) in prepubertal children with PHIV with sustained viral suppression in a low-income country in Africa.
For this cross-sectional analysis, arterial stiffness was assessed by pulse wave velocity -score (PWVz), measured using a Vicorder device. Metabolic syndrome components were measured. We retrospectively collected the antiretroviral therapy (ART) exposures, HIV stage, CD4 count and HIV viral load. A multivariate linear regression model was constructed for MetS components, retaining age and gender as obligatory variables. We then added HIV-related metrics to assess whether these had an independent or additive effect.
We studied 77 virally suppressed children with PHIV without evidence of cardiovascular disease (from medical history and physical examination). In the initial model, the PWVz was independently associated with each MetS component. The PWVz was higher in participants with proportionally greater visceral fat (waist/height ratio), elevated lipids (triglyceride/high-density lipoprotein ratio) and insulin resistance (log homeostatic model assessment [HOMA]). The addition of age at ART initiation increased the model value from 0.36 to 0.43. In the resulting model, younger age at ART initiation was independently associated with a better PWVz ( < 0.001).
Earlier ART initiation was independently associated with lower large artery stiffness. This effect was independent of the effect of elevated lipids, visceral fat and insulin resistance.
心血管疾病是成人艾滋病病毒感染者发病和死亡的主要原因。围产期感染艾滋病病毒（PHIV）且病毒得到持续抑制的儿童发生心血管疾病的原因尚不清楚。
在非洲一个低收入国家，我们探讨了艾滋病病毒特异性危险因素对处于青春期前且病毒得到持续抑制的PHIV儿童动脉僵硬度的影响，该影响独立于传统危险因素（代谢综合征[MetS]）。
对于这项横断面分析，使用Vicorder设备通过脉搏波速度评分（PWVz）评估动脉僵硬度。测量代谢综合征的各项指标。我们回顾性收集抗逆转录病毒疗法（ART）暴露情况、艾滋病病毒分期、CD4细胞计数和艾滋病病毒载量。针对代谢综合征各项指标构建多元线性回归模型，保留年龄和性别作为必需变量。然后加入与艾滋病病毒相关的指标，以评估这些指标是否具有独立或累加效应。
我们研究了77名病毒得到抑制且无心血管疾病证据（根据病史和体格检查）的PHIV儿童。在初始模型中，PWVz与代谢综合征的每个组成部分均独立相关。在内脏脂肪比例更高（腰高比）、血脂升高（甘油三酯/高密度脂蛋白比）和胰岛素抵抗（稳态模型评估[HOMA]对数）的参与者中，PWVz更高。加入开始接受ART治疗时的年龄后，模型值从0.36增加到0.43。在最终模型中，开始接受ART治疗时年龄较小与更好的PWVz独立相关（<0.001）。
更早开始接受ART治疗与较低的大动脉僵硬度独立相关。这种效应独立于血脂升高、内脏脂肪和胰岛素抵抗的影响。
