Rainbow Babies and Children's Hospital.
Case Western Reserve University, Cleveland.
Curr Opin HIV AIDS. 2022 Sep 1;17(5):286-292. doi: 10.1097/COH.0000000000000755. Epub 2022 Jul 5.
HIV and antiretroviral therapy (ART) use are linked to an increased incidence of atherosclerotic cardiovascular disease (ASCVD). Immune activation persists in ART-treated people with HIV (PWH), and markers of inflammation (i.e. IL-6, C-reactive protein) predict mortality in this population. This review discusses underlying mechanisms that likely contribute to inflammation and the development of ASCVD in PWH.
Persistent inflammation contributes to accelerated ASCVD in HIV and several new insights into the underlying immunologic mechanisms of chronic inflammation in PWH have been made (e.g. clonal haematopoiesis, trained immunity, lipidomics). We will also highlight potential pro-inflammatory mechanisms that may differ in vulnerable populations, including women, minorities and children.
Mechanistic studies into the drivers of chronic inflammation in PWH are ongoing and may aid in tailoring effective therapeutic strategies that can reduce ASCVD risk in this population. Focus should also include factors that lead to persistent disparities in HIV care and comorbidities, including sex as a biological factor and social determinants of health. It remains unclear whether ASCVD progression in HIV is driven by unique mediators (HIV itself, ART, immunodeficiency), or if it is an accelerated version of disease progression seen in the general population.
HIV 和抗逆转录病毒疗法（ART）的使用与动脉粥样硬化性心血管疾病（ASCVD）的发病率增加有关。在接受 ART 治疗的 HIV 感染者（PWH）中，免疫激活持续存在，并且炎症标志物（即 IL-6、C 反应蛋白）可预测该人群的死亡率。这篇综述讨论了可能导致 PWH 炎症和 ASCVD 发展的潜在机制。
持续的炎症导致 HIV 患者的 ASCVD 加速，并且对 PWH 慢性炎症的潜在免疫机制有了一些新的认识（例如，克隆性造血、训练性免疫、脂质组学）。我们还将强调可能在脆弱人群中存在不同的促炎机制，包括女性、少数族裔和儿童。
正在进行针对 PWH 慢性炎症驱动因素的机制研究，这可能有助于制定有效的治疗策略，降低该人群的 ASCVD 风险。重点还应包括导致 HIV 护理和合并症持续存在差异的因素，包括作为生物学因素的性别和健康的社会决定因素。HIV 本身、ART、免疫缺陷是否会导致 HIV 患者 ASCVD 进展，或者这是否是一般人群中疾病进展的加速版本，目前仍不清楚。
