Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.
Clin Infect Dis. 2023 Feb 8;76(3):e599-e606. doi: 10.1093/cid/ciac686.
Prospective investigations on the risk of cardiovascular disease among youth with perinatally acquired human immunodeficiency virus (PHIV) in sub-Saharan Africa are lacking.
A prospective observational cohort study was performed in 101 youth (aged 10-18 years) with PHIV and 97 who were human immunodeficiency virus (HIV) uninfected (HIV-), from 2017 to 2021 at the Joint Clinical Research Center in Uganda. Participants with PHIV were receiving antiretroviral therapy (ART) and had HIV-1 RNA levels ≤400 copies/mL. The common carotid artery intima-media thickness (IMT) and pulse wave velocity (PWV) were evaluated at baseline and at 96 weeks. Groups were compared using unpaired t-test, and potential predictors of IMT and PWV were assessed using quantile regression.
Of the 198 participants recruited at baseline, 168 (89 with PHIV, 79 HIV-) had measurements at 96 weeks. The median age (interquartile range) age was 13 (11-15) years; 52% were female, and 85% had viral loads <50 copies/mL that remained undetectable at week 96. The baseline mean common carotid artery IMT was slightly higher in participants with PHIV compared with controls (P < .01), and PWV did not differ between groups (P = .08). At week 96, IMT decreased and PWV increased in the PHIV group (P ≤ .03); IMT increased in the HIV- group (P = .03), with no change in PWV (P = .92). In longitudinal analyses in those with PHIV, longer ART duration was associated with lower PWV (β = .008 [95% confidence interval, -.008 to .003]), and abacavir use with greater IMT (β = .043 [.012-.074]).
In healthy Ugandan youth with PHIV, virally suppressed by ART, the common carotid artery IMT did not progress over 2 years. Prolonged and early ART may prevent progression of subclinical vascular disease, while prolonged use of abacavir may increase it.
在撒哈拉以南非洲，针对围产期感染人类免疫缺陷病毒（PHIV）的青年人群罹患心血管疾病风险的前瞻性研究较为缺乏。
这是一项于 2017 年至 2021 年在乌干达联合临床研究中心进行的前瞻性观察队列研究，共纳入了 101 名 PHIV 感染者（年龄 10-18 岁）和 97 名未感染 HIV（HIV-）的对照者。PHIV 感染者正在接受抗逆转录病毒治疗（ART），且 HIV-1 RNA 水平≤400 拷贝/mL。在基线和 96 周时，评估参与者的颈总动脉内膜中层厚度（IMT）和脉搏波速度（PWV）。使用未配对 t 检验比较两组间的差异，使用分位数回归评估 IMT 和 PWV 的潜在预测因素。
在基线时纳入的 198 名参与者中，有 168 名（85 名 PHIV 感染者，83 名 HIV- 感染者）在 96 周时完成了所有评估。中位年龄（四分位间距）为 13（11-15）岁，52%为女性，85%的参与者在第 96 周时病毒载量<50 拷贝/mL，且持续不可检测。与对照组相比，PHIV 感染者的基线颈总动脉 IMT 稍高（P<0.01），但两组间 PWV 无差异（P=0.08）。在 PHIV 组中，第 96 周时 IMT 降低，PWV 升高（P≤0.03）；而 HIV-组 IMT 升高（P=0.03），PWV 无变化（P=0.92）。在 PHIV 感染者的纵向分析中，ART 持续时间较长与较低的 PWV 相关（β=-0.008[95%置信区间，-0.008 至 -0.003]），而使用阿巴卡韦与较高的 IMT 相关（β=0.043[0.012-0.074]）。
在乌干达接受 ART 抑制病毒的 PHIV 感染的健康青年中，2 年内颈总动脉 IMT 无进展。长期和早期的 ART 可能预防亚临床血管疾病的进展，而长期使用阿巴卡韦可能会增加其发生风险。
