Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
Division of Biostatistics and Bioinformatics, School of Public Health, University of California, San Diego, California, USA.
AIDS. 2023 Jun 1;37(7):1115-1123. doi: 10.1097/QAD.0000000000003525. Epub 2023 Feb 16.
HIV is associated with accelerated cardiovascular disease, due to HIV-associated metabolic abnormalities, antiretroviral therapy (ART), and HIV itself. Carotid-femoral pulse wave velocity (PWV) is the noninvasive gold standard measurement of arterial stiffness, and associated with incident vascular events in adults. It is unclear if arterial stiffness is accelerated in children living with perinatal HIV (CHIV) who initiate ART early in life. We compared the longitudinal trajectory of PWV in CHIV to children unexposed to HIV. A secondary comparison compared HIV exposed uninfected children (CHEU) to unexposed children.
Four hundred and sixty-five children (141 CHIV, 160 CHEU, 164 unexposed) previously in the children with HIV early antiretroviral therapy (ART) (CHER) and P1060 trials were followed annually at Tygerberg Children's Hospital, South Africa between 2014 and 2020. CHIV initiated ART in infancy or early childhood, with excellent ART adherence and largely sustained viral suppression. The primary outcome was PWV, measured using the Vicorder system, and evaluated using linear mixed effects models.
Median (interquartile range) age at first PWV measurement was 8.64 (7.7-9.1) years, and median follow-up time 2.9 (1.6-4.0) years. Adjusted analyses showed no significant mean difference in PWV in CHIV and CHEU compared to unexposed [CHIV: 0.101 m/s, 95% confidence interval (CI) -0.012 to 0.214; CHEU: 0.068 m/s, 95% CI -0.047 to 0.183], after adjusting for gender, age, ethnicity, mean arterial pressure, resting average heart rate and family history of cardiovascular disease.
Early-treated CHIV with sustained viral suppression have similar PWV to unexposed children. Excellent adherence and early ART initiation may protect against cardiovascular disease.
HIV 与心血管疾病的加速发生有关，这归因于 HIV 相关的代谢异常、抗逆转录病毒治疗（ART）以及 HIV 本身。颈动脉-股动脉脉搏波速度（PWV）是动脉僵硬度的非侵入性金标准测量方法，与成年人的血管事件发生有关。目前尚不清楚在生命早期开始接受 ART 的围生期 HIV 感染儿童（CHIV）中，动脉僵硬度是否会加速。我们比较了 CHIV 与未感染 HIV 的儿童的 PWV 纵向轨迹。次要比较将 HIV 暴露未感染儿童（CHEU）与未暴露儿童进行比较。
465 名儿童（141 名 CHIV、160 名 CHEU、164 名未暴露）之前参加过儿童 HIV 早期抗逆转录病毒治疗（ART）（CHER）和 P1060 试验，于 2014 年至 2020 年期间在南非泰格伯格儿童医院每年进行一次随访。CHIV 在婴儿期或幼儿期开始接受 ART，ART 依从性极好，并且病毒得到了很大程度的持续抑制。主要结局指标是使用 Vicorder 系统测量的 PWV，并使用线性混合效应模型进行评估。
首次 PWV 测量的中位（四分位间距）年龄为 8.64（7.7-9.1）岁，中位随访时间为 2.9（1.6-4.0）年。调整分析显示，与未暴露组相比，CHIV 和 CHEU 的 PWV 平均差异无统计学意义[CHIV：0.101 m/s，95%置信区间（CI）-0.012 至 0.214；CHEU：0.068 m/s，95%CI-0.047 至 0.183]，在调整性别、年龄、种族、平均动脉压、静息平均心率和心血管疾病家族史后。
具有持续病毒抑制的早期治疗 CHIV 的 PWV 与未暴露儿童相似。极好的依从性和早期开始 ART 可能有助于预防心血管疾病。
