人类免疫缺陷病毒（HIV）作为年轻成年人冠状动脉内皮功能风险调节因子的作用。

The role of HIV as a risk modifier for coronary endothelial function in young adults.

作者信息

Abd-Elmoniem Khaled Z, Yeramosu Teja, Purdy Julia B, Ouwerkerk Ronald, Matta Jatin R, Ishaq Hadjira, Hawkins Karyn, Curl Kara-Anne, Dee Nicola, Gharib Ahmed M, Hadigan Colleen

机构信息

Biomedical and Metabolic Imaging Branch National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA.

National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA.

出版信息

HIV Med. 2023 Jul;24(7):818-826. doi: 10.1111/hiv.13484. Epub 2023 Mar 30.

DOI:10.1111/hiv.13484

PMID:36997324

Abstract

BACKGROUND

People living with HIV have an increased risk of cardiovascular disease (CVD). Although coronary endothelial function (CEF) is an early direct indicator of CVD, only a few studies have been able to interrogate CEF directly. Most studies have examined vascular endothelial function through indirect assessment of brachial flow-mediated dilatation (FMD). However, peripheral arteries are significantly larger and manifest atherogenesis differently from the coronary arteries, and so produce conflicting results. Additionally, none of these studies focused on young adults who acquired HIV perinatally or in early childhood.

OBJECTIVE

The present study investigates CEF in a unique population of young adults with lifelong HIV using direct magnetic resonance imaging (MRI) of coronary FMD (corFMD) with an in-house developed MRI-integrated isometric handgrip exercise system with continuous feedback and monitoring mechanisms (fmIHE).

METHODS

Young adults who acquired HIV perinatally or in early childhood (n = 23) and group-matched healthy participants (n = 12) completed corFMD-MRI with fmIHE. CorFMD was measured as the coronary cross-sectional area response to the fmIHE.

RESULTS

In univariable and multivariable regression analysis, HIV status was a significant risk modifier. CD8+ T-cell count and smoking pack-years and their interaction with HIV status were independently associated with impaired coronary artery response to fmIHE. In people living with HIV, corFMD was significantly inversely correlated with CD8+ T-cells and smoking pack-years. In a multivariable regression analysis adjusted for age and body mass index, CD8+ T-cells and smoking and their interaction with HIV status remained significant independent predictors of coronary endothelial dysfunction.

DISCUSSION

In this unique population of young adults, HIV status was a significant risk modifier, and immune activation and smoking were associated with decreased CEF, directly measured from the coronary vascular response to fmIHE.

CONCLUSIONS

Management of CVD risk factors such as smoking and developing strategies that target immune activation in people living with HIV are warranted.

摘要

背景

人类免疫缺陷病毒（HIV）感染者患心血管疾病（CVD）的风险增加。尽管冠状动脉内皮功能（CEF）是CVD的早期直接指标，但仅有少数研究能够直接检测CEF。大多数研究通过间接评估肱动脉血流介导的血管舒张功能（FMD）来检测血管内皮功能。然而，外周动脉明显更粗大，其动脉粥样硬化的表现与冠状动脉不同，因此产生的结果相互矛盾。此外，这些研究均未关注围产期或儿童早期感染HIV的年轻成年人。

目的

本研究使用冠状动脉FMD（corFMD）的直接磁共振成像（MRI）以及内部开发的具有连续反馈和监测机制的MRI集成等长握力运动系统（fmIHE），对一群感染HIV且病程贯穿一生的独特年轻成年人的CEF进行研究。

方法

围产期或儿童早期感染HIV的年轻成年人（n = 23）以及年龄匹配的健康参与者（n = 12）完成了使用fmIHE的corFMD-MRI检查。CorFMD通过冠状动脉横截面积对fmIHE的反应来测量。

结果

在单变量和多变量回归分析中，HIV感染状态是一个显著的风险调节因素。CD8 + T细胞计数、吸烟包年数及其与HIV感染状态的相互作用与冠状动脉对fmIHE的反应受损独立相关。在HIV感染者中，corFMD与CD8 + T细胞和吸烟包年数显著负相关。在对年龄和体重指数进行校正的多变量回归分析中，CD8 + T细胞、吸烟及其与HIV感染状态的相互作用仍然是冠状动脉内皮功能障碍的显著独立预测因素。