Department of Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, NG.
Department of Medicine, Renal Unit, Ibrahim Badamasi Babangida Specialist Hospital, Minna, NG.
Glob Heart. 2023 Oct 20;18(1):57. doi: 10.5334/gh.1264. eCollection 2023.
Endothelial dysfunction constitutes an early pathophysiological event in atherogenesis and cardiovascular disease. This study aimed to assess the prevalence, determinants, and degree of endothelial dysfunction in antiretroviral therapy (ART)-treated people living with HIV (PLWH) in northwestern Nigeria using brachial flow-mediated dilatation (FMD).
This was a comparative, cross-sectional study. A total of 200 ART-treated adults living with HIV with no evidence of kidney disease were compared with 200 HIV-negative participants attending a tertiary hospital in Kano, Nigeria, between September 2020 and May 2021. Endothelial function was evaluated by measuring FMD with a high-resolution vascular ultrasound transducer. FMD was calculated as the ratio of the brachial artery diameter after reactive hyperemia to baseline diameter and expressed as a percentage of change. Blood and urine samples were obtained from participants in both arms. Urine albumin-to-creatinine ratio (uACR) was calculated using the 2021 CKD-EPI estimated glomerular filtration rate (eGFR) creatinine-cystatin C equation without the race variable, and low-density lipoprotein (LDL) cholesterol was measured using enzymatic method.
The overall mean age (± standard deviation) of the study participants was 42 ± 11 years. Participants in the comparison arm were younger than PLWH (38 ± 11 versus 46 ± 10 years, respectively). The median (interquartile range) uACR was 41.6 (23.2-162.9) mg/g for the ART-treated PLWH versus 14.5 (7.4-27.0) mg/g for healthy controls. PLWH had a significantly lower mean percent FMD when compared to HIV-negative participants (9.8% ± 5.4 versus 12.1% ± 9.2, respectively). Reduced FMD was independently associated with HIV infection (β = -2.83%, 95% CI, -4.44% to -1.21%, = 0.001), estimated glomerular filtration rate (β = -0.04%, 95% CI, -0.07% to -0.01%, = 0.004) and LDL cholesterol (β = -1.12%, 95% CI, -2.13% to -0.11%, = 0.029).
HIV-positive status, lower estimated GFR, and higher LDL cholesterol levels were independently associated with endothelial dysfunction. Future prospective studies with larger cohorts of persons living with HIV (and age- and sex-matched HIV-negative controls) are needed to gain further insight into these important findings. In the interim, aggressive management of modifiable risk factors is warranted.
内皮功能障碍构成了动脉粥样硬化和心血管疾病发病的早期病理生理事件。本研究旨在使用肱动脉血流介导的舒张（FMD）评估尼日利亚西北部接受抗逆转录病毒疗法（ART）的艾滋病毒感染者（PLWH）中内皮功能障碍的患病率、决定因素和程度。
这是一项比较性的横断面研究。共纳入 200 名接受 ART 治疗且无肾脏疾病证据的 HIV 感染者，与 2020 年 9 月至 2021 年 5 月在尼日利亚卡诺的一家三级医院接受治疗的 200 名 HIV 阴性参与者进行比较。使用高分辨率血管超声换能器测量 FMD 来评估内皮功能。FMD 通过计算反应性充血后肱动脉直径与基线直径的比值，并以百分比变化表示。两组参与者均采集血液和尿液样本。使用 2021 年 CKD-EPI 估算的肾小球滤过率（eGFR）肌酐胱抑素 C 方程（不使用种族变量）计算尿白蛋白与肌酐比值（uACR），并使用酶法测量低密度脂蛋白（LDL）胆固醇。
研究参与者的总体平均年龄（±标准差）为 42 ± 11 岁。与 PLWH 相比，对照组参与者更年轻（38 ± 11 岁与 46 ± 10 岁）。接受 ART 治疗的 PLWH 的中位数（四分位距）uACR 为 41.6（23.2-162.9）mg/g，而健康对照组为 14.5（7.4-27.0）mg/g。与 HIV 阴性参与者相比，PLWH 的平均 FMD 百分比明显较低（9.8%±5.4%与 12.1%±9.2%，分别）。FMD 降低与 HIV 感染独立相关（β=-2.83%，95%CI，-4.44%至-1.21%， =0.001）、估算肾小球滤过率（β=-0.04%，95%CI，-0.07%至-0.01%， =0.004）和 LDL 胆固醇（β=-1.12%，95%CI，-2.13%至-0.11%， =0.029）。
HIV 阳性状态、较低的估算肾小球滤过率和较高的 LDL 胆固醇水平与内皮功能障碍独立相关。需要对更多的 HIV 感染者（以及年龄和性别匹配的 HIV 阴性对照者）进行前瞻性研究，以进一步深入了解这些重要发现。在此期间，需要积极管理可改变的危险因素。
