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Impact of human immunodeficiency virus infection on arterial stiffness and wave reflections in the early disease stages

Abstract

Background

Human immunodeficiency virus (HIV) infection is associated with subclinical inflammation and increased cardiovascular risk. Arterial stiffness and enhanced wave reflections are markers of cardiovascular disease and independent predictors of cardiovascular risk. The effect of HIV infection, per se, on aortic stiffness and wave reflections has not been clearly defined.

Methods

We studied 51 adults with a recent HIV infection, free of antiretroviral treatment and AIDS diagnosis, as well as 35 controls matched for age, sex and smoking status. Carotid-femoral pulse wave velocity (PWV) and timing of the reflected wave (Tr) were measured as indices of aortic stiffness, while aortic augmentation index (AIx) and augmented pressure (AP) were measured as indices of wave reflections.

Results

While PWV was similar in the two populations, Tr was significantly lower in HIV-infected subjects compared to controls (by 16.5 ms, p = 0.002). In addition, AIx and AP were decreased (by 6.4%, p = 0.048 and by 3.3 mmHg, p = 0.010, respectively) in subjects with HIV infection. Moreover, HIV-infected patients compared with controls had increased values of hs-CRP [1.37 (0.85–2.53) vs. 0.75 (0.41–1.90) mg/l, p = 0.007] and interleukin-6 [1.90 (0.91–3.9) vs. 1.28 (0.80–2.65) pg/ml, p = 0.048]. Tr was negatively correlated with hs-CRP (r = −0.283, p = 0.010) and interleukin-6 (r = −0.278, p = 0.018).

Conclusions

Our study provides evidence of decreased wave reflections and similar aortic stiffness, as assessed by PWV, in the early stages of HIV infection in treatment-naive patients compared to controls. Subclinical inflammation and resultant peripheral vasodilatation constitute potential mediators of the whole pathophysiological process.

References

  1. Friis-Møller N, Sabin CA, Weber R, d’Arminio Monforte A, El-Sadr WM, Reiss P, et al. N Engl J Med. Combination antiretroviral therapy and the risk of myocardial infarction [published correction appears in N Engl J Med 2004;350: 955]. Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group 2003;349:1993–2003.

    Google Scholar 

  2. Currier JS, Taylor A, Boyd F, Dezii CM, Kawabata H, Burtcel F, et al. Coronary heart disease in HIV-infected individuals. J Acquir Immune Defic Syndr 2003;33:506–12.

    Google Scholar 

  3. Bozzette SA, Ake CF, Tam HK, Chang SW, Louis TA. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med 2003;348:702–10.

    Google Scholar 

  4. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. On behalf of the European Network for Non-invasive Investigation of Large Arteries. Abridged version of the expert consensus document on arterial stiffness. Artery Res 2007;1:2–12.

    Google Scholar 

  5. Schillaci G, De Socio GV, Pirro M, Savarese G, Mannarino MR, Baldelli F, et al. Impact of treatment with protease inhibitors on aortic stiffness in adult patients with human immunodeficiency virus infection. Arterioscler Thromb Vasc Biol 2005;25:2381–5.

    Google Scholar 

  6. Schillacci G, De Socio GV, Pucci G, Mannarino MR, Helou J, Pirro M, et al. Aortic stiffness in untreated adult patients with human immunodeficiency virus infection. Hypertension 2008; 52(2):308–13.

    Google Scholar 

  7. van Wijk JP, de Koning EJ, Cabezas MC, Joven J, op’t Roodt J, Rabelink TJ, et al. Functional and structural markers of atherosclerosis in human immunodeficiency virus-infected patients. J Am Coll Cardiol 2006;47(6):1117–23.

    Google Scholar 

  8. Boccara F, Simon T, Lacombe K, Cohen A, Laloux B, Bozec E, et al. Influence of pravastatin on carotid artery structure and function in dyslipidemic HIV-infected patients receiving antiretroviral therapy. AIDS 2006;20(18):2395–8.

    Google Scholar 

  9. Sevastianova K, Sutinen J, Westerbacka J, Ristola M, Yki-Jarvinen H. Arterial stiffness in HIV-infected patients receiving highly active antiretroviral therapy. Antivir Ther 2005;10:925–35.

    Google Scholar 

  10. Vlachopoulos C, Dima I, Aznaouridis K, Vasiliadou C, Ioakeimidis N, Aggeli C, et al. Acute systemic inflammation increases arterial stiffness and decreases wave reflections in healthy individuals. Circulation 2005;112:2193–200.

    Google Scholar 

  11. Vlachopoulos C, Pietri P, Aznaouridis K, Vyssoulis G, Vasiliadou C, Bratsas A, et al. Relationship of fibrinogen with arterial stiffness and wave reflections. J Hypertens 2007;10:2110–6.

    Google Scholar 

  12. Mattace-Raso FU, van der Cammen TJ, van der Meer IM, Schalekamp MA, Asmar R, Hofman A, et al. C-reactive protein and arterial stiffness in older adults: the Rotterdam Study. Atherosclerosis 2004;176(1):111–6.

    Google Scholar 

  13. Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 1992;41(RR-17):1–19.

  14. Vlachopoulos C, O’Rourke M. Genesis of the normal and abnormal arterial pulse. Curr Probl Cardiol 2000;25:297–368.

    Google Scholar 

  15. Raggi P, Bellasi A, Ferramosca E, Islam T, Muntner P, Block GA. Association of pulse wave velocity with vascular and valvular calcification in hemodialysis patients. Kidney Int 2007;71(8):802–7.

    Google Scholar 

  16. Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac AM, et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement: validation and clinical application studies. Hypertension 1995;26:485–90.

    Google Scholar 

  17. Agabiti-Rosei E, Mancia G, O’Rourke MF, Roman MJ, Safar ME, Smulyan H, et al. Central blood pressure measurements and antihypertensive therapy: a consensus document. Hypertension 2007;50(1):154–60.

    Google Scholar 

  18. Carr A, Grund B, Neuhaus J, El-Sadr WM, Grandits G, Gibert C, et al. The SMART Study Investigators. Asymptomatic myocardial ischaemia in HIV-infected adults. AIDS 2008;22:257–67.

    Google Scholar 

  19. Strategies for Management of Antiretroviral Therapy (SMART) Study Group. CD4 count-guided interruption of antiretroviral treatment. N Engl J Med 2006;355:2283–96.

  20. Bonnet D, Aggoun Y, Szezepanski I, Bellal N, Blanche S. Arterial stiffness and endothelial dysfunction in HIV-infected children. AIDS 2004;18:1037–41.

    Google Scholar 

  21. Stein JH, Klein MA, Bellehumeur JL, McBride PE, Wiebe DA, Otvos JD, et al. Use of human immunodeficiency virus-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction. Circulation 2001;104:257–62.

    Google Scholar 

  22. Riddler SA, Smit E, Cole SR, Chmiel JS, Dobs A, Palella F, et al. Impact of HIV infection and HAART on serum lipids in men. JAMA 2003;289:2978–82.

    Google Scholar 

  23. Booth AD, Wallace S, McEniery CM, Yasmin, Brown J, Jayne DR, Wilkinson IB. Inflammation and arterial stiffness in systemic vasculitis: a model of vascular inflammation. Arthritis Rheum 2004;50(2):581–8.

    Google Scholar 

  24. Mäki-Petäjä KM, Hall FC, Booth AD, Wallace SM, Yasmin, Bearcroft PW, et al. Rheumatoid arthritis is associated with increased aortic pulse-wave velocity, which is reduced by antitumor necrosis factor-alpha therapy. Circulation 2006; 114(11):1185–92.

    Google Scholar 

  25. de Gaetano Donati K, Rabagliati R, Iacoviello L, Cauda R. HIV infection, HAART and endothelial adhesion molecules. Lancet Infect Dis 2004;4:213–22.

    Google Scholar 

  26. Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF. Cardiovascular disease in HIV infection. Am Heart J 2006;151:1147–55.

    Google Scholar 

  27. Ren Z, Yao Q, Chen C. HIV-1 envelope glycoprotein 120 increases intercellular adhesion molecule-1 expression by human endothelial cells. Lab Invest 2002;82(3):245–55.

    Google Scholar 

  28. Saumoy M, López-Dupla M, Veloso S, Alonso-Villaverde C, Domingo P, Broch M, et al. The IL-6 system in HIV-1-infection and in HAART-related fat redistribution syndromes. AIDS 2008;22(7):893–6.

    Google Scholar 

  29. Clapp BR, Hirschfield GM, Storry C, Gallimore JR, Stidwill RP, Singer M, et al. Inflammation and endothelial function: direct vascular effects of human C-reactive protein on nitric oxide bioavailability. Circulation 2005;111:1530–6.

    Google Scholar 

  30. Lau B, Sharrett AR, Kingsley LA, Post W, Palella FJ, Visscher B, et al. C-reactive protein is a marker for human immunodeficiency virus disease progression. Arch Intern Med 2006;166:64–70.

    Google Scholar 

  31. Schiffrin EL. Vascular stiffening and arterial compliance. Implications for systolic blood pressure. Am J Hypertens 2004;17:39S–48S.

    Google Scholar 

  32. Eugenin EA, Morgello S, Klotman ME, Mosoian A, Lento PA, Berman JW, et al. Human Immunodeficiency Virus (HIV) infects human arterial smooth muscle cells in vivo and in vitro. Am J Pathol 2008;172:1100–11.

    Google Scholar 

  33. Pirro M, Schillaci G, Savarese G, Gemelli F, Vaudo G, Siepi D, et al. Low-grade systemic inflammation impairs arterial stiffness in newly diagnosed hypercholesterolemia. Eur J Clin Invest 2004;34:335–41.

    Google Scholar 

  34. Grunfeld C, Kotler DP, Arnett DK, Falutz JM, Haffner SM, Hruz P, et al. for Working Group 1. Contribution of metabolic and anthropometric abnormalities to cardiovascular disease risk factors. Circulation 2008;118(2):e20–8.

    Google Scholar 

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Correspondence to Charalambos Vlachopoulos.

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Vlachopoulos, C., Sambatakou, H., Tsiachris, D. et al. Impact of human immunodeficiency virus infection on arterial stiffness and wave reflections in the early disease stages. Artery Res 3, 104–110 (2009). https://doi.org/10.1016/j.artres.2009.08.001

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