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Inflammatory Markers Correlate with Carotid Intima-Media Thickness and Endothelial Activation in HIV-infected Patients
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Reported by Jules Levin
15th CROI, Feb 3-6, 2008, Boston
Allison C. Ross, MD1,3, Nesrine Rizk, MD2,3, Mary Ann O'Riordan, MS1,3, Jerome Adell2, BS, Norma Storer, RN1,3,
Marisa Tungsiripat, MD4,Vikram Dogra, MD5, Danielle Harrill1,3, Dean Nakamoto, MD2,3, and Grace A. McComsey, MD1,3
1Rainbow Babies and Children's Hospital, 2University Hospitals Case Medical Center, 3Case Western Reserve University, Cleveland, OH;
4Cleveland Clinic Foundation, Cleveland, OH; 5University of Rochester, Rochester, NY
This poster study should be read along with the sister study by the same group.
AUTHOR CONCLUSIONS
· Carotid IMT is higher in HIV+ vs. uninfected healthy controls (84% of HIV+ had <400 c/ml, see table below)
· Endothelial activation and inflammation are enhanced in HIV+ patients
· Inflammatory markers correlated with the endothelial activation marker, sVCAM-1
· Support further investigations into the role of inflammation in endothelial dysfunction and CVD in HIV
BACKGROUND
HIV+ patients are at increased risk of cardiovascular disease (CVD). Carotid intima-media thickness (IMT) is an established marker for subclinical atherosclerosis and is increased in HIV+ pts. Chronic inflammation and endothelial dysfunction may play a key role in the development of CVD, but little data exists in this population.
OBJECTIVES
· To assess carotid IMT, inflammatory and endothelial activation biomarkers in HIV+ vs. HIV-
· To correlate inflammatory and endothelial activation biomarkers to carotid IMT in HIV+ vs. HIV-
Patient Characteristics
[[Median (Range)] Unless Stated Otherwise.
HIV+ were on HAART with 84% <400 c/ml. Triglycerides, glucose, and systolic/diastolic BP, and insulin were higher in HIV+ vs HIV- but total chol was the same, LDL was the same, HDL was lower in HIV+, and HIV+ smoked more currently or had a history of smoking more. BMI was greater in HIV+ and waist-to-hip ratio was greater in HIV+.
METHODS
Study design
· Prospective, single-site, observational cohort study of HIV+ patients and age- and sex-matched uninfected healthy controls
Inclusion Criteria
· ≥13 years of age and HIV+
Exclusion Criteria
· Known cardiovascular disease, diabetes, or current opportunistic infection or other acute inflammatory condition
Study Evaluations
· PE, BP, ht/wt, hip-to-waist ratio, past medical history
· Carotid ultrasound:
- Separately measured right and left common carotid artery (CCA) and internal carotid artery (ICA) intima-media thicknesses
· Blood sampling after ≥ 8 hours fasting
- Lipoprotein profile, glucose, insulin
- Inflammatory markers:
* Tumor necrosis factor-_ (TNF- _)
* Soluble tumor necrosis factor receptors I & II (sTNFR-I, II)
* Interleukin-6 (IL-6)
* High sensitivity C-reactive protein (hsCRP)
- Endothelial activation markers:
* vonWillebrand's factor (vWF)
* Soluble intercellular adhesion molecule-1 (sICAM-1)
* Soluble vascular cell adhesion molecule-1 (sVCAM-1)
- Established cardiovascular marker:
* Myeloperoxidase (MPO)
Data analysis
· Group comparison done using distributionally appropriate two-sample tests
· Correlations done using Spearman correlation coefficients
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