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Peripheral Endothelial Function is Reduced after Initiation of Antiretroviral Therapy in Treatment Naïve HIV Patients: A Prospective Longitudinal Study
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Reported by Jules Levin
ICAAC Sept 11-15 2009 San Francisco
Ulrik Sloth Kristoffersen1,2, Anne-Mette Lebech3, Niels Wiinberg4, Jan Gerstoft5, Claus Leth Petersen4, Andreas Kjaer1,2 1 Dept. of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Denmark, 2Cluster for Molecular Imaging, University of Copenhagen, Denmark 3 Dept. of Infectious Diseases, Hvidovre University Hospital, Denmark, 4Dept. of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark, 5 Dept. of Clinical Physiology and Nuclear Medicine, Frederiksberg University Hospital, Denmark
Ulrik Sloth Kristoffersen, MD Department of Clinical Physiology,
Nuclear Medicine & PET
Rigshospitalet KF-4011,
Blegdamsvej 9
Dk-2100 Copenhagen
P 3545 8460
F 3532 7546
E ulriksk@mfi.ku.dk
Author Conclusions
FMD decreases one month after initiation of ART in treatment naïve HIV patients. This indicates that ART initiation leads to endothelial dysfunction which could be a mechanism involved in the increased risk of CVD found in recent observational studies.
Background
Recent observational studies have found antiretroviral therapy (ART) to be associated with increased risk of myocardial infarction in HIV patients.
However,
a causal link between initiation of ART and cardiovascular disease still remains to be discovered. The aim of the present study was, in a prospective design, to investigate if peripheral vasomotor function changed in treatment naïve HIV
patients when ART was initiated.
Methods
Peripheral vasomotor function was assessed by determination of flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) of the brachial artery using a high-resolution ultrasound-Doppler- system. Nine treatment naïve male HIV patients were examined before and one month after initiation of ART. Scans of the brachial artery were recorded at baseline rest and during the increased blood-flow achieved by creating reactive hyperemia in the artery. The reactive hyperemia was induced by inflating a cuff placed around the forearm and deflating it again after 4.5 minutes. This induces endothelial dependent vasodilation and FMD was calculated as the percentage increase from baseline in mean diameter of the brachial artery during reactive hyperemia. NMD (endothelial independent vasodilation) was calculated as the percentage increase from baseline in mean diameter of the brachial artery four minutes after sublingual administration of 400 µg nitroglycerin. A paired t-test was used to test for significance between time points.
Results
Seven patients initiated an ART combination of tenofovir, emtricitabine (FTC), and efavirenz, one patient initiated a combination of abacavir, lamivudine
(3TC), and efavirenz, and one patient initiated a combination of zidovudine, lamivudine (3TC), and efavirenz. Background parameters are presented in Table 1, lipid changes are presented in Table 2, and HIV parameters are presented in
Table 3. One month after initiation of ART, FMD (Figure 1) decreased from 8.7±1.7% to 4.6±0.9% (p=0.027). Six months after initiation of ART (N=7), FMD was still decreased at 5.1±0.8%; however this was only borderline significantly different from before ART initiation (p=0.064). No change was observed in NMD (Figure 2) after one month (12.8±1.0% to 14.3±1.4%; p=0.2, NS) or after six months (14.6±2.8%; p=0.6, NS; N=7).
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