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Three CVD Markers High in 347 Young Adults With HIV in Thailand
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AIDS 2024, July 22-26, 2024, Munich
Mark Mascolini
Half of 347 perinatally infected 18- to 25-years-olds in Thailand had risky levels of high-sensitivity C-reactive protein (hsCRP), a much-studied predictor of cardiovascular disease (CVD) [1]. Median levels of two other CVD markers, interleukin 18 (IL-18) and sCD163, also ran high in this population almost evenly divided between women and men.
Detecting cardiovascular dysfunction at an early age has proved difficult in people with HIV infection, noted Linda Aurpibul and colleagues from Chiang Mai University and other centers in Thailand, although some work saw higher intima-media thickness [2], low ejection fraction, and fractional shortening in adolescents taking antiretroviral therapy (ART). Other research has tied higher levels of proinflammatory cytokines to greater cardiovascular morbidity and mortality across a wide range of ages in people with HIV.
Aurpibul and colleagues focused on three biomarkers in a cohort of young adults with HIV: hsCRP (which reflects systemic inflammation), sCD163 (a marker of innate immune activation), and IL-18 (a gauge of microbial translocation). From November 2020 to July 2021, their cross-sectional study enrolled 18- to 25-year-olds taking ART in 1 of 5 clinics in Bangkok, Chiang Mai, and Khon Kaen. They defined an hsCRP from 1.0 to less than 3.0 as intermediate risk of CVD and 3.0 or higher as high risk, and they defined metabolic syndrome according to the US National Cholesterol Education Program Adult Treatment Panel III [3].
The 347 study participants included 187 females (54%) and had a median age of 21.8 years and a median 16.7 years of antiretroviral therapy ART. Median current CD4 count stood at 564, and 19% of participants had a current viral load above 1000 copies. Twenty-seven people (7.8%) had metabolic syndrome, and 238 (69%) already had one or more noncommunicable disease risks (including abnormal lipids, obesity, and hypertension).
Median hsCRP stood at 1.04 mg/L (interquartile range [IQR] 0.41 to 3.22), with 88 people (25%) at intermediate risk of CVD and 89 (26%) at high risk (defined two paragraphs above). Young adults without viral suppression (viral load below 1000 copies) had significantly higher hsCRP than those with viral suppression (2.0 vs 0.8 mg/L, P = 0.001). Participants with versus without metabolic syndrome had significantly higher hsCRP (2.7 vs 1.0 mg/L, P = 0.008).
Investigators recorded a median IL-18 level of 82.4 pg/mL (IQR 33.8 to 151.9). Medians proved higher in males (111.2 vs 62.9 pg/mL, P < 0.001) and people with a CD4 count below 500 (111.2 vs 62.9 pg/mL, P = 0.002) or a viral load above 1000 copies (129.1 vs 74.0 pg/mL, P = 0.003). IL-18 levels did not differ significantly between young adults with versus without metabolic syndrome.
Median sCD163 stood at 53.6 ng/mL (IQR 31.1 to 90.1). sCD163 levels stood higher in people with a CD4 count below 500 (64.2 vs 45.9 ng/mL, P = 0.004) or a viral load above 1000 copies (71.8 vs 46.4 ng/mL, P < 0.001). Mood's median nonparametric test disclosed a trend toward higher median sCD163 in people with metabolic syndrome (61.5 vs 52.5 ng/mL, P = 0.07).
Aurpibul and colleagues noted that IL-18 strongly predicts cardiovascular death in adults with coronary artery disease and that sCD163 independently predicts cardiovascular and all-cause death in adults. Their study of 18- to 25-year-old adults with perinatally acquired HIV tied a viral load above 1000 copies to higher hsCRP, IL-18, and sCD163, findings that underline the importance of tight viral control in this group. But they emphasized that measuring biomarkers once in a relatively small group does not support interpretation of their clinical significance.
References
1. Aurpibul L, Lumbiganon P, Ounchanum P, et al. Increased biomarkers of cardiovascular disease in a long-term survivor cohort of young adults living with perinatal HIV with virologic non-suppression or metabolic syndrome. AIDS 2024, July 22-26, 2024, Munich. Abstract OAB2104.
2. Ross AC, Storer N, O'Riordan MA, Dogra V, McComsey GA. Longitudinal changes in carotid intima-media thickness and cardiovascular risk factors in human immunodeficiency virus-infected children and young adults compared with healthy controls. Pediatr Infect Dis J. 2010;29:634-8. doi: 10.1097/inf.0b013e3181d770c4. https://pubmed.ncbi.nlm.nih.gov/20589981/
3. Morantz C, Torrey B. Practice guideline briefs. American Family Physician. "Waist circumference of more than 102 cm (40 in) in men and more than 88 cm (35 in) in women; triglyceride levels of at least 150 mg per dL (1.70 mmol per L); high-density lipoprotein cholesterol levels of less than 40 mg per dL (1.04 mmol per L) in men and less than 50 mg per dL (1.30 mmol per L) in women; blood pressure of at least 130/85 mm Hg; and fasting glucose levels of at least 110 mg per dL (6.10 mmol per L)." https://www.aafp.org/pubs/afp/issues/2005/0101/p193.html
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