Endothelial dysfunction similar in ARV-experienced and -naive patients
Graham McKerrow, HIV i-Base
A Spanish study of 61 HIV-positive men on ARV therapy found endothelial dysfunction (ED) in 18%, a similar proportion to naive patients. Its presence was independent of fat redistribution abnormalities, plasma adipokines, lipoproteins, immune status or use of PIs or NNRTIs.
Low adiponectin (AD) plasma levels are observed in patients on treatment with fat redistribution abnormalities (FRA) and low levels of adiponectin have been associated with impaired vasoreactivity in the general population. Previous studies found a significant relationship between use of PIs and endothelial dysfunction.
Estrada and colleagues in Madrid analysed the relationships between plasma AD, FRA, and endothelial function as measured by high-resolution ultrasound. Of the 61 ART-experienced people studied, 44.2% presented with FRA, most of them with lipoatrophy.
Mean flow-mediated vasodilation (FMD) of patients on ARV treatment was 11.6% (IC 95%, 8.3-14.9) similar to control group, 11.7% (IC 95%, 7.4-16), p=NS. The proportion of patients who presented ED was similar between treated 11/61 (18%) and naïve groups 6/17 (35,3%) p=ns. There was a significant correlation between FMD and vasodilator response to nitrates (r=0,48, p=0,001). Plasma adiponectin, leptin, lipoproteins, insulin, CD4 lymphocyte count, HIV-1 viral load, did not correlate with FMD. Presence of fat distribution changes did not influence FMD values. Patients on PI or NNRTI showed similar FMD values. In multivariate linear regression analyses, only basal artery diameter significantly contributed to FMD.
Estrada V, Zamorano JL, Sainz T et al. Endothelial dysfunction, adiponectin plasma levels and lipodystrophy in patients on antiretroviral therapy. 6th Lipodystrophy Workshop (6th IWADRLH), Washington, 2004. Abstract 117. Antiviral Therapy 2004; 9:L66.