HIV and atherosclerosis: Heterogeneity of studies results

Cristina Giannattasio; Alessandro Maloberti; Andrea Gori

doi:10.1016/j.artres.2013.02.001

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Volume 7, Issue 2, June 2013, Pages 81 - 83

HIV and atherosclerosis: Heterogeneity of studies results

Authors

Cristina Giannattasio^{, *}, Alessandro Maloberti, Andrea Gori

Cardiology IV Unit, Niguarda Ca Granda Hospital and Milano-Bicocca University, Piazza Ospedale Maggiore 3, 20162 Milano, Italy

Internal Medicina Department, San Gerardo Hospital, Monza, Italy E-mail address:a.maloberti@campus.unimib.it

Infectious Disease Department, San Gerardo Hospital, Monza, Italy E-mail address:andrea.gori@unimib.it

^*Corresponding author. Tel.: +39 02 64 44 21 41; fax: +39 02 64 44 25 66. E-mail address: cristina.giannattasio@unimib.it (C. Giannattasio)

Corresponding Author

Cristina Giannattasio

Received 6 June 2012, Available Online 8 April 2013.

DOI: 10.1016/j.artres.2013.02.001 How to use a DOI?
Copyright: © 2013 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.
Open Access: This is an open access article distributed under the CC BY-NC license.

Dear Editor,

We appreciated the article by Palios and colleagues published on your journal.¹ One notable point of the article is the detailed review of cardiovascular disease in HIV-infected subjects. While a certain degree of selection is necessary for such a kind of papers, we noticed some incompleteness on cited data on carotid atherosclerosis.

In recent years a large number of paper had focused on Intima-Media-Thickness (IMT) in HIV-positive subjects. Taking into consideration only studies of comparison with the general population, and among these, only the studies with at least 50 subjects enrolled (supposed as the minimum number needed to make a good IMT comparison study) results are not homogeneous. Some studies found an higher IMT value in HIV than in controls (and they were partially listed by Palios)^2–9 while others found the opposite result.^10–12

One possible explanation of this difference is the heterogeneity in subjects selection between studies. Some studies have enrolled subjects treated with antiretroviral,^3,5,7,11 while others enrol only never treated subjects.¹⁰ Some researcher excludes subjects with cardiovascular disease³ while others do not.^4,7

Methodological difference in acquisition of IMT is a second possible explanation of the not homogeneous results. Some protocols acquire IMT on several carotid artery (CA) segment (common, bulb and internal) and use both proximal and far wall.^2–4 Instead others measure IMT only at the far wall of the common CA.^5–12

It is possible that these methodological differences alone, or together with the difference in inclusion criteria, lead to the different results obtained. As it is shown in Table 1, when measurements are acquired in different CA segments, results are in favour of a broader difference in IMT (more than 0.1 mm) between HIV+ and controls.^2–4 On the contrary, this difference is less broad (less than 0.1 mm)^5–9 or it does not appear at all^10–12 when only common CA is considered.

Reference	Number of patients	IMT measurement methods	IMT value
Studies with a broad (more than 0.1 MM) IMT difference
Hsue PY,² Circulation 2004.	148 HIV+ (A) 63 controls (B).	Near and far wall of the common, bulb and internal carotid artery.	0.91 (A) and 0.74 (B).
Hsue PY,³ AIDS 2006.	93 HIV+ on ART (A) 37 controls (B).	Near and far wall of the common, bulb and internal carotid artery.	0.95 (A) and 0.68 (B).
Ross AC,⁴ Clin Infect Dis 2009.	73 HIV+ (A) 21 controls (B).	Near and far wall of the common, bulb and internal carotid artery.	1.25 (A) and 1.05 (B).
Studies with a less broad (less than 0.1 MM) IMT difference
Papita A,⁵ Med Ultrason 2011.	65 HIV+ on ART (A) 36 controls (B).	Far wall of the common carotid.	0.6 (A) and 0.51 (B).
Charakida M,⁶ Circulation 2005.	83 HIV+ (A) 59 controls (B).	Far wall of the common carotid.	0.6 (A) and 0.5 (B).
Johnsen S,⁷ J Clin Endocrinol Metab 2006.	44 HIV+ on ART on PI (A) 40 HIV+ on ART not on PI (B) 86 controls (C).	Far wall of the common carotid.	0.65 (A), 0.61 (B) and 0.61 (C).
Lorenz MW,⁸ Atherosclerosis 2008.	292 HIV+ (A) 1168 controls (B).	Far wall of the common carotid.	0.74 (A) and 0.72 (B).
Giuliano Ide C,⁹ Coron Artery Dis 2008.	83 HIV+ (A) 83 controls (B).	Far wall of the common carotid.	0.48 (A) and 0.42 (B).
Studies with no difference in IMT measurements
Bongiovanni M,¹⁰ J Antimicrob Chemother 2008.	53 HIV+ naive (A) 133 HIV+ on ART (B) 54 controls (C).	Far wall of the common carotid.	0.58 (A), 0.64 (B) and 0.65 (C).
Currier JS,¹¹ AIDS 2005.	44 HIV+ on ART on PI (A) 44 HIV+ on ART not on PI (B) 44 controls (C).	Far wall of the common carotid.	0.69 (A), 0.71(B) and 0.69 (C).
Kaplan RC,¹² AIDS 2008.	Women: 1231 HIV+ (A) 496 controls (B) Men: 600 HIV+ (C) 325 controls (D).	Far wall of the common carotid.	0.72 (A), 0.71 (B), 0.75 (C) and 0.77 (D).

IMT = Intima Media Thickness.

Table 1

Results of the principal IMT comparison studies on HIV-positive subjects.

Notable Grunfeld et al.¹³ measure IMT both in internal and in common CA. In the internal CA they found an higher value in HIV+ in comparison with controls, while data on common CA were similar in the two groups. It has to be noticed that in general population IMT has a higher reproducibility when acquired in the common CA.^14,15

The inhomogeneity of data published extends also to endothelial function. Some studies show an impairment in Flow Mediated Dilation^16–19 and others do not.^20–22 When specific antiretroviral drugs were considered old generation protease inhibitors (PI) has determine endothelial dysfunction^23–26 while newer PI do not.^27–29

Because of the increasing cardiovascular morbidity and mortality in HIV-subjects, the large interest of the scientific community on early atherosclerosis in this framework do not surprise.

With this brief letter we want to underline that the issue is not completely defined and understood and there are still a lot of uncertainties. The article of Palios et al. has the merit to focus on the importance of IMT and endothelial function in understanding atherosclerosis progression in HIV.

References

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2.PY Hsue, JC Lo, A Franklin, AF Bolger, JN Martin, SG Deeks, et al., Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection, Circulation, Vol. 109, No. 13, 6 Apr 2004, pp. 1603-8.

3.PY Hsue, PW Hunt, E Sinclair, B Bredt, A Franklin, M Killian, et al., Increased carotid intima-media thickness in HIV patients is associated with increased cytomegalovirus-specific T-cell responses, AIDS, Vol. 20, No. 18, 28 Nov 2006, pp. 2275-83.

4.AC Ross, N Rizk, MA O’Riordan, V Dogra, D El-Bejjani, N Storer, et al., Relationship between inflammatory markers, endothelial activation markers, and carotid intima-media thickness in HIV-infected patients receiving antiretroviral therapy, Clin Infect Dis, Vol. 49, No. 7, 1 Oct 2009, pp. 1119-27.

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11.JS Currier, MA Kendall, R Zackin, WK Henry, B Alston-Smith, FJ Torriani, et al., AACTG 5078 Study Team, Carotid artery intima-media thickness and HIV infection: traditional risk factors overshadow impact of protease inhibitor exposure, AIDS, Vol. 19, No. 9, 10 Jun 2005, pp. 927-33.

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13.C Grunfeld, JA Delaney, C Wanke, JS Currier, R Scherzer, ML Biggs, et al., Preclinical atherosclerosis due to HIV infection: carotid intima-medial thickness measurements from the FRAM study, AIDS, Vol. 23, No. 14, 10 Sep 2009, pp. 1841-9.

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22.AM Lebech, US Kristoffersen, N Wiinberg, K Kofoed, O Andersen, B Hesse, et al., Coronary and peripheral endothelial function in HIV patients studied with positron emission tomography and flow-mediated dilation: relation to hypercholesterolemia, Eur J Nucl Med Mol Imaging, Vol. 35, No. 11, Nov 2008, pp. 2049-58.

23.SS Shankar, MP Dubé, JC Gorski, JE Klaunig, and HO Steinberg, Indinavir impairs endothelial function in healthy HIV-negative men, Am Heart J, Vol. 150, No. 5, Nov 2005, pp. 933.

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Journal: Artery Research
Volume-Issue: 7 - 2
Pages: 81 - 83
Publication Date: 2013/04/08
ISSN (Online): 1876-4401
ISSN (Print): 1872-9312
DOI: 10.1016/j.artres.2013.02.001 How to use a DOI?
Open Access: This is an open access article distributed under the CC BY-NC license.

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ris enw bib

TY  - JOUR
AU  - Cristina Giannattasio
AU  - Alessandro Maloberti
AU  - Andrea Gori
PY  - 2013
DA  - 2013/04/08
TI  - HIV and atherosclerosis: Heterogeneity of studies results
JO  - Artery Research
SP  - 81
EP  - 83
VL  - 7
IS  - 2
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2013.02.001
DO  - 10.1016/j.artres.2013.02.001
ID  - Giannattasio2013
ER  -

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