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Zaaqoq AM, Khasawneh FA, Smalligan RD. Cardiovascular Complications of HIV-Associated Immune Dysfunction. Cardiol Res Pract 2015; 2015:302638. [PMID: 25648075 PMCID: PMC4305617 DOI: 10.1155/2015/302638] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/27/2014] [Indexed: 12/25/2022] Open
Abstract
Prolonged survival in HIV infection is accompanied by an increased frequency of non-HIV-related comorbidities. It is suggested that cardiovascular diseases (CVD) occur earlier among HIV-positive patients compared with HIV-negative patients, and at a higher rate. Several factors have been proposed which can be categorized into traditional and nontraditional risk factors. Immune dysfunction is a nontraditional risk factor that contributes significantly to cardiovascular pathology. Markers of inflammation are elevated in HIV-infected patients, and elevations in markers such as high-sensitivity C-reactive protein, D-dimer, and interleukin-6 (IL-6) have been associated with increased risk for cardiovascular disease. However, the data currently suggest the most practical advice is to start antiretroviral therapy early and to manage traditional risk factors for CVD aggressively. A better understanding of the mechanisms of CVD in this population and further efforts to modify chronic inflammation remain an important research area.
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Affiliation(s)
- Akram M. Zaaqoq
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Faisal A. Khasawneh
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
- Division of Infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Roger D. Smalligan
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
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Papakonstantinou VD, Chini M, Mangafas N, Stamatakis GM, Tsogas N, Tsoupras AB, Psarra K, Fragopoulou E, Antonopoulou S, Gargalianos P, Demopoulos CA, Lazanas MC. In vivo effect of two first-line ART regimens on inflammatory mediators in male HIV patients. Lipids Health Dis 2014; 13:90. [PMID: 24884881 PMCID: PMC4055908 DOI: 10.1186/1476-511x-13-90] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 05/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent immune activation and inflammation are lying behind HIV-infection even in the setting of ART mediated viral suppression. The purpose of this study is to define the in vivo effect of two first-line ART regimens on certain inflammatory mediators in male HIV patients. METHODS Male, naive, HIV-infected volunteers were assigned either to tenofovir-DF/emtricitabine/efavirenz (Group_T) or abacavir/lamivudine/efavirenz (Group_A). Platelet Activating Factor (PAF) levels and metabolic enzymes together with HIV-implicated cytokines (IL-1beta, IL-6, IL-8, IL-10, IL-12p70, TNFa) and VEGF were determined for a 12-month period. Differences within each group were determined by non-parametric Friedman and Wilcoxon test, while the differences between the groups were checked by ANOVA repeated measures. RESULTS Both ART regimens present pronounced effect on inflammatory mediators, resulting in decreased PAF levels and Lipoprotein-associated phospholipase A2 (Lp-PLA2) activity for tenofovir-containing regimen and same as baseline PAF levels with a peak though at the 3rd month as well as elevated Lp-PLA2 activity for abacavir-containing regimen. CONCLUSIONS Studies regarding the effect of first-line ART regimens on inflammation may be beneficial in preventing chronic morbidities during HIV-treatment. From this point of view, the present study suggests an anti-inflammatory effect of tenofovir-containing ART, while the temporary increase of PAF levels in abacavir-containing ART may be the link between the reported cardiovascular risk and abacavir administration.
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Affiliation(s)
- Vasiliki D Papakonstantinou
- Faculty of Chemistry, National & Kapodistrian University of Athens, Panepistimioupolis Zografou, 15771 Athens, Greece
| | - Maria Chini
- 3rd Internal Medicine Department-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Nikos Mangafas
- 3rd Internal Medicine Department-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - George M Stamatakis
- Faculty of Chemistry, National & Kapodistrian University of Athens, Panepistimioupolis Zografou, 15771 Athens, Greece
| | - Nickolaos Tsogas
- 3rd Internal Medicine Department-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Alexandros B Tsoupras
- Faculty of Chemistry, National & Kapodistrian University of Athens, Panepistimioupolis Zografou, 15771 Athens, Greece
| | - Katherina Psarra
- Department of Immunology and Histocompatibility, Evangelismos Hospital, Athens, Greece
| | | | | | - Panagiotis Gargalianos
- 1st Internal Medicine Department-Infectious Diseases Unit, “G. Gennimatas” Hospital, Athens, Greece
| | - Constantinos A Demopoulos
- Faculty of Chemistry, National & Kapodistrian University of Athens, Panepistimioupolis Zografou, 15771 Athens, Greece
| | - Marios-C Lazanas
- 3rd Internal Medicine Department-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
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Russell ES, Mohammed T, Smeaton L, Jorowe B, MacLeod IJ, Hoffman RM, Currier JS, Moyo S, Essex M, Lockman S. Immune activation markers in peripartum women in Botswana: association with feeding strategy and maternal morbidity. PLoS One 2014; 9:e89928. [PMID: 24657960 PMCID: PMC3962339 DOI: 10.1371/journal.pone.0089928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/23/2014] [Indexed: 12/03/2022] Open
Abstract
Hormone levels shift the immune state in HIV-uninfected pregnant and breastfeeding women away from Th1 responses and toward regulation to permit fetal tolerance. Limited data exist on inflammation during pregnancy or postpartum in HIV-infected women, though certain inflammatory markers are associated with adverse health outcomes among HIV-infected persons. We measured hsCRP, D-dimer, IFN-γ, IL-6, IL-10 and TNF-α at 34 weeks gestation and six months postpartum in HIV-infected women from the Botswana Mashi PMTCT trial who were randomized to breastfeeding or formula-feeding. Differences in inflammatory markers between gestation and postpartum periods, and by randomized feeding method, were estimated using generalized estimating equations, adjusting for baseline plasma HIV-1 viral load, CD4 count, calendar time, and antiretroviral treatment status. Additionally, we studied the association between marker concentrations at six months postpartum and major adverse clinical events over the following 4.5 years, using case-cohort sampling and adjusted Cox proportional hazards models. In 86 breastfeeding and 75 formula-feeding women, hsCRP and D-dimer decreased significantly between 34 weeks gestation and six months postpartum, while IFN-γ increased. There was no significant association between inflammatory marker change and randomized feeding method after adjusting for multiple comparisons and removing outliers. In univariate analysis, TNF-α, D-dimer, and IFN-γ concentrations at six months postpartum were significant predictors of subsequent clinical events, and TNF-α remained significant in multivariate analysis (HR = 4.16, p = 0.001). In young HIV-infected women in Botswana inflammatory marker concentrations did not differ significantly between women who breast- vs. formula-fed. However, postpartum TNF-α level was predictive of subsequent adverse clinical event.
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Affiliation(s)
- Elizabeth S Russell
- Harvard AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America; Botswana-Harvard AIDS Institute, Gaborone, Botswana
| | | | - Laura Smeaton
- Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | | | - Iain J MacLeod
- Harvard AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America; Botswana-Harvard AIDS Institute, Gaborone, Botswana
| | - Risa M Hoffman
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Judith S Currier
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | | | - Max Essex
- Harvard AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America; Botswana-Harvard AIDS Institute, Gaborone, Botswana
| | - Shahin Lockman
- Harvard AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America; Botswana-Harvard AIDS Institute, Gaborone, Botswana; Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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