Arterial Stiffness in a Cohort of Young People Living With Perinatal HIV and HIV Negative Young People in England

Frontiers in Cardiovascular Medicine

article

J. Mellin¹  M. Le Prevost²  J. Kenny³  K. Sturgeon²  L. C. Thompson²  C. Foster⁴  H. H. Kessler⁵  Nandu Goswami¹  N. Klein⁷  A. Judd²  H. Castro² 

[1] Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz;Medical Research Council Clinical Trials Unit at University College London;Guy's and St. Thomas' National Heath Service Foundation Trust, Evelina London Children's Hospital, St. Thomas' Hospital;Imperial College Healthcare National Heath Service Trust, St. Mary's Hospital;Diagnostic and Research Institute of Hygiene, Microbiology, and Environmental Medicine, Medical University of Graz;Mohammed Bin Rashid University of Medicine and Health Sciences;Department of Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health

关键词: HIV;    perinatal;    pulse wave velocity;    arterial stiffness;    young people;    England;    vascular function;    cardiovascular disease;   

DOI  :  10.3389/fcvm.2022.821568

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Antiretroviral therapy (ART) has increased life expectancy and consequently the risk of cardiovascular disease (CVD) in adults living with HIV. We investigated the levels and predictors of arterial stiffness in young people (YP) living with perinatal HIV (PHIV) and HIV negative YP in the Adolescents and Adults Living with Perinatal HIV (AALPHI) study. Methods AALPHI was a prospective study evaluating the impact of HIV infection and exposure to ART on YP living with PHIV (aged 13–21 years) who had known their HIV status for at least 6 months, and HIV negative YP (aged 13–23 years) who either had a sibling, friend or parent living with HIV. Participants were enrolled from HIV clinics and community services in England. Two hundred and thirteen PHIV and 65 HIV negative YP (42% siblings of PHIV) had pulse wave velocity (PWV) measurements taken (Vicorder software) from the supra-sternal notch to the middle of the thigh cuff, at their second interview in the study between 2015 and 2017. Average PWV was calculated from the three closest readings (≥3 and ≤ 12 m/s) within 0.6 m/s of each other. Linear regression examined predictors of higher (worse) PWV, including age, sex, HIV status and height as a priori , ethnicity, born outside UK/Ireland, alcohol/nicotine/drug use, weight, waist-to-hip-ratio, mean arterial pressure (MAP), caffeine 2 h before PWV and nicotine on day of PWV. A separate PHIV model included CD4, viral load, years taking ART and ART regimen. Findings One hundred and twenty eight (60%) PHIV and 45 (69%) HIV negative YP were female ( p = 0.18), with median (IQR) age 18 (16, 20) and 18 (16, 21) years ( p = 0.48) respectively. Most PHIV were taking a combination of three ART drugs from two classes. There was a trend toward higher (worse) mean PWV in the PHIV group than the HIV negative group [unvariable analysis 6.15 (SD 0.83) m/s vs. 5.93 (0.70) m/s, respectively, unadjusted p = 0.058], which was statistically significant in the multivariable analysis [adjusted p (ap) = 0.020]. In multivariable analysis being male (ap = 0.002), older age (ap < 0.001), higher MAP (ap < 0.001) and nicotine use on day of measurement (ap = 0.001) were also predictors of higher PWV. The predictors were the same in the PHIV model. Interpretation By late adolescence PHIV had worse PWV in comparison to HIV negative peers, and traditional risk factors for CVD (higher arterial pressure, being male and older age) were associated with higher PWV values. Regular detailed monitoring of cardiovascular risk factors should become standard of care for every young person with PHIV worldwide.

【 授权许可】

CC BY