Abstract PS1/2
 
Greater Arterial Stiffness in Middle-aged HIV-positive Men on cART May be Explained by an Increased Prevalence of Hypertension, Smoking and Systemic Inflammation Print
 
K.W. Kooij1, F. Wit1, J. Schouten1,2, M. van der Valk3, N. Kootstra4, I. Stolte5, M. Prins5, B.-J. van den Born6, P. Reiss1,3, on behalf of the AGEhIV Cohort Study Group
1Academic Medical Center and Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam, Netherlands, 2Academic Medical Center, Department of Neurology, Amsterdam, Netherlands, 3Academic Medical Centre, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam, Netherlands, 4Academic Medical Centre, Department of Experimental Immunology, Amsterdam, Netherlands, 5Public Health Service Amsterdam, Infectious Diseases Research, Amsterdam, Netherlands, 6Academic Medical Centre, Department of Vascular Medicine, Amsterdam, Netherlands
 
Objectives: Patients with HIV, even when adequately treated, are at increased risk for cardiovascular disease (CVD). Pulse wave velocity (PWV) as a marker of arterial stiffness has been associated with CVD risk. Therefore, we compared PWV in a cohort of HIV-positive and HIV-uninfected men.
Methods: Assessment of PWV and mean arterial pressure (MAP) using an Arteriograph® system, which registers oscillometric pressure curves by an upper arm cuff, in HIV-negative men and HIV-1-positive men on combination antiretroviral therapy (cART) with HIV-RNA < 40 copies/ml ≥2 years, aged ≥45 years, participating in the ongoing AGEhIV cohort study. Potential determinants of PWV were explored by multivariable linear regression.
Results: Demographic and HIV-related characteristics are shown in Table 1 and traditional CVD risk factors and inflammatory markers in Table 2. The prevalence of CVD risk factors was higher in HIV-positives; 4.7 vs. 1.2% had a prior myocardial infarction (p=0.003). Unadjusted median PWV was higher in HIV-positive men (8.03 vs. 7.67 m/s, p< 0.001), and remained significantly different after adjustment for MAP and age (+0.27 m/s, p=0.007). Following further adjustment for use of antihypertensive drugs, HIV was no longer significantly associated with PWV (+0.18 m/s, p=0.08). In the final multivariable model all factors listed in table 3 with the exception of HIV, remained significantly associated with PWV, which included levels of hs-CRP and soluble (s)CD163, but not sCD14.
Conclusion: The observed relatively small difference in PWV between middle-aged HIV-negative and HIV-positive men well-suppressed on cART was largely explained by an increased prevalence of hypertension and smoking, with an additional contribution from markers of systemic inflammation and monocyte activation in particular. This difference in PWV may be indicative of a few years greater vascular age which may become more important as this population with HIV gets older. Table 1
 HIV-positives
n = 399
% or median (IQR)
HIV-negatives
n = 452
% or median (IQR)
Chi2 or
Wilcoxon rank sum
Age (years)53.9 (48.7 - 60.7)52.2 (47.8 - 58.8)0.02
Men having sex with men (MSM)83.6%82.8%0.7
Born in the Netherlands76.6%82.5%0.04
Known duration of HIV-infection, years13.4 (8.7 - 18.0)n/an/a
Duration of ART-treatment, years11.8 (6.9 - 14.9)n/an/a
Prior AIDS diagnosis32.6%n/an/a
Current CD4 + T-cell count, cells/mm3610 (460 - 790)820 (630 - 1020)<0.001
Nadir CD4 + T-cell count, cells/mm3160 (60 - 230)n/an/a
[Demographics and HIV-related characteristics]
Table 2
 HIV-positives
n = 399
% or median (IQR)
HIV-negatives
n = 452
% or median (IQR)
Chi2, Wilcoxon rank sum, non-parametric test for trend
BMI, kg/m224.2 (22.4 - 26.5)24.5 (22.9 - 27.0)0.006
Smoking (current, past)32.9%, 37.0%23.8%, 39.7%0.006
Mean arterial pressure, mmHg99.797.60.005
Current use of antihypertensive drugs27.1%11.3%<0.001
Total cholesterol/HDL ratio4.3 (3.3 - 5.3)4.0 (3.2 - 5.2)0.04
Triglycerides, mmol/L1.7 (1.1 - 2.8)1.5 (1.0 - 2.2)<0.001
hs-CRP, mg/L1.5 (0.7 - 3.4)1.0 (0.6 - 1.9)<0.001
sCD163, ng/mL280 (199 - 411)260 (183 - 346)0.005
sCD14, ng/mL1607 (1318 - 2075)1393 (1096 - 1851)<0.001
[CVD risk factors and inflammatory markers]
Table 3
 Difference in PWV (m/s)
per unit change of covariate
p-value
HIV-status (positive)-0.0790.5
Age, per 5 years0.25<0.001
Use of antihypertensive drugs0.350.02
Pack years, per 5 years (current smoker)0.12<0.001
Pack years, per 5 years (past smoker)0.0430.008
Being MSM-0.270.05
sCD163, per 100 ng/mL0.110.001
hs-CRP, per mg/L0.0390.004
log-triglycerides, per log-mmol/L0.36<0.001
[Multivariable regression, corrected for MAP]


Assigned speakers:
MD Katherine Kooij , Academic Medical Center and Amsterdam Institute for Global Health and Development , Amsterdam , Netherlands

Assigned in sessions:
17.10.2013, 10:30-12:30, Parallel Session, PS1, Prevention and Management of Co-Morbidities - Joint Session with the 15th International Workshop on Co-Morbidities & Adverse Drug Reactions in HIV, Bozar (Plenary Hall)