Inflammatory Biomarkers and Carotid Thickness in HIV Infected Patients under Antiretroviral Therapy, Undetectable HIV-1 Viral Load, and Low Cardiovascular Risk

Abstract Background: People living with HIV are at increased risk of cardiovascular disease and carotid thickness, due to the inflammation caused by the virus, the antiretroviral therapy, and other risk factors. However, few studies have observed the occurrence of cardiovascular diseases and carotid thickness in HIV-positive population at low cardiovascular risk and with undetectable viral load. Objectives: To evaluate the association between levels of inflammatory markers and carotid thickness in people living with HIV, under antiretroviral therapy and at low cardiovascular risk. Methods: To determine low cardiovascular risk in both groups (HIV infected and non-infected individuals), the Framingham Risk Score was used. Inflammatory markers (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1, and sICAM-1) were assessed using flow cytometry. Carotid thickness (mm) was measured using Doppler ultrasound. Level of significance was p < 0.05. Results: In People living with HIV, age and smoking status were associated with carotid thickness alterations. In the non-HIV group, age, higher total cholesterol, and LDL levels were associated with increased carotid thickness. Using the multivariate analysis, a significant association between TNF-α and IL- 1( levels, and a higher chance of atherosclerosis development in HIV group were observed. Conclusions: Both groups have a similar risk for developing cardiovascular disease, therefore our study demonstrates that HIV-positive individuals with undetectable viral load in antiretroviral therapy without protease inhibitors and with low cardiovascular risk do not present differences in carotid thickness in relation to uninfected individuals.

背景：人类免疫缺陷病毒（HIV）感染者因病毒诱导的炎症、抗反转录病毒治疗（antiretroviral therapy，ART）及其他危险因素，罹患心血管疾病与出现颈动脉厚度异常的风险均显著升高。然而目前鲜有研究针对心血管风险较低且病毒载量不可检测的HIV阳性人群，开展心血管疾病发生情况与颈动脉厚度的相关观察。
研究目的：本研究旨在评估接受抗反转录病毒治疗、且心血管风险较低的HIV感染者体内炎症标志物水平与颈动脉厚度之间的关联。
研究方法：本研究采用弗雷明汉风险评分（Framingham Risk Score）对两组受试者（HIV感染者与非感染者）进行低心血管风险分层。通过流式细胞术检测炎症标志物水平，涵盖γ干扰素（IFN-γ）、肿瘤坏死因子α（TNF-α）、白细胞介素1β（IL-1β）、白细胞介素6（IL-6）、可溶性血管细胞黏附分子1（sVCAM-1）及可溶性细胞间黏附分子1（sICAM-1）。采用多普勒超声测量颈动脉厚度（单位：mm）。本研究设定检验水准为p < 0.05。
研究结果：在HIV感染者组中，年龄与吸烟状态与颈动脉厚度改变存在显著关联；而在非HIV感染对照组中，年龄、总胆固醇与低密度脂蛋白（LDL）水平升高与颈动脉厚度增加显著相关。经多变量分析后，本研究观察到HIV感染者组中肿瘤坏死因子α（TNF-α）与白细胞介素1β（IL-1β）水平与动脉粥样硬化发生风险升高存在显著关联。
研究结论：两组受试者的心血管疾病发病风险相似，本研究结果表明，接受不含蛋白酶抑制剂的抗反转录病毒治疗、病毒载量不可检测且心血管风险较低的HIV阳性人群，其颈动脉厚度与未感染HIV的人群无显著差异。