Judith M Haissman1, Andreas Knudsen, Hedda Hoel, Andreas Kjær, Ulrik S Kristoffersen, Rolf K Berge, Terese L Katzenstein, Asbjørn Svardal, Thor Ueland, Pål Aukrust, Anne-Mette Lebech, Susanne D Nielsen, Marius Trøseid. 1. *Department of Infectious Diseases; †Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen; ‡Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark; §Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet; ‖Department of Clinical Science, University of Bergen; ¶Department of Heart Disease, Haukeland University Hospital; #Research Institute of Internal Medicine; **Institute of Clinical Medicine; ††K.G. Jebsen Inflammatory Research Center; and ‡‡Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.
Abstract
OBJECTIVES: HIV infection is associated with increased risk of coronary heart disease beyond that explained by traditional risk factors, and altered gut microbiota has been proposed as a potential trigger. Trimethylamine-N-oxide (TMAO) is a proatherogenic substance formed in the liver from trimethylamine, exclusively generated by gut microbiota from dietary phosphatidylcholine. We aimed to investigate whether TMAO is associated with subclinical and clinical coronary heart disease in HIV infection. METHODS: Two previously described cohorts were examined as follows: (1) cross-sectional cohort of HIV-infected persons and uninfected controls with known atherosclerotic plaque burden as assessed by myocardial perfusion scintigraphy, coronary artery calcium score, and intima-media thickness and (2) nested case-control study of HIV-infected persons with first-time myocardial infarction (MI) compared with HIV-infected persons without MI, assessed at 4 time points from before initiation of antiretroviral therapy (ART) to last sample before the case's MI (median: 51, range: 0-239 days). RESULTS: There was no difference in plasma TMAO when comparing HIV-infected persons and uninfected controls. TMAO was elevated in HIV-infected persons with myocardial perfusion defects but was not associated with coronary artery calcium score, intima media thickness, or Framingham risk score. In the nested case control study, plasma TMAO was not associated with first-time MI. However, TMAO increased after ART introduction and was associated with the use of protease inhibitors in both cohorts. CONCLUSIONS: TMAO was elevated in HIV-infected persons with myocardial perfusion defects, but was not associated with first-time MI. Our data question TMAO as a useful biomarker of cardiovascular risk in HIV infection, at least in ART-treated individuals.
OBJECTIVES:HIV infection is associated with increased risk of coronary heart disease beyond that explained by traditional risk factors, and altered gut microbiota has been proposed as a potential trigger. Trimethylamine-N-oxide (TMAO) is a proatherogenic substance formed in the liver from trimethylamine, exclusively generated by gut microbiota from dietary phosphatidylcholine. We aimed to investigate whether TMAO is associated with subclinical and clinical coronary heart disease in HIV infection. METHODS: Two previously described cohorts were examined as follows: (1) cross-sectional cohort of HIV-infectedpersons and uninfected controls with known atherosclerotic plaque burden as assessed by myocardial perfusion scintigraphy, coronary artery calcium score, and intima-media thickness and (2) nested case-control study of HIV-infectedpersons with first-time myocardial infarction (MI) compared with HIV-infectedpersons without MI, assessed at 4 time points from before initiation of antiretroviral therapy (ART) to last sample before the case's MI (median: 51, range: 0-239 days). RESULTS: There was no difference in plasma TMAO when comparing HIV-infectedpersons and uninfected controls. TMAO was elevated in HIV-infectedpersons with myocardial perfusion defects but was not associated with coronary artery calcium score, intima media thickness, or Framingham risk score. In the nested case control study, plasma TMAO was not associated with first-time MI. However, TMAO increased after ART introduction and was associated with the use of protease inhibitors in both cohorts. CONCLUSIONS:TMAO was elevated in HIV-infectedpersons with myocardial perfusion defects, but was not associated with first-time MI. Our data question TMAO as a useful biomarker of cardiovascular risk in HIV infection, at least in ART-treated individuals.
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