Rudolph L Gleason1, Alexander W Caulk2, Daniel Seifu3, Julia C Rosebush4, Alyssa M Shapiro2, Matthew H Schwartz5, Allison Ross Eckard6, Wondwossen Amogne7, Workeabeba Abebe8. 1. The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Biochemistry, Addis Ababa University, Addis Ababa, Ethiopia. Electronic address: rudy.gleason@me.gatech.edu. 2. The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA. 3. Department of Biochemistry, Addis Ababa University, Addis Ababa, Ethiopia. 4. Emory University School of Medicine, Atlanta, GA, USA. 5. The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA. 6. Medical University of South Carolina, Charleston, SC, USA. 7. Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia. 8. Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia.
Abstract
BACKGROUND: HIV patients on highly-active antiretroviral therapy (HAART) have shown elevated incidence of dyslipidemia, lipodystrophy, and markers of cardiovascular disease. Evidence is beginning to emerge that implicates efavirenz (EFV) as a potential mediator of early on-set cardiovascular disease. METHODS: Pediatric and adult HIV-infected HAART-naïve, EFV-treated, nevirapine (NVP)-treated, and ritonavir-boosted lopinavir (LPV/r)-treated subjects were recruited from Black Lion Hospital in Addis Ababa, Ethiopia. Pulse wave velocity (PWV), carotid intima-media thickness (cIMT), carotid arterial stiffness, brachial artery flow-mediated dilation (FMD), body mass index, waist-to-hip circumference ratio, and skinfold thickness were measured. CD4+ cell count, fasting glucose, lipoprotein profiles and triglycerides were also determined. Results were segmented into pediatric (6-17 years of age), young adults (25-39 years old) and older adults (40-60 years old). RESULTS: PWV was generally elevated in EFV- and LPV/r-treated subjects compared to NVP-treated subjects across age groups. cIMT was elevated in EFV- and LPV/r-treated compared to NVP-treated older adults and in EFV-treated compared to HAART-naïve older adults. FMD was impaired in EFV- and LPV/r-treated compared to HAART-naïve younger adults, in EFV-treated compared to NVP-treated young and older adults, and in LPV/r-treated compared to NVP-treated older adults. Differences in lipoprotein profiles and skinfold thickness with HAART regimen were observed in pediatric and young adults, but less so in older adults. CONCLUSIONS: Whereas LPV/r and other protease inhibitors have long been recognized as mediators of HIV/HAART-associated atherosclerosis, this report supports the emerging evidence that EFV may also mediate cardiovascular disease in people living with HIV on HAART.
BACKGROUND:HIVpatients on highly-active antiretroviral therapy (HAART) have shown elevated incidence of dyslipidemia, lipodystrophy, and markers of cardiovascular disease. Evidence is beginning to emerge that implicates efavirenz (EFV) as a potential mediator of early on-set cardiovascular disease. METHODS: Pediatric and adult HIV-infected HAART-naïve, EFV-treated, nevirapine (NVP)-treated, and ritonavir-boosted lopinavir (LPV/r)-treated subjects were recruited from Black Lion Hospital in Addis Ababa, Ethiopia. Pulse wave velocity (PWV), carotid intima-media thickness (cIMT), carotid arterial stiffness, brachial artery flow-mediated dilation (FMD), body mass index, waist-to-hip circumference ratio, and skinfold thickness were measured. CD4+ cell count, fasting glucose, lipoprotein profiles and triglycerides were also determined. Results were segmented into pediatric (6-17 years of age), young adults (25-39 years old) and older adults (40-60 years old). RESULTS: PWV was generally elevated in EFV- and LPV/r-treated subjects compared to NVP-treated subjects across age groups. cIMT was elevated in EFV- and LPV/r-treated compared to NVP-treated older adults and in EFV-treated compared to HAART-naïve older adults. FMD was impaired in EFV- and LPV/r-treated compared to HAART-naïve younger adults, in EFV-treated compared to NVP-treated young and older adults, and in LPV/r-treated compared to NVP-treated older adults. Differences in lipoprotein profiles and skinfold thickness with HAART regimen were observed in pediatric and young adults, but less so in older adults. CONCLUSIONS: Whereas LPV/r and other protease inhibitors have long been recognized as mediators of HIV/HAART-associated atherosclerosis, this report supports the emerging evidence that EFV may also mediate cardiovascular disease in people living with HIV on HAART.
Authors: Christine Kelly; Henry C Mwandumba; Robert S Heyderman; Kondwani Jambo; Raphael Kamng'ona; Mishek Chammudzi; Irene Sheha; Ingrid Peterson; Alicja Rapala; Jane Mallewa; A Sarah Walker; Nigel Klein; Saye Khoo Journal: J Infect Dis Date: 2019-05-24 Impact factor: 5.226
Authors: Alinda G Vos; Klariska Hoeve; Roos E Barth; Joyce Peper; Michelle Moorhouse; Nigel J Crowther; Willem D F Venter; Diederick E Grobbee; Michiel L Bots; Kerstin Klipstein-Grobusch Journal: Retrovirology Date: 2019-12-03 Impact factor: 4.602