Q J Med 2003; 96: 825-832
© 2003 Association of Physicians
Endothelial function in HIV-infected patients receiving protease inhibitor therapy: does immune competence affect cardiovascular risk?
From the 1Centre for Clinical Immunology and Biomedical Statistics, Royal Perth Hospital and Murdoch University, 2University Department of Medicine, University of Western Australia and West Australian Institute of Medical Research, Royal Perth Hospital, and 3Department of Clinical Immunology and Biochemical Genetics, Royal Perth Hospital, and Department of Pathology, University of Western Australia, Australia
Received 23 July 2003 and in revised form 8 September 2003
Background: The use of HIV protease inhibitors (PIs) as a component of combination antiretroviral therapy in HIV-infected patients has been associated with dyslipidaemia, but its significance as a risk factor for cardiovascular disease is unclear. Endothelial dysfunction is an early phase of atherogenesis that may be assessed non-invasively with ultrasonography in vivo.
Aim: To evaluate vascular function and investigate potential determinants of endothelial dysfunction of the peripheral circulation in PI-treated, HIV-infected men with dyslipidaemia.
Design: Observational, case-control study.
Methods: We studied 24 HIV-infected, PI-treated men with dyslipidaemia and 24 normolipidaemic, healthy male controls matched for age and body mass index. Brachial artery endothelial function was studied using high-resolution ultrasound and computerized edge-detection software. This non-invasive technique measured post-ischaemic flow-mediated dilatation (FMD), and the endothelium-independent vasodilatory response to glyceryl trinitrate (GTN).
Results: Within the HIV patient group, FMD was significantly associated with percentage of ‘naïve’ CD4 + 45RA + T cells (p = 0.03), while plasma lipid/lipoprotein and insulin levels, body mass, and smoking status did not correlate with endothelial function. FMD was not significantly different between the study group and the controls.
Conclusions: The atherogenic potential of PI-associated dyslipidaemia may be attenuated in HIV-infected patients with decreased immune competence, reflecting a possible contribution of cell-mediated immune responses to the pathogenesis of atherosclerosis.
Address correspondence to Professor S. Mallal, Centre for Clinical Immunology and Biomedical Statistics, 2nd level North Block, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia. e-mail: S.Mallal{at}murdoch.edu.au
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