Endothelial activation and cardiometabolic profiles of treated and never-treated HIV infected Africans

- Is endothelial activation, stiffness, atherosclerosis related to HIV in Africans?
- We compared 165 HIV free to 66 antiretroviral treated and 78 never treated Africans.
- HIV infected Africans showed endothelial activation compared to HIV free controls.
- The endothelial activation was not accompanied by increased CRP or IL-6.
- Increased endothelial activation was not reflected by elevated BP, stiffness or IMT.
- Seems that the burden of hypertension in SA may not be amplified by HIV infection.

ObjectiveThe role the human immunodeficiency virus (HIV) and antiretroviral treatment on endothelial activation, and the subsequent relationship with cardiovascular disease, is not well understood. We investigated endothelial activation, inflammatory and cardiometabolic profiles, and measures of vascular structure and function of 66 antiretroviral treated (ART), 78 never-treated (no-ART) HIV infected and 165 HIV free Africans.MethodsBlood samples were obtained for biochemical analysis and blood pressure, pulse wave velocity (PWV) and carotid intima-media thickness (IMT) measurements were performed.ResultsThe HIV infection duration was at least five years and the treatment 2.86 ± 0.13 years. The intracellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) levels were elevated in the HIV infected groups compared to the controls. The odds of higher adhesion molecule levels were increased when HIV infected (especially in the no-ART group); OR no-ART vs. no-HIV: ICAM 3.92 (2.2-7.0); VCAM 16.2 (7.5-35). ICAM and VCAM associated with HIV status and interleukin-6 (IL-6) in the total group (all p < 0.01). In both HIV infected groups VCAM associated inversely with CD4 counts (no-ART: β = −0.28, p = 0.01; ART: β = −0.22, p = 0.07) and TC (no-ART: β = −0.36, p < 0.01; ART: β = −0.27, p = 0.03). The ART group had an unfavourable lipid profile compared to the no-ART group. The inflammatory markers (C-reactive protein (CRP) and IL-6), PWV and IMT did not differ between the three groups.ConclusionHIV infected Africans showed endothelial activation when compared to HIV free controls. The endothelial activation was not accompanied by increased inflammation (as measured with CRP and IL-6), arterial stiffness or sub-clinical atherosclerosis.