Coronary and peripheral endothelial function in HIV patients studied with positron emission tomography and...

Area of Science:

• Cardiovascular medicine
• Infectious diseases
• Immunology

Background:

• Increased cardiovascular risk is observed in HIV patients undergoing antiretroviral therapy (ART).
• Mechanisms behind this heightened risk, particularly concerning endothelial function, remain unclear.
• This study investigates endothelial function in HIV patients with varying cholesterol levels.

Purpose of the Study:

• To assess coronary artery endothelial function in HIV patients on ART using cardiac perfusion positron emission tomography (PET).
• To evaluate flow-mediated dilation (FMD) of the brachial artery and plasma levels of endothelial markers.
• To compare endothelial function and markers between HIV patients with normal and high cholesterol and healthy controls.

Main Methods:

• Inclusion of HIV patients on ART with total cholesterol ≤5.5 mmol/L or ≥6.5 mmol/L, and healthy controls.
• Assessment of myocardial perfusion and coronary flow reserve using (13)NH(3) perfusion PET.
• Measurement of brachial artery FMD and plasma levels of E-Selectin, ICAM-1, VCAM-1, tPAI-1, and hs-CRP.

Main Results:

• Myocardial perfusion and coronary flow reserve were similar across all groups (HIV normal cholesterol, HIV high cholesterol, controls).
• Brachial artery FMD did not differ significantly between the groups.
• HIV patients exhibited elevated plasma levels of E-Selectin, ICAM-1, tPAI-1, and hs-CRP compared to controls, with higher E-Selectin and ICAM-1 in those on protease inhibitors (PIs).

Conclusions:

• ART-treated HIV patients, even with hypercholesterolemia, showed no evidence of endothelial dysfunction.
• Elevated plasma endothelial markers in HIV patients were not directly related to cholesterol levels.
• Protease inhibitor use may be associated with increased levels of specific endothelial markers.