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Long-term effects of an intensive intervention in HIV-infected patients with moderate-high atherosclerotic
Mar Masiá1, Enrique Bernal2, Catalina Robledano2
1Infectious Diseases Unit, Hospital General Universitario de Elche, Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain marmasiac@gmail.com.
Insights
An intensive intervention effectively managed cardiovascular risk factors in HIV patients on antiretroviral therapy (ART), achieving long-term low-density lipoprotein cholesterol (LDL-C) targets safely. Both intensive and standard care reduced inflammatory cytokines without impacting carotid intima-media thickness (cIMT).
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease (CVD) is a significant concern for HIV-infected individuals on antiretroviral therapy (ART).
- Managing traditional CVD risk factors is crucial in this population.
Purpose of the Study:
- To compare the 5-year effects of an intensive intervention versus standard care on cardiovascular risk factors in HIV patients on ART.
- To assess the feasibility, safety, and efficacy of intensive CVD risk factor management.
Main Methods:
- A longitudinal study involving virologically suppressed HIV patients with elevated CVD risk.
- Interventions focused on achieving specific low-density lipoprotein cholesterol (LDL-C) targets using lipid-lowering drugs, with ART adjustments and aspirin in the intensive group.
- Comparison of LDL-C levels, carotid intima-media thickness (cIMT), and cardiovascular biomarkers over 5 years.
Main Results:
- Both intensive and standard interventions achieved LDL-C targets in over 80% of patients.
- The intensive group showed significantly greater reductions in LDL-C and Framingham risk score compared to standard care (P=0.04 and P=0.01, respectively).
- Significant reductions in interleukin-6 and tumor necrosis factor-alpha were observed in both groups; no significant changes in cIMT were noted.
Conclusions:
- Intensive intervention for cardiovascular risk factors in HIV patients on ART is feasible, safe, and achieves long-term LDL-C targets.
- Both intensive and standard interventions led to favorable changes in inflammatory cytokines, suggesting antiatherosclerotic effects.
- No progression in cIMT was observed, indicating stable arterial health over the study period.
Objectives:
To evaluate the 5 year effects of an intensive intervention versus the standard-of-care intervention on cardiovascular risk factors in HIV-infected patients on antiretroviral therapy (ART).
Methods:
This was a longitudinal study including virologically suppressed patients with at least two cardiovascular risk factors or a Framingham risk score ≥10%. Intensive and standard-of-care interventions aimed for low-density lipoprotein cholesterol (LDL-C) <100 and <130 mg/dL, respectively, by using lipid-lowering drugs. In the intensive group, switching ART when needed to achieve the LDL-C target and low-dose aspirin were used. Achievement of LDL-C targets and changes in carotid intima-media thickness (cIMT) and cardiovascular biomarkers were compared between groups at different timepoints through a 5 year period.
Results:
Twenty-two and 25 patients in the intensive and standard intervention groups, respectively, were followed up. At 5 years, pre-specified LDL-C targets were achieved in 82% (intensive) and 81% (standard of care) of patients. The median (IQR) change in LDL-C in the intensive and standard intervention groups was -78 (-96/-39.7) and -49 (-72/-3) mg/dL, respectively (P = 0.04), and in the Framingham score was -4% (-8%/-1%) and 0% (-4%/6.5%), respectively (P = 0.01). There were no significant intra- or between-group changes in cIMT measurements. A significant decrease was observed in the intensive and standard groups in interleukin 6 (P = 0.001 and P = 0.002, respectively) and in tumour necrosis factor α (P = 0.023 and P = 0.052, respectively). Asymptomatic creatine phosphokinase elevations were observed in two patients assigned to the standard intervention group.
Conclusions:
An intensive intervention on cardiovascular risk factors in HIV-infected patients on ART was feasible, safe and capable of achieving LDL-C targets in the long term. Both intensive and standard interventions were accompanied by antiatherosclerotic changes in inflammatory cytokines and lack of cIMT progression.
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