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The role of HIV as a risk modifier for coronary endothelial function in young adults
Khaled Z Abd-Elmoniem1, Teja Yeramosu2, Julia B Purdy3
1Biomedical and Metabolic Imaging Branch National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA.
Insights
People living with HIV have increased cardiovascular disease risk. This study found immune activation and smoking significantly impair coronary endothelial function in young adults with lifelong HIV.
Area of Science:
- Cardiovascular disease research
- HIV/AIDS research
- Immunology
Background:
- People with HIV (PLWH) face higher cardiovascular disease (CVD) risk.
- Assessing coronary endothelial function (CEF) directly is challenging.
- Previous studies used indirect measures in peripheral arteries, yielding conflicting results, and often excluded young adults with lifelong HIV.
Purpose of the Study:
- To directly investigate CEF in young adults with lifelong HIV.
- To utilize advanced magnetic resonance imaging (MRI) for precise coronary flow-mediated dilation (corFMD) assessment.
- To explore the impact of HIV status on coronary vascular health in this unique population.
Main Methods:
- Employed coronary FMD MRI (corFMD-MRI) with a specialized MRI-integrated isometric handgrip exercise system (fmIHE).
- Recruited young adults with perinatally/early childhood HIV acquisition (n=23) and matched healthy controls (n=12).
- Measured corFMD as the change in coronary cross-sectional area during fmIHE.
Main Results:
- HIV status significantly modified CVD risk.
- Higher CD8+ T-cell counts and smoking pack-years were independently linked to impaired coronary artery response to fmIHE.
- In PLWH, corFMD showed an inverse correlation with CD8+ T-cells and smoking pack-years, even after adjusting for age and BMI.
Conclusions:
- HIV status is a significant risk modifier for CVD in young adults.
- Immune activation (indicated by CD8+ T-cells) and smoking are associated with reduced CEF in this population.
- Strategies targeting smoking cessation and immune activation are crucial for managing CVD risk in PLWH.
Background:
People living with HIV have an increased risk of cardiovascular disease (CVD). Although coronary endothelial function (CEF) is an early direct indicator of CVD, only a few studies have been able to interrogate CEF directly. Most studies have examined vascular endothelial function through indirect assessment of brachial flow-mediated dilatation (FMD). However, peripheral arteries are significantly larger and manifest atherogenesis differently from the coronary arteries, and so produce conflicting results. Additionally, none of these studies focused on young adults who acquired HIV perinatally or in early childhood.
Objective:
The present study investigates CEF in a unique population of young adults with lifelong HIV using direct magnetic resonance imaging (MRI) of coronary FMD (corFMD) with an in-house developed MRI-integrated isometric handgrip exercise system with continuous feedback and monitoring mechanisms (fmIHE).
Methods:
Young adults who acquired HIV perinatally or in early childhood (n = 23) and group-matched healthy participants (n = 12) completed corFMD-MRI with fmIHE. CorFMD was measured as the coronary cross-sectional area response to the fmIHE.
Results:
In univariable and multivariable regression analysis, HIV status was a significant risk modifier. CD8+ T-cell count and smoking pack-years and their interaction with HIV status were independently associated with impaired coronary artery response to fmIHE. In people living with HIV, corFMD was significantly inversely correlated with CD8+ T-cells and smoking pack-years. In a multivariable regression analysis adjusted for age and body mass index, CD8+ T-cells and smoking and their interaction with HIV status remained significant independent predictors of coronary endothelial dysfunction.
Discussion:
In this unique population of young adults, HIV status was a significant risk modifier, and immune activation and smoking were associated with decreased CEF, directly measured from the coronary vascular response to fmIHE.
Conclusions:
Management of CVD risk factors such as smoking and developing strategies that target immune activation in people living with HIV are warranted.
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