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Inflamación arterial en pacientes con VIH

Sharath Subramanian¹, Ahmed Tawakol, Tricia H Burdo

¹MR-PET-CT Program and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.

|July 24, 2012

Resumen

Los pacientes con el virus de la inmunodeficiencia humana (VIH) muestran un aumento de la inflamación arterial, incluso con la enfermedad controlada y los bajos factores de riesgo tradicionales. Esta inflamación está relacionada con los marcadores de activación de monocitos y macrófagos.

Área de la Ciencia:

Investigaciones cardiovasculares en la investigación cardiovascular.
Inmunología Inmunología.
Radiología Radiología.

Sus antecedentes:

El riesgo de enfermedad cardiovascular (ECV) es elevado en individuos infectados por el virus de la inmunodeficiencia humana (VIH).
Los mecanismos precisos que impulsan este mayor riesgo de ECV siguen sin estar claros.
La activación de monocitos y macrófagos, indicada por el CD163 soluble (sCD163), puede desempeñar un papel.

Objetivo del estudio:

Para evaluar la inflamación de la pared arterial en pacientes con VIH utilizando la tomografía por emisión de positrones de 18fluorino-2-desoxi-D-glucosa (18F-FDG-PET).
Para correlacionar la inflamación arterial con los marcadores de riesgo cardiovascular tradicionales y no tradicionales, incluyendo sCD163.
Para comparar la inflamación arterial en pacientes con VIH con grupos de control sin VIH.

Principales métodos:

Un estudio transversal que involucró a 81 participantes (27 VIH, 54 controles) en el Hospital General de Massachusetts.
El 18F-FDG-PET cardíaco evaluó la inflamación arterial a través de la relación objetivo-fondo (TBR) en la aorta.
La exploración de tomografía computarizada coronaria evaluó el calcio de la arteria coronaria; se hicieron comparaciones con controles de edad/sexo/Framingham Risk Score (FRS) y controles ateroscleróticos.

Principales resultados:

Los participantes con VIH tenían una enfermedad por VIH bien controlada y un FRS promedio bajo, similar a los controles emparejados con FRS.
La TBR aórtica (inflamación arterial) fue significativamente mayor en pacientes con VIH en comparación con los controles emparejados con FRS (P < .001).
La TBR aórtica en pacientes con VIH se asoció con niveles de sCD163 (P = .04) pero no con proteína C reactiva o D-dimer.

Conclusiones:

Las personas infectadas por el VIH presentan un aumento de la inflamación arterial en comparación con las personas no infectadas con perfiles de riesgo cardíaco similares.
Esta mayor inflamación está asociada con los marcadores de activación de monocitos y macrófagos.
Los hallazgos sugieren un vínculo entre el VIH, la activación inmune y la inflamación vascular subclínica.

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