Persistent Endothelial Dysfunction, CVD Complications May Be Associated With Delayed ART

Endothelial dysfunction (EDF) was found to be common in early HIV infection, as was an associated reversal in most patients taking antiretroviral therapy (ART), according to data published in JAMA Open Network. Researchers also suggested that endothelial dysfunction and cardiovascular disease (CVD) complications may be associated with delayed ART.

A cohort study of 61 members of the United States Air Force with early seroconversion to HIV infection and low risk for CVD were evaluated for baseline endothelial dysfunction. Noninvasive reactive hyperemia index (RHI) was used to assess endothelial function at baseline and after ART initiation. To define abnormal and normal function natural log–transformed RHI values (lnRHI) of < 0.51 were defined as abnormal and values >0.51 were considered normal.

The median time from estimated seroconversion to RHI assessment was 10.6 months (interquartile range [IQR], 5.1-13.2 months). Median CD4 lymphocyte count was 552/μL (IQR, 449/μL-674/μL). Mean body mass index of 26.2 kg/m² (standard deviation [SD], 4.0), median low-density lipoprotein cholesterol level of 97 mg/dL (IQR, 80-126 mg/dL), median total cholesterol level of 163 mg/dL (IQR, 146-195 mg/dL), and no diabetes diagnoses were observed in study patients.

The mean lnRHI in patients at HIV diagnosis was 0.70 (SD, 0.29). Baseline measures of RHI were normal in 47 patients with a mean lnRHI of 0.82 (SD, 0.20) and abnormal in 14 patients with a mean lnRHI of 0.30 (SD, 0.18).

In a subgroup of patients with follow-up RHI assessments, 40 started ART immediately and repeated RHI assessments at a median of 6.4 months (IQR, 6.0-7.8 months). Results demonstrated that ART use was associated with an overall significant increase in mean lnRHI of 0.13 (SD, 0.33; P = .02). Compared with normal lnRHI measures at diagnosis (n=29), abnormal measures (n=11) were associated with an overall significant increase in mean lnRHI (0.33 [SD, 0.34]; P =.01 vs .04 [SD 0.30]; P =.38). After initiation of ART, 8 patients with abnormal lnRHI at baseline showed improved endothelial function, while 1 patient who declined ART went from normal lnRHI of 0.60 to an abnormal lnRHI of 0.11 after 8.3 months.

The study was limited by its small sample size and lack of availability of all patients for follow-up. However, investigators believe “these findings merit further research to elucidate the incidence and natural history of [endothelial dysfunction] in persons with HIV infection and the effects of contemporary ART regimens.”

Overall, 23% of young patients with recent HIV seroconversion and low CVD risk showed signs of endothelial dysfunction and it was observed that this dysfunction reversed in association with ART in most patients. Investigators concluded that, “persistent [endothelial dysfunction] and associated CVD complications from HIV infection may be associated with delayed ART,” but further studies are needed to define the role and timing of non-invasive testing of endothelial function in this patient population.

Reference

Bush KNV, Teel JL, Watts JA, et al. Association of endothelial dysfunction and antiretroviral therapy in early HIV infection. JAMA Netw Open. 2019; 2(10):e1913615.