Microcirculatory Vascular Dysfunction in HIV-1 Infected Patients Receiving Highly Active Antiretroviral Therapy
2010; Wiley; Volume: 17; Issue: 4 Linguagem: Inglês
10.1111/j.1549-8719.2010.00023.x
ISSN1549-8719
AutoresJohn Palios, Ignatios Ikonomidis, John Lekakis, Sotirios Tsiodras, Garyfalia Poulakou, Anastasia Antoniadou, Periklis Panagopoulos, Antonios Papadopoulos, Helen Giamarellou, Maria Anastasiou‐Nana, Dimitrios Th. Kremastinos,
Tópico(s)Bone and Joint Diseases
ResumoMicrocirculationVolume 17, Issue 4 p. 303-310 Microcirculatory Vascular Dysfunction in HIV-1 Infected Patients Receiving Highly Active Antiretroviral Therapy JOHN PALIOS, JOHN PALIOS Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this authorIGNATIOS IKONOMIDIS, IGNATIOS IKONOMIDIS Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this authorJOHN LEKAKIS, JOHN LEKAKIS Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this authorSOTIRIOS TSIODRAS, SOTIRIOS TSIODRAS Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorGARYFALIA POULAKOU, GARYFALIA POULAKOU Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorANASTASIA ANTONIADOU, ANASTASIA ANTONIADOU Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorPERIKLIS PANAGOPOULOS, PERIKLIS PANAGOPOULOS Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorANTONIOS PAPADOPOULOS, ANTONIOS PAPADOPOULOS Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorHELEN GIAMARELLOU, HELEN GIAMARELLOU Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorMARIA ANASTASIOU-NANA, MARIA ANASTASIOU-NANA Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this authorDIMITRIOS KREMASTINOS, DIMITRIOS KREMASTINOS Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this author JOHN PALIOS, JOHN PALIOS Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this authorIGNATIOS IKONOMIDIS, IGNATIOS IKONOMIDIS Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this authorJOHN LEKAKIS, JOHN LEKAKIS Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this authorSOTIRIOS TSIODRAS, SOTIRIOS TSIODRAS Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorGARYFALIA POULAKOU, GARYFALIA POULAKOU Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorANASTASIA ANTONIADOU, ANASTASIA ANTONIADOU Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorPERIKLIS PANAGOPOULOS, PERIKLIS PANAGOPOULOS Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorANTONIOS PAPADOPOULOS, ANTONIOS PAPADOPOULOS Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorHELEN GIAMARELLOU, HELEN GIAMARELLOU Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, GreeceSearch for more papers by this authorMARIA ANASTASIOU-NANA, MARIA ANASTASIOU-NANA Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this authorDIMITRIOS KREMASTINOS, DIMITRIOS KREMASTINOS Second Department of Cardiology, Attikon University Hospital, University of Athens Medical School, AthensSearch for more papers by this author First published: 28 April 2010 https://doi.org/10.1111/j.1549-8719.2010.00023.xCitations: 8 Dr. Ignatios Ikonomidis, MD, PhD, FESC,Department of Cardiology, Attikon University Hospital, University of Medical School, Perikleous 19, 1434 N Chalkidona, Athens, Greece. E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Microcirculation (2010) 17, 303–310. doi: 10.1111/j.1549–8719.2010.00023.x Objectives: We investigated whether HIV-1 infected patients receiving highly active antiretroviral therapy (HAART) and HIV-1 infected patients who had never received HAART had differences in their vascular microcirculatory function. Methods: We assessed the forearm blood flow before and after four minutes of ischemic occlusion of the brachial artery using venous occlusion strain gauge plethysmography. The hyperaemic forearm blood flow was recorded for three minutes at 15 second intervals. We calculated the maximal percent increase of the forearm blood flow during hyperemia. Forty HIV-infected male patients receiving HAART were compared to 20 age- and BMI- matched, male HIV-infected patients who had never received HAART (control group). Results: Patients on HAART had similar baseline forearm blood flow but lower maximal and percentage (%) change in forearm blood flow than control patients (4.2 ± 1.7 vs. 4.1 ± 1.7 l/ 100mL/min P = 0.8, 32 ± 11.2 vs. 38.9 ± 10.5 l/100 mL/min. P = 0.04 and 714 ± 255 vs. 907 ± 325%, P = 0.01, respectively). Patients receiving HAART had higher cholesterol than control patients (221 ± 58 vs. 163 ± 38 mg/dL, P = 0.001). HAART was associated with the percentage change in the blood flow during hyperemia (coefficient regression B = −0.32, P = 0.02) after adjustment for age, cholesterol and viral load. Conclusions: HIV-infected patients receiving HAART present abnormalities of arterial microcirculation in comparison with never-treated patients. References 1 UNAIDS/WHO. (2007). AIDS Epidemic Update the UNAIDS/WHO Annual Report. http://www.unaids.org/ . 2 Palella FJ, Delaney KM, Moorman A, et al. (1998). Declining morbidity and mortality among patients with advanced HIV infection. N Engl J Med 338: 853–860. 3 Carr A, Samaras K, Burton S, et al. (1998). A syndrome of peripheral lipodystrophy, hyperlipidemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 12: F51–F58. 4 Tsiodras S, Mantzoros C, Hammer S, Samore M. (2000). Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy: a 5-year 29 cohort study. Arch Intern Med 160: 2050–2056. 5 Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA. (1999). Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidemia, and diabetes mellitus: a cohort study. Lancet 353: 2093–2099. 6 Stein JH, Klein MA, Bellehumeur JL, et al. (2001). Use of human immunodeficiency virus-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction. Circulation 104: 257–262. 7 Depairon M, Chessex S, Sudre P, et al. (2001). Premature atherosclerosis in HIV-infected individuals: focus on protease inhibitor therapy. AIDS 15: 329–334. 8 Henry K, Melroe H, Huebsch J, et al. (1998). Severe premature coronary artery disease with protease inhibitors. Lancet 351: 1328. 9 Grinspoom S, Carr A. (2003). Cardiovascular risk and body fat abnormalities in HIV infected adults. New Engl J Med 349: 48–62. 10 Walli R, Herfort O, Michi GM, et al. (1998). Treatment with protease inhibitors associated with peripheral insulin resistance and impaired oral glucose tolerance in HIV patients. AIDS 12: 163–167. 11 Periard D, Telenti A, Sudre P, et al. (1999). Atherogenic dyslipidemia in HIV-infected individuals treated with protease inhibitors. Circulation 100: 700–705. 12 Nolan D, Watts GF, Herrmann SE, French MA, John M, Mallal S. (2003). Endothelial function in HIV-infected patients receiving protease inhibitor therapy: does immune competence affect cardiovascular risk? Q J Med 96: 825–832. 13 Blum A, Hadas V, Burke M, Yust I, Kessler A. (2005). Viral load of the human immunodeficiency virus could be an independent risk factor for endothelial dysfunction. Clin Cardiol 28: 149–153. 14 De Saint Martin L, Vandhuick O, Guillo P, et al. (2006). Premature atherosclerosis in HIV infected patients and cumulated time of exposure to antiretroviral therapy (SHIVA study). Atherosclerosis 185(2): 361–367. 15 Jerico C, Knobel H, Calvo N, et al. (2006). Subclinical carotid atherosclerosis in HIV infected patients. Role of combination antiretroviral therapy. Stroke 37: 812–817. 16 Holmberg SD, Moorman AC, Williamson JM, et al. (2002). Protease inhibitors and cardiovascular outcomes in patients with HIV-1. Lancet 360: 1747–1748. 17 DAD Study Group. (2003). Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 349: 1991–2003. 18 Bozzette SA, Ake CF, Tam HK, Chang SW, Louis TA. (2003). Cardiovascular and cerebrovascular events in patients treated for HIV infection. N Engl J Med 348: 702–710. 19 Lekakis J, Tsiodras S, Ikonomidis I, et al. (2008). HIV positive patients treated with protease inhibitors have vascular changes resembling those observed in atherosclerotic cardiovascular disease. Clin Sci 115: 189–196. 20 Lekakis J, Ikonomidis I, Palios J, et al. (2009). Association of highly active antiretroviral therapy with increased arterial stiffness in patients infected with human immunodeficiency virus. Am J Hypertens 22: 828–834. 21 Thijssen DH, Bleeker MW, Smits P, Hopman MT. (2005). Reproducibility of blood flow and post-occlusive reactive hyperemia as measured by venous occlusion plethysmograrhy. Clin Sci (Lond) 108(2): 151–157. 22 Tonari S, Nishimura H, Fukunishi K, Mori T, Kitaura Y. (2003). Forearm hyperemia is a better marker than carotid intima-media thickness or ankle-brachial index for coronary artery disease in Japanese males under 65. Hypertens Res 26: 59–65. 23 Gamble J, Gartside IB, Christ F. (1993). A reassessment of mercury in silastic strain gauge plethysmography for microvascular permeability assessment in man. J Physiol (Lond) 464: 407–422. 24 Jaap AJ, Shore AC, Gartside IB, Gamble J, Tooke JE. (1993). Increased microvascular fluid permeability in young type 1 diabetic patients. Diabetologia 36: 648–652. 25 Tousoulis D, Antoniades C, Bosinakou E, et al. (2005). Effects of atorvastatin on reactive hyperemia and inflammatory process in patients with congestive heart failure. Atherosclerosis 178: 359–363. 26 Ouchi N, Ohishi M, Kihara S, et al. (2003). Association of hypoadiponectinemia with impaired vasoreactivity. Hypertension 42: 231–234. 27 Perticone F, Ceravolo R, Pujia A, et al. (2001). Prognostic significance of endothelial dysfunction in hypertensive patients. Circulation 104: 191–196. 28 Fichtlscherer S, Breuer S, Zeiher A. (2004). Prognostic value of systematic endothelial dysfunction in patients with acute coronary syndromes. Circulation 110: 1926–1932. 29 Ishibashi Y, Duncker DJ, Zhan GJ. (1998). ATP-sensitive K+ channels, adenosine, and nitric oxide-mediated mechanisms account for coronary vasodilation during exercise. Circ Res 82: 346–359. 30 Bijlstra PJ, Den Arend CACJ, Lutterman JA. (1996). Blockade of vascular ATP-sensitive potassium channels reduces the vasodilator response to ischaemia in adults. Diabetologia 39: 1562–1568. 31 Rui-Juan X, Cheng J, Berglund O. (1991). Microcirculatory disturbances in AIDS patients. Microvasc Res 42: 151–159. 32 Monsuez JJ, Dufaux J, Vittecoq D, Vicaut E. (2000). Reduced reactive hyperemia in HIV- infected patients. J Acquir Immune Defic Syndr 25: 434–442. 33 Hammer SM, Saag MS, Schechter M, et al. (2006). Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society-USA panel. JAMA 296: 827–843. 34 Dressman J, Kincer J, Matveev SV, et al. (2003). HIV protease inhibitors promote atherosclerotic lesion formation independent of dyslipidemia by increasing CD-36 dependent cholesterol accumulation in macrophages. J Clin Invest 111: 389–397. 35 Paton P, Tabib A, Loire R, Tete R. (1993). Coronary artery lesions and HIV infection. Res Virol 144: 225–231. 36 Lewis W. (2005). Nucleoside reverse transcriptase inhibitors, mitochondrial DNA and AIDS therapy. Antivir Ther 10(Suppl 2): M13–M27. 37 Conklin BS, Fu W, Lin PH, Lumsden AB, Yao Q, Chen C. (2004). HIV protease inhibitor ritonavir decreases endothelium-dependent vasorelaxation and increases superoxide in porcine arteries. Cardiovasc Res 63: 168–175. 38 Zhong DS, Lu XH, Conklin BS, et al. (2002). HIV protease inhibitor ritonavir induces cytotoxicity of human endothelial cells. Arterioscler Thromb Vasc Biol 22: 1560–1566. 39 Monsuez J, Charniot J, Escaut L, et al. (2009). HIV-associated vascular diseases: structural and functional changes, clinical implications. Int J Cardiol 133: 293–306. 40 Zangerle R, Fuchs D. (2008). Increased cardiovascular risk in patients with human immunodeficiency virus infection under highly active antiretroviral therapy. Am J Cardiol 102: 373–374. 41 Hoffmann G, Kenn S, Wirleitner B, et al. (1998). Neopterin induces nitric oxide-dependent apoptosis in rat vascular smooth muscle cells. Immunobiology 199: 63–73. 42 Eugenin EA, Morgello S, Klotman ME. (2008). Human immunodeficiency virus (HIV) infects human arterial smooth muscle cells in vivo and in vitro: implications for the pathogenesis of HIV-mediated vascular disease. Am J Pathol 172: 1100–1111. 43 Strano S, Masseti A, Mastroianni CM, Vullo V. (2009). Increased carotid intima media thickness is associated with depletion of circulating myeloid dendritic cells in HIV-infected patients on suppressive antiretroviral treatment. Atherosclerosis 204: e1–e3. 44 Lima EM, Gualandro DM, Yu PC, et al. (2009). Cardiovascular prevention in HIV patients: results from a successful intervention program. Atherosclerosis 204(1): 229–232. 45 De Lorenzo F, Boffito M, Collot-Teixeira S, et al. (2009). Prevention of atherosclerosis in patients living with HIV. Vasc Health Risk Manag 5(1): 287–300. Citing Literature Volume17, Issue4May 2010Pages 303-310 ReferencesRelatedInformation
Referência(s)