Portal de Periódicos da CAPES

Chronological and biological age in HIV infection

2010; Elsevier BV; Volume: 61; Issue: 5 Linguagem: Inglês

10.1016/j.jinf.2010.09.001

1532-2742

Giuseppe Vittorio De Socio, Elena Ricci, Giustino Parruti, Paolo Maggi, Giordano Madeddu, Tiziana Quirino, Paolo Bonfanti,

HIV/AIDS Research and Interventions

Several studies have so far documented the dramatic impact of highly active antiretroviral therapy (HAART) in improving survival estimates of HIV-infected patients. 1 Lohse N. Hansen A.B. Pedersen G. Kronborg G. Gerstoft J. Sørensen H.T. et al. Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med. 2007; 146: 87-95 Crossref PubMed Scopus (624) Google Scholar , 2 Antiretroviral Therapy Cohort Collaboration Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008; 372: 293-299 Abstract Full Text Full Text PDF PubMed Scopus (1332) Google Scholar Within such a scenario, the growing impact of cardiovascular disease and accelerated biological aging is of particular concern. 3 Aberg J.A. Cardiovascular complications in HIV management: past, present, and future. J Acquir Immune Defic Syndr. 2009; 50: 54-64 Crossref PubMed Scopus (84) Google Scholar , 4 Guaraldi G. Zona S. Alexopoulos N. Orlando G. Carli F. Ligabue G. et al. Coronary aging in HIV-infected patients. Clin Infect Dis. 2009; 49: 1756-1762 Crossref PubMed Scopus (101) Google Scholar Indeed, HIV-infected patients are generally considered a special population experiencing an acceleration of the aging process, as well as a substantial burden of additional co-morbidity. 5 Deeks S.G. Immune dysfunction, inflammation, and accelerated aging in patients on antiretroviral therapy. Top HIV Med. 2009; 17: 118-123 PubMed Google Scholar An important role in determining premature aging has been attributed to conventional cardiovascular risk factors, as these are widely prevalent in HIV-infected people. 6 De Socio G.V. Martinelli L. Morosi S. Fiorio M. Roscini A.R. Stagni G. et al. Is estimated cardiovascular risk higher in HIV-infected patients than in the general population?. Scand J Infect Dis. 2007; 39: 805-812 Crossref PubMed Scopus (39) Google Scholar A better evaluation of their impact may be provided by the estimate of vascular age as calculated by a new sex-specific multivariable risk factor algorithm derived from the Framingham Heart Study. It includes age, total and HDL-cholesterol, blood pressure, diabetes and tobacco use. This equation may be applied to obtain a derived estimate of vascular age in the general population. 7 D’Agostino Sr., R.B. Vasan R.S. Pencina M.J. Wolf P.A. Cobain M. Massaro J.M. et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008; 117: 743-753 Crossref PubMed Scopus (4555) Google Scholar The aim of our present investigation was to estimate the difference between chronological age and vascular age, calculated using the Framingham equation, 7 D’Agostino Sr., R.B. Vasan R.S. Pencina M.J. Wolf P.A. Cobain M. Massaro J.M. et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008; 117: 743-753 Crossref PubMed Scopus (4555) Google Scholar in a large cohort of HIV-infected patients. In 2 recent multicenter Italian studies, “SIM-One” 8 De Socio G.V. Parruti G. Quirino T. Ricci E. Schillaci G. Adriani B. et al. Identifying HIV patients with an unfavorable cardiovascular risk profile in clinical practice: results from the SIMONE study. J Infect. 2008; 57: 33-40 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar and “HERMES”, 9 Bonfanti P. De Socio G.V. Marconi P. Franzetti M. Martinelli C. Vichi F. et al. Is metabolic syndrome associated to HIV infection per se? Results from the Hermes Study. Curr HIV Res. 2010; 8: 165-171 Crossref PubMed Scopus (33) Google Scholar we collected clinical and laboratory data, including information on cardiovascular risk factors, on 1243 HIV-infected patients (most on HAART) and 317 antiretroviral naïve HIV patients, respectively. The main characteristics of evaluated patients are summarized in Table 1. The estimated vascular age was higher than chronological age in both groups (+6.0 and +4.2 in SIM-One and HERMES, respectively). Table 1Clinical features and estimated vascular age (VA) in HIV-infected patients in the Hermes and SIM-One studies. Hermes N=317 (%) 9 Bonfanti P. De Socio G.V. Marconi P. Franzetti M. Martinelli C. Vichi F. et al. Is metabolic syndrome associated to HIV infection per se? Results from the Hermes Study. Curr HIV Res. 2010; 8: 165-171 Crossref PubMed Scopus (33) Google Scholar Sim-One N=1243 (%) 8 De Socio G.V. Parruti G. Quirino T. Ricci E. Schillaci G. Adriani B. et al. Identifying HIV patients with an unfavorable cardiovascular risk profile in clinical practice: results from the SIMONE study. J Infect. 2008; 57: 33-40 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar Total patients N=1560 (%) Naïve to Antiretroviral therapy 317 (100) 186 (15.0) 503 (32.2) Men 241 (75.0) 892 (71.8) 1133 (72.6) Age, years (mean±SD) 39.0±10.2 43.2±9.2 42.3±9.2 Body mass index, kg × m−2 (mean±SD) 23.6±3.5 23.6±3.4 23.6±3.4 Current smokers 158 (50.2) 748 (61.4) 906 (58.1) Diabetes 11 (3.5) 68 (5.5) 79 (5.0) Hypertension 17 (5.4) 117 (9.5) 134 (8.6) 10-year global CVD risk (mean±SD) 6.5±8.0 9.3±10.2 8.8±9.8 Metabolic syndrome (ATP III) a 292 HERMES, 1230 SIM-One. 36 (12.3) 273 (22.0) 309 (19.8) Total cholesterol, mg/dL (mean±SD) 169.2±40.9 190.6±47.8 186.3±47.2 HDL-cholesterol mg/dL (mean±SD) 44.0±13.9 47.7±13.4 46.9±15.9 Triglycerides, mg/dL (mean±SD) 133.6±83.6 197.4±183.2 184.6±170.0 CD4+ cell count, cells/μL (mean±SD) 419.9±271.9 484.9±279.1 471.6±278.8 VA (years, mean±SD) 43.2±13.6 49.2±14.2 48.0 ± 14.3 VA – chronological age (mean±SD) 4.2±8.0 6.0±9.2 5.7±9.0 Patients with VA increased 218 (68.6%) 912 (73.4%) 1130 (72.4) VA – chronological age in patients with VA increased 7.7±6.8 9.7±7.6 9.3±7.5 SIM-One: patients on therapy. 8 De Socio G.V. Parruti G. Quirino T. Ricci E. Schillaci G. Adriani B. et al. Identifying HIV patients with an unfavorable cardiovascular risk profile in clinical practice: results from the SIMONE study. J Infect. 2008; 57: 33-40 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar HERMES: naïve HIV patients. 9 Bonfanti P. De Socio G.V. Marconi P. Franzetti M. Martinelli C. Vichi F. et al. Is metabolic syndrome associated to HIV infection per se? Results from the Hermes Study. Curr HIV Res. 2010; 8: 165-171 Crossref PubMed Scopus (33) Google Scholar a 292 HERMES, 1230 SIM-One. Open table in a new tab SIM-One: patients on therapy. 8 De Socio G.V. Parruti G. Quirino T. Ricci E. Schillaci G. Adriani B. et al. Identifying HIV patients with an unfavorable cardiovascular risk profile in clinical practice: results from the SIMONE study. J Infect. 2008; 57: 33-40 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar HERMES: naïve HIV patients. 9 Bonfanti P. De Socio G.V. Marconi P. Franzetti M. Martinelli C. Vichi F. et al. Is metabolic syndrome associated to HIV infection per se? Results from the Hermes Study. Curr HIV Res. 2010; 8: 165-171 Crossref PubMed Scopus (33) Google Scholar