Endocrine Abstracts

Background: Treatment of HIV patients with antiretroviral therapies may confer an increased cardiovascular risk, possibly mediated through metabolic perturbations induced by these therapies. We sought to determine whether large arterial stiffening, an early marker and predictor of cardiovascular disease, occurs in HIV recipients of HAART, and if so the plausible mechanisms involved.

Methods: In this case-control analysis, 56 HIV subjects (mean age 46 ± 10 yrs) and 40 healthy age- and sex -matched controls were studied. Arterial stiffness and wave reflections were assessed by measuring aortic pulse wave velocity (PWV) and augmentation index (AIX). Cardiovascular autonomic function was assessed by measurements of heart rate variability following standard manoeuvres. Insulin, glucose, lipids, adiponectin, leptin and high-sensitivity C-reactive protein (hsCRP) were measured from fasting venous blood samples.

Results: (mean±S.D., HIV versus controls) Aortic PWV (7.2±1.2 vs 6.5±1.2 m/s, P<0.05) and AIX (16±12 vs 10±15%, P<0.05) were increased in HIV subjects. Abnormal cardiovascular autonomic function (autonomic score) was more prevalent in HIV subjects (1.35±1.26 vs 0.9±0.94, P<0.05) and correlated with AIX in HIV subjects (r=0.41, P<0.01) but not controls. hsCRP (4.3±6.6 vs 2.3±2.9 mg/L, P<0.05) was higher in HIV subjects but there were no differences in insulin sensitivity (homeostatic model assessment – HOMA-IR), lipids, leptin and adiponectin. Amongst controls, aortic PWV correlated with HOMA-IR (r=0.41, P<0.05), hsCRP (r=0.51, P<0.01), LDL (r=0.48, P<0.01) and HDL cholesterol (r=−0.31, P=0.05) but these relationships were not evident in HIV subjects.

Conclusions: Premature large artery stiffening and enhanced pressure wave reflection occur in HIV patients receiving HAART. Amongst HIV subjects, abnormalities in cardiovascular autonomic nerve function were more closely associated with vascular abnormalities than measures of insulin sensitivity, inflammation and adipokines.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.