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Seplowe M, Goyal A, Fowler T, Michaud L, Glassman R, Frishman WH, Aronow WS. Atherosclerosis and HIV: Exploring Cardiovascular Risks and Management. Cardiol Rev 2024:00045415-990000000-00296. [PMID: 38980010 DOI: 10.1097/crd.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
The advent of antiretroviral therapy has markedly improved the life expectancy of individuals with HIV, leading to a shift in clinical focus from managing opportunistic infections to addressing chronic conditions, such as atherosclerotic cardiovascular disease (ASCVD). Emerging evidence highlights an elevated risk of ASCVD among people living with HIV, characterized by a higher incidence of acute myocardial infarction, ischemic stroke, and heart failure compared with the general population. This review examines the epidemiology, pathophysiology, and management of ASCVD in the context of HIV. It explores the interplay between HIV infection, antiretroviral therapy, and traditional cardiovascular risk factors, underscoring the need for comprehensive cardiovascular risk reduction strategies tailored to people living with HIV. Through synthesizing data from clinical trials, observational studies, and basic research, the review aims to enhance understanding of HIV-associated ASCVD and inform healthcare practices to improve the longevity and quality of life for this patient population.
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Affiliation(s)
- Matthew Seplowe
- From the Department of Hospital Medicine, Mount Sinai Morningside, New York, NY
| | - Anjali Goyal
- Department of Medicine, New York Medical College, Valhalla, NY
| | - Tolison Fowler
- Department of General Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Liana Michaud
- Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Rebecca Glassman
- Department of General Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | | | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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Rahman F, Martin SS, Whelton SP, Mody FV, Vaishnav J, McEvoy JW. Inflammation and Cardiovascular Disease Risk: A Case Study of HIV and Inflammatory Joint Disease. Am J Med 2018; 131:442.e1-442.e8. [PMID: 29269230 DOI: 10.1016/j.amjmed.2017.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 11/25/2017] [Accepted: 11/29/2017] [Indexed: 02/07/2023]
Abstract
The epidemiologic data associating infection and inflammation with increased risk of cardiovascular disease is well established. Patients with chronically upregulated inflammatory pathways, such as those with HIV and inflammatory joint diseases, often have a risk of future cardiovascular risk that is similar to or higher than patients with diabetes. Thus, it is of heightened importance for clinicians to consider the cardiovascular risk of patients with these conditions. HIV and inflammatory joint diseases are archetypal examples of how inflammatory disorders contribute to vascular disease and provide illustrative lessons that can be leveraged in the prevention of cardiovascular disease. Managing chronic inflammatory diseases calls for a multifaceted approach to evaluation and treatment of suboptimal lifestyle habits, accurate estimation of cardiovascular disease risk with potential upwards recalibration due to chronic inflammation, and more intensive treatment of risk factors because current tools often underestimate the risk in this population. This approach is further supported by the recently published CANTOS trial demonstrating that reducing inflammation can serve as a therapeutic target among persons with residual inflammatory risk for cardiovascular disease.
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Affiliation(s)
- Faisal Rahman
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Seth S Martin
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Seamus P Whelton
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Freny V Mody
- Department of Medicine, Greater Los Angeles Veterans Affairs Medical and Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at University of California, Los Angeles
| | | | - John William McEvoy
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
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3
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Haser GC, Sumpio B. Systemic and cell-specific mechanisms of vasculopathy induced by human immunodeficiency virus and highly active antiretroviral therapy. J Vasc Surg 2016; 65:849-859. [PMID: 26994951 DOI: 10.1016/j.jvs.2016.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Patients infected with human immunodeficiency virus (HIV) have higher rates of dyslipidemia, atherosclerosis, and chronic inflammation that can damage the vascular system compared with the general population. This can be attributed both to HIV itself and to highly active antiretroviral therapy (HAART) they receive. This review outlines the mechanisms by which HIV and HIV medications can cause vascular complications and identifies strategic areas of research to treat these dysfunctions. REVIEW HIV and HAART affect the vascular system through several mechanisms that target systemic or metabolic systems and specific cells. HIV causes dyslipidemia and chronic immune activation, which can contribute to atherosclerosis. In addition, HIV damages macrophages, endothelial cells, smooth muscle cells, and platelets, and this damage also plays a role in the development of atherosclerosis. HAART, particularly protease inhibitors, interferes with cholesterol metabolism and can affect macrophages, endothelial cells, and smooth muscle cells. The metabolic changes and cell damage induced by HIV and HAART put HIV patients at increased risk for atherosclerosis, dyslipidemia, and serious cardiovascular events such as myocardial infarction and stroke. CONCLUSIONS HIV patients have increased risk of developing potentially life-threatening cardiovascular pathology, which cannot be explained by traditional cardiovascular risk factors alone. More research is needed into therapies to target this HIV-specific vasculopathy.
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Affiliation(s)
- Grace C Haser
- Department of Vascular Surgery, Yale School of Medicine, New Haven, Conn
| | - Bauer Sumpio
- Department of Vascular Surgery, Yale School of Medicine, New Haven, Conn.
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Suwalak T, Srisawasdi P, Puangpetch A, Santon S, Koomdee N, Chamnanphon M, Charoenyingwattana A, Chantratita W, Sukasem C. Polymorphisms of the ApoE (Apolipoprotein E) gene and their influence on dyslipidemia in HIV-1-infected individuals. Jpn J Infect Dis 2014; 68:5-12. [PMID: 25420659 DOI: 10.7883/yoken.jjid.2013.190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this retrospective case-control study was to investigate the frequency of Apolipoprotein E (ApoE) polymorphisms and their influence on antiretroviral therapy (ART)-induced lipodystrophy or dyslipidemia in HIV-infected Thai patients. The clinical characteristics and frequencies of ApoE genotypes were compared between the case (moderate to severe lipodystrophy, n = 67) and control (absent to mild lipodystrophy, n = 18) groups. The ApoE genotype frequencies among the 85 participants were 2.35% (n = 2) for E2/E2, 20% (n = 17) for E2/E3, 9.41% (n = 8) for E2/E4, 36.47% (n = 31) for E3/E3, 30.59% (n = 26) for E3/E4, and 1.18% (n = 1) for E4/E4. None of the ApoE genotypes showed association with ART-induced lipodystrophy. However, the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-cholesterol), and ApoB were lower in patients carrying the E2 allele but higher in E4 carriers. Interestingly, the ratios between TC and high-density lipoprotein (TC/HDL cholesterol ratio) and ApoB/ApoA-I ratio were significantly higher in the case group. Patients carrying the E2 allele displayed protective lipid profile, while those carrying E4 appeared to be at higher risk of dyslipidemia. In conclusion, ApoE polymorphisms were not associated with lipodystrophy in patients undergoing antiretroviral therapy but influenced lipid alteration.
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Affiliation(s)
- Tanida Suwalak
- Division of Pharmacogenomics and Personalized Medicine; Division of Clinical Chemistry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
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5
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da Cunha J, Ferreira Maselli LM, Treitinger A, Monteiro AM, Gidlund M, Maranhão RC, Spada C, Bydlowski SP. Serum levels of IgG antibodies against oxidized LDL and atherogenic indices in HIV-1-infected patients treated with protease inhibitors. Clin Chem Lab Med 2014; 51:371-8. [PMID: 23241595 DOI: 10.1515/cclm-2012-0225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 08/20/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Antibodies against low-density lipoproteins (LDLs) that have been oxidized are associated with development of atherosclerotic lesions. In individuals infected with human immunodeficiency virus type 1 (HIV-1) with or without therapy, dyslipidemia and increased cardiovascular risk are observed. METHODS Serum levels of IgG antibodies against oxidized LDLs (IgG anti-oxLDL Abs) were determined by assay in 151 HIV-1-infected patients. Of these, 42 patients did not receive anti-retroviral therapy (ART-naïve), whereas 109 received highly active anti-retroviral therapy (HAART) consisting of lopinavir/ritonavir (LOP/r; n=50), efavirenz (EFV; n=30) and nevirapine (NVP; n=29) associated with nucleoside reverse transcriptase inhibitors. HIV-1 seronegative individuals (n=43) participated in the study. The following parameters were quantified: total cholesterol and its fractions, atherogenic indices (AIs), apolipoproteins A1 and B100, high sensitivity C-reactive protein, CD4+ and CD8+ T cells, and HIV-1-RNA. RESULTS Levels of IgG anti-oxLDL Abs were significantly higher (p<0.05) in the LOP/r group compared with the EFV and/or NVP and the seronegative group: median 0.32 (0.15, 0.58; 95% confidence interval) vs. 0.25 (0.13, 0.53) vs. 0.18 (0.04, 0.38), respectively. HIV-1-infected ART-naïve patients (n=42) presented antibodies levels similar to those observed for the LOP/r group, 0.33 (0.13, 0.63; p>0.05). The levels of IgG anti-oxLDL Abs correlated with an increase in AIs (r=0.216; p=0.036) and triglycerides (r=0.220; p=0.044) in the LOP/r group, and AIs in the ART-naïve group (r=0.300; p=0.046). CONCLUSIONS Patients treated with LOP/r showed higher levels of IgG anti-oxLDL Abs compared with patients treated with EFV or NVP regimens, and these levels were associated with an increase in AIs.
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Affiliation(s)
- Joel da Cunha
- Laboratory of Genetics and Molecular Hematology, University of Sao Paulo Medical School (HCFMUSP), Sao Paulo, Brazil
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6
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Maisa A, Westhorpe C, Elliott J, Jaworowski A, Hearps AC, Dart AM, Hoy J, Crowe SM. Premature onset of cardiovascular disease in HIV-infected individuals: the drugs and the virus. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.10.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Life expectancy in HIV-infected individuals has been greatly enhanced through immunologic restoration and virologic suppression resulting from antiretroviral therapy. Current clinical HIV care in Western countries focuses on treatment of drug toxicities and prevention of comorbidities. These non-AIDS HIV-related comorbidities, such as cardiovascular disease, occur even in individuals with virologic suppression and manifest at an earlier age than when normally presenting in the general population. While traditional risk factors are present in many HIV-infected individuals who develop cardiovascular disease, the additional roles of HIV-related chronic inflammation and immune activation as well as chronic HIV viremia may be significant. This review provides current evidence for the contributions of the virus, in terms of both chronic viremia and its contribution via chronic low-level inflammation, immune activation, premature immune senescence and dyslipidemia, to the pathogenesis of HIV-related cardiovascular disease, and balances this against the propensity of specific antiretroviral therapies to cause cardiovascular disease, in particular through altered cholesterol metabolism.
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Affiliation(s)
- Anna Maisa
- Centre for Virology, Burnet Institute, Commercial Road, Melbourne, Australia
| | - Clare Westhorpe
- Centre for Virology, Burnet Institute, Commercial Road, Melbourne, Australia
| | - Julian Elliott
- Infectious Diseases Unit, The Alfred Hospital, Melbourne, Australia
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, Australia
- Deptment of Epidemiology & Preventive Medicine, Monash University, Commercial Road, Melbourne
| | - Anthony Jaworowski
- Centre for Virology, Burnet Institute, Commercial Road, Melbourne, Australia
- Deptment of Immunology, Monash University, Clayton, Australia
- Deptment of Medicine, Monash University, Clayton, Australia
| | - Anna C Hearps
- Centre for Virology, Burnet Institute, Commercial Road, Melbourne, Australia
| | - Anthony M Dart
- Deptment of Medicine, Monash University, Clayton, Australia
- Deptment of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia
| | - Jennifer Hoy
- Infectious Diseases Unit, The Alfred Hospital, Melbourne, Australia
- Deptment of Medicine, Monash University, Clayton, Australia
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de Carvalho ÉH, Filho DDBM, Ximenes RADA, de Albuquerque MDFPM, de Melo HRL, Gelenske T, Medeiros ZDB, Montarroyos U, Bandeira F. Prevalence of Hyperapolipoprotein B and Associations with Other Cardiovascular Risk Factors Among Human Immunodeficiency Virus–Infected Patients in Pernambuco, Brazil. Metab Syndr Relat Disord 2010; 8:403-10. [DOI: 10.1089/met.2009.0092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Érico Higino de Carvalho
- Endocrinology and Internal Medicine Service, Institute of Integral Medicine Professor Fernando Figueira (IMIP), Recife, Brazil
| | | | - Ricardo Arraes de Alencar Ximenes
- Department of Tropical Medicine, Federal University of Pernambuco, Recife, PE, Brazil, and Postgraduate Studies Center, University of Pernambuco, Recife, Brazil
| | | | - Heloísa Ramos Lacerda de Melo
- Department of Tropical Medicine, Federal University of Pernambuco, Recife, PE, Brazil, and Postgraduate Studies Center, University of Pernambuco, Recife, Brazil
| | - Thais Gelenske
- Endocrinology and Internal Medicine Service, Institute of Integral Medicine Professor Fernando Figueira (IMIP), Recife, Brazil
| | - Zoraya de Barros Medeiros
- Department of Internal Medicine, School of Medical Sciences, University of Pernambuco, Recife, Brazil
| | - Ulisses Montarroyos
- Department of Tropical Medicine, Federal University of Pernambuco, Recife, PE, Brazil, and Postgraduate Studies Center, University of Pernambuco, Recife, Brazil
| | - Francisco Bandeira
- Department of Internal Medicine, School of Medical Sciences, University of Pernambuco, Recife, Brazil
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8
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Anuurad E, Semrad A, Berglund L. Human immunodeficiency virus and highly active antiretroviral therapy-associated metabolic disorders and risk factors for cardiovascular disease. Metab Syndr Relat Disord 2009; 7:401-10. [PMID: 19355810 DOI: 10.1089/met.2008.0096] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The successful introduction of highly active antiretroviral therapy (HAART), a combination of potent antiretroviral agents, including protease inhibitors, nucleoside reverse transcriptase inhibitors, and nonnucleoside reverse transcriptase inhibitors, has impacted positively on morbidity and mortality among human immunodeficiency virus (HIV)-positive patients. Over time, HAART has been associated with a number of metabolic and anthropometric abnormalities, including dyslipidemia and insulin resistance as well as subcutaneous fat loss and abdominal obesity, potentially contributing to cardiovascular risk. Recent studies have more firmly established that both HIV infection and HAART might increase the risk of clinical cardiovascular events. Furthermore, whereas HIV/HAART is associated with multiple aspects of endocrine dysfunction, there has been less focus on bone disease, although some studies indicate a higher prevalence of osteoporosis among HIV-positive subjects compared to HIV-negative controls. The relationship between bone and fat metabolism under HIV-positive conditions deserves further attention, and available data suggest the possibility of an intriguing connection. In the future, an increasing population of aging HIV-positive patients with a spectrum of antiretroviral therapies and accumulation of endocrine abnormalities and conventional cardiovascular risk factors will present preventive and therapeutic challenges to our health-care system.
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Affiliation(s)
- Erdembileg Anuurad
- Department of Medicine, University of California Davis, Sacramento, California 95817, USA
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9
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Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is one of the most common causes of death in HIV-infected adults. Understanding the pathogenesis of cardiovascular disease in the setting of HIV infection is essential for the development of appropriate management strategies. RECENT FINDINGS Antiretroviral therapy with most protease inhibitors and thymidine nucleoside analogue reverse transcriptase inhibitors has been linked to dyslipidaemia and insulin resistance. The adverse glycaemic effects of longer term, current generation protease inhibitors, however, appear relatively modest. Nevertheless, about half of the risk associated with antiretroviral therapy remains unexplained by lipid abnormalities. More recently, HIV has been associated with increased risk of cardiovascular disease. HIV nef inhibits HDL efflux from macrophages and so may directly lower HDL cholesterol levels. Untreated HIV infection is also associated with increased levels of D-dimer, a pro-inflammatory and pro-thrombotic marker of cardiovascular disease, and HIV has direct effects on vascular tissue in vitro that remains of uncertain clinical significance. SUMMARY Antiretroviral therapy without metabolic effects that suppresses HIV effectively is likely to be associated with the lowest risk of cardiovascular disease.
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10
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Crowe SM, Westhorpe CLV, Mukhamedova N, Jaworowski A, Sviridov D, Bukrinsky M. The macrophage: the intersection between HIV infection and atherosclerosis. J Leukoc Biol 2009; 87:589-98. [PMID: 19952353 DOI: 10.1189/jlb.0809580] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
HIV-infected individuals are at increased risk of coronary artery disease (CAD) with underlying mechanisms including chronic immune activation and inflammation secondary to HIV-induced microbial translocation and low-grade endotoxemia; direct effects of HIV and viral proteins on macrophage cholesterol metabolism; and dyslipidemia related to HIV infection and specific antiretroviral therapies. Monocytes are the precursors of the lipid-laden foam cells within the atherosclerotic plaque and produce high levels of proinflammatory cytokines such as IL-6. The minor CD14+/CD16+ "proinflammatory" monocyte subpopulation is preferentially susceptible to HIV infection and may play a critical role in the pathogenesis of HIV-related CAD. In this review, the central role of monocytes/macrophages in HIV-related CAD and the importance of inflammation and cholesterol metabolism are discussed.
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Affiliation(s)
- Suzanne M Crowe
- Centre for Virology, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne 3004, Australia.
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Guo W, Wong S, Pudney J, Jasuja R, Hua N, Jiang L, Miller A, Hruz PW, Hamilton JA, Bhasin S. Acipimox, an inhibitor of lipolysis, attenuates atherogenesis in LDLR-null mice treated with HIV protease inhibitor ritonavir. Arterioscler Thromb Vasc Biol 2009; 29:2028-32. [PMID: 19762785 DOI: 10.1161/atvbaha.109.191304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The advent of HIV protease inhibitors has greatly extended the life span of AIDS patients. With an aging HIV(+) population, the cardiometabolic side effects of these drugs are becoming increasingly important clinical concerns. The purpose of this study was to test the hypothesis that inhibition of adipose lipolysis will retard atherogenic lesion development induced by the antiviral protease inhibitors. METHODS AND RESULTS LDLR-null mice receiving ritonavir were compared with those receiving ritonavir plus lipolysis inhibitor acipimox or vehicle alone to determine how acipimox would affect ritonavir-induced atherogenesis. Intermittent high-fat high-cholesterol diet was used to facilitate optimal atheromatous lesion development. Drug effects were assessed as changes in aortic lesion score, plasma lipid and lipoprotein profile, body fat mass, and insulin-induced suppression of plasma fatty acid concentrations. Ritonavir increased aortic lesions, in association with decreased body fat mass, impaired antilipolysis action of insulin, and increased proatherogenic plasma lipoproteins. All these adverse effects were attenuated by cotreatment with acipimox. CONCLUSIONS Our results provide the first direct evidence that supports the hypothesis that dysregulation of adipose lipolysis is an important contributor to the proatherogenic role of selected HIV protease inhibitors.
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Affiliation(s)
- Wen Guo
- Section of Endocrinology, Boston University School of Medicine, 670 Albany Street, Second Floor, Boston, MA 02118, USA.
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12
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Zou W, Berglund L. HIV and highly active antiretroviral therapy: dyslipidemia, metabolic aberrations, and cardiovascular risk. ACTA ACUST UNITED AC 2007; 10:96-103; quiz 104-5. [PMID: 17392622 DOI: 10.1111/j.1520-037x.2007.03071.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Wei Zou
- Department of Medicine, Division of Endocrinology, Clinical Nutrition, and Vascular Medicine, University of California School of Medicine, Sacramento, CA 95812, USA
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13
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Abstract
PURPOSE OF REVIEW Dyslipoproteinemia is a cardinal feature of the metabolic syndrome that accelerates atherosclerosis. Recent in-vivo kinetic studies of dyslipidemia in the metabolic syndrome are reviewed here. RECENT FINDINGS The dysregulation of lipoprotein metabolism may be caused by a combination of overproduction of VLDL apolipoprotein B-100, decreased catabolism of apolipoprotein B-containing particles, and increased catabolism of HDL apolipoprotein A-I particles. Nutritional modifications and increased physical exercise may favourably alter lipoprotein transport by collectively decreasing the hepatic secretion of VLDL apolipoprotein B and the catabolism of HDL apolipoprotein A-I, as well as by increasing the clearance of LDL apolipoprotein B. Conventional and new pharmacological treatments, such as statins, fibrates and cholesteryl ester transfer protein inhibitors, can also correct dyslipidemia by several mechanisms, including decreased secretion and increased catabolism of apolipoprotein B, as well as increased secretion and decreased catabolism of apolipoprotein A-I. SUMMARY Kinetic studies provide a mechanistic insight into the dysregulation and therapy of lipid and lipoprotein disorders. Future research mandates the development of new tracer methodologies with practicable in-vivo protocols for investigating fatty acid turnover, macrophage reverse cholesterol transport, cholesterol transport in plasma, corporeal cholesterol balance, and the turnover of several subpopulations of HDL particles.
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Affiliation(s)
- Dick C Chan
- Lipoprotein Research Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
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14
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Rose H, Woolley I, Hoy J, Dart A, Bryant B, Mijch A, Sviridov D. HIV infection and high-density lipoprotein: the effect of the disease vs the effect of treatment. Metabolism 2006; 55:90-5. [PMID: 16324925 DOI: 10.1016/j.metabol.2005.07.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 07/11/2005] [Indexed: 12/13/2022]
Abstract
HIV infection is commonly associated with hypoalphalipoproteinemia. It is not clear how much the HIV infection and/or treatment contribute to the changes in high-density lipoprotein (HDL) levels. Blood lipids of HIV-positive males were assessed in a retrospective study. The following groups of patients were studied: (1) untreated for at least 6 months; (2) treatment with highly active antiretroviral therapy (HAART) without protease inhibitor (PI); (3) treatment with a HAART regimen that includes a PI (HAART/PI); (4) treatment with HAART that includes low-dose ritonavir and a PI (HAART/PI/boost). Lipoprotein levels were compared with those of age-matched HIV-negative healthy subjects. Compared with the control group, HDL-cholesterol (HDL-C) levels were 22%, 11%, 14%, and 11% lower for currently untreated HIV, HAART, HAART/PI, and HAART/PI/boost groups, respectively. Negative correlations were found among HDL-C level, peak and current viral load, and duration of the disease and the treatment. A positive correlation was found between HDL-C and current and nadir CD4 cell count and CD4 percentage. When patients were divided into subgroups based on duration of antiretroviral therapy, patients treated with HAART and HAART/PI for 3 to 6 years were significantly less likely to have high HDL-C levels compared with the control group and patients treated for 1 to 3 years. A 5-fold decrease in the proportion of subjects with high HDL-C and a 3-fold increase in those with low HDL-C were found in the group treated with HAART/PI/boost. These data suggest that hypoalphalipoproteinemia in patients with HIV is likely to be secondary to HIV infection itself.
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Affiliation(s)
- Honor Rose
- Baker Heart Research Institute, Melbourne 3004, Australia.
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15
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Nolan D, Reiss P, Mallal S. Adverse effects of antiretroviral therapy for HIV infection: a review of selected topics. Expert Opin Drug Saf 2005; 4:201-18. [PMID: 15794714 DOI: 10.1517/14740338.4.2.201] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the current era of HIV treatment, the toxicity profiles of antiretroviral drugs have increasingly emerged as a basis for selecting initial antiretroviral regimens as well as a reason for switching therapy in treatment-experienced patients. In this respect, an intensive research effort involving clinical research as well as basic science research over the past six years, has focused on the cluster of metabolic and body composition abnormalities that have come to be termed the 'lipodystrophy syndrome'. These data have now provided a clear and clinically relevant understanding of the individual profiles of drugs within the nucleoside analogue reverse transcriptase inhibitor , HIV protease inhibitor and non-nucleoside analogue reverse transcriptase inhibitor drug classes, and have provided a rational basis for assessing and monitoring these adverse effects in clinical practice. In this review, current and emerging drug toxicities are considered with an emphasis on lipodystrophy complications.
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Affiliation(s)
- David Nolan
- Royal Perth Hospital and Murdoch University, Centre for Clinical Immunology and Biomedical Statistics, 2nd Floor, North Block, Wellington Street, Perth, 6000, Western Australia, Australia
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16
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Duvillard L, Florentin E, Baillot-Rudoni S, Lalanne-Mistrich ML, Brun-Pacaud A, Petit JM, Brun JM, Gambert P, Vergès B. Comparison of apolipoprotein B100 metabolism between continuous subcutaneous and intraperitoneal insulin therapy in type 1 diabetes. J Clin Endocrinol Metab 2005; 90:5761-4. [PMID: 16091481 DOI: 10.1210/jc.2005-0989] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE In type 1 diabetic patients, the replacement of s.c. insulin infusion with i.p. insulin infusion restores the normal physiological gradient between the portal vein and the peripheral circulation, which is likely to modify lipoprotein metabolism. DESIGN To check this hypothesis, we performed two apolipoprotein (apo) B100 kinetic studies in seven type 1 diabetic patients, first under s.c. insulin infusion and then 3 months after the beginning of i.p. insulin infusion. RESULTS Glycemic control was similar under s.c. insulin infusion and i.p. insulin infusion, as assessed by glycated hemoglobin A1c and the capillary glycemic curve determined during the kinetic study. Very low-density and intermediate-density lipoprotein apoB100 pool size, production rate, and fractional catabolic rate (FCR) were similar under s.c. insulin infusion and i.p. insulin infusion. The low-density lipoprotein apoB100 FCR tended to decrease under ip insulin (0.45 +/- 0.06 vs. 0.55 +/- 0.11 pool/d), but the difference did not reach statistical significance (95% confidence interval for the difference, -0.33, 0.11). The low-density lipoprotein apoB100 pool size and production rate remained unchanged under i.p. insulin infusion compared with s.c. insulin infusion. CONCLUSION In type 1 diabetic patients, the replacement of s.c. insulin infusion with i.p. insulin infusion does not induce profound modifications of apoB100-containing lipoprotein production and FCRs.
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Affiliation(s)
- Laurence Duvillard
- Institut National de la Santé et de la Recherche Médicale, Unité 498, Hôpital du Bocage, BP 77908, 21079 Dijon Cedex, France.
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17
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Umeh OC, Currier JS. Lipids, metabolic syndrome, and risk factors for future cardiovascular disease among HIV-infected patients. Curr HIV/AIDS Rep 2005; 2:132-9. [PMID: 16091260 DOI: 10.1007/s11904-005-0006-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The availability of potent combination antiretroviral therapy has changed the long-term prognosis for people living with HIV/AIDS. There is increasing concern, however, about the effect of HIV therapy on lipid disorders and subsequent development of coronary artery disease. Virtually all classes of antiretroviral drugs have been associated with some aspect of atherogenic changes in the lipid profiles. This article reviews the current literature on HIV-associated dyslipidemias and the metabolic syndrome, their potential effect on future coronary heart disease, and reviews strategies for management.
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Affiliation(s)
- Obiamiwe C Umeh
- Center for AIDS Research and Education, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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Nolan D, Reiss P, Mallal S. Adverse effects of antiretroviral therapy for HIV infection: a review of selected topics. Expert Opin Drug Saf 2005. [PMID: 15794714 DOI: 10.1517/14740338.4.2.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In the current era of HIV treatment, the toxicity profiles of antiretroviral drugs have increasingly emerged as a basis for selecting initial antiretroviral regimens as well as a reason for switching therapy in treatment-experienced patients. In this respect, an intensive research effort involving clinical research as well as basic science research over the past six years, has focused on the cluster of metabolic and body composition abnormalities that have come to be termed the 'lipodystrophy syndrome'. These data have now provided a clear and clinically relevant understanding of the individual profiles of drugs within the nucleoside analogue reverse transcriptase inhibitor , HIV protease inhibitor and non-nucleoside analogue reverse transcriptase inhibitor drug classes, and have provided a rational basis for assessing and monitoring these adverse effects in clinical practice. In this review, current and emerging drug toxicities are considered with an emphasis on lipodystrophy complications.
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Affiliation(s)
- David Nolan
- Royal Perth Hospital and Murdoch University, Centre for Clinical Immunology and Biomedical Statistics, 2nd Floor, North Block, Wellington Street, Perth, 6000, Western Australia, Australia
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Lee GA, Rao MN, Grunfeld C. The effects of HIV protease inhibitors on carbohydrate and lipid metabolism. Curr HIV/AIDS Rep 2005; 2:39-50. [PMID: 16091248 DOI: 10.1007/s11904-996-0008-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Since the introduction of HIV protease inhibitors (PIs), disorders of glucose and lipid metabolism have emerged. In dissecting out the direct effect on lipid and glucose metabolism, it has become apparent that individual PIs have different effects on metabolism. Some PIs such as indinavir acutely induce insulin resistance. PIs have also been shown to cause other disorders of glucose metabolism, including impairment of insulin secretion and increased endogenous glucose production. Individual PIs also have different effects on lipid metabolism. Ritonavir predominantly increases triglyceride and very low-density lipoprotein cholesterol levels. Limited studies in HIV-negative volunteers suggest that several of the PIs do not increase low-density lipoprotein cholesterol levels. This review examines the direct effects of PIs on glucose and lipid metabolism by assessing prospective studies of HIV-infected and healthy normal volunteers, and in vitro studies.
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Affiliation(s)
- Grace A Lee
- Department of Veterans Affairs Medical Center, Metabolism Section (Box 111F), 4150 Clement Street, San Francisco, CA 94121, USA.
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Rudich A, Ben-Romano R, Etzion S, Bashan N. Cellular mechanisms of insulin resistance, lipodystrophy and atherosclerosis induced by HIV protease inhibitors. ACTA ACUST UNITED AC 2005; 183:75-88. [PMID: 15654921 DOI: 10.1111/j.1365-201x.2004.01383.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Accumulating clinical evidence now links HIV protease inhibitors (HPIs) to the pathogenesis of insulin resistance, dyslipidaemia, lipodystrophy and atherosclerosis associated with highly active anti-retroviral therapy. Here we briefly describe the evidence for a distinct causative role for HPIs, and explore the cellular mechanisms proposed to underlie these side-effects. Acute inhibition of GLUT4-mediated glucose transport, and defective insulin signalling induced by chronic exposure to nelfinavir, are described as cellular mechanisms of insulin resistance. Interference with adipogenesis and adipocyte apoptosis and nelfinavir-induced activation of lipolysis are discussed as potential mechanisms of HPI-induced lipodystrophy. HPI-induced free radical production, apoptosis and increased glucose utilization in vascular smooth muscle cells are presented as possible novel mechanisms for atherosclerosis. Common pathways and cause-effect relationships between the various cellular mechanisms presented are then discussed, with emphasis on the role of insulin resistance, free radical production and enhanced lipolysis. Understanding the cellular mechanisms of HPI-induced side-effects will enhance the search for improved anti-retroviral therapy, and may also shed light on the pathogenesis of common forms of insulin resistance, dyslipidaemia and atherosclerosis.
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Affiliation(s)
- A Rudich
- Department of Clinical Biochemistry, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84103, Israel
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Lee GA, Rao MN, Grunfeld C. The effects of HIV protease inhibitors on carbohydrate and lipid metabolism. Curr Infect Dis Rep 2004; 6:471-482. [PMID: 15538985 DOI: 10.1007/s11908-004-0067-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Since the introduction of HIV protease inhibitors (PIs), disorders of glucose and lipid metabolism have emerged. In dissecting out the direct effect on lipid and glucose metabolism, it has become apparent that individual PIs have different effects on metabolism. Some PIs such as indinavir acutely induce insulin resistance. PIs have also been shown to cause other disorders of glucose metabolism, including impairment of insulin secretion and increased endogenous glucose production. Individual PIs also have different effects on lipid metabolism. Ritonavir predominantly increases triglyceride and very low-density lipoprotein cholesterol levels. Limited studies in HIV-negative volunteers suggest that several of the PIs do not increase low-density lipoprotein cholesterol levels. This review examines the direct effects of PIs on glucose and lipid metabolism by assessing prospective studies of HIV-infected and healthy normal volunteers, and in vitro studies.
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Petit JM, Duong M, Masson D, Buisson M, Duvillard L, Bour JB, Brindisi MC, Galland F, Guiguet M, Gambert P, Portier H, Vergès B. Serum adiponectin and metabolic parameters in HIV-1-infected patients after substitution of nevirapine for protease inhibitors. Eur J Clin Invest 2004; 34:569-75. [PMID: 15305892 DOI: 10.1111/j.1365-2362.2004.01379.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the context of HIV infection and antiretroviral therapy, adiponectin concentrations have been shown to be related to lipodystrophy, metabolic alterations and HIV-protease inhibitor (PI) use. The replacement of PI by nevirapine has improved the lipid profile of patients under antiretroviral therapy. The aim of the present study was to examine whether adiponectin concentration or insulin sensitivity level correlate with the modifications of lipid parameters after the switch of PI by nevirapine. MATERIAL AND METHODS The evolution of metabolic parameters before and after 6 months of substitution of nevirapine for protease inhibitors was evaluated in a cohort of 55 HIV-1 infected patients. Adiponectin concentration, insulin sensitivity, lipid profile, cholesterol ester transfer protein (CETP) mass concentration and triglyceride enrichment of HDL were determined before and after the replacement of PI by nevirapine. Insulin sensitivity was evaluated by the HOMA model assessment. RESULTS Twenty-four weeks of treatment with nevirapine improved significantly the lipid profile with a significant reduction of apoB (from 0.98 to 0.92 g L(-1); P = 0.005) and triglyceride (from 2.02 to 1.66 mmol L(-1); P = 0.02). HDL cholesterol and apoA1 increased significantly (from 0.99 to 1.19 mmol L(-1); P = 0.001 and from 1.40 to 1.57 g L(-1); P < 0.001, respectively). The triglyceride enrichment of HDL significantly decreased after the replacement of PI by nevirapine (from 0.248 +/- 0.092 to 0.213 +/- 0.093; P = 0.003). At baseline, and after 24 weeks of nevirapine treatment, we observed significant correlations between adiponectin level and lipid parameters [(HDL-cholesterol (r = 0.66, P = 0.001 and r = 0.69, P = 0.001); triglycerides (r = -0.42, P = 0.002 and r = -0.57, P = 0.001), and triglyceride enrichment of HDL (r = -0.43, P = 0.005 and r = -0.53, P = 0.005)]. Twenty-four weeks of treatment with nevirapine did not significantly change adiponectin concentrations (from 984 to 1086 micro g L(-1), P = 0.22), CETP mass and insulin sensitivity. CONCLUSION This study shows that even though a strong correlation was found between adiponectin and some metabolic parameters at baseline and after 24 weeks of treatment by nevirapine, the improvement of lipid profile observed after the replacement of PI by nevirapine was not in relation to the change of plasma adiponectin concentration. The significant decrease of triglyceride enrichment of HDL after the replacement of PI by nevirapine probably leads to a decreased catabolism of HDL lipoprotein, and consequently explains the increase of plasma HDL concentration observed in this study.
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Affiliation(s)
- J M Petit
- Hôpital Universitaire du Bocage, Dijon, France.
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