Prospective study in Mexico affirms cardiovascular benefits of antiretroviral therapy initiation

One year of antiretroviral treatment (ART) improved cardiovascular health in a small sample of young, mostly male, treatment naïve people living with HIV (PLWH) in this prospective study in Mexico.

About This Study

“Effect of antiretroviral therapy on decreasing arterial stiffness, metabolic profile, vascular and systemic inflammatory cytokines in treatment-naïve HIV: A one-year prospective study” was published online on March 17, 2023, in PLoS One. The lead author is Pedro Martínez-Ayala, M.Sc., M.D., of the HIV Unit Department at University Hospital “Fray Antonio Alcalde” of the University of Guadalajara, Mexico.

Key Research Findings

This small, prospective study (n=29) determined aortic stiffness and other cardiovascular markers in treatment-naïve PLWH before and after one year of ART, and compared results to markers in HIV-negative controls. Twenty participants were living with HIV and the nine controls were matched on metabolic profile and Framingham score, a measure of heart disease risk. Participants were enrolled from January 2015 to August 2019.

Most participants were men (95% of PLWH, 89% of controls) with an average age of 34 to 35 years. Seventy percent of the HIV group smoked compared to 11% of controls. Factors evaluated included inflammatory biomarkers and vascular cytokines, as well as aortic stiffness and metabolic profile. At baseline, these markers were significantly higher among PLWH than controls.

As the study began, the treatment-naïve group had higher levels of inflammatory, vascular cytokines, and arterial stiffness markers compared to the HIV-negative controls. After a year of HIV treatment, all PLWH were virally suppressed and most of their cardiovascular markers had dropped to levels similar to those in the controls. The exceptions were hs-CRP–a vascular cytokine–and the lipid profile: The hs-CRP remained higher in the HIV group than in the controls, and total cholesterol and triglycerides increased after ART in PLWH.

Discussion Highlights and Implications for Practice

Study limitations included the small sample size, few women, and a lack of information on lifestyle and other factors beyond smoking that may affect cardiovascular health. Markers were only measured twice, at baseline and at study end; as a result, it is unclear how quickly biomarkers dropped after treatment began.

Researchers pointed out that elevated lipids may be related to the specific antiretroviral regimens used. All participants received a regimen containing tenofovir disoproxil fumarate/emtricitabine, with efavirenz (74%), boosted darunavir (16%), or boosted atazanavir (11%) rounding out the ART regimen. The authors also noted that higher hs-CRP may indicate persistent inflammation despite ART.

Study authors called for further research into the biomarkers used to determine which ones may be of clinical importance in treating excess cardiovascular risk in aging PLWH.

By Barbara Jungwirth