Endothelial Function in Human Immunodeficiency Virus-Infected Antiretroviral-Naive Subjects Before and After Starting Potent Antiretroviral Therapy. The ACTG (AIDS Clinical Trials Group) Study 5152s

Francesca J. Torriani*, Lauren Komarow, Robert A. Parker, Bruno R. Cotter, Judith S. Currier, Michael P. Dubé, Carl J. Fichtenbaum, Mariana Gerschenson, Carol K.C. Mitchell, Robert L. Murphy, Kathleen Squires, James H. Stein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

235 Scopus citations

Abstract

Objectives: This study evaluated the effects of 3 class-sparing antiretroviral therapy (ART) regimens on endothelial function in human immunodeficiency virus (HIV)-infected subjects participating in a randomized trial. Background: Endothelial dysfunction has been observed in patients receiving ART for HIV infection. Methods: This was a prospective, multicenter study of treatment-naive subjects who were randomly assigned to receive a protease inhibitor-sparing regimen of nucleoside reverse transcriptase inhibitors (NRTIs) + efavirenz, a non-nucleoside reverse transcriptase inhibitor-sparing regimen of NRTIs + lopinavir/ritonavir, or a NRTI-sparing regimen of efavirenz + lopinavir/ritonavir. The NRTIs were lamivudine + stavudine, zidovudine, or tenofovir. Brachial artery flow-mediated dilation (FMD) was determined by B-mode ultrasound before starting on ART, then after 4 and 24 weeks. Results: There were 82 subjects (median age 35 years, 91% men, 54% white). Baseline CD4 cell counts and plasma HIV ribonucleic acid (RNA) values were 245 cells/mm3 and 4.8 log10 copies/ml, respectively. At baseline, FMD was 3.68% (interquartile range [IQR] 1.98% to 5.51%). After 4 and 24 weeks of ART, plasma HIV RNA decreased by 2.1 and 3.0 log10 copies/ml, respectively. FMD increased by 0.74% (IQR -0.62% to +2.74%, p = 0.003) and 1.48% (IQR -0.20% to +4.30%, p < 0.001), respectively, with similar changes in each arm (Kruskal-Wallis p value >0.600). The decrease in plasma HIV RNA at 24 weeks was associated with greater FMD (rs = -0.30, p = 0.017). Conclusions: Among treatment-naive individuals with HIV, 3 different ART regimens rapidly improved endothelial function. Benefits were similar for all ART regimens, appeared quickly, and persisted at 24 weeks.

Original languageEnglish (US)
Pages (from-to)569-576
Number of pages8
JournalJournal of the American College of Cardiology
Volume52
Issue number7
DOIs
StatePublished - Aug 12 2008

Keywords

  • antiretroviral therapy
  • cardiovascular disease risk
  • endothelial function
  • human immunodeficiency virus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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