TY - JOUR
T1 - Relationship between HIV infection, antiretroviral therapy, inflammatory markers, and cerebrovascular endothelial function among adults in urban China
AU - Chow, Felicia C.
AU - Li, Yanling
AU - Hu, Yinghuan
AU - Chan, Joy
AU - Wang, Huanling
AU - Xu, Weihai
AU - Price, Richard W.
AU - Sorond, Farzaneh A.
AU - Li, Taisheng
N1 - Funding Information:
Supported by National Institutes of Health (NIH) Research Training Grant R25TW009343 funded by the Fogarty International Center, the NIH Office of the Director Office of AIDS Research, the NIH Office of the Director Office of Research on Women's Health, the NIH Office of the Director Office of Behavioral and Social Science Research, the National Institute of Mental Health, the National Institute on Drug Abuse, and the University of California Global Health Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the University of California Global Health Institute. Support for statistical analysis was provided through the University of California, San Francisco, Clinical and Translational Science Institute grant UL1TR000004.
Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background: Cerebrovascular risk is increased in people living with HIV infection compared with age-matched uninfected individuals. Cerebrovascular endothelial dysfunction related to antiretroviral therapy (ART) and inflammation may contribute to higher stroke risk in HIV infection. Methods: We compared cerebral vasoreactivity-a measure of cerebrovascular endothelial function assessed by the breath-holding index (BHI) using transcranial Doppler ultrasound-between virologically suppressed Chinese HIV-infected individuals followed in an HIV clinic in Beijing, China, and uninfected controls. We constructed mixed-effects models to evaluate the association of HIV, ART, and inflammatory markers with cerebral vasoreactivity. Results: In an unadjusted model, HIV infection was associated with a trend toward lower cerebral vasoreactivity (BHI 1.08 versus 1.26, P = 0.079). In multivariable analyses, cholesterol modified the association between HIV infection and cerebral vasoreactivity (P = 0.015 for interaction). At a lower total cholesterol of 4.15 mmol/L, HIV was associated with lower cerebral vasoreactivity (BHI 20.28, P = 0.019), whereas at a cholesterol of 5.15 mmol/L, the reduction in cerebral vasoreactivity associated with HIV was no longer statistically significant (BHI 20.05, P = 0.64). Among HIV-infected individuals, use of lopinavir/ritonavir compared with efavirenz was associated with lower cerebral vasoreactivity (BHI 20.24, P = 0.040). We did not find a significant association between inflammatory markers and cerebral vasoreactivity. Conclusions: Cerebrovascular endothelial dysfunction associated with HIV infection may be most relevant for individuals with less traditional vascular risk, such as those with lower cholesterol. Further study of the impact of ART on cerebrovascular endothelial function is warranted to aid with ART selection in individuals at high cerebrovascular risk.
AB - Background: Cerebrovascular risk is increased in people living with HIV infection compared with age-matched uninfected individuals. Cerebrovascular endothelial dysfunction related to antiretroviral therapy (ART) and inflammation may contribute to higher stroke risk in HIV infection. Methods: We compared cerebral vasoreactivity-a measure of cerebrovascular endothelial function assessed by the breath-holding index (BHI) using transcranial Doppler ultrasound-between virologically suppressed Chinese HIV-infected individuals followed in an HIV clinic in Beijing, China, and uninfected controls. We constructed mixed-effects models to evaluate the association of HIV, ART, and inflammatory markers with cerebral vasoreactivity. Results: In an unadjusted model, HIV infection was associated with a trend toward lower cerebral vasoreactivity (BHI 1.08 versus 1.26, P = 0.079). In multivariable analyses, cholesterol modified the association between HIV infection and cerebral vasoreactivity (P = 0.015 for interaction). At a lower total cholesterol of 4.15 mmol/L, HIV was associated with lower cerebral vasoreactivity (BHI 20.28, P = 0.019), whereas at a cholesterol of 5.15 mmol/L, the reduction in cerebral vasoreactivity associated with HIV was no longer statistically significant (BHI 20.05, P = 0.64). Among HIV-infected individuals, use of lopinavir/ritonavir compared with efavirenz was associated with lower cerebral vasoreactivity (BHI 20.24, P = 0.040). We did not find a significant association between inflammatory markers and cerebral vasoreactivity. Conclusions: Cerebrovascular endothelial dysfunction associated with HIV infection may be most relevant for individuals with less traditional vascular risk, such as those with lower cholesterol. Further study of the impact of ART on cerebrovascular endothelial function is warranted to aid with ART selection in individuals at high cerebrovascular risk.
KW - Cerebral vasoreactivity
KW - Cerebrovascular endothelial function
KW - China
KW - HIV and stroke
KW - Transcranial Doppler ultrasound
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U2 - 10.1097/QAI.0000000000001254
DO - 10.1097/QAI.0000000000001254
M3 - Article
C2 - 27875362
AN - SCOPUS:84996946630
VL - 74
SP - 339
EP - 346
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
SN - 1525-4135
IS - 3
ER -
