Cardiovascular risk in advanced naïve HIV-infected patients starting antiretroviral therapy

Comparison of three different regimens - PREVALEAT II cohort

Paolo Maggi, Chiara Bellacosa, Armando Leone, Anna Volpe, Elena Delfina Ricci, Nicoletta Ladisa, Stefania Cicalini, Elisabetta Grilli, Rosaria Viglietti, Antonio Chirianni, Lara Ines Bellazzi, Renato Maserati, Canio Martinelli, Paola Corsi, Benedetto Maurizio Celesia, Federica Sozio, Gioacchino Angarano

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background and aims PREVALEAT (PREmature VAscular LEsions and Antiretroviral Therapy) II is a multicenter, longitudinal cohort study aimed at the evaluation of cardiovascular risk among advanced HIV-positive, treatment-naïve patients starting their first therapy. We hypothesized that these patients, present a higher cardiovascular (CV) risk. Methods The study included all consecutive naïve patients with less than 200 CD4 cells/ml starting antiretroviral therapy. Our primary objective was to evaluate changes in carotid intima- media thickness (IMT). Secondary endpoints included changes in flow mediated vasodilation (FMD), inflammatory markers, triglycerides and cholesterol. Patients were evaluated at time 0, and after 3, 6 and 12 months. Results We enrolled 119 patients, stratified into three different groups: patients receiving atazanavir/ritonavir boosted (ATV/r) based regimens, efavirenz (EFV) based regimens and darunavir/ritonavir boosted (DRV/r) based regimens. At baseline, advanced naïve patients showed a relevant deterioration of CV conditions in terms of traditional CV risk factors, endothelial dysfunction and serum biomarkers. During the 12-month follow up period, mean blood lipids significantly increased: total cholesterol from 159 to 190 mg/dL, HDL-C from 31 to 41 mg/dL, and LDL-C from 99 to 117 mg/dL. D-dimers steadily decreased (median level 624 at baseline and 214 at T3), whereas ICAM and VCAM consistently raised. DRV/r and ATV/r determined a more marked decrease of D-dimers as compared to EFV. Regarding the epi-aortic changes (IMT >1 mm or presence of atherosclerotic plaques), patients in the DRV/r group were at risk of developing pathological IMT during the study (OR 6.0, 95% CI 0.9–36.9), as compared to EFV ones. Conclusions CV risk was elevated in advanced naïve patients and tended to remain high in the first year of therapy.

Original languageEnglish
Pages (from-to)398-404
Number of pages7
JournalAtherosclerosis
Volume263
DOIs
Publication statusPublished - Aug 1 2017

Fingerprint

Blood Vessels
efavirenz
HIV
Ritonavir
Therapeutics
Cholesterol
Carotid Intima-Media Thickness
Atherosclerotic Plaques
Vasodilation
Longitudinal Studies
Triglycerides
Cohort Studies
Biomarkers
Lipids
Serum
Darunavir

Keywords

  • Atazanavir
  • Atherosclerosis
  • Cardiovascular risk
  • Darunavir
  • Efavirenz
  • HIV

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiovascular risk in advanced naïve HIV-infected patients starting antiretroviral therapy : Comparison of three different regimens - PREVALEAT II cohort. / Maggi, Paolo; Bellacosa, Chiara; Leone, Armando; Volpe, Anna; Ricci, Elena Delfina; Ladisa, Nicoletta; Cicalini, Stefania; Grilli, Elisabetta; Viglietti, Rosaria; Chirianni, Antonio; Bellazzi, Lara Ines; Maserati, Renato; Martinelli, Canio; Corsi, Paola; Celesia, Benedetto Maurizio; Sozio, Federica; Angarano, Gioacchino.

In: Atherosclerosis, Vol. 263, 01.08.2017, p. 398-404.

Research output: Contribution to journalArticle

Maggi, P, Bellacosa, C, Leone, A, Volpe, A, Ricci, ED, Ladisa, N, Cicalini, S, Grilli, E, Viglietti, R, Chirianni, A, Bellazzi, LI, Maserati, R, Martinelli, C, Corsi, P, Celesia, BM, Sozio, F & Angarano, G 2017, 'Cardiovascular risk in advanced naïve HIV-infected patients starting antiretroviral therapy: Comparison of three different regimens - PREVALEAT II cohort', Atherosclerosis, vol. 263, pp. 398-404. https://doi.org/10.1016/j.atherosclerosis.2017.05.004
Maggi, Paolo ; Bellacosa, Chiara ; Leone, Armando ; Volpe, Anna ; Ricci, Elena Delfina ; Ladisa, Nicoletta ; Cicalini, Stefania ; Grilli, Elisabetta ; Viglietti, Rosaria ; Chirianni, Antonio ; Bellazzi, Lara Ines ; Maserati, Renato ; Martinelli, Canio ; Corsi, Paola ; Celesia, Benedetto Maurizio ; Sozio, Federica ; Angarano, Gioacchino. / Cardiovascular risk in advanced naïve HIV-infected patients starting antiretroviral therapy : Comparison of three different regimens - PREVALEAT II cohort. In: Atherosclerosis. 2017 ; Vol. 263. pp. 398-404.
@article{a37d63082e154068b9351aceb91ac243,
title = "Cardiovascular risk in advanced na{\"i}ve HIV-infected patients starting antiretroviral therapy: Comparison of three different regimens - PREVALEAT II cohort",
abstract = "Background and aims PREVALEAT (PREmature VAscular LEsions and Antiretroviral Therapy) II is a multicenter, longitudinal cohort study aimed at the evaluation of cardiovascular risk among advanced HIV-positive, treatment-na{\"i}ve patients starting their first therapy. We hypothesized that these patients, present a higher cardiovascular (CV) risk. Methods The study included all consecutive na{\"i}ve patients with less than 200 CD4 cells/ml starting antiretroviral therapy. Our primary objective was to evaluate changes in carotid intima- media thickness (IMT). Secondary endpoints included changes in flow mediated vasodilation (FMD), inflammatory markers, triglycerides and cholesterol. Patients were evaluated at time 0, and after 3, 6 and 12 months. Results We enrolled 119 patients, stratified into three different groups: patients receiving atazanavir/ritonavir boosted (ATV/r) based regimens, efavirenz (EFV) based regimens and darunavir/ritonavir boosted (DRV/r) based regimens. At baseline, advanced na{\"i}ve patients showed a relevant deterioration of CV conditions in terms of traditional CV risk factors, endothelial dysfunction and serum biomarkers. During the 12-month follow up period, mean blood lipids significantly increased: total cholesterol from 159 to 190 mg/dL, HDL-C from 31 to 41 mg/dL, and LDL-C from 99 to 117 mg/dL. D-dimers steadily decreased (median level 624 at baseline and 214 at T3), whereas ICAM and VCAM consistently raised. DRV/r and ATV/r determined a more marked decrease of D-dimers as compared to EFV. Regarding the epi-aortic changes (IMT >1 mm or presence of atherosclerotic plaques), patients in the DRV/r group were at risk of developing pathological IMT during the study (OR 6.0, 95{\%} CI 0.9–36.9), as compared to EFV ones. Conclusions CV risk was elevated in advanced na{\"i}ve patients and tended to remain high in the first year of therapy.",
keywords = "Atazanavir, Atherosclerosis, Cardiovascular risk, Darunavir, Efavirenz, HIV",
author = "Paolo Maggi and Chiara Bellacosa and Armando Leone and Anna Volpe and Ricci, {Elena Delfina} and Nicoletta Ladisa and Stefania Cicalini and Elisabetta Grilli and Rosaria Viglietti and Antonio Chirianni and Bellazzi, {Lara Ines} and Renato Maserati and Canio Martinelli and Paola Corsi and Celesia, {Benedetto Maurizio} and Federica Sozio and Gioacchino Angarano",
year = "2017",
month = "8",
day = "1",
doi = "10.1016/j.atherosclerosis.2017.05.004",
language = "English",
volume = "263",
pages = "398--404",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Cardiovascular risk in advanced naïve HIV-infected patients starting antiretroviral therapy

T2 - Comparison of three different regimens - PREVALEAT II cohort

AU - Maggi, Paolo

AU - Bellacosa, Chiara

AU - Leone, Armando

AU - Volpe, Anna

AU - Ricci, Elena Delfina

AU - Ladisa, Nicoletta

AU - Cicalini, Stefania

AU - Grilli, Elisabetta

AU - Viglietti, Rosaria

AU - Chirianni, Antonio

AU - Bellazzi, Lara Ines

AU - Maserati, Renato

AU - Martinelli, Canio

AU - Corsi, Paola

AU - Celesia, Benedetto Maurizio

AU - Sozio, Federica

AU - Angarano, Gioacchino

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background and aims PREVALEAT (PREmature VAscular LEsions and Antiretroviral Therapy) II is a multicenter, longitudinal cohort study aimed at the evaluation of cardiovascular risk among advanced HIV-positive, treatment-naïve patients starting their first therapy. We hypothesized that these patients, present a higher cardiovascular (CV) risk. Methods The study included all consecutive naïve patients with less than 200 CD4 cells/ml starting antiretroviral therapy. Our primary objective was to evaluate changes in carotid intima- media thickness (IMT). Secondary endpoints included changes in flow mediated vasodilation (FMD), inflammatory markers, triglycerides and cholesterol. Patients were evaluated at time 0, and after 3, 6 and 12 months. Results We enrolled 119 patients, stratified into three different groups: patients receiving atazanavir/ritonavir boosted (ATV/r) based regimens, efavirenz (EFV) based regimens and darunavir/ritonavir boosted (DRV/r) based regimens. At baseline, advanced naïve patients showed a relevant deterioration of CV conditions in terms of traditional CV risk factors, endothelial dysfunction and serum biomarkers. During the 12-month follow up period, mean blood lipids significantly increased: total cholesterol from 159 to 190 mg/dL, HDL-C from 31 to 41 mg/dL, and LDL-C from 99 to 117 mg/dL. D-dimers steadily decreased (median level 624 at baseline and 214 at T3), whereas ICAM and VCAM consistently raised. DRV/r and ATV/r determined a more marked decrease of D-dimers as compared to EFV. Regarding the epi-aortic changes (IMT >1 mm or presence of atherosclerotic plaques), patients in the DRV/r group were at risk of developing pathological IMT during the study (OR 6.0, 95% CI 0.9–36.9), as compared to EFV ones. Conclusions CV risk was elevated in advanced naïve patients and tended to remain high in the first year of therapy.

AB - Background and aims PREVALEAT (PREmature VAscular LEsions and Antiretroviral Therapy) II is a multicenter, longitudinal cohort study aimed at the evaluation of cardiovascular risk among advanced HIV-positive, treatment-naïve patients starting their first therapy. We hypothesized that these patients, present a higher cardiovascular (CV) risk. Methods The study included all consecutive naïve patients with less than 200 CD4 cells/ml starting antiretroviral therapy. Our primary objective was to evaluate changes in carotid intima- media thickness (IMT). Secondary endpoints included changes in flow mediated vasodilation (FMD), inflammatory markers, triglycerides and cholesterol. Patients were evaluated at time 0, and after 3, 6 and 12 months. Results We enrolled 119 patients, stratified into three different groups: patients receiving atazanavir/ritonavir boosted (ATV/r) based regimens, efavirenz (EFV) based regimens and darunavir/ritonavir boosted (DRV/r) based regimens. At baseline, advanced naïve patients showed a relevant deterioration of CV conditions in terms of traditional CV risk factors, endothelial dysfunction and serum biomarkers. During the 12-month follow up period, mean blood lipids significantly increased: total cholesterol from 159 to 190 mg/dL, HDL-C from 31 to 41 mg/dL, and LDL-C from 99 to 117 mg/dL. D-dimers steadily decreased (median level 624 at baseline and 214 at T3), whereas ICAM and VCAM consistently raised. DRV/r and ATV/r determined a more marked decrease of D-dimers as compared to EFV. Regarding the epi-aortic changes (IMT >1 mm or presence of atherosclerotic plaques), patients in the DRV/r group were at risk of developing pathological IMT during the study (OR 6.0, 95% CI 0.9–36.9), as compared to EFV ones. Conclusions CV risk was elevated in advanced naïve patients and tended to remain high in the first year of therapy.

KW - Atazanavir

KW - Atherosclerosis

KW - Cardiovascular risk

KW - Darunavir

KW - Efavirenz

KW - HIV

UR - http://www.scopus.com/inward/record.url?scp=85019588920&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019588920&partnerID=8YFLogxK

U2 - 10.1016/j.atherosclerosis.2017.05.004

DO - 10.1016/j.atherosclerosis.2017.05.004

M3 - Article

VL - 263

SP - 398

EP - 404

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -