Cardiovascular risk in advanced naïve HIV-infected patients starting antiretroviral therapy: Comparison of three different regimens - PREVALEAT II cohort

• Published in: Atherosclerosis Vol. 263; pp. 398 - 404
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.08.2017
• Subjects: Adult; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Atazanavir; Atazanavir Sulfate - therapeutic use; Atherosclerosis; Benzoxazines - therapeutic use; Biomarkers - blood; Brachial Artery - physiopathology; Cardiovascular; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - etiology; Cardiovascular Diseases - physiopathology; Cardiovascular risk; Carotid Intima-Media Thickness; CD4 Lymphocyte Count; Chi-Square Distribution; Darunavir; Darunavir - therapeutic use; Efavirenz; Endothelium, Vascular - physiopathology; Female; HIV; HIV Infections - complications; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - virology; Humans; Inflammation Mediators - blood; Italy; Lipids - blood; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Risk Factors; Ritonavir - therapeutic use; Time Factors; Treatment Outcome; Vasodilation; Atazanavir; HIV; Darunavir; Efavirenz; Cardiovascular risk; Atherosclerosis
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2017.05.004

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.