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

• Published in: Journal of the American College of Cardiology Vol. 52; no. 7; pp. 569 - 576
• Main Authors: TORRIANI, Francesca J, KOMAROW, Lauren, SQUIRES, Kathleen, STEIN, James H, PARKER, Robert A, COTTER, Bruno R, CURRIER, Judith S, DUBE, Michael P, FICHTENBAUM, Carl J, GERSCHENSON, Mariana, MITCHELL, Carol K. C, MURPHY, Robert L
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 12-08-2008; Elsevier Limited
• Subjects: Adenine - administration & dosage; Adenine - analogs & derivatives; Adult; Aging; Anti-HIV Agents - administration & dosage; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Benzoxazines - administration & dosage; Biological and medical sciences; Brachial Artery - drug effects; Brachial Artery - physiopathology; Cardiology; Cardiology. Vascular system; CD4 Lymphocyte Count; Cholesterol; Clinical trials; Deflation; Diabetes; Drug therapy; Endothelium, Vascular - drug effects; Endothelium, Vascular - pathology; Female; HIV; HIV Infections - drug therapy; HIV Infections - physiopathology; HIV Protease Inhibitors - administration & dosage; HIV-1; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infections; Infectious diseases; Lamivudine - administration & dosage; Lopinavir; Male; Medical sciences; Organophosphonates - administration & dosage; Pharmacology. Drug treatments; Prospective Studies; Pyrimidinones - administration & dosage; Reverse Transcriptase Inhibitors - administration & dosage; Risk factors; Ritonavir - administration & dosage; Stavudine - administration & dosage; Studies; Tenofovir; Time Factors; Ultrasonic imaging; Veins & arteries; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Zidovudine - administration & dosage; Human; Immunopathology; Antiretroviral agent; AIDS; Endothelial function; Immune deficiency; Infection; Symptomatology; Treatment; Viral disease; Starting; Antiviral; Clinical trial; Circulatory system; Cardiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2008.04.049

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.
Endothelial dysfunction has been observed in patients receiving ART for HIV infection.
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.
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/mm(3) and 4.8 log(10) 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 log(10) 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 (r(s) = -0.30, p = 0.017).
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.