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.

TitleEndothelial function in human immunodeficiency virus-infected antiretroviral-naive subjects before and after starting potent antiretroviral therapy: The ACTG (AIDS Clinical Trials Group) Study 5152s.
Publication TypeJournal Article
Year of Publication2008
AuthorsTorriani FJ, Komarow L, Parker RA, Cotter BR, Currier JS, Dubé MP, Fichtenbaum CJ, Gerschenson M, Mitchell CKC, Murphy RL, Squires K, Stein JH
Corporate AuthorsACTG 5152s Study Team
JournalJ Am Coll Cardiol
Volume52
Issue7
Pagination569-76
Date Published2008 Aug 12
ISSN1558-3597
KeywordsAdenine, Adult, Anti-HIV Agents, Benzoxazines, Brachial Artery, CD4 Lymphocyte Count, Endothelium, Vascular, Female, HIV Infections, HIV Protease Inhibitors, HIV-1, Humans, Lamivudine, Lopinavir, Male, Organophosphonates, Prospective Studies, Pyrimidinones, Reverse Transcriptase Inhibitors, Ritonavir, Stavudine, Tenofovir, Time Factors, Zidovudine
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/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).

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.

DOI10.1016/j.jacc.2008.04.049
Alternate JournalJ. Am. Coll. Cardiol.
PubMed ID18687253
PubMed Central IDPMC2603599
Grant ListAI068634 / AI / NIAID NIH HHS / United States
AI068636 / AI / NIAID NIH HHS / United States
AI069424 / AI / NIAID NIH HHS / United States
AI069428 / AI / NIAID NIH HHS / United States
AI069471 / AI / NIAID NIH HHS / United States
AI069513 / AI / NIAID NIH HHS / United States
AI25859 / AI / NIAID NIH HHS / United States
AI25915 / AI / NIAID NIH HHS / United States
AI34853 / AI / NIAID NIH HHS / United States
AI38558 / AI / NIAID NIH HHS / United States
AI38855 / AI / NIAID NIH HHS / United States
AI56933 / AI / NIAID NIH HHS / United States
AI69432 / AI / NIAID NIH HHS / United States
HL72711 / HL / NHLBI NIH HHS / United States
MD000173 / MD / NIMHD NIH HHS / United States
R01 HL062897 / HL / NHLBI NIH HHS / United States
RR00075 / RR / NCRR NIH HHS / United States
RR00750 / RR / NCRR NIH HHS / United States
RR16176 / RR / NCRR NIH HHS / United States
RR16467 / RR / NCRR NIH HHS / United States
U01 AI069432 / AI / NIAID NIH HHS / United States
U01 AI069432-01 / AI / NIAID NIH HHS / United States