People living with HIV on ART face increased risks of developing heart disease compared to people without HIV. Heart disease risk among people living with HIV is believed to relate to traditional heart disease risk factors (like high blood pressure, cigarette smoking), as well as to increased inflammation (which tends to be higher among individuals living with HIV).
This study examined factors associated with levels of two markers of inflammation (soluble CD14 and oxidized LDL) among people living with HIV participating in the REPRIEVE trial. REPRIEVE is a global clinical research study testing whether treatment with a statin medication helps prevent heart disease among people living with HIV. The study reports on 4,907 people living with HIV on ART who have no known heart disease. Their average age was 50 years old, 38% were female, and 48% were Black or African American.
Researchers found that female sex, white race (among people living in high-income regions), current use of NRTI+NNRTI ART, and residence in South Asia or Sub-Saharan Africa were associated with higher levels of soluble CD14, while higher body mass index (a measure of overweight/obesity) and current use of NRTI+INSTI ART regimens were associated with lower levels of soluble CD14. They found that male sex, residence in high-income regions, white race (among those in high-income regions), and higher body mass index were associated with higher levels of oxidized LDL. Among women specifically, being post-menopausal was associated with increased levels of soluble CD14 but not with increased levels of oxidized LDL.
This study demonstrates that levels of different inflammatory markers are influenced in different ways by the same factors (for example, sex and body mass index). Recognizing this is important to anticipating that levels of markers may differ between women and men and that one single intervention may not affect all inflammatory markers the same way. Further, the fact that women’s reproductive aging (transitioning to menopause) relates to a key marker of inflammation may help explain, to some extent, a way in which menopause may increase women’s risk of heart disease. Future studies may increase understanding of the ways that medications (such as statins) and changes in behavior (such as a healthy diet) influence levels of inflammation markers and whether lowering levels of these key inflammation markers may help protect against heart disease among people living with HIV.
Sara E Looby, Amy Kantor, Tricia H Burdo, Judith S Currier, Carl J Fichtenbaum, Edgar T Overton, Judith A Aberg, Carlos D Malvestutto, Gerald S Bloomfield, Kristine M Erlandson, Michelle Cyespedes, Esper G Kallas, Mar Masiá, Alice C Thornton, Mandy D Smith, Jacqueline M Flynn, Emma M Kileel, Evelynne Fulda, Kathleen V Fitch, Michael T Lu, Pamela S Douglas, Steven K Grinspoon, Heather J Ribaudo , Markella V Zanni. Factors Associated With Systemic Immune Activation Indices in a Global Primary Cardiovascular Disease Prevention Cohort of People With Human Immunodeficiency Virus on Antiretroviral Therapy. Clin Infect Dis. 2022 Oct 12;75(8):1324-1333. doi: 10.1093/cid/ciac166.