Abstract
Background: Recent reports of myocardial infarction in young persons infected with human immunodeficiency virus (HIV) who are receiving protease inhibitor therapy have raised concerns about premature coronary artery disease in this population. However, endothelial dysfunction, hypercoagulability, hypertriglyceridemia, and abnormal coronary artery pathology have been observed in association with HIV infection prior to the availability of protease inhibitor therapy.
Hypothesis: The study was undertaken to determine the association between endothelial function, viral load, CD4+ count, and other well‐established risk factors for atherosclerosis.
Methods: This prospective, case‐controlled study compared viral (HIV) load and the CD4+ T‐lymphocyte count and endothelial function in 24 HIV‐positive carriers. Brachial artery diameter, HIV viral load, and CD4 count were measured.
Results: We found that viral load correlated inversely with endothelial function; the higher the viral load, the worse the endothelial dysfunction (p < 0.005).
Conclusion: High viral load appears to be associated with endothelial dysfunction in patients with HIV. This preliminary observation supports the infectious theory that viruses may play an important role in the pathogenesis of atherosclerosis.
Keywords: human immunodeficiency virus, endothelial dysfunction, atherosclerosis, viral load
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References
- 1. Passalaris JD, Sepkowitz KA, Glesby MJ: Coronary artery human immunodeficiency virus infection. Clin Infect Dis 2000; 31 (3): 787–797 [DOI] [PubMed] [Google Scholar]
- 2. Zandotti C, Quilichini R, Aubert L, Tamalet C, Juhan‐Vague I, Gastaut JA: Endothelial cell dysfunction in HIV infection. J Acq Immune Defic Syndr 1992; 5 (2): 127–131 [PubMed] [Google Scholar]
- 3. Speir E, Modali R, Huang ES, Leon MB, Shawl F, Finkel T, Epstein SE: Potential role of human cytomegalovirus and p53 interaction in coronary restenosis. Science 1994; 265 (5170): 391–394 [DOI] [PubMed] [Google Scholar]
- 4. Blum A, Giladi M, Weinberg M, Kaplan G, Pasternack H, Laniado S, Miller H: High anti‐cytomegalovirus (CMV) IgG antibody titer is associated with coronary artery disease and may predict post‐coronary balloon angioplasty restenosis. Am J Cardiol 1998; 81 (7): 866–888 [DOI] [PubMed] [Google Scholar]
- 5. Shah F: Link between infection and atherosclerosis: Who are the culprits: Viruses, bacteria, both, or neither? Circulation 2001; 103 (1): 5–6 [DOI] [PubMed] [Google Scholar]
- 6. Celermajer DS, Sorensen KE, Gooch VM: Non‐invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340: 1111–1115 [DOI] [PubMed] [Google Scholar]
- 7. Behrens G, Schmidt H, Meyer D, Stoll M, Schmidt RE: Vascular complications associated with use of HIV protease inhibitors (comment). Lancet 1998; 351: 1958 [DOI] [PubMed] [Google Scholar]
- 8. Henry K, Melroe H, Huebsch J, Hermundson J, Levine C, Swensen JD, Daley J: Severe premature coronary artery disease with protease inhibitors. Lancet 1998; 351: 1328 [DOI] [PubMed] [Google Scholar]
- 9. Stein JH, Klein MA, Bellehumeur JL, Aeschlimann SE, McBride PE, Sosman JM: Use of human immunodeficiency virus‐1 protease inhibitors is associated with endothelial dysfunction (letter). American Heart Association 2000;II–7: 3812
- 10. Lafeuillade A, Alessi MC, Poizot‐Martin I, Boyer‐Neumann C, Zandotti C, Quilichini R, Aubert L, Tamalet C, Juhan‐Vague I, Gastaut JA: Endothelial cell dysfunction in HIV infection. J Acq Immune Defic Syndr 1991; 5 (2): 127–131 [PubMed] [Google Scholar]
- 11. Fabricant CG, Fabricant J, Litrenta MM, Minick CR: Virus induced atherosclerosis. J Exp Med 1978; 148: 335–340 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Melnick JL, Petrie BL, Dreesman GR, Burek J, McCollum CH, DeBakey ME: Cytomegalovirus antigen within human arterial smooth muscle cells. Lancet 1983; 2 (8351): 644–647 [DOI] [PubMed] [Google Scholar]
- 13. Hendrix MGR, Salimans MMM, van Boven CRA, Bruggeman CA: High prevalence of latently present cytomegalovirus in arterial walls of patients suffering from grade III atherosclerosis. Am J Pathol 1990; 136: 23–28 [PMC free article] [PubMed] [Google Scholar]
- 14. Adam E, Melnick JL, Probtsfield JL, Petrie BL, Burek J, Bailey KR, McCollum CH, DeBakey ME: High level of cytomegalovirus antibody in patients requiring vascular surgery for atherosclerosis. Lancet 1987; 2: 291–293 [DOI] [PubMed] [Google Scholar]
- 15. Zhou YF, Leon MB, Waclawin MA, Popma JJ, Yu ZX, Finkel T, Epstein SE: Association between prior cytomegalovirus infection and the risk of restenosis after coronary atherectomy. N Engl J Med 1996; 335: 624–630 [DOI] [PubMed] [Google Scholar]
- 16. Nieto FJ, Adam E, Sorlie P, Farzadegan H, Melnick JL, Comstock GW, Szklo M: Cohort study of cytomegalovirus infection as a risk factor for carotid intimal‐medial thickening, a measure of subclinical atherosclerosis. Circulation 1996; 94: 922–927 [DOI] [PubMed] [Google Scholar]
- 17. Sorlie PD, Nieto FJ, Adam E, Folsom AR, Shahar E, Massing M: A prospective study of cytomegalovirus, herpes simplex virus 1, and coronary artery disease: The atherosclerosis Risk In Communities (ARIC) study. Arch Intern Med 2000; 160 (13): 2027–2032 [DOI] [PubMed] [Google Scholar]
- 18. Zhu J, Quyyumi AA, Norman JE, Costello R, Csako G, Epstein SE: The possible role of hepatitis A virus in the pathogenesis of atherosclerosis. J Infect Dis 2000; 182 (6): 1583–1587 [DOI] [PubMed] [Google Scholar]
- 19. Lin TM, Jiang MJ, Eng HL, Shi GY, Lai LC, Huang BJ, Huang KY, Wu HL: Experimental infection with bovine herpesvirus‐4 enhances atherosclerotic process in rabbits. Lab Invest 2000; 80 (1): 3–11 [DOI] [PubMed] [Google Scholar]
- 20. Zhu J, Nieto J, Horne BD, Anderson JL, Muhlestein JB, Epstein SE: Prospective study of pathogen burden and risk of myocardial infarction or death. Circulation 2001; 103: 45–57 [DOI] [PubMed] [Google Scholar]
- 21. Prasad A, Zhu J, Halcox JPJ, Waclawiw MA, Epstein SE, Quyyumi AA: Predisposition to atherosclerosis by infections. Role of endothelial dysfunction. Circulation 2002; 106: 184–197 [DOI] [PubMed] [Google Scholar]
- 22. Tabib A, Leroux C, Mornex JF, Loire R: Accelerated coronary atherosclerosis and arteriosclerosis in young human‐immunodeficiency‐virus‐positive patients. Coron Artery Dis 2000; 11 (1): 41–46 [DOI] [PubMed] [Google Scholar]