Table 2.
Coronary Microvascular and Endothelial Function in PLWH
| Reference | Publication Year | Imaging Modality (Stressor) | No. HIV+ Participants (Subgroups)/No. Controls | Cardiovascular RF (Exclusion Criteria, Baseline Characteristics of PLWH vs Controls) | HIV Characteristics | Results | MFR/CEF | Limitations |
|---|---|---|---|---|---|---|---|---|
| Lebech et al102 | 2008 | PET/CT (dipyridamole) | 25 (13 with TC ≤215 mg/dL; 12 with TC ≥254 mg/dL)/14 |
Excluded: antihypertensive therapy, CVD, DM, (current) smoking, statin use; in TC <215 mg/dL, lower HDL, higher TC vs controls |
100% ART, 60% on PI; mean CD4, 653±273 cells/mm3; VL suppressed in 80% | No significant difference in MFR, FMD, and NMD | MFR in PLWH: 3.2±0.3 (normal TC), 3.2±0.3 (elevated TC); MFR in controls: 3.0±0.3 | Small sample size, restrictive inclusion criteria |
| Kristoffersen et al103 | 2010 | PET/CT (cold‐pressor testing, dipyridamole) | 12/0 | Excluded: DM, HTN, ischemic heart disease, lipid‐lowering treatment |
Baseline: 0% on ART; mean CD4, 251±68 cells/mm3; VL unsuppressed; after ART: not reported |
FMD, MFR significantly lower after ART initiation; not significant in cold‐pressor reserve | MFR at baseline: 3.11±0.32; after treatment: 2.48±0.25 | No control group, small sample size |
| Knudsen et al104, a | 2015 | PET/CT (adenosine) | 56/25 | No cardiovascular RF exclusion criteria; increased TC and HDL in PLWH | 100% on ART (34% on PI); median CD4, 675 cells/mm3 (range: 285–1390); 100% VL <40 copies/mL | No significant differences in MFR | MFR in PLWH: 2.97±0.11; MFR in controls: 3.13±0.17 | Danish cohort, generalizable to US population? |
| Iantorno et al105, b | 2017 | cMRI (IHE) | 35 (18 CAD−, 17 CAD+)/77 (36 CAD−, 41 CAD+) |
HIV−/CAD−: ≤50 y excluded CAD, DM, >1 cardiovascular RF; >50 y (HIV+/HIV−): CACS=0, CAD+; >50 y (HIV−/HIV+): 30–70% luminal stenosis, HIV+ significantly higher HCV positivity |
CAD−: 94% on ART (60% on PI); mean CD4, 614±93 cells/mm3; VL suppressed in 83%; CAD+: 100% on ART (58% on PI); mean CD4, 629±63 cells/mm3; VL suppressed in 95% |
HIV+/CAD− significantly impaired CEF compared with HIV−/CAD−; IL‐6 inversely correlated with CEF in HIV+ |
HIV−/CAD− CSA change: +10.2±0.9%; CBF change: +41.2±5.1%; HIV+/CAD− CSA change: +3.22±1.2% CBF change: (+6.2±3.0%) |
Use of new method to assess CEF, small subgroups, frequent PI use, variability in VL suppression |
| Knudsen et al106, a | 2018 | PET/CT (adenosine) | 94 (50 men, 44 women)/0 |
No exclusion based on cardiovascular RF; women younger, less likely on antihypertensives and statins, higher DBP and HDL, lower creatinine and FRS |
Men: 100% on ART (52% on PI); median CD4, 645 cells/mm3 (range: 285–1390); 94% with suppressed VL; women: 100% on ART (27% PI); median CD4, 644 cells/mm3 (range: 222–1780); 93% with suppressed VL |
Women significantly lower MFR than men; significant (negative) association between CMV IgG and MFR in women |
Women with HIV: 2.13±0.10; men with HIV: 2.57±0.11 | No control group, significant differences in baseline cardiovascular RF |
| Iantorno et al107, b | 2018 | cMRI (IHE) | 51 (36 CAD−, 15 CAD+)/14 CAD− |
HIV−: excluded CAD or any CAD RF; if >50 y, excluded CACS >0; HIV+/CAD−: excluded CACS >0; in HIV+/CAD+, 30% to 70% luminal stenosis |
CAD−: 94% on ART (16% on PI); mean CD4, 611±480 cells/mm3; 89% with suppressed VL; CAD+: 73% on ART (40% on PIs); mean CD4, 619±254 cells/mm3; 80% with suppressed VL |
CEF significantly impaired in HIV+; epicardial adipose tissue correlated with CSA change in HIV+ |
HIV−/CAD− CSA change, +10.1±5.5%; CBF change, +33.2±15.2%; HIV+/CAD− CSA change, +0.2±12.3%; CBF change, +0.2±22.5%; HIV+/CAD+ CSA change, −1.1±3.8%; CBF change, +2.3±17.5% |
Participants not on ART, use of new method to assess CEF |
| Leucker et al108 | 2018 | cMRI (IHE) | 48/15 |
HIV−: excluded CVD if >1 cardiovascular RF; if ≥40 y, CACS >0; HIV+: excluded CACS >0, CVD, significantly lower HDL, higher statin use; higher % men in HIV+ |
100% on ART (0% on PI); 100% with suppressed VL; median CD4, 665 (range: 456–933) |
CEF significantly impaired in HIV+ Inverse relationship between CSA change and PCSK9 level |
HIV−/CAD− CSA change: +11.1±‐3.7% CBF change: +37.5±10.0% HIV+/CAD− CSA change: +2.9±9.6% CBF change: +6.2±19.2% |
Use of new method to assess CEF, differences in cardiovascular RF between groups |
ART indicates antiretroviral therapy; CACS, coronary artery calcium score; CAD, coronary artery disease; CBF, coronary blood flow; CEF, coronary endothelial function; cMRI, cardiac magnetic resonance imaging; CMV, cytomegalovirus; CSA, coronary surface area; CVD, cardiovascular disease; DBP, diastolic blood pressure; DM, diabetes mellitus; FMD, flow‐mediated dilation; FRS, Framingham risk score; HCV, hepatitis C virus; HDL, high‐density lipoprotein; HTN, hypertension; IHE, isometric handgrip exercise; IL, interleukin; MFR, myocardial flow reserve; NMD, nitroglycerine‐mediated dilation; PET/CT, positron emission tomography/computed tomography; PI, protease inhibitor; PLWH, people living with HIV; RF, risk factor; TC, total cholesterol; TG, triglycerides; VL, viral load.
Some participants were included in both studies.
VL suppressed: <20 copies/mL.