Early ART May Not Inhibit Arterial Inflammation in HIV Patients

Association found between persistent immune activation, arterial inflammation, and plaque development in HIV

Initiating antiretroviral therapy (ART) shortly after an HIV diagnosis did not prevent the progression of significant arterial inflammation, a recent study found.

Findings from prior studies suggested that HIV patients have a 50 to 75% increased risk of heart attack and stroke compared with HIV-negative individuals.

The current study, published in JAMA Cardiology, enrolled 12 previously untreated men with HIV who were about to start ART with a combination of 4 antiviral medications on an average of 11 months after diagnosis.

The control group included 12 HIV-negative participants matched by age to compare the immune system and inflammatory factors.

None of the patients had significant cardiovascular risk factors, a prior history of coronary artery disease, or autoimmune and inflammatory diseases besides HIV.

PET scans with a radiopharmaceutical called FDG were conducted at the start of the study and again 6 months later. CT angiograms were also performed to look for coronary artery plaques, as well as blood tests to analyze lipid and immune system factors, and the HIV viral loads.

The results of the study showed that despite ART’s suppression of viral loads and the increased levels of CD4 T cells, 80% of HIV-positive patients developed increased inflammation of the aorta.

Inflammation in the lymph nodes were significantly reduced, but only somewhat in the spleen. However, the arterial inflammation increased to levels that were similar to those seen in an earlier study of patients already receiving ART.

At the onset of the study, 25% of HIV-positive participants had some level of coronary artery plaque. After 6 months the plaques had all enlarged. One participant developed a new plaque during the study.

“Further research is needed to better understand the relationship between persistent immune activation, arterial inflammation and plaque development in HIV infection,” said lead researcher Steven Grinspoon, MD. “We need to compare the effects of different antiretroviral therapy regimens on arterial inflammation over time. Moreover, we need to investigate the important question of whether administering immune-modulatory strategies along with ART can help suppress arterial inflammation, stabilize coronary plaques and reduce cardiovascular risk in HIV-infected patients.”