Early antiretroviral therapy at high CD4 counts does not improve arterial elasticity

A substudy of the strategic timing of antiretroviral treatment (START) trial

INSIGHT START Arterial Elasticity Substudy Team

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background. Both human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Vascular function assessments can be used to study CVD pathogenesis. We compared the effect of immediate versus deferred ART initiation at CD4 counts >500 cells/mm3 on small arterial elasticity (SAE) and large artery elasticity (LAE). Methods. Radial artery blood pressure waveforms were recorded noninvasively. Small arterial elasticity and LAE were derived from analysis of the diastolic pulse waveform. Randomized treatment groups were compared with linear models at each visit and longitudinal mixed models. Results. Study visits involved 332 participants in 8 countries: mean (standard deviation [SD]) age 35 (10), 70% male, 66% nonwhite, 30% smokers, and median CD4 count 625 cells/mm3 and 10-year Framingham risk score for CVD 1.7%. Mean (SD) SAE and LAE values at baseline were 7.3 (2.9) mL/mmHg × 100 and 16.6 (4.1) mL/mmHg × 10, respectively. Median time on ART was 47 and 12 months in the immediate and deferred ART groups, respectively. The treatment groups did not demonstrate significant within- person changes in SAE or LAE during the follow-up period, and there was no difference in mean change from baseline between treatment groups. The lack of significant differences persisted after adjustment, when restricted to early or late changes, after censoring participants in deferred group who started ART, and among subgroups defined by CVD and HIV risk factors. Conclusions. Among a diverse global population of HIV-positive persons with high CD4 counts, these randomized data suggest that ART treatment does not have a substantial influence on vascular function among younger HIV-positive individuals with preserved immunity.

Original languageEnglish (US)
JournalOpen Forum Infectious Diseases
Volume3
Issue number4
DOIs
StatePublished - Jan 1 2016

Fingerprint

Elasticity
CD4 Lymphocyte Count
Secondary Prevention
Cardiovascular Diseases
Arteries
HIV
Therapeutics
Blood Vessels
Social Adjustment
Radial Artery
Virus Diseases
Group Psychotherapy
Pulse
Immunity
Linear Models
Blood Pressure
Population

Keywords

  • Antiretroviral therapy
  • Arterial elasticity
  • Cardiovascular disease
  • HIV infection
  • Vascular dysfunction

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Early antiretroviral therapy at high CD4 counts does not improve arterial elasticity : A substudy of the strategic timing of antiretroviral treatment (START) trial. / INSIGHT START Arterial Elasticity Substudy Team.

In: Open Forum Infectious Diseases, Vol. 3, No. 4, 01.01.2016.

Research output: Contribution to journalArticle

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title = "Early antiretroviral therapy at high CD4 counts does not improve arterial elasticity: A substudy of the strategic timing of antiretroviral treatment (START) trial",
abstract = "Background. Both human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Vascular function assessments can be used to study CVD pathogenesis. We compared the effect of immediate versus deferred ART initiation at CD4 counts >500 cells/mm3 on small arterial elasticity (SAE) and large artery elasticity (LAE). Methods. Radial artery blood pressure waveforms were recorded noninvasively. Small arterial elasticity and LAE were derived from analysis of the diastolic pulse waveform. Randomized treatment groups were compared with linear models at each visit and longitudinal mixed models. Results. Study visits involved 332 participants in 8 countries: mean (standard deviation [SD]) age 35 (10), 70{\%} male, 66{\%} nonwhite, 30{\%} smokers, and median CD4 count 625 cells/mm3 and 10-year Framingham risk score for CVD 1.7{\%}. Mean (SD) SAE and LAE values at baseline were 7.3 (2.9) mL/mmHg × 100 and 16.6 (4.1) mL/mmHg × 10, respectively. Median time on ART was 47 and 12 months in the immediate and deferred ART groups, respectively. The treatment groups did not demonstrate significant within- person changes in SAE or LAE during the follow-up period, and there was no difference in mean change from baseline between treatment groups. The lack of significant differences persisted after adjustment, when restricted to early or late changes, after censoring participants in deferred group who started ART, and among subgroups defined by CVD and HIV risk factors. Conclusions. Among a diverse global population of HIV-positive persons with high CD4 counts, these randomized data suggest that ART treatment does not have a substantial influence on vascular function among younger HIV-positive individuals with preserved immunity.",
keywords = "Antiretroviral therapy, Arterial elasticity, Cardiovascular disease, HIV infection, Vascular dysfunction",
author = "{INSIGHT START Arterial Elasticity Substudy Team} and Baker, {Jason V.} and Hullsiek, {Katherine Huppler} and Engen, {Nicole Wyman} and Ray Nelson and Ploenchan Chetchotisakd and Jan Gerstoft and Heiko Jessen and Marcelo Losso and Norman Markowitz and Paula Munderi and Antonios Papadopoulos and Jonathan Shuter and Claire Rappoport and Pearson, {Mary T.} and Elizabeth Finley and Abdel Babiker and Sean Emery and Daniel Duprez and B. Aagaard and H. Borges and Jansson, {P. O.} and Neilsen, {B. Riis} and A. Arenas-Pinto and Atako, {N. B.} and Babiker, {A. G.} and E. Dennis and S. Forcat and F. Hudson and B. Jackson and D. Maas and C. Purvis and C. Russell and C. Carey and M. Clewett and S. Emery and S. Jacoby and Finley, {E. B.} and A. S{\'a}nchez and Vjecha, {M. J.}",
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T1 - Early antiretroviral therapy at high CD4 counts does not improve arterial elasticity

T2 - A substudy of the strategic timing of antiretroviral treatment (START) trial

AU - INSIGHT START Arterial Elasticity Substudy Team

AU - Baker, Jason V.

AU - Hullsiek, Katherine Huppler

AU - Engen, Nicole Wyman

AU - Nelson, Ray

AU - Chetchotisakd, Ploenchan

AU - Gerstoft, Jan

AU - Jessen, Heiko

AU - Losso, Marcelo

AU - Markowitz, Norman

AU - Munderi, Paula

AU - Papadopoulos, Antonios

AU - Shuter, Jonathan

AU - Rappoport, Claire

AU - Pearson, Mary T.

AU - Finley, Elizabeth

AU - Babiker, Abdel

AU - Emery, Sean

AU - Duprez, Daniel

AU - Aagaard, B.

AU - Borges, H.

AU - Jansson, P. O.

AU - Neilsen, B. Riis

AU - Arenas-Pinto, A.

AU - Atako, N. B.

AU - Babiker, A. G.

AU - Dennis, E.

AU - Forcat, S.

AU - Hudson, F.

AU - Jackson, B.

AU - Maas, D.

AU - Purvis, C.

AU - Russell, C.

AU - Carey, C.

AU - Clewett, M.

AU - Emery, S.

AU - Jacoby, S.

AU - Finley, E. B.

AU - Sánchez, A.

AU - Vjecha, M. J.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background. Both human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Vascular function assessments can be used to study CVD pathogenesis. We compared the effect of immediate versus deferred ART initiation at CD4 counts >500 cells/mm3 on small arterial elasticity (SAE) and large artery elasticity (LAE). Methods. Radial artery blood pressure waveforms were recorded noninvasively. Small arterial elasticity and LAE were derived from analysis of the diastolic pulse waveform. Randomized treatment groups were compared with linear models at each visit and longitudinal mixed models. Results. Study visits involved 332 participants in 8 countries: mean (standard deviation [SD]) age 35 (10), 70% male, 66% nonwhite, 30% smokers, and median CD4 count 625 cells/mm3 and 10-year Framingham risk score for CVD 1.7%. Mean (SD) SAE and LAE values at baseline were 7.3 (2.9) mL/mmHg × 100 and 16.6 (4.1) mL/mmHg × 10, respectively. Median time on ART was 47 and 12 months in the immediate and deferred ART groups, respectively. The treatment groups did not demonstrate significant within- person changes in SAE or LAE during the follow-up period, and there was no difference in mean change from baseline between treatment groups. The lack of significant differences persisted after adjustment, when restricted to early or late changes, after censoring participants in deferred group who started ART, and among subgroups defined by CVD and HIV risk factors. Conclusions. Among a diverse global population of HIV-positive persons with high CD4 counts, these randomized data suggest that ART treatment does not have a substantial influence on vascular function among younger HIV-positive individuals with preserved immunity.

AB - Background. Both human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Vascular function assessments can be used to study CVD pathogenesis. We compared the effect of immediate versus deferred ART initiation at CD4 counts >500 cells/mm3 on small arterial elasticity (SAE) and large artery elasticity (LAE). Methods. Radial artery blood pressure waveforms were recorded noninvasively. Small arterial elasticity and LAE were derived from analysis of the diastolic pulse waveform. Randomized treatment groups were compared with linear models at each visit and longitudinal mixed models. Results. Study visits involved 332 participants in 8 countries: mean (standard deviation [SD]) age 35 (10), 70% male, 66% nonwhite, 30% smokers, and median CD4 count 625 cells/mm3 and 10-year Framingham risk score for CVD 1.7%. Mean (SD) SAE and LAE values at baseline were 7.3 (2.9) mL/mmHg × 100 and 16.6 (4.1) mL/mmHg × 10, respectively. Median time on ART was 47 and 12 months in the immediate and deferred ART groups, respectively. The treatment groups did not demonstrate significant within- person changes in SAE or LAE during the follow-up period, and there was no difference in mean change from baseline between treatment groups. The lack of significant differences persisted after adjustment, when restricted to early or late changes, after censoring participants in deferred group who started ART, and among subgroups defined by CVD and HIV risk factors. Conclusions. Among a diverse global population of HIV-positive persons with high CD4 counts, these randomized data suggest that ART treatment does not have a substantial influence on vascular function among younger HIV-positive individuals with preserved immunity.

KW - Antiretroviral therapy

KW - Arterial elasticity

KW - Cardiovascular disease

KW - HIV infection

KW - Vascular dysfunction

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U2 - 10.1093/ofid/ofw213

DO - 10.1093/ofid/ofw213

M3 - Article

VL - 3

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

SN - 2328-8957

IS - 4

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