About this Research Topic
Vascular endothelial dysfunction (EDy) is an early precursor of cardiovascular disease. Very few studies have investigated the association between HIV‐infection and antiretroviral treatment (ART), and Edy. Included in this translational research topic will be epidemiological/ population based (human) studies as well animal studies and in vitro preparations.
This research topic aims to provide novel data regarding the overall prevalence of EDy, and effects of HIV infection and ART on vascular endothelial function. This is particularly important. In view of the clinical advantages of the detection of EDy, examining HIV and its possible vascular effects could help identify people who are at risk of developing adverse cardiovascular events. In addition, the papers published in this research topic could be used to compile educational/awareness material for health care workers and patients on cardiovascular risk factors associated with HIV-infection and/or ART.
Finally, a unique feature of the research topic is to include data from studies carried all over the world, including developing countries. This is important as extensive research in the role of HIV and ART in cardiovascular diseases has been carried out mostly in North America, Australia, France and the UK. But there is currently very little data available from, for example, Sub-Saharan Africa (SSA), although it is the most affected area in the world.
HIV, ART, and cardiovascular diseases
The human immunodeficiency (HIV) virus infects CD4 positive cells thus leading to immunosuppression and the syndrome of acquired immune deficiency (AIDS).1 The latent time of progression to AIDS has now increased up to 30 years. This is accompanied by an increase in non-communicable diseases in this population.
Cardiovascular diseases are now the second leading cause of death in the HIV population. Current evidence suggests that both HIV and ART are associated with increase of insulin resistance, endothelial activation and dysfunction (arising partly because of the chronic infection and inflammation). There is also an acceleration of the atherosclerosis process and a shift towards cardiovascular diseases such as coronary artery disease, myocardial infarction and stroke. However, in most studies in which the effects of cardiovascular effects of ART was investigated did not often differentiate between different classes of ART. Even ART drugs from the same drug class could potentially pose different cardiovascular and endothelial risks. Therefore, there is a need to differentiate the impact of HIV infection and its treatment. This is especially important in developing countries (e.g. in Sub-Saharan Africa) where the contribution of HIV and ART in cardiovascular diseases remains unclear. This is largely due to a paucity of large epidemiological studies from this region. Even though atherosclerotic disease is not common among black Africans, such studies are required in view of the increased urbanization as well as adoption of western diet, which contribute to an increased prevalence of traditional cardiovascular risk factors. These include high blood pressure, high BMI, high fasting blood glucose, smoking and high total cholesterol in African populations. Furthermore, there is a need to investigate the effect of geographical and ethnical differences on cardiovascular risk in African populations as compared to European and North American cohorts. This is particularly important as some differences between the HIV infection in Caucasian and African HIV populations (e.g. HIV‐1 group M subtype B is most prevalent in Europe and North America subtype C is the predominant subtype in Sub‐Saharan Africa) may contribute to altered pathophysiological pathways. Additionally, populations of African descent have proven to show more favorable lipid profiles and also higher protective HDL-C levels, which could decelerate the cardiovascular changes enhanced by HIV. Finally, cultural differences in the prevalence of traditional cardiovascular risk factors such as alcohol and tobacco consumption should be considered.
Assessment of endothelial function and cardiovascular risk
There are several methods of assessing the above mentioned anatomical and functional changes in vascular function that can be associated with endothelial dysfunction (e.g. biomarkers; Flow mediated dilatation, FMD; Pulse wave velocity, PWV; intima media thickness; IMT; etc.). Recently, asssements of the retinal vasculature have been proposed as early indicator of micorvascular changes that occur in HIV, with- and without- ART.
This unique translational and multi disciplinary research topic will be the first of its kind to investigate the cardiovascular risk associated with HIV, with and without ART, and compare the results obtained in populations of developing countries with those obtained from Western countries. In view of the clinical advantages of the detection of EDy, research included in this research topic could help identify people who are at risk of developing future adverse cardiovascular events. The study findings could be used to compile educational and awareness material for health care workers and patients at health care sites on cardiovascular risk factors associated with HIV‐infection and/or ART.
Included in this research topic will be original research articles, hypotheses, perspectives and (mini) reviews from experts.
Keywords: HIV-1, HIV-2, Antiretroviral therapy, Endothelium, Cardiovascular risk, Retina
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