Fatores associados à aterosclerose subclínica em pacientes infectados pelo HIV no nordeste do Brasil

Autores

DOI:

https://doi.org/10.33448/rsd-v10i12.20484

Palavras-chave:

HIV; AIDS; Fatores de risco cardiovasculares; Escore de cálcio coronariano; Calcificação coronariana.

Resumo

Introdução: A AIDS mudou sua curva de morbidade, aumentando as doenças cardiovasculares. Pacientes infectados pelo HIV têm taxas aumentadas de eventos cardiovasculares, mas os dados sobre a prevalência de aterosclerose subclínica não são uniformes. Métodos: Pacientes infectados pelo HIV foram submetidos à tomografia coronariana para avaliação do EC. Realizou-se um comparação entre 97 pacientes infectados pelo HIV e 129 controles saudáveis ​​soronegativos. Resultados: Pacientes infectados pelo HIV com EC acima de zero eram mais velhos (54,8 ± 7,0 vs. 43,3,5 ± 11,0 anos) e mais propensos a ter hipertensão (36,7% vs. 12,5%) do que os HIV(-) com EC zero. Os fatores associados a EC alterado na razão de risco não ajustada foram idade (HR = 1,13; IC 95% = 1,07-1,20) e hipertensão (HR = 4,05; IC 95% = 1,42-11,60). Quando a razão de risco ajustada foi construída, o sexo masculino e o uso de inibidores de protease (IP) apareceram como fatores associados à calcificação coronariana. Pacientes infectados pelo HIV eram menos propensos a ter hipertensão (20,2% vs 50,4%; p <0,001) e diabetes (5,3% vs 23,3%) do que os não infectados pelo HIV. Conclusão: O aumento da incidência de EC foi associado à idade, sexo masculino e uso de IP entre pacientes infectados pelo HIV. Apesar de mais jovens, menos fatores de risco tradicionais e doenças controladas, as PVHIV tiveram níveis de EC semelhantes em comparação com os controles. Além do próprio vírus, os antirretrovirais desempenham um papel importante, porque controlam os vírus às custas da piora do perfil lipídico.

Referências

Agatston, A. S., Janowitz, W. R., Hildner, F. J., Zusmer, N. R., Viamonte, M., & Detrano, R. (1990). Quantification of coronary artery calcium using ultrafast computed tomography. Journal of the American College of Cardiology, 15(4), 827-832.

Almeida-Brasil, C. C., Nascimento, E. D., Silveira, M. R., Bonolo, P. D. F., & Ceccato, M. D. G. B. (2019). New patient-reported outcome measure to assess perceived barriers to antiretroviral therapy adherence: the PEDIA scale. Cadernos de saude publica, 35.

Chandra, D., Gupta, A., Fitzpatrick, M., Haberlen, S. A., Neupane, M., Leader, J. K., Kingsley, L. A., Kleerup, E., Budoff, M. J., Witt, M., Sciurba, F. C., Post, W. S., & Morris, A. (2019). Lung Function, Coronary Artery Disease, and Mortality in HIV. Annals of the American Thoracic Society, 16(6), 687–697.

Erbel, R., Möhlenkamp, S., Moebus, S., Schmermund, A., Lehmann, N., Stang, A., ... & Heinz Nixdorf Recall Study Investigative Group. (2010). Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. Journal of the American College of Cardiology, 56(17), 1397-1406.

Freiberg, M. S., Chang, C. C. H., Kuller, L. H., Skanderson, M., Lowy, E., Kraemer, K. L., ... & Justice, A. C. (2013). HIV infection and the risk of acute myocardial infarction. JAMA internal medicine, 173(8), 614-622.

Freiberg, M. S., Chang, C. H., Kuller, L. H., Goetz, M. B., Leaf, D., & Oursler, K. A. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med [Internet]. 2013; 173 (8): 614–22.

Friis-Møller, N., Ryom, L., Smith, C., Weber, R., Reiss, P., Dabis, F., ... & Law, M. (2016). An updated prediction model of the global risk of cardiovascular disease in HIV-positive persons: The Data-collection on Adverse Effects of Anti-HIV Drugs (D: A: D) study. European journal of preventive cardiology, 23(2), 214-223.

Ghislain, M., Bastard, J. P., Meyer, L., Capeau, J., Fellahi, S., Gérard, L., ... & ANRS-COPANA Cohort Study Group. (2015). Late antiretroviral therapy (ART) initiation is associated with long-term persistence of systemic inflammation and metabolic abnormalities. PLoS One, 10(12), e0144317.

Gilbert, J. M., Fitch, K. V., & Grinspoon, S. K. (2015). HIV-related cardiovascular disease, statins, and the REPRIEVE trial. Topics in antiviral medicine, 23(4), 146.

Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., ... & Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 73(24), e285-e350.

Gutierrez, J., Albuquerque, A. L. A., & Falzon, L. (2017). HIV infection as vascular risk: a systematic review of the literature and meta-analysis. PloS one, 12(5), e0176686.

Ingle, S. M., May, M. T., Gill, M. J., Mugavero, M. J., Lewden, C., Abgrall, S., ... & Antiretroviral Therapy Cohort Collaboration. (2014). Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients. Clinical Infectious Diseases, 59(2), 287-297.

Julius, H., Basu, D., Ricci, E., Wing, J., Kusari Basu, J., Pocaterra, D., & Bonfanti, P. (2011). The burden of metabolic diseases amongst HIV positive patients on HAART attending The Johannesburg Hospital. Current HIV research, 9(4), 247-252.

Kearns, A., Gordon, J., Burdo, T. H., & Qin, X. (2017). HIV-1–associated atherosclerosis: unraveling the missing link. Journal of the American College of Cardiology, 69(25), 3084-3098.

Kingsley, L. A., Jennifer, D. E. A. L., Jacobson, L., Budoff, M., Mallory, W. I. T. T., Palella, F., & Calhoun, B. (2015). Incidence and progression of coronary artery calcium (CAC) in HIV-infected and HIV-uninfected men. AIDS (London, England), 29(18), 2427.

Lang, S., Boccara, F., Mary-Krause, M., & Cohen, A. (2015). Epidemiology of coronary heart disease in HIV-infected versus uninfected individuals in developed countries. Archives of cardiovascular diseases, 108(3), 206-215.

Lewden, C., Chêne, G., Morlat, P., Raffi, F., Dupon, M., Dellamonica, P., ... & Leport, C. (2007). HIV-infected adults with a CD4 cell count greater than 500 cells/mm3 on long-term combination antiretroviral therapy reach same mortality rates as the general population. JAIDS Journal of Acquired Immune Deficiency Syndromes, 46(1), 72-77.

Lo, J., Abbara, S., Shturman, L., Soni, A., Wei, J., Rocha-Filho, J. A., ... & Grinspoon, S. K. (2010). Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men. AIDS (London, England), 24(2), 243.

Lo, J., Looby, S. E. D., Wei, J., Adler, G. K., & Grinspoon, S. K. (2009). Increased aldosterone among HIV-infected women with visceral fat accumulation. AIDS (London, England), 23(17), 2366.

Lundgren, J. D., Babiker, A. G., Gordin, F., Emery, S., Grund, B., Sharma, S., ... & Neaton, J. D. (2015). Initiation of antiretroviral therapy in early asymptomatic HIV infection. The New England journal of medicine, 373(9), 795-807.

Mooney, S., Tracy, R., Osler, T., & Grace, C. (2015). Elevated biomarkers of inflammation and coagulation in patients with HIV are associated with higher Framingham and VACS risk index scores. PloS one, 10(12), e0144312.

Nadel, J., & Holloway, C. J. (2017). Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV medicine, 18(4), 292-299.

Patel, A. A., & Budoff, M. J. (2021). Coronary artery disease in patients with HIV infection: an update. American Journal of Cardiovascular Drugs, 21(4), 411-417

Sara L, Szarf G, Tachibana A, Shiozaki AA, Villa AV, Oliveira AC et al. Sociedade Brasileira de Cardiologia. II Diretriz de Ressonância Magnética e Tomografia Computadorizada Cardiovascular da Sociedade Brasileira de Cardiologia e do Colégio Brasileiro de Radiologia. Arq Bras Cardiol 2014; 103(6Supl.3): 1-86

Senoner, T., Barbieri, F., Adukauskaite, A., Sarcletti, M., Plank, F., Beyer, C., ... & Feuchtner, G. M. (2019). Coronary atherosclerosis characteristics in HIV-infected patients on long-term antiretroviral therapy: insights from coronary computed tomography–angiography. Aids, 33(12), 1853-1862.

Sinha, A., & Feinstein, M. J. (2019). Coronary artery disease manifestations in HIV: what, how, and why. Canadian Journal of Cardiology, 35(3), 270-279.

Triant, V. A., Lee, H., Hadigan, C., & Grinspoon, S. K. (2007). Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. The Journal of Clinical Endocrinology & Metabolism, 92(7), 2506-2512.

Vachiat, A., McCutcheon, K., Tsabedze, N., Zachariah, D., & Manga, P. (2017). HIV and ischemic heart disease. Journal of the American College of Cardiology, 69(1), 73-82.

Vilela, F. D., Lorenzo, A. R. D., Tura, B. R., Ferraiuoli, G. I., Hadlich, M., Barros, M. V. D. L., ... & Meirelles, V. (2011). Risk of coronary artery disease in individuals infected with human immunodeficiency virus. Brazilian Journal of Infectious Diseases, 15, 521-527.

Wang, X., Chai, H., Yao, Q., & Chen, C. (2007). Molecular mechanisms of HIV protease inhibitor-induced endothelial dysfunction. JAIDS Journal of Acquired Immune Deficiency Syndromes, 44(5), 493-499.

World Health Organization. (2016). Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. World Health Organization.

World Health Organization. (2016). Global health sector strategy on viral hepatitis 2016-2021. Towards ending viral hepatitis (No. WHO/HIV/2016.06). World Health Organization.

Worm, S. W., Sabin, C., Weber, R., Reiss, P., El-Sadr, W., Dabis, F., ... & Lundgren, J. (2010). Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D: A: D) study. The Journal of infectious diseases, 201(3), 318-330.

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Publicado

26/09/2021

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BURGOS, U. M. M. C. .; MELO, E. V. de .; SILVA, A. M. da .; SOUSA, A. C. S. .; MATOS, W. de .; REIS, M. A. M. .; BEZERRA, L. A. .; CORREIA FILHO, D.; OLIVEIRA, J. L. M. . Fatores associados à aterosclerose subclínica em pacientes infectados pelo HIV no nordeste do Brasil . Research, Society and Development, [S. l.], v. 10, n. 12, p. e442101220484, 2021. DOI: 10.33448/rsd-v10i12.20484. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/20484. Acesso em: 26 nov. 2024.

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