Cardiovascular risk in patients infected by the human immunodeficiency virus compared with that of uninfected patients and general population = Estudio del riesgo cardiovascular en pacientes infectados por el virus de la inmunodeficiencia humana respecto a pacientes no infectados y población general

Abstract

Introduction:

So far, HIV patients-tailored clinical guidelines, are based on the available recommendations for the general population plus on considering earlier initiation of antiretroviral therapy. This is a basic approach that although correct is likely amenable for optimization. A better understanding of the differences regarding pathogenesis, epidemiology and clinical characteristics of cardiovascular disease between HIV- 1-infected patients and uninfected individuals can help to design and develop prevention and clinical interventions to reduce cardiovascular disease risk among HIV-1-infected patients.

Primary objective: The common main objective of the studies herein presented is to elucidate whether HIV-1-infected patients present with differences in cardiovascular risk relative to un-infected individuals.

Secondary objetives: I. Epidemiologic. II. Clinical. III: Genetic.

Results I. Two parallel case-control studies assessing the independent impact of smoking, diabetes and hypertension on the development of acute coronary syndrome in HIV-infected patients comparing with un-infected adults. Calvo-Sánchez M, Perelló R, Pérez I, Mateo MG, Junyent M, Laguno M, Blanco JL, Martínez-Rebollar M, Sánchez M, Mallolas J, Gatell JM, Domingo P, Martínez E. HIV Med. 2013 Jan;14(1):40-8. Conclusions: In this study, the first to our knowledge assessing PARs of common traditional cardiovascular risk factors in the HIV+ population, we found that: -The contribution of smoking to ACS in HIV-positive adults was almost twice as high as that in un- infected adults. - Smoking contributes to ACS in HIV-positive adults more than diabetes and hypertension do. These results support smoking cessation strategies as a priority when addresssing cardiovascular risk reduction in HIV-1-infected patients. II. A retrospective analysis of a prospective collected cohort of patients presenting with acute coronary syndrome (ACS) comparing the clinical presentation and short-term prognosis of ACS in those who were HIV-infected and those un-infected. Perelló R, Calvo M, Miró O, Castañeda M, Saubí N, Camón S, Foix A, Gatell JM, Masotti M, Mallolas J, Sánchez M, Martinez E. Eur J Intern Med. 2011 Oct;22(5):485-8.

Conclusions:

Comparing with un-infected adults, HIV-infected patients present ACS at younger ages with greater prevalence of traditional cardiovascular risk factors and less symptoms. HIV-1-infected patients present predominantly ST-elevation myocardial infarctions and were treated more frequently with percoutaneous coronary artery intervention. All theses differences lost their significance when controlling by age and gender. Short term prognosis was similar in both groups, HIV-infected and un-infected. III. Nested case-control study assessing the association of lipoprotein(a) genetic markers with traditional risk factors and with coronary heart disease in HIV-infected individuals. Egaña-Gorroño L, Martínez E, Escribà T, Calvo M, Gatell JM, Arnedo M. Front Immunol. 2012 Dec 6;3:367.

Conclusions:

No association was detected between myocardial infarction and KIV-2 copy-number variation and single- nucleotide polymorphisms in LPA. These two gentetic variants of LPA have not been identified as genetic markers of coronary heart disease in HIV-infected patients. Traditional cardiovascular risk factors and CD4 T-cell count did show significant association with myocardial infarction.

IV. Systematic review of recent scientific evidence regarding HIV infection and body fat redistribution, lipidic and glucose metabolism and their implications in aging patients. Calvo M, Martinez E. Curr Opin HIV AIDS. 2014 Jul;9(4):332-9.

Conclusions: Since chronic inflammation and microbial translocation will impact significantly metabolism despite sustained viral suppression in aging HIV- infected persons, new strategies will be required in this increasing group of patients to prevent frailty and comorbidities added to age-related ones. V. A systemic Review of the available scientific literature addressing smoking cessation in HIV-infected individuals. Calvo-Sánchez M, Martínez E. HIV Med. 2015 Apr;16(4):201-10. HIV-positive smokers exhibit greater motivation to quit but lower rates of smoking cessation and similar number of relapses than un-infected smokers with the available anti-smoking strategies. The regularity of their consultations, their trust on HIV physicians and their young mean age favor optimizing the achievable health benefits of smoking cessation. Smoking cessation strategies tailored for HIV patients are needed. VI. A systematic review of the pathogenic mechanisms and clinical implications of tobacco smoking and HIV infection. Calvo M, Laguno M, Martínez M, Martínez E. AIDS Rev. 2015 Jan-Mar;17(1):47-55. Tobacco smoking exerts greater impact on HIV-1-infected patients´ health than on uninfected smokers´ through cumulative and synergistic effects.

Introducción:

Hasta ahora las estrategias preventivas y terapéuticas de la enfermedad cardiovascular en pacientes con infección VIH presentes en las guías clínicas de VIH, se basan en las recomendaciones dirigidas a la población general junto a un inicio temprano de la terapia antirretroviral. Este acercamiento es aunque correcto, susceptible de ser optimizado. Entender mejor las características que diferencian en términos de patogénesis, epidemiología y clínica la enfermedad cardiovascular de pacientes VIH y no infectados, puede contribuir al diseño y desarrollo de intervenciones clínicas y preventivas para disminuir el riesgo de la enfermedad cardiovascular en pacientes VIH.

Objetivo principal: El objetivo común principal de los estudios que se presentan a continuación es investigar las posibles diferencias en el riesgo cardiovascular de los pacientes infectados por VIH frente a pacientes no infectados e individuos sanos de la población general.

Resultados

I. Dos estudios casos-controles paralelos. Análisis de la contribución individual del tabaco, la diabetes y la hipertensión arterial en el desarrollo del síndrome coronario agudo en pacientes VIH frente a individuos no infectados. HIV Med. 2013 Jan;14(1):40-8. Calvo- Sánchez M et al. II. Análisis retrospectivo de una cohorte prospectiva de pacientes con síndrome coronario agudo (SCA) comparando su presentación clínica y pronóstico a corto plazo en pacientes VIH y no infectados. Eur J Intern Med. 2011 Oct;22(5):485-8. Perelló R, Calvo M, et al. III. Estudio casos-controles anidado que evalúa la asociación entre variantes genéticas de la lipoproteína (a) con factores de riesgo cardiovascular tradicionales y el riesgo de presentar infarto de miocardio en pacientes VIH. Egaña-Gorroño L, Martínez E, Escribà T, Calvo M, Gatell JM, Arnedo M. Front Immunol. 2012 Dec 6;3:367.

IV. Revisión sistemática de la evidencia científica sobre redistribución de la grasa corporal, alteraciones metabólicas y su impacto en pacientes en edades avanzadas infectados por VIH. Calvo M, Martinez E. Curr Opin HIV AIDS. 2014 Jul;9(4):332-9. V. Revisión sistemática de la literatura científica sobre el abandono del consumo de tabaco en la población VIH. Calvo M, Martínez E. HIV Medicine 2014. VI. Revisión de los mecanismos fisiopatológicos e implicaciones clínicas del consumo de tabaco y la infección por VIH. Calvo M, Laguno M, Martínez M, Martínez E. AIDS Reviews 2014.