title: Initiation of antiretroviral therapy at higher nadir CD4+ T-cell counts is associated with reduced arterial stiffness in HIV-infected individuals.
abstract: OBJECTIVE
  HIV infection is associated with increased rates of cardiovascular disease. We sought to evaluate whether initiation of HIV therapy at higher nadir CD4(+) T-cell counts might reduce cardiovascular risk, as measured by arterial stiffness.
  
  
  METHODS
  We conducted a cross-sectional study of 80 HIV-infected men who were antiretroviral-treated with undetectable plasma HIV RNA levels.
  
  
  METHODS
  Participants underwent noninvasive assessment of arterial stiffness by pulse wave analysis (augmentation index normalized for heart rate of 75 bpm) and carotid-femoral pulse wave velocity, both sensitive measures of cardiovascular risk. A generalized linear model was used to determine the relationship between cardiovascular and HIV-related predictors, and arterial stiffness.
  
  
  RESULTS
  In unadjusted analyses, predictors of arterial stiffness included age, blood pressure, antihypertensive medication use, and nadir CD4(+) T-cell count below 350 cells/microl (all P < 0.05). After adjusting for both cardiovascular risk factors (age, blood pressure, antihypertensive medication use, diabetes, hypercholesterolemia, and smoking) and HIV-related covariates, nadir CD4(+) T-cell count below 350 cells/microl was independently associated with a 0.41 m/s increase in pulse wave velocity (95% confidence interval 0.03-0.79, P = 0.03) and a 7.3% increase in augmentation index (augmentation index normalized for heart rate of 75 bpm; 95% confidence interval 2.6-11.9, P = 0.003). Neither duration of antiretroviral therapy nor exposure to protease inhibitors was associated with arterial stiffness.
  
  
  CONCLUSIONS
  Among treated HIV-infected individuals, arterial stiffness is independently associated with both traditional cardiovascular risk factors as well as a low nadir CD4(+) T-cell count. Our data suggest that cardiovascular risk among HIV-infected individuals could be reduced through early initiation of antiretroviral therapy, before CD4 T-cell counts are depressed, a concept that should be tested prospectively in future studies.
authors.affiliation: Division of Cardiology, San Francisco General Hospital, San Francisco, California 94110, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Ho
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Hecht
authors.forename: Yu
authors.initials: Y
authors.lastname: Xie
authors.forename: Amanda
authors.initials: A
authors.lastname: Schnell
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.forename: Peter
authors.initials: P
authors.lastname: Ganz
authors.forename: Priscilla Y
authors.initials: PY
authors.lastname: Hsue
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000502:physiology*; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000503:physiopathology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology*; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires; D019562:Viral Load