Reduction in coronary and peripheral vasomotor function in patients with HIV after initiation of antiretroviral therapy: a longitudinal study with positron emission tomography and flow-mediated dilation.
OBJECTIVE
The mechanisms underlying the increased cardiovascular risk in patients with HIV on antiretroviral therapy (ART) are not known. Our aim was to study the endothelial function of the coronary arteries by cardiac perfusion positron emission tomography (PET) in patients with HIV initiating ART. In addition, flow-mediated dilation (FMD) of the brachial artery was measured.


METHODS
Patients with HIV scheduled to initiate ART (n=12) were included. NH3 perfusion PET and FMD scans were performed both before and 5 weeks (24-67 days) after initiation of ART. Data were compared with paired t-tests and a P value of less than 0.05 was considered significant.


RESULTS
No changes were found in the pulse-pressure-corrected myocardial rest perfusion (1.22+/-0.07-1.09+/-0.05 ml/min/g tissue, NS) or cold pressor reserve (1.18+/-0.08-1.27+/-0.05, NS). However, the maximal myocardial perfusion decreased 31% from 2.50+/-0.25 to 1.73+/-0.15 ml/min/g tissue (P=0.009) and the myocardial perfusion reserve decreased 20% from 3.11+/-0.32 to 2.48+/-0.25 (P=0.042). FMD decreased from 8.68+/-1.70 to 4.58+/-0.93% (P=0.027). No change was observed in nitroglycerin-mediated dilation (12.8+/-1.0-14.4+/-1.4%, NS).


CONCLUSIONS
In patients with HIV initiating ART, signs of development of endothelial dysfunction assessed by coronary perfusion PET and FMD were found early after starting medication.
Kristoffersen
Ulrik Sloth
US
Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen, Denmark. ulriksk@mfi.ku.dk
Wiinberg
Niels
N
Petersen
Claus Leth
CL
Gerstoft
Jan
J
Gutte
Henrik
H
Lebech
Anne-Mette
AM
Kjaer
Andreas
A
D000328:Adult; D000368:Aged; D000641:Ammonia; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D001916:Brachial Artery / Q000187:drug effects / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000187:drug effects; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D049268:Positron-Emission Tomography; D013997:Time Factors; D014666:Vasomotor System / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D055815:Young Adult
D019380:Anti-HIV Agents; D000641:Ammonia