title: Is the atherosclerotic process accentuated under conditions of HIV infection, antiretroviral therapy, and protease inhibitor exposure? Meta-analysis of the markers of arterial structure and function.
abstract: OBJECTIVE
  To evaluate the apparent association of human immunodeficiency virus (HIV) infection, antiretroviral therapy (ART), and protease inhibitor (PI) exposure with the functional and structural markers of vasculature.
  
  
  METHODS
  A meta-analysis of the relationship between HIV infection, ART, and PI exposure and the functional and structural markers of vasculature. A systematic literature search was performed electronically using specific eligibility criteria. Weighted mean difference (WMD) and corresponding 95% confidence interval (CI) were calculated and combined appropriately.
  
  
  RESULTS
  Fifty-seven articles were included with nine different outcomes. Compared with HIV-negative patients, HIV-positive patients demonstrated significant elevated intima-media thickness (IMT) (WMD (95% CI) = 0.042 (0.028-0.057)), increased pulse wave velocity (PWV) (0.538 (0.283-0.792)), and reduced flow-mediated vasodilation (FMD) (-2.049 (-2.806 to -1.293)). Elevated IMT was observed in HIV patients receiving ART when compared with those naïve to ART in the 20- to 40-year-old age group (0.078 (0.033-0.123)), the >40-year-old age group (0.038 (0.018-0.057)), and the group comprising >50% males (0.070 (0.041-0.099)). In addition, ART resulted in an increased PWV in HIV patients receiving ART in the group with >50% male proportion (0.628 (0.405-0.851)). HIV patients exposed to PI showed a significant trend toward elevated IMT (0.033 (0.007-0.058)) and increased PWV (0.264 (0.118-0.410)) compared with those without PI exposure.
  
  
  CONCLUSIONS
  The atherosclerotic process was accentuated by elevated IMT, increased PWV, and reduced FMD under condition of HIV infection. Comparison of ART-receiving with ART-naïve patients showed a significant trend toward elevated IMT and increased PWV, especially under treatment with PI-containing drugs.
authors.affiliation: Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Liaoning Province, Shenyang 110001, China.
authors.forename: Dandan
authors.initials: D
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Liaoning Province, Shenyang 110001, China.
authors.forename: Yupeng
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Tumor Etiology and Screening, Cancer Institute and General Surgery, The First Affiliated Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention, Liaoning Provincial Education Department, Shenyang 110001, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Liaoning Province, Shenyang 110001, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Liaoning Province, Shenyang 110001, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Liaoning Province, Shenyang 110001, China. Electronic address: yangjun@cmu1h.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D050197:Atherosclerosis / Q000139:chemically induced / Q000453:epidemiology* / Q000503:physiopathology; D001916:Brachial Artery / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D063177:Pulse Wave Analysis; D012737:Sex Factors; D014664:Vasodilation; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors
keywords: Antiretroviral therapy; Atherosclerotic process; Human immunodeficiency virus; Meta-analysis; Protease inhibitor; The markers of arterial structure and function