title: Early Antiretroviral Therapy at High CD4 Counts Does Not Improve Arterial Elasticity: A Substudy of the Strategic Timing of AntiRetroviral Treatment (START) Trial.
abstract: BACKGROUND
  Both human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Vascular function assessments can be used to study CVD pathogenesis. We compared the effect of immediate versus deferred ART initiation at CD4 counts >500 cells/mm3on small arterial elasticity (SAE) and large artery elasticity (LAE).
  
  
  METHODS
  Radial artery blood pressure waveforms were recorded noninvasively. Small arterial elasticity and LAE were derived from analysis of the diastolic pulse waveform. Randomized treatment groups were compared with linear models at each visit and longitudinal mixed models.
  
  
  RESULTS
  Study visits involved 332 participants in 8 countries: mean (standard deviation [SD]) age 35 (10), 70% male, 66% nonwhite, 30% smokers, and median CD4 count 625 cells/mm3and 10-year Framingham risk score for CVD 1.7%. Mean (SD) SAE and LAE values at baseline were 7.3 (2.9) mL/mmHg × 100 and 16.6 (4.1) mL/mmHg × 10, respectively. Median time on ART was 47 and 12 months in the immediate and deferred ART groups, respectively. The treatment groups did not demonstrate significant within-person changes in SAE or LAE during the follow-up period, and there was no difference in mean change from baseline between treatment groups. The lack of significant differences persisted after adjustment, when restricted to early or late changes, after censoring participants in deferred group who started ART, and among subgroups defined by CVD and HIV risk factors.
  
  
  CONCLUSIONS
  Among a diverse global population of HIV-positive persons with high CD4 counts, these randomized data suggest that ART treatment does not have a substantial influence on vascular function among younger HIV-positive individuals with preserved immunity.
authors.affiliation: Department ofMedicine and; Infectious Diseases, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Jason V
authors.initials: JV
authors.lastname: Baker
authors.affiliation: Division of Biostatistics, University of Minnesota , Minneapolis.
authors.forename: Katherine Huppler
authors.initials: KH
authors.lastname: Hullsiek
authors.affiliation: Division of Biostatistics, University of Minnesota , Minneapolis.
authors.forename: Nicole Wyman
authors.initials: NW
authors.lastname: Engen
authors.affiliation: Division of Biostatistics, University of Minnesota , Minneapolis.
authors.forename: Ray
authors.initials: R
authors.lastname: Nelson
authors.affiliation: Department of Medicine, Faculty of Medicine, Khon Kaen University , Thailand.
authors.forename: Ploenchan
authors.initials: P
authors.lastname: Chetchotisakd
authors.affiliation: Department of Infectious Diseases, Rigshospitalet University of Copenhagen , Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Gerstoft
authors.affiliation: Praxis Jessen2 + Kollegen, ID, Teaching Practice of Medical School , Charité, Berlin , Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Jessen
authors.affiliation: HIV Unit, Hospital GA JM Ramos Mejia and Coordinacion de Investigacion Clinica Academica en Latinoamerica , Buenos Aires, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Losso
authors.affiliation: Department of Medicine, Henry Ford Hospital and Wayne State University , Detroit, Michagan.
authors.forename: Norman
authors.initials: N
authors.lastname: Markowitz
authors.affiliation: Uganda Virus Research Institute , Entebbe.
authors.forename: Paula
authors.initials: P
authors.lastname: Munderi
authors.affiliation: Department of Internal Medicine, University General Hospital "ATTIKON'', Medical School, National and Kapodistrian University of Athens , Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Papadopoulos
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine , Bronx, New York.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shuter
authors.affiliation: Division of HIV, Infectious Diseases and Global Medicine, University of California , San Francisco.
authors.forename: Claire
authors.initials: C
authors.lastname: Rappoport
authors.affiliation: Center for Health and Infectious Disease Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen , Demark.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Pearson
authors.affiliation: Infectious Diseases, Veterans Affairs Medical Center , Washington, District of Columbia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Finley
authors.affiliation: Medical Research Council Clinical Trials Unit, University College London , United Kingdom.
authors.forename: Abdel
authors.initials: A
authors.lastname: Babiker
authors.affiliation: Kirby Institute, University of New South Wales , Sydney , Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Emery
authors.affiliation: Department of Medicine and.
authors.forename: Daniel
authors.initials: D
authors.lastname: Duprez
keywords: HIV infection; antiretroviral therapy; arterial elasticity; cardiovascular disease; vascular dysfunction.