title: Endothelial Glycocalyx Damage and Renal Dysfunction in HIV Patients Receiving Combined Antiretroviral Therapy.
abstract: Widespread use of combined antiretroviral therapy (cART) increased HIV patients' life expectancy, however, favored the development of kidney and cardiovascular diseases. The aim of this study was to investigate endothelial glycocalyx (eGC) damage and its association with renal function in HIV patients receiving cART. This is a cross-sectional study with HIV-infected patients with no renal and cardiovascular disease, recruited in public health centers in Brazil. Clinical and laboratory parameters of HIV patients were compared according to cART use and with a healthy control group. Blood ICAM-1 and syndecan-1 levels were quantified by ELISA kit. Estimated glomerular filtration rate (eGFR) was evaluated. A total of 69 HIV patients were included, with mean age of 33.4 ± 8.9 years, and 77.3% were male. Serum urea, creatinine, and eGFR were similar in all groups. No HIV patient had decreased GFR <60 ml/min. All HIV patients had higher systemic syndecan-1 compared with healthy controls (71.8 ± 25.4 ng/ml vs. 36.5 ± 14.3 ng/ml, p < .001). Syndecan-1 showed a significant positive correlation with serum creatinine (r = 0.437, p = .001), serum urea levels (r = 0.352, p = .006), and a negative correlation with eGFR (r = -0.315, p = .015) in HIV patients. Syndecan-1 remained independently associated with serum creatinine and reduced GFR even after we forced variables related with HIV infection status, tenofovir use, treatment time, dyslipidemia, and others in a multivariate analysis. HIV patients using cART with no clinical renal and cardiovascular disease presented eGC damage and it is associated with clinical markers of kidney dysfunction. Syndecan-1 may be a useful early biomarker to monitoring renal dysfunction in HIV patients in chronic use of cART. Further research is needed to evaluate this applicability.
authors.affiliation: 1 Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará , Fortaleza, Brazil .
authors.forename: Gdayllon Cavalcante
authors.initials: GC
authors.lastname: Meneses
authors.affiliation: 2 Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará. Fortaleza, Brazil .
authors.forename: Malena Gadelha
authors.initials: MG
authors.lastname: Cavalcante
authors.affiliation: 3 Public Health Postgraduate Program, School of Medicine, Health Sciences Center, University of Fortaleza , Fortaleza, Brazil .
authors.forename: Geraldo Bezerra
authors.initials: GB
authors.lastname: da Silva Junior
authors.affiliation: 1 Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará , Fortaleza, Brazil .|4 Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará , Fortaleza, Brazil .
authors.forename: Alice Maria Costa
authors.initials: AMC
authors.lastname: Martins
authors.affiliation: 5 Public Health Postgraduate Program, Department of Community Health, School of Medicine, Federal University of Ceará , Fortaleza, Brazil .
authors.forename: Roberto da Justa Pires
authors.initials: RDJP
authors.lastname: Neto
authors.affiliation: 6 Medical Sciences Postgraduate Program, School of Medicine, University of Fortaleza , Fortaleza, Brazil .
authors.forename: Alexandre Braga
authors.initials: AB
authors.lastname: Libório
authors.affiliation: 2 Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará. Fortaleza, Brazil .
authors.forename: Elizabeth
authors.initials: E
authors.lastname: De Francesco Daher
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001938:Brazil; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D042783:Endothelial Cells / Q000502:physiology*; D005260:Female; D005919:Glomerular Filtration Rate; D019276:Glycocalyx; D015658:HIV Infections / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D007668:Kidney / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D053668:Syndecan-1 / Q000097:blood*; D014508:Urea / Q000097:blood; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; C508241:SDC1 protein, human; D053668:Syndecan-1; D014508:Urea; D003404:Creatinine
keywords: HIV; antiretroviral therapy; chronic kidney disease; endothelial glycocalyx; syndecan-1