采用特定高活性抗逆转录病毒疗法的艾滋病病毒感染者的内皮功能障碍和心血管疾病:临床研究的系统回顾

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE Atherosclerosis plus Pub Date : 2024-02-05 DOI:10.1016/j.athplu.2024.01.003
Haskly Mokoena , Sihle E. Mabhida , Joel Choshi , Phiwayinkosi V. Dludla , Bongani B. Nkambule , Zandile J. Mchiza , Duduzile E. Ndwandwe , André P. Kengne , Sidney Hanser
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摘要

尽管高效抗逆转录病毒疗法(HAART)在抑制病毒方面的疗效有所提高,但新出现的证据表明,艾滋病病毒感染者(PLWH)的非传染性疾病负担加重。免疫激活和持续升高的炎症水平与艾滋病病毒感染者的内皮功能障碍有关,可能会导致心血管疾病(CVDs)的发生。在此,我们使用电子检索数据库(包括PubMed、Google Scholar、Cochrane Library和Science Direct)检索了有关接受HAART治疗的PLWH患者内皮功能标志物与心血管疾病相关结果之间关系的科学证据。提取的数据采用唐斯和布莱克核对表进行质量评估。大多数(60%)研究结果表明,接受 HAART 治疗的 PLWH 存在内皮功能障碍,主要表现为血流介导的扩张减少以及血清中 ICAM-1、VCAM-1 和 P-selectin 等粘附分子的含量升高。总结的证据表明,在接受 HAART 治疗的 PLWH 患者中,内皮功能障碍标志物的持续升高与促炎状态之间存在关联。只有少数研究报告了接受 HAART 治疗的 PLWH 患者的内皮功能指标有所改善,而证明内皮功能障碍与心血管疾病风险相关的证据有限,这可能是由于 HAART 的治疗效果所致。本系统综述纳入了证据质量相对较高的有限研究。总之,本综述的结果为今后的研究(甚至是荟萃分析)奠定了重要基础,有助于更好地了解导致接受 HAART 治疗的 PLWH 患者心血管疾病负担的因素。
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Endothelial dysfunction and cardiovascular diseases in people living with HIV on specific highly active antiretroviral therapy regimen: A systematic review of clinical studies

Despite the improved efficacy of highly active antiretroviral therapy (HAART) in viral suppression, emerging evidence indicates an increased burden of noncommunicable diseases in people living with HIV (PLWH). Immune activation and persistently elevated levels of inflammation have been associated with endothelial dysfunction in PLWH, likely contributing to the development of cardiovascular diseases (CVDs). Here, electronic search databases including PubMed, Google Scholar, Cochrane Library, and Science Direct were used to retrieve scientific evidence reporting on any association between markers of endothelial function and CVD-related outcomes in PLWH on HAART. Extracted data was subjected to quality assessment using the Downs and Black checklist. Most (60 %) of the results indicated the presence of endothelial dysfunction in PLWH on HAART, and this was mainly through reduced flow mediated dilation and elevated serum makers of adhesion molecules like ICAM-1, VCAM-1, and P-selectin. The summarized evidence indicates an association between persistently elevated markers of endothelial dysfunction and a pro-inflammatory state in PLWH on HAART. Only a few studies reported on improved endothelial function markers in PLWH on HAART, while limited evidence is available to prove that endothelial dysfunction is associated with CVD-risk, which could be attributed to therapeutic effects of HAART. Limited studies with relatively high quality of evidence were included in this systematic review. In conclusion, results from this review lay an important foundation for future research, even a meta-analysis, that will improve the understanding of the contributing factors to the burden of CVDs in PLWH on HAART.

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来源期刊
Atherosclerosis plus
Atherosclerosis plus Cardiology and Cardiovascular Medicine
CiteScore
2.60
自引率
0.00%
发文量
0
审稿时长
66 days
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