Medizinische Universität Graz - Research portal
Selected Publication:
Wende, J.
Effects of Different Types of Antiretroviral Therapy on Vasculature in HIV Patients: A Sub-Saharan Study
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp. 89
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- Authors Med Uni Graz:
- Advisor:
- Goswami Nandu
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- Abstract:
- Background: The human immunodeficiency virus (HIV) is one of the leading causes of morbidity and mortality worldwide. Up to date there is no curative therapy available to treat this infection. However, since antiretroviral treatment became available, HIV patients are living longer. Thus, the HIV infection has developed into a chronic disease, which shifts the focus from typical AIDS and AIDS-associated opportunistic diseases to possible long-term complications of antiretroviral therapy (ART). This is particularly so as ART has been shown to affect the cardiovascular system. Seventy percent of all HIV-infected persons currently live in Sub-Saharan Africa. Despite this, only limited data about the long-term effects of ART in this region are available. Aims and objectives: This diploma thesis aims to investigate the cardiovascular effects of different antiretroviral regimens currently used in Sub-Saharan Africa. It specifically examines the effects of first- and second-line ART on lipid parameters and vascular function. Methods: Two HIV patients on first- and second-line ART were selected from the cohort of the ongoing EndoAfrica study and are presented as case studies. Patient A was on first-line ART (Efavirenz 600mg, Emtricitabine 200mg, Tenofovir 300mg) and Patient B on second-line ART (Lapanavir 200mg, Ritonavir 50mg, Zidovudine 300mg, Lamivudine 50mg). Cardiovascular risk factors (blood pressure, body mass index, (BMI), serum lipids, blood glucose) as well as early markers of endothelial dysfunction and atherosclerosis (flow mediated dilatation, FMD) were evaluated. Results: Both patients had normal ranges of blood pressure, blood glucose, Creactive protein and BMI. The serum lipid levels presented differences: Patient A had normal values whereas patient B showed a total cholesterol of 5.21 mmol/L (target value < 4.90 mmol/L) and a LDL cholesterol of 3.49 mmol/L (target value < 3.00 mmol/L). Patient A had an FMD of 8.65% in the Arteria brachialis, whereas Patient B had an FMD of 18.30%. Discussion: The different serum lipid levels could be associated with the variable ART regimens because protease inhibitors (part of second-line ART) have been shown to cause dyslipidemia in other studies. Both FMD results are within the normal range; therefore, vascular function does not seem to be affected by ART type. These results should be interpreted with caution, as they have been obtained from only two patients on ART. Future studies should also investigate the complex interaction of other factors such as smoking, physical activity and age on the cardiovascular system in HIV patients on different types of ART. Aspects such as viral load, period of ART duration as well as any other co-morbidities should be included in future research.