The achievement of antilipidemic treatment in HIV seropositive patients and correlation of it with CRP level in serum

Postgraduate Thesis uoadl:1691195 547 Read counter

Unit:
ΠΜΣ Καρδιοαναπνευστική Αναζωογόνηση
Library of the School of Health Sciences
Deposit date:
2017-06-28
Year:
2017
Author:
Bisia Athanasia
Supervisors info:
Ευαγγελία Κουσκούνη, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Σερένα Βαλσάμη, Επ. Καθηγήτρια, Ιατρική, ΕΚΠΑ
Νικολέτα Ιακωβίδου, Αν. Καθηγήτρια, Ιατρική, ΕΚΠΑ
Original Title:
Η επίτευξη στόχων αντιλιπιδαιμικής αγωγής σε HIV οροθετικούς ασθενείς και η συσχέτισή της με τα επίπεδα CRP στον όρο
Languages:
Greek
Translated title:
The achievement of antilipidemic treatment in HIV seropositive patients and correlation of it with CRP level in serum
Summary:
Introduction
Increasing aging of Human Immunodeficiency Virus positive (HIV+) patients after the successful introduction of antiretroviral therapy (ART) exhibits significantly increased rates of cardiovascular disease (CVD), including coronary artery disease (CAD), myocardial infarction (MI), and peripheral arterial diseases (PAD). Despite the demographic differences of HIV+ patients between developed and developing countries, CVD remains a major cause of non-HIV related mortality. Also HIV+ patients have a persistent state of inflammation and immune activation in spite of the suppression of HIV replication via ART. ART treated HIV+ patients experience a premature and accelerated aging probably driven by side effects of antiretroviral drugs, chronic inflammation and persistent immune activation.
Aims and objectives
The aim of study was to evaluate hsCRP in HIV+ patients and correlate with various demographic, clinical, biochemical, immunological, qualitative or quantitative parameters. Furthermore we studied the correlation between hsCRP and cardiovascular disease risk scores, Framingham, DAD (Data collection on Adverse events of Anti-HIV Drugs) score, ASCVD (atherosclerotic cardiovascular disease) and HEARTSCORE.
The achievement of low density lipoprotein (LDL) goal according to European society of cardiology as well as the maintenance of the above mentioned four cardiovascular risk scores below the cutoff of high risk was the final aim of the study.

Material and method
We studied in a cross-sectional observational study a population which consists of 102 HIV+ patients who are registered in the Infectious Diseases Unit of the “Korgialeneio-Benakeio” general public hospital of Athens.
Various clinical or demographic, qualitative or quantitative variables/parameters were studied and compared in relationship with hsCRP levels in the serum. The patients were under statin treatment for primary or secondary prevention of CVD.

Results
The univariate analysis of hsCRP index with the demographic and clinical indices showed that chronic kidney disease (CKD) and Obesity factors affected hsCRP level in HIV+ patients statistical significantly. Specifically, individuals with hsCRP ≥ 2 mg/dl had statistically significantly higher CKD rate and higher Obesity rate than those with hsCRP < 2 mg/dl (40% vs. 16.1%; p=0.010), (27.5% vs.6.5%; p=0.008) respectivelly.
The multivariate analysis of hsCRP with the demographic and clinical indices also showed that CKD and Obesity affected hsCRP. Specifically, individuals with CKD were 3.4 times more likely to have hsCRP ≥ 2 mg/dl compared to individuals without CKD. Obese individuals were 6.6 times more likely to have hsCRP ≥ 2 mg/dl compared to non-obese individuals.
The correlation of hsCRP with the cardiovascular risk scores showed no statistically significant results. Specifically, the rates with DAD score (≥ 5%), FRAMINGHAM score (≥ 20%) and ASVD RISK score (≥ 7.5) for individuals with hsCRP ≥ 2 mg/dl were 53.2%, 36.2% and 57,4%, respectively, while for individuals with hsCRP< 2 mg/dl were 54.8%, 48.4% and 64.5%, respectively. However patients with hsCRP ≥ 2 mg/dl showed higher cardiovascular scores than patients with hsCRP< 2 mg/dl.
The multivariate analysis of DAD score index showed that hsCRP index does not affect the DAD score index, while the factors affecting it were Lipodystrophy (p=0.053), CKD (p=0.038) and body mass index (BMI) (p=0.010).
The multivariate analysis of FRAMINGHAM score index showed that hsCRP index does not significantly statistically affect FRAMINGHAM score index, while the factor affecting it was CKD (p=0.005).
The multivariate analysis of ASCVD RISK score index showed that hsCRP index does not affect ASCVD RISK score index, while the factors affecting it were Lipodystrophy (p=0.005), CKD (p=0.016) and BMI (p=0.002).
Finally, there was no statistically significant correlation of hsCRP levels with the index of LDL target achievement. Specifically, the target of LDL for individuals with hsCRP < 2 mg/dl was reached in 33.9% of them, while for those with hsCRP ≥ 2 mg/dl in 32.5%.

Conclusions-Recommendations
According to our study hsCRP was significantly correlated with Obesity and CKD. In addition, even if we couldn’t find a statistically significant affect of hsCRP on the cardiovascular risk scores, we found in general higher cardiovascular risk scores in patients with hsCRP ≥ 2 mg/dl. The use of hsCRP is not recommended at this time in the everyday clinical practice as data showing correlation with lipid lowering effects or cardiovascular outcomes are still poor. However additional studies are needed to elucidate the actual role of hsCRP in the further stratification of the cardiovascular risk of HIV+ patients.
Main subject category:
Health Sciences
Keywords:
HIV, CRP, Antilipidemic treatment, Cardiovascular disease risk
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
66
Number of pages:
189
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