Improvement in Aortic Stiffness After 9 Months of Antiretroviral Therapy in Treatment-Naïve People Living with HIV

Abstract

Background: People living with HIV (PLWH) are at increased risk of cardiovascular disease (CVD). Aortic stiffness measured with carotid-femoral pulse wave velocity (PWV) is a validated predictor of CVD and has been shown to be elevated in PLWH at HIV diagnosis. Objectives: To prospectively evaluate the effect of 9 months of contemporary antiretroviral therapy (ART) on aortic stiffness in newly diagnosed PLWH. Methods: A group of ART-naïve PLWH with modest cardiovascular risk and without known CVD were recruited at the time of HIV diagnosis. Aortic stiffness was measured using carotid-femoral PWV (ViCorder, Skidmore Medical, UK) before ART initiation and after 9 months on treatment. Results: Seventy-three participants were analysed (mean age 32 ± 7 years; 45% female). PWV decreased significantly after 9 months of ART (5.93 ± 1.0 vs. 5.69 ± 1.0 m/s; p = 0.01) with increased aortic distensibility (0.36 [IQR 0.30 to 0.46] vs. 0.40 [IQR 0.34 to 0.50] mmHg−1; p = 0.02). The reduction in PWV remained significant after adjustment for covariates (mean change −0.26 m/s; 95% CI −0.07 to −0.45; p = 0.01). Conclusions: Aortic stiffness improved in a group of newly diagnosed PLWH after ART initiation at 9 months, in keeping with a modifiable component of HIV-associated vascular dysfunction. The findings are consistent with reversible functional vascular abnormality, potentially mediated by changes in vasomotor tone, although it is unknown if this effect will be sustained long-term. The trajectory of aortic stiffness in PLWH and the mechanisms that underpin vasomotor tone require further study.