Nutrition, Metabolism and GI Research in HIV - CFAR Centers for AIDS Research

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Research Topics: Cardiovascular Disease - CVD risk in HIV Infection

The recognition of cardiovascular risk among people living with HIV infection has been a growing concern that pre-dates the era of potent antiretroviral therapy (ART).  Alterations in lipid metabolism as evidenced by elevations in serum triglycerides and low high-density lipoprotein cholesterol (HDL-C) were common and associated with poor nutritional status.  Increased serum triglycerides and increasing low lipoprotein cholesterol (LDL-C) continue to be a risk factor during the ART era where persistently low HDL-C remains. Overall, traditional risk factors appear to be the driving forces of the premature risk of metabolic and vascular complications, but viral factors and ART exposure may play a role as well.

Since both HIV and CVD are inflammatory processes, markers of inflammation have been the focus of many recent studies attempting to understand the pathogenic process of CVD in HIV infection as well as to improve risk stratification in this population. The multifactorial nature of CVD and the complex interplay of additional and unique risk factors in HIV-infected persons contribute to the clinical and research challenges and controversies that have arisen over the past several years.

The CVD risk factors most prevalent among the HIV-infected population include dyslipidemia, impaired glucose tolerance, smoking, diet, and the role of ART agents and chronic viral replication contributing to inflammation. Surrogate markers of CVD risk include thickening of the carotid artery wall.  High-sensitivity C-reactive protein (hsCRP), an inflammatory biomarker for cardiovascular disease is an increasingly popular screening tool for CVD risk and is associated with future risk of coronary heart disease, stroke, and death from vascular and non-vascular disease.  The diagram below highlights the traditional risk factors for increased CVD risk in the general population. 

http://www.cholesterolneversleeps.com/cvd-risk-factors

There is strong evidence in the non-HIV literature that a better quality diet including increased dietary fiber, reduced saturated fat, dietary balance and variety can minimize incidences of diabetes, CV events, and other chronic diseases.

For a variety of reasons patients living with HIV do not maintain optimal eating habits. According to an analysis from a large cohort of HIV-infected participants, the Nutrition for Healthy Living (NHFL) study, almost 30% of women and 13% of men were obese and obesity was associated with low quality dietary intake as defined by higher than recommended amount of dietary fat and saturated fat. In addition, the intake of dietary fiber decreased as BMI increased. In all BMI categories, micronutrient intakes were below the Dietary Reference Intakes indicating poor nutritional status in this cohort.

Attention to the modifiable risk factors such as diet, smoking, and exercise can greatly impact and empower patients who want to gain control and make a difference to reduce cardiovascular risk.

REFERENCES:

Mangili A, Polak J, Quach L, Gerrior J, Wanke C. Markers of atherosclerosis and inflammation and mortality in patients with HIV infection. Atherosclerosis 214 (2011) 468-473.

Jones C. Metabolic syndrome in HIV-infected patients: No different than the general population? Clin Inf Dis 2007;44:735-8.

Mangili A, Jacobson D, Gerrior J et al. Metabolic syndrome and subclinical atherosclerosis in patients infected with HIV. 2007; 44:1368-74.

Triant V, Lee H., Hadigan C. Grinspoon S. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. Jul 2007; 92(7):2506-2512.

Hendricks KM, Willis K, Houser R, Jones CY. Obesity in HIV-Infection: Dietary Correlates. J Am Coll Nutr 2006;25(4):321-331.

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For information on our Nutrition, Metabolism & GI Core services,
please contact Chris Wanke, MD (christine.wanke@tufts.edu) or
Tamsin Knox, MD (tamsin.knox@tufts.edu).

Lifespan/Tufts/Brown CFAR is funded by the National Institutes of Health.
Please remember to cite the LTB CFAR (Grant P30 AI042853)
in all publications that have benefited from the Center's Core services.