The online version of this article (doi:10.1007/s40121-016-0115-0) contains supplementary material, which is available to authorized users.
To view enhanced content for this article go to http://www.medengine.com/Redeem/58D4F0605862A836.
The increased risk of abacavir in cardiovascular disease (CVD) in HIV-infected patients is still being debated. Maraviroc, a CCR5 blocker, has been shown to decrease immune activation and monocyte infiltration in atherosclerotic plaques in murine experiments. Therefore, we examined the effect of maraviroc intensification on flow-mediated dilatation (FMD) in abacavir-treated HIV-infected patients and its effect on immunological and inflammatory parameters.
A open-label prospective crossover study with a duration of 16 weeks: 8 weeks of intervention (maraviroc intensification) and 8 weeks of control (unchanged cART regimen). FMD, HIV-specific variables, expression of HIV co-receptors, markers of inflammation and coagulation and cellular markers of immune activation were measured at weeks 0, 8 and 16. The changes (Δ) in these variables were compared between intervention and control periods using non-parametric tests. To evaluate the relation with the change in FMD, linear regression modeling was used.
Twenty-one male patients with suppressed plasma HIV-RNA, on cART, had a known HIV infection for 9.2 years (IQR 6.9–13.5) with abacavir use for 6.5 years (2.8–9.3). A significantly increased FMD of 0.73% (IQR −0.25 to 1.70) was seen after maraviroc intensification compared to a decrease of −0.42% (IQR −1.89 to 0.25; p = 0.049) in the control period. There was a negative relation between ΔFMD with ΔD-dimer (β −22.70, 95% CI −39.27; −6.13, p = 0.011) and ΔCD95+ CD4+ T cells (β −0.16, 95% CI −0.28; −0.04, p = 0.013), adjusted for age and duration of HIV.
Maraviroc intensification modestly improves endothelial function in HIV-infected patients on an abacavir-containing regimen.
Supplementary material 1 (DOCX 15 kb)40121_2016_115_MOESM1_ESM.docx
Friis-Moller N, Sabin CA, Weber R, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 2003;349(21):1993–2003. doi: 10.1056/NEJMoa030218.
Ding X, Andraca-Carrera E, Cooper C, et al. No association of abacavir use with myocardial infarction: findings of an FDA meta-analysis. J Acquir Immune Defic Syndr. 2012;61(4):441–47.
Ndhlovu LC, Umaki T, Chew GM, et al. Treatment intensification with maraviroc (CCR5 antagonist) leads to declines in CD16-expressing monocytes in cART-suppressed chronic HIV-infected subjects and is associated with improvements in neurocognitive test performance: implications for HIV-associa. J Neurovirol. 2014;20(6):571–82. doi: 10.1007/s13365-014-0279-x. CrossRefPubMedPubMedCentral
Hürlimann D, Chenevard R, Ruschitzka F, et al. Effects of statins on endothelial function and lipid profile in HIV infected persons receiving protease inhibitor-containing anti-retroviral combination therapy: a randomised double blind crossover trial. Heart. 2006;92(1):110–2. doi: 10.1136/hrt.2004.056523. CrossRefPubMedPubMedCentral
Simons LA, Sullivan D, Simons J, Celermajer DS. Effects of atorvastatin monotherapy and simvastatin plus cholestyramine on arterial endothelial function in patients with severe primary hypercholesterolaemia. Atherosclerosis. 1998;137(1):197–203. http://www.ncbi.nlm.nih.gov/pubmed/9568752. Accessed May 15, 2016.
Hsue PY, Scherzer R, Gilman L, Wu Y, Maka K, Mohammed S, Grundfeld C, Martin J, Deeks S. Maraviroc intensification on endothelial function in treated HIV infection. Abstract #123. In: 19th conference on retroviruses and opportunistic infections, Seattle; 2012.
Wannamethee SG, Whincup PH, Shaper AG, Rumley A, Lennon L, Lowe GDO. Circulating inflammatory and hemostatic biomarkers are associated with risk of myocardial infarction and coronary death, but not angina pectoris, in older men. J Thromb Haemost. 2009;7(10):1605–11. doi: 10.1111/j.1538-7836.2009.03574.x. CrossRefPubMedPubMedCentral
- Maraviroc Intensification Improves Endothelial Function in Abacavir-Treated Patients, an Open-Label Randomized Cross-Over Pilot Study
Joop E. Arends
Sigrid A. Otto
Steven F. L. van Lelyveld
Frank J. L. Visseren
Andy I. M. Hoepelman
- Springer Healthcare
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II