HIV and Cardiovascular Risk
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Purpose
HIV-infected patients treated with combination antiretroviral therapy demonstrate metabolic abnormalities that may predispose them to cardiovascular disease. In HIV-infected patients we will investigate progression rates of cardiovascular disease and assess whether these progression rates are predicted by increased inflammatory indices.
| Condition |
|---|
|
HIV Infections Cardiovascular Disease |
| Study Type: | Observational |
| Study Design: | Observational Model: Case Control Time Perspective: Prospective |
| Official Title: | Assessment of Cardiovascular Risk in HIV Patients |
- Carotid Intima Media Thickness [ Time Frame: 2 years ] [ Designated as safety issue: No ]
- Waist Circumference [ Time Frame: 2 years ] [ Designated as safety issue: No ]
- Blood pressure [ Time Frame: 2 years ] [ Designated as safety issue: No ]
- Lipid levels [ Time Frame: 2 years ] [ Designated as safety issue: No ]
- Glucose [ Time Frame: 2 years ] [ Designated as safety issue: No ]
- Inflammatory markers [ Time Frame: 2 years ] [ Designated as safety issue: No ]
- Visceral adiposity [ Time Frame: 2 years ] [ Designated as safety issue: No ]
Biospecimen Retention: Samples Without DNA
blood will be frozen for end of study analysis for insulin, CRP, adiponectin, TNF-α, sTNFR2, IL-6, PAI-1, MCP-1
| Enrollment: | 129 |
| Study Start Date: | April 2007 |
| Study Completion Date: | November 2011 |
| Primary Completion Date: | November 2011 (Final data collection date for primary outcome measure) |
| Groups/Cohorts |
|---|
|
1
HIV Positive men and women 18-65 years of age
|
|
2
HIV negative men and women 18-65 years of age
|
Detailed Description:
HIV-infected patients treated with combination antiretroviral (ARV) therapy increasingly demonstrate metabolic abnormalities, including dyslipidemia, insulin resistance and body composition abnormalities that may predispose them to cardiovascular disease (CVD). Initial studies suggest increased carotid intima-media thickness (IMT) and endothelial dysfunction in this population. Increased carotid IMT over time has been demonstrated in HIV-infected patients compared to control subjects. However, traditional risk factors, such as dyslipidemia, diabetes mellitus and body composition changes alone do not fully predict increased cardiovascular disease in HIV-infected patients. One possible explanation is increased inflammation, related directly to effects of ARV therapy or indirectly from changes in fat distribution. In preliminary studies, our group has shown that changes in fat distribution were highly predictive of TNF and IL-6, as well as adiponectin, and that specific inflammatory cytokines were related in cross-sectional studies to increased IMT. In the proposed study we will investigate using detailed methodologies the relationship between adipocytokine concentrations and subclinical atherosclerosis in both cross-sectional and longitudinal studies. We will determine in HIV-infected patients on ARVs for greater than 6 months, progression rates of IMT and whether progression rates are predicted by increased inflammatory indices, controlling for traditional risk factors, and body composition changes. We will test the hypothesis that inflammation, more than traditional risk factors and ARV use, mediates subclinical atherosclerotic disease in HIV-infected patients.
Eligibility| Ages Eligible for Study: | 18 Years to 65 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | Yes |
| Sampling Method: | Probability Sample |
Flyers and advertisements regarding this study will be posted in community centers and newspapers
Inclusion Criteria:
Inclusion Criteria for Group 1 (HIV-infected group)
- Age greater than or equal to 18 and less than or equal to 65 years of age
- HIV positive, on the same combination ARV regimen for > than 6 months, including but not limited to either 2 NRTIs and an NNRTI or PI, or a triple NRTI regimen
- CD4 >350 cells/mm3
Inclusion Criteria for Group 2 (HIV Negative, Healthy Control, age and BMI matched to HIV subjects)
- No history of HIV infection (negative HIV test)
- Age greater than or equal to 18 and less than or equal to 65 years of age
Exclusion Criteria:
Exclusion Criteria for Group 1 (HIV-infected group)
- Hgb < 10.0 g/dL, creatinine > 1.5 mg/dL, SGPT > 2.5x ULN
- Use of glucocorticoid, testosterone, growth hormone or other anabolic agents within the past 6 months
- New antiretroviral regimen within 6 months of study initiation
- Active substance abuse
- Medications known to affect glucose or body composition
- Positive pregnancy test or recently pregnant within the past year or lactating
- Presence of active cancers
- Acute viral, bacterial or other infections (excluding HIV)
- Weight loss in the past 3 months of greater than 10 pounds
Criteria for Group 2 (HIV Negative, Healthy Control, age and BMI matched to HIV subjects)
- Hgb < 10.0 g/dL, creatinine > 1.5 mg/dL, SGPT > 2.5x ULN
- Use of glucocorticoid, testosterone, growth hormone or other anabolic agents within the past 6 months.
- Active substance abuse
- Medications known to affect glucose or body composition
- Positive pregnancy test or recently pregnant within the past year or lactating
- Acute viral, bacterial or other infections
- Weight loss in the past 3 months of greater than 10 pounds
Contacts and Locations| United States, Massachusetts | |
| Massachusetts General Hospital | |
| Boston, Massachusetts, United States, 02114 | |
| Principal Investigator: | Steven K Grinspoon, MD | Massachusetts General Hospital |
More Information
No publications provided by Massachusetts General Hospital
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Steven K. Grinspoon, MD, Principal Investigator, Massachusetts General Hospital |
| ClinicalTrials.gov Identifier: | NCT00465426 History of Changes |
| Other Study ID Numbers: | DK49302-10AR, R01DK049302 |
| Study First Received: | April 24, 2007 |
| Last Updated: | October 30, 2012 |
| Health Authority: | United States: Federal Government |
Keywords provided by Massachusetts General Hospital:
|
HIV Infection Cardiovascular Disease Antiretroviral Therapy Inflammatory Markers Treatment Experienced |
Additional relevant MeSH terms:
|
HIV Infections Acquired Immunodeficiency Syndrome Cardiovascular Diseases Lentivirus Infections Retroviridae Infections RNA Virus Infections |
Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases Slow Virus Diseases |
ClinicalTrials.gov processed this record on May 23, 2013