Background:People with HIV have an increased risk for cardiovascular morbidity and mortality. Inflammation and immune activation may contribute to this excess risk.Methods:We assessed thirty-one biomarkers in a subset of POPPY participants and identified three distinct inflammatory profiles: 'gut/immune activation', 'neurovascular', and 'reference' (relatively low levels of inflammation). Ten-year cardiovascular disease (CVD) risk predictions were calculated using the QRISK, Framingham Risk Score (FRS) and the Data Collection on Adverse effects of anti-HIV Drugs (D:A:D) algorithms. The distributions of CVD risk scores across the different inflammatory profiles, stratified by HIV status, were compared using median quantile regression.Results:Of the 312 participants included [70% living with HIV, median (interquartile range; IQR) age 55 (51-60) years; 82% male; 91% white], 36, 130, and 146 were in the 'gut/immune activation', 'neurovascular', and 'reference' cluster, respectively. The median (IQR) QRISK scores were 9.3% (4.5-14.5) and 10.2% (5.5-16.9) for people with and without HV, respectively, with similar scores obtained with the FRS and D:A:D. We observed statistically significant differences between the distributions of scores in the three clusters among people with HV. In particular, median QRISK [5.8% (1.0-10.7) and 3.1% (0.3-5.8)] scores were higher, respectively, for those in the 'gut/immune activation' and 'neurovascular' clusters compared to those in the reference cluster.Conclusions:People with HIV with increased gut/immune activation have a higher CVD risk compared to those with relatively low inflammation. Our findings highlight that clinically important inflammatory subgroups could be useful to differentiate risk and maximise prediction of CVD among people with HIV.
Bibliographical noteFunding Information:
Financial disclosure: The POPPY-Sleep sub-study (which these analyses used biomarker data collected from) was funded by National Heart Lung and Blood Institute (R01 HL131049). The parent POPPY Study is primarily funded by investigator-initiated grants from BMS, Gilead Sciences, Janssen, MSD and ViiV Healthcare. We acknowledge the use of the National Institute for Health Research (NIHR)/Wellcome Trust Clinical Research Facility at King's College Hospital. The research is also funded by the National Institute for Health Research Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. This material is also the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center, Minneapolis, USA. LS was funded through the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU, Grant no.: NIHR200911) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the UK Health Security Agency (UKHSA). The funders had no role in the design of this study, analyses, interpretation of the data, or decision to submit results.
C.S. reports receipt of funding from Gilead Sciences and ViiV Healthcare for membership of Advisory Boards and for preparation of educational materials. K.M.K. has received consultancy fees from Allergan/AbbVie and Data and Safety Monitoring Board activity fees from Nuvaira and Organicell, outside the work presented here. A.W. has received speaker fees, advisory board honoraria or grants via Imperial College London from Gilead Sciences, ViiV Healthcare, MSD and Janssen. P.W.G.M. has received honoraria and/or travel grants from Gilead Sciences, MSD, Bristol-Myers Squibb, and ViiV Healthcare, and has been awarded grants by Science Foundation Ireland, outside the submitted work. J.A. reports personal fees from Gilead Sciences and ViiV; all outside of the work reported here. M.B. has acted as a speaker or adviser to, has been an investigator for, or has received grants to her institution from Gilead, ViiV, Janssen, B.M.S., Teva, Cipla, Mylan, and MSD; all outside the work presented here. F.A.P. reports grants and/or personal fees from Gilead Sciences, ViiV, Janssen, and MSD; all outside of the work reported here. J. V. reports travel, research grants, and personal fees from Merck, Janssen Cilag, Piramal Imaging, ViiV Healthcare, and Gilead sciences; all outside of the work reported here.
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- cardiovascular disease
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't
- Research Support, N.I.H., Extramural