Pulse Wave Velocity as Index of Arterial Stiffness in HIV-Infected Patients Compared With a Healthy Population
ABSTRACT Chronic HIV infection leads to premature atherosclerosis. Arterial stiffness is considered a subclinical marker of cardiovascular disease.
Pulse wave velocity (PWV) was determined in 254 individuals (174 HIV-infected patients and 80 healthy controls, 2:1 matched by age and gender), to compare the prevalence of arterial stiffness and to identify associated factors. PWV was determined using non-invasive automated device (Complior). Factors associated with impaired PWV were assessed among cardiovascular risk factors, HIV-infection parameters and laboratory data. Logistic regression analyses were performed to determine differences between groups and factors associated to arterial stiffness.
Overall, 81.4% of participants were male, median age was 46.54 (IQR 41, 52) years. Higher percentages of HIV-infected subjects showed dyslipemia (p=0.012) and smoking habit (p=0.002). The median time from HIV diagnosis was 13 (IQR 6, 18) years and the median time on antiretroviral therapy was 11 (IQR 5, 15) years. Nearly all patients were virologically suppressed (89.7%) at the time of PWV. Arterial stiffness in the global population was 20.5%, 18.9% in HIV-infected group and 23.8% in controls (p=0.405). High diastolic blood pressure and high levels of triglycerides at time of PWV were associated with increased PWV (p= 0.009 and p= 0.023, respectively).
Virologically suppressed HIV-infected patients showed similar arterial elasticity to non-HIV-infected patients. HIV-related conditions were not associated with arterial stiffness, probably because of the good immunological and virological status of this group. However, high diastolic pressure at the time of PWV and high levels of triglycerides were associated risk factors.
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ABSTRACT: Patients infected with the human immunodeficiency virus (HIV) have an increased cardiovascular risk. Although initially this increased risk was attributed to metabolic alterations associated with antiretroviral treatment, in recent years, the attention has been focused on the HIV disease itself. Inflammation, immune system activation, and endothelial dysfunction facilitated by HIV infection have been identified as key factors in the development and progression of atherosclerosis. In this review, we describe the epidemiology and pathogenesis of cardiovascular disease in patients with HIV infection and summarize the latest knowledge on the relationship between traditional and novel inflammatory, immune activation, and endothelial dysfunction biomarkers on the cardiovascular risk associated with HIV infection.Vascular Health and Risk Management 01/2015; 11:35-48. DOI:10.2147/VHRM.S65885
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ABSTRACT: Background The care giving experience has an impact on every facet of a caregiver’s life, from physical to psychological and emotional health (Dyck, Short, & Vitalino, 1999). Caregivers of children with chronic diseases face circumstances that challenge their adaptation to the disease and influence their well-being. The aim of this research was to study the role emotional burden plays in predicting the quality of life of informal caregivers of children infected with HIV. Materials and Methods The sample comprised 20 Portuguese informal caregivers (17 women; M=42.7 years old, DP=10.2) of 20 children and adolescents with HIV (6 to 17 years old). Subjects answered to the Portuguese version of The Revised Burden Measure (RBM; Montgomery et al., 2006) composed by four dimensions – Burden of the relationship (Cronbach’s α=.86; M=10.1;SD=7.2), Objective burden (α=.89; M=16.2; SD=7.2), Subjective burden (α=.93; M=14.8; SD=6.8) and Personal growth (α =.77; M=22.0; SD=5.3) – and to the World Health Organization Quality of Life Questionnaire (WHOQOL-Bref; Fleck et al., 2000) that measures four quality of life domains – Physical health (α=.89; M=65.2; SD=23.3), Psychological health (α=.91; M=67.5; SD=22.2), Social relationships (α=.87; M=64.6; SD=24.2) and Environment (α=.87; M=60.2; SD=19.9). Results The four dimensions of emotional burden explain 53.4% of the caregiver’s quality of life, Rmultiple= .73, F(4,15)=4.3, p<.05, with the Psychological health domain being the most affected (R2=.51), followed by Environment (R2=.36), Physical health (R2=.34), and Social relationships (R2=.33). The three types of emotional burden predict negatively on the four domains of quality of life, whereas Personal growth predicts positively on Psychological health, though with low magnitude (see Figure 1). The Subjective burden is the strongest predictive dimension of the four quality of life domains. Conclusions Since Subjective burden seems to be the main negative predictor of caregivers’ physical and psychological quality of life, it might be important that social and health services develop adequate responses in considering caregivers’ welfare when the well-being of children and adolescents with HIV is at stake. Key-words: Emotional burden; Quality of life; Caregivers; Children; HIV.Journal of the International AIDS Society 01/2014; 17(1):22-23. DOI:10.7448/IAS.17.2.19131 · 4.21 Impact Factor
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ABSTRACT: Background: The evaluation of health-related quality of life in children with chronic diseases has gained increasing interest as they face a host of psychological and social problems that need to be considered along with their physical treatments (Malee et al., 2011; Wang et al., 2012). The aim of this research is to analyze the influence of physical well-being, family, and social support of children and adolescents with HIV on their self-perception, psychological well-being and emotions. Materials and Methods: The sample comprises children and adolescents with HIV recruited from the Consultation of Infectious Diseases of a Portuguese Pediatric Hospital, 11 boys aged between 8 and 17 years-old (M=11.73; SD=3.43) and 4 girls aged between 9 and 13 years-old /M=10.50; SD=1.92). They responded to six dimensions of the Portuguese version of the KIDSCREEN-52 (The Kidscreen Group Europe, 2006; consistency coefficient of .821). Results: The mean scores (from 0 to 100%) showed higher values for Social support and peers (M=90.8; SD=15.3), followed by Moods and Emotions (M=84.7; SD=16.7), Psychological Well-Being (M=84.6; SD=15.4), Relations with parents and home life (M=82.9; SD=14.5), Physical well-being (M=70.1; SD=33.3), and Self-perception (M=57.5; SD=13.7). Altogether, Relations with parents and home life, Physical well-being, and Social support and peers explained 40% of the children and adolescents’ Psychological well-being, 46% of their Moods and emotions, but only 5% of their Self-perception (see results of Multivariate Multiple Regression in Figure 1). The Relations with parents and home life didn’t show any significant influence. Inversely, the Physical well-being had a strong influence on Moods and emotions (β=.59) and Psychological well-being (β=.46), but less in Self-perception (β=.22). Social support and peers showed a positive albeit moderate influence in Psychological well-being (β=.25) and Moods and emotions (β=.28), but not in Self-perception. Conclusions: When considering the emotional and psychological health of young people with HIV, accounting for their physical well-being and supporting their socio-developmental tasks can serve as important protective factors, enhancing their quality of life and promoting more adaptive developmental pathways. Key-words: Children and adolescent; HIV; Psychological well-being; Physical Well-Being; Self-perception; Emotions; Social support.HIV in the Americas Congress - HIV Drug Therapy in the Americas, Rio de Janeiro, Brazil; 05/2014