The Pathological Link Between Elevated Markers of Inflammation, Endothelial Activation, and Cardiovascular Diseases in People Living with HIV on Combination Antiretroviral Therapy: A Systematic Review

INTRODUCTION: Despite administering combination antiretroviral therapy (cART), people living with the human immunodeficiency virus (PLWH) have been identified to be at an elevated risk of cardiovascular diseases (CVDs). Notably, inflammation and endothelial activation are likely factors associated with increased CVD risk in PLWH. Thus, the present study reviews evidence reporting on the potential link between increased markers of inflammatory, endothelial activation, and CVD risk in PLWH on cART. METHODOLOGY: Web databases incorporating Cochrane libraries, PubMed, Web of Science, Google Scholar, and ScienceDirect were searched to identify suitable clinical research reports. The validity and reliability of the quality of the included evidence were appraised utilising the Downs and Black checklist. RESULTS: Fifteen clinical research reports were incorporated within the present study, involving PLWH on cART (n=7117). We classified these research reports based on short-term (ƒ% 12 months) and prolonged exposure (EŸ 12 months) to cART of PLWH. Overwhelming results showed that short- and long-term exposure to cART are closely associated with elevated markers of inflammation that were consistent with the existence of endothelial activation in PLWH on cART. Prominent inflammatory markers, which were elevated included interleukin-6 (IL-6), high sensitivity C-reactive protein (hsCRP) and tumor necrosis factor alpha (TNF-Iñ). While those indicating endothelial activation included soluble intercellular and vascular adhesion molecule-1 (sICAM-1 and sVCAM-1). The quality of included research reports was relatively high, while there was very limited information on the effect of the specific type of cART. CONCLUSION: The current study supports the hypothesis indicating a close association between elevated inflammatory markers and endothelial activation potentially contributing to CVDs in PLWH on cART. However, these effects may be associated with prolonged exposure to cART in conjunction to specific cART-drug regimen combinations. Nonetheless, the available evidence is still very limited, and more research is needed to confirm these findings

• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment
• Co-morbidities
  • Cardiovascular