HIV-infected patients now live longer because of the availability of highly active antiretroviral therapy (HAART). There is growing evidence however that HIV-infected subjects in the era of HAART are at increased risk of cardiovascular (CV) morbidity and mortality. While dyslipidemia and insulin resistance induced by protease inhibitors and other classes of HIV medications likely contribute to this increased risk, there is now substantial evidence to suggest that much of the increased CV risk may stem from the inability of these potent antiretroviral medications to completely eliminate the immune mediated chronic inflammatory effects of HIV per se on the vascular system. HMG-CoA reductase inhibitors (statins) are medications commonly prescribed to lower levels of low density lipoprotein cholesterol (LDL-C) in individuals with dyslipidemia and increased CV risk. In the general non-HIV-infected population, statins have been demonstrated to have efficacy for both primary and secondary prevention of CV events and mortality. In these studies, the reduction in CV morbidity cannot be explained completely by the known ability of statins to lower LDL-C levels and it has been hypothesized that much of the beneficial effects of these medications may be due to the anti-inflammatory properties of this class of medications. We hypothesize that the increased CV risk in the HIV population on HAART has an inflammatory component secondary to incompletely suppressed HIV-induced chronic inflammation and that statins may have efficacy in reducing such inflammation. We propose to evaluate, in 100 HIV subjects at intermediate CV risk, the effect of low dose atorvastatin on surrogate markers of CV risk over a 2 year period;specifically its effect on flow-mediated vasodilation of the brachial artery, on deposition of coronary artery calcium by electron beam tomography, and on changes in levels of hs-CRP. Within this clinical trial, we propose to assess the role of Th17 lymphocytes and their secretory compounds interleukin 17 in perpetuating the HIV-induced inflammatory process leading to increased CV risk in individuals on HAART. In addition, we propose to assess the impact of HIV-induced inflammatory processes on insulin resistance and on oxidative phosphorylation enzyme and activity levels. HIV-infected individuals may be at high risk for cardiovascular (CV) disease. We propose to establish a 150 patient cohort to look at the role of oxidative stress and inflammation as causes for this high CV risk. In addition, we propose a small clinical trial of rosuvastatin (a lipid lowering drug) in 50 patients from the cohort with evidence of inflammation (high C- reactive protein levels in blood) but low cholesterol levels, to see if the anti-inflammatory properties of this class of medication will decrease CV risk.
HIV-infected individuals may be at high risk for cardiovascular (CV) disease. We propose to establish a 150 patient cohort to look at the role of oxidative stress and inflammation as causes for this high CV risk. In addition, we propose a small clinical trial of rosuvastatin (a lipid lowering drug) in 50 patients from the cohort with evidence of inflammation (high C- reactive protein levels in blood) but low cholesterol levels, to see if the anti-inflammatory properties of this class of medication will decrease CV risk.
|McIntosh, Roger C; Chow, Dominic C; Lum, Corey J et al. (2017) Reduced functional connectivity between ventromedial prefrontal cortex and insula relates to longer corrected QT interval in HIV+ and HIV- individuals. Clin Neurophysiol 128:1839-1850|
|Wirunsawanya, Kamonkiat; Belyea, Loni; Shikuma, Cecilia et al. (2017) Plasminogen Activator Inhibitor-1 Predicts Negative Alterations in Whole-Body Insulin Sensitivity in Chronic HIV Infection. AIDS Res Hum Retroviruses 33:723-727|
|Riangwiwat, Tanawan; Kohorn, Lindsay B; Chow, Dominic C et al. (2016) CD4/CD8 Ratio Predicts Peripheral Fat in HIV-Infected Population. J Acquir Immune Defic Syndr 72:e17-9|
|Zungsontiporn, Nath; Tello, Raquel R; Zhang, Guangxiang et al. (2016) Non-Classical Monocytes and Monocyte Chemoattractant Protein-1 (MCP-1) Correlate with Coronary Artery Calcium Progression in Chronically HIV-1 Infected Adults on Stable Antiretroviral Therapy. PLoS One 11:e0149143|
|Chow, Dominic C; Kagihara, Jamie M; Zhang, Guangxiang et al. (2016) Non-classical monocytes predict progression of carotid artery bifurcation intima-media thickness in HIV-infected individuals on stable antiretroviral therapy. HIV Clin Trials 17:114-22|
|Kallianpur, Kalpana J; Sakoda, Marissa; Gangcuangco, Louie Mar A et al. (2016) Frailty Characteristics in Chronic HIV Patients are Markers of White Matter Atrophy Independently of Age and Depressive Symptoms: A Pilot Study. Open Med J 3:138-152|
|Kallianpur, Kalpana J; Gerschenson, Mariana; Mitchell, Brooks I et al. (2016) Oxidative mitochondrial DNA damage in peripheral blood mononuclear cells is associated with reduced volumes of hippocampus and subcortical gray matter in chronically HIV-infected patients. Mitochondrion 28:8-15|
|Chow, Dominic; Kohorn, Lindsay; Souza, Scott et al. (2016) Atazanavir use and carotid intima media thickness progression in HIV: potential influence of bilirubin. AIDS 30:672-4|
|Gangcuangco, Louie Mar A; Kohorn, Lindsay B; Chow, Dominic C et al. (2016) High 25-hydroxyvitamin D is associated with unexpectedly high plasma inflammatory markers in HIV patients on antiretroviral therapy. Medicine (Baltimore) 95:e5270|
|Mitchell, Brooks I; Byron, Mary Margaret; Ng, Roland C et al. (2016) Elevation of Non-Classical (CD14+/lowCD16++) Monocytes Is Associated with Increased Albuminuria and Urine TGF-?1 in HIV-Infected Individuals on Stable Antiretroviral Therapy. PLoS One 11:e0153758|
Showing the most recent 10 out of 27 publications