期刊
AIDS
卷 22, 期 6, 页码 707-715出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e3282f560d9
关键词
fibrinogen; HIV; nonnucleoside reverse transcriptase inhibitors; protease inhibitors
资金
- NCRR NIH HHS [RR00051, M01 RR000083, M01 RR000054, M01 RR000052, M01- RR00036, M01 RR000051, RR00865, M01 RR000036, RR00054, RR00052, RR00083, RR00636, M01 RR000865] Funding Source: Medline
- NHLBI NIH HHS [R01 HL074814-06, K08 HL077499, R01 HL074814-07, HL53359, R01 HL074814-05, R01 HL074814, HL74814, R01 HL074814-04, HL77499] Funding Source: Medline
- NIDDK NIH HHS [R01 DK057508-03, R01 DK057508-03S1, R01 DK057508-01S1, R01 DK057508-02, R01 DK057508-01, R01 DK057508-03S2, R01 DK057508, R01- DK57508] Funding Source: Medline
Background: HIV infection is associated with an increased risk of coronary artery disease, but the contribution of inflammation versus antiretroviral drugs is not well understood. Fibrinogen is an inflammatory factor associated with atherosclerosis. Methods: A total of 1131 HIV-infected patients and 281 controls [from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based study of cardiovascular risk assessment] in the Study of Fat Redistribution and Metabolic Change in HIV infection (FRAM) had plasma fibrinogen levels measured. Multivariable linear regression identified factors associated with fibrinogen. Results: HIV-infected patients had higher levels of fibrinogen compared with controls (males: 25 mg/dl higher, P=0.006; females: 21 mg/dl higher, P=0.39). Among HIV-infected persons, median levels of fibrinogen were 11% higher in patients currently using any protease inhibitor (PI) compared with those not using a PI (P < 0.0001). The strongest univariate associations were with the individual Pis, ritonavir and indinavir. Patients taking indinavir boosted with ritonavir had median fibrinogen levels 8% higher than those on indinavir alone (P=0.049). Lower levels of fibrinogen were seen in those HIV-infected patients currently using any nonnucleoside reverse transcriptase inhibitor (NNRTI) compared to those not using an NNRTI (nevirapine -14.4%, P<0.0001; efavirenz -7%, P=0.0002). The associations of ritonavir, indinavir, efavirenz and nevirapine with fibrinogen levels persisted after multivariable analysis and were independent of other antiretroviral use. Conclusion: Protease inhibitor use is associated with elevated fibrinogen levels which may contribute to increased risk of atherosclerosis in HIV-infected patients. Conversely, NNRTI use is associated with lower fibrinogen levels which may decrease risk of atherosclerosis. (C) 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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