Key result
Antiretroviral therapy substantially reduces VCAM-1 in HIV, indicating improved endothelial function.
Why the study?
Anticipated rising use of antiretroviral therapy (ART) among people living with HIV may lead to associated vascular disorders, warranting evaluation of its impact on endothelial function.
Does antiretroviral therapy improve endothelial function in people living with HIV?
Meta-Analysis (n=3,700)
Does antiretroviral therapy improve endothelial function in people living with HIV?
Antiretroviral therapy improves endothelial function in people living with HIV by reducing adhesion molecules, though its small effect on flow-mediated dilation suggests residual risk of endothelial dysfunction.
Answers are grounded in this paper and cite their sources.
Supports ART for endothelial benefits in HIV; challenges prior low-certainty evidence against benefit.
Aim Although antiretroviral therapy (ART) is available, the rate of new HIV infections is alarming. With this trend, it is anticipated that the use of ART will continue to rise, potentially resulting in associated vascular disorders. Therefore, we aimed to examine the impact of ART on endothelial function in people living with HIV (PLHIV), a predictor of cardiovascular diseases. METHOD: A comprehensive search for evidence was made on PubMed and Scopus on May 06, 2023, following the Preferred Reporting Items for Systematic Review and Meta-analysis. Cochrane and Newcastle-Ottawa quality assessment scales were used to evaluate quality, while the metaHun web tool and Review Manager version 5.4.1 were used for analysis. Subgroup, sensitivity, and publication bias were conducted for each outcome measure. RESULTS: We identified 37 studies, including a sample size of 3700 with 2265 individuals on ART. The analyzed evidence showed a large significant effect of ART on vascular cell adhesion molecule-1, with a standardized mean difference (SMD) of -1.23 (95 % CI: -1.72, -0.74; p = 0.0013). Similarly, a significant medium effect of ART was observed on intercellular cell adhesion molecule-1 in PLHIV, with an SMD of -1.28 (95 % CI: -2.00, -0.56; p = 0.0231) compared to the control group. Furthermore, ART exhibited a significant but small effect on flow-mediated dilation (FMD) with an SMD of -0.40 (95 % CI: -0.62, -0.19, p = 0.0159). CONCLUSION: Our findings show an improved endothelial function in PLHIV on ART, as demonstrated by reduced adhesion molecules; however, ART exhibited a small effect on FMD, thus suggesting PLHIV on ART may still be at risk of endothelial dysfunction and further cardiovascular diseases.
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Strauss et al. (2024) conducted a meta-analysis in HIV (n=3,700). Antiretroviral therapy (ART) vs. Control group was evaluated on Vascular cell adhesion molecule-1 (VCAM-1) (SMD -1.23, 95% CI -1.72, -0.74, p=0.0013). Antiretroviral therapy in people living with HIV significantly reduced vascular cell adhesion molecule-1 (SMD -1.23; 95% CI -1.72, -0.74; p=0.0013), indicating improved endothelial function.
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