Aortic Stiffness in HIV Infection with and without Antiretroviral Therapy. A Meta-analysis of Observational Studies

Background: The risk of Cardiovascular (CV) events is higher in HIV-infected patients (HIV+) compared to HIV-uninfected persons (HIV-). Large artery stiffness, a well-documented predictor of adverse CV prognosis, may mediate this enhanced risk. It is usually assessed by measuring aortic Pulse Wave Velocity (aPWV). Studies examining arterial stiffness in HIV+ yielded inconsistent results. We performed a meta-analysis with the aim to evaluate the association of HIV infection and its therapy [Antiretroviral Therapy (ART)] with aPWV. Design and Method: The Standardized Mean Difference (SMD) and corresponding 95% confidence intervals were calculated for aPWV in different comparison groups. Statistical heterogeneity, assessed by Q-test and I-2 statistic, was observed in all these comparisons. Therefore, random effects model was implemented. Results: In a total of 12 studies, naive HIV+ (n = 547) showed increased aPWV compared to HIV- (n = 864): SMD = 0.333 (0.125-0.542), p < 0.002. A total of 22 studies were identified comparing HIV+ treated with ART (n = 3348) to HIV- (n = 2547) showing higher values of aPWV in the former than in latter: SMD = 0.391 (0.225-0.556), p < 0.001. In 10 studies, HIV+ treated with ART (n = 761) exhibited greater aPWV values than those of naive HIV+ (n = 457): SMD = 0.262 (0.006-0.518), p = 0.045. Conclusion: Our meta-analysis seems to suggest that HIV infection "per se" and ART may impair aortic distensibility. However, interpretation of our results needs caution due to between-study heterogeneity and some potential publication biases. (c) 2020 Association for Research into Arterial Structure and Physiology. Publishing services by Atlantis Press International B.V. This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).