37 After adjustment

for predicted 10-year risk of CHD, recent use of both didanosine and abacavir remained associated with increased rates of cardiovascular disease.37 Of note is that the SMART study population had a high rate of cardiac risk factors at baseline, with 39% of participants being current smokers, 36% having ischemic changes on their baseline electrocardiograms, 19% taking antihypertensive agents, and FMO5 18% being on lipid-lowering drugs.37 Interestingly, an African study performed in newly identified HIV-positive individuals showed that ART improved the dyslipidemic profile found before starting ART.14 In another study carried out in HIV-infected urban dwellers in Nigeria, the lipid profiles were followed for a period of 15 months in individuals on ART and in treatment-negative asymptomatic HIV-infected patients.38 When compared with apparently healthy HIV-negative individuals, TC, HDL, LDL, and triglyceride

levels in the ART-experienced subjects were not significantly different, while the levels of TC and HDL were significantly lower in the HIV-positive antiretroviral-na?ve versus ART-experienced patients.38 The low levels of HDL observed in antiretroviral-na?ve patients PF-06463922 seem to be a recurring theme in most studies, including ours, but whether ART contributes to increased cardiovascular risk remains uncertain. The mechanisms of how HIV infection and ART induce these lipid abnormalities are still unknown. Chronic immune activation caused by HIV has been proposed, an activation that persists even after successful treatment with ART.39 Even if ART induces lipid abnormalities that are classic

risk factors for the development of atherosclerosis, ART is of tremendous importance for survival and reduction of morbidities in HIV-positive patients. These patients have longer survival, but are more threatened Bafilomycin A1 cost by cardiovascular disease. A Nigerian study conducted by Muhammad et al in 100 ART-experienced and 100 ART-na?ve patients found a significantly higher burden of some risk factors for cardiovascular disease (hypertension, hypercholesterolemia, obesity, and metabolic syndrome) among ART-treated HIV patients than in their ART-na?ve counterparts.15 Interestingly, in our study, antihypertensive medication was started in 17% of the ART-experienced participants compared with 2% of the ART-na?ve participants (P<0.001). Prior results exploring the effect of ART on BP are conflicting.40,41 Previous studies have shown a correlation between sustained hypertension and a nadir CD4 cell count <200 cells/��L, as well as with duration of ART, with an especially high proportion of hypertensive HIV patients having a nadir cell count <50 cells/��L.42�C44 We have no measurements regarding immunodeficiency in our study, but the patients on ART would be expected to have had more advanced immunodeficiency (and hence the lowest nadir CD4 cell counts) in the past than the ART-na?ve patients.
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