最近美国麻省总医院的一项研究表明在HIV感染得到明确诊断，并且从未接受过治疗的一小部分病人中，进行抗逆转录病毒治疗（ART）不足以阻止动脉炎症的进展，动脉炎症可能促进HIV感染病人发生心血管疾病的风险。
文章作者Markella Zanni这样说道："我们在之前的研究中已经发现持续的动脉炎症可能促进艾滋病病人形成冠状动脉斑块，并可能进一步出现动脉破裂以及发生心脏病。而这项研究则提示我们为了进一步降低接受ART治疗病人的动脉炎症，还需要使用其他治疗方法。"
这项研究共包含了12名发生HIV感染的男性，他们在诊断之后11个月（平均时间）开始ART治疗，还使用了四种抗病毒药物的联合治疗。对照组包含了12名未受到感染并且年龄匹配的参与者，进行免疫系统和炎症因子的对比。所有参与者从未有过冠状动脉疾病，自身免疫疾病以及炎症性疾病史，也不存在显著的心血管风险因子。
在研究开始以及研究进行到六个月分别对参与者进行了PET扫描，利用一种叫做FDG的放射性药物发现炎症性位点，HIV感染者的主动脉，心脏，腋下淋巴结，脾脏以及骨髓都得到了图像显示。这些病人还进行了CT血管造影用以寻找冠状动脉斑块，通过血液检测分析脂质和免疫系统因子，以及HIV病毒载量。
虽然ART治疗方法能够抑制病人体内的病毒载量并增加CD4 T细胞数目，但是80%的病人在六个月的时间内出现主动脉炎症增加的情况。虽然淋巴结部位的炎症显著下降，脾脏出现轻微下降，但是动脉炎症明显增加，类似早期研究中已经接受过ART治疗的病人水平。在研究开始的时候，有大约25%的HIV感染病人存在一定程度的冠状动脉斑块，而六个月后斑块全部增大，同时在研究期间又有一名病人出现了新的斑块。
研究人员表示，还需要进一步研究深入理解在HIV感染过程中持续免疫激活，动脉炎症以及斑块形成之间的关系，除此之外在ART治疗过程中加入免疫调节策略是否能够帮助抑制动脉炎症，稳定冠状动脉斑块并降低HIV感染病人发生心血管疾病的风险还需要进一步研究。
相关研究结果发表在国际学术期刊JAMA Cardiology上。
doi:10.1001/jamacardio.2016.0846
Effects of Antiretroviral Therapy on Immune Function and Arterial Inflammation in Treatment-Naive Patients With Human Immunodeficiency Virus Infection
Markella V. Zanni, MD1; Mabel Toribio, MD1; Gregory K. Robbins, MD2; Tricia H. Burdo, PhD3; Michael T. Lu, MD4; Amorina E. Ishai, MD4; Meghan N. Feldpausch, NP1; Amanda Martin, AB1; Kathy Melbourne, PharmD5; Virginia A. Triant, MD, MPH2,6; Sujit Suchindran, MD2; Hang Lee, PhD7; Udo Hoffmann, MD, MPH4; Kenneth C. Williams, PhD3; Ahmed Tawakol, MD4; Steven K. Grinspoon, MD
Results For the 12 participants with HIV infection (mean (SD) age, 35 [11] years), combined ART suppressed viral load (mean [SD] log viral load, from 4.3 [0.6] to 1.3 [0] copies/mL; P?<?.001), increased the CD4+ T-cell count (median [IQR], from 461 [332-663] to 687 [533-882] cells/mm3; P?<?.001), and markedly reduced percentages of circulating activated CD4+ T cells (human leukocyte antigen-D related [HLA-DR]+CD38+CD4+) (from 3.7 [1.8-5.0] to 1.3 [0.3-2.0]; P?=?.008) and CD8+ T cells (HLA-DR+CD38+CD8+) (from 18.3 [8.1-27.0] to 4.0 [1.5-7.8]; P?=?.008), increased the percentage of circulating classical CD14+CD16? monocytes (from 85.8 [83.7-90.8] to 91.8 [87.5-93.2]; P?=?.04), and reduced levels of CXCL10 (mean [SD] log CXCL10, from 2.4 [0.4] to 2.2 [0.4] pg/mL; P?=?.03). With combined ART, uptake of [18F]-FDG in the axillary lymph nodes, as measured by TBR, decreased from a median (IQR) of 3.7 (1.3-7.0) at baseline to 1.4 (0.9-1.9; P?=?.01) at study end. In contrast, no significant decrease was seen in aortic TBR in response to combined ART (mean [SD], 1.9 [0.2]; median [IQR], 2.0 [1.8-2.1] at baseline to 2.2?[0.4]; 2.1 [1.9-2.6], respectively, at study end; P?=?.04 by 2-way test, P?=?.98 for test of decrease by 1-way test). Changes in aortic TBR during combined ART were significantly associated with changes in lipoprotein-associated phospholipase A2 (n?=?10; r?=?0.67; P?=?.03). Coronary plaque increased among 3 participants with HIV infection with baseline plaque and developed de novo in 1 participant during combined ART.
Conclusions and Relevance Newly initiated combined ART in treatment-naive individuals with HIV infection had discordant effects to restore immune function without reducing arterial inflammation. Complementary strategies to reduce arterial inflammation among ART-treated HIV-infected individuals may be needed.
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