Investigating platelet and endothelial activation in ART-treated women living with HIV and obesity.

Abstract

Background: Antiretroviral therapy (ART) has reduced morbidity and mortality in people living with Human immunodeficiency virus (PLWH). However, metabolic and thrombotic complications have now become prevalent in the aging population of PLWH. The spectrum of cardiovascular disease in patients with HIV is broad and the mechanisms underlying the risk of cardiovascular disease (CVD) in PLWH remains complex and multifactorial. This includes an interplay between traditional risk factors such as obesity which in the general population is more prevalent in women. This study aimed to assess the association between platelet activation, endothelial activation and CVD-risk in women living with HIV. Methods: In this study we included 66 female participants living with HIV (n=33 normal weight and n=33 overweight/obese) enrolled in the prospective multi-country PEPFAR PROMise Ongoing Treatment Evaluation (PROMOTE) study from the Umlazi clinical research site. The time of blood draws ranges from December 2018- November 2019. We measured the levels of high sensitivity creactive protein (hsCRP), lipid profiles, platelet activation (P-selectin, CD36 and platelet factor-4) and markers of endothelial activation (endothelin-1, von Willebrand factor). Results:Women living with HIV(WLHIV) and obesity showed significantly elevated levels of soluble CD36 4.36[2.71-9.53] when compared to the control group 2.79[2.24-3.55], p=0.0064. Furthermore, the levels of (vWF) were elevated in WLHIV and obesity 8.83[1.59-9.78] when compared to controls 5.34[0.65-7.7] p=0.0009. However, the levels of soluble P-selectin, platelet factor-4 (PF4) and endothelin-1 (ET-1) were comparable between two study groups (p>0.05). Lastly, the levels of hsCRP levels were significantly higher in WLHIV and obesity (7.71±9.95) when compared to controls (3.68±5.89) p= 0.0005. Conclusion: The levels of platelet and endothelial activation are elevated in WLHIV and obesity despite successful ART. Moreover, the levels of inflammation remain persistently high even during ART. Therefore, WLHIV and obesity are at an increased risk of developing CVD.