urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.3.7ZMIHHRurmj-1530Research ArticleОригинальные статьи | Original articlesOriginal articlesАнализ коморбидной патологии у ВИЧ‑инфицированных пациентов с иммунологической неэффективностью антиретровирусной терапииAnalysis of Comorbidity in HIV–Infected Patients with Immunological Inefficiency of Antiretroviral Therapyhttps://orcid.org/0000-0003-0973-9701БалыкчиноваТ. В.BalykchinovaT. V.

Татьяна Владимировна Балыкчинова — врач-инфекционист

Екатеринбург

Tatiana V. Balykchinova — Infectious Disease Doctor

Ekaterinburg

spilnik.tatyana@yandex.ruhttps://orcid.org/0000-0003-0858-9529СабитовА. У.SabitovA. U.

Алебай Усманович Сабитов — доктор медицинских наук, профессор, заведующий кафедрой инфекционных болезней, фтизиатрии и пульмонологии

Екатеринбург

Alebay U. Sabitov — Doctor of Sciences (Medicine), Professor, Head of the Department of Infectious Diseases, Phthisiology and Pulmonology

Ekaterinburg

postdiplom@usma.ruhttps://orcid.org/0009-0007-8541-1616ЖуковВ. В.ZhukovV. V.

Вячеслав Владимирович Жуков — кандидат медицинских наук, заместитель главного врача по лечебной части

Екатеринбург

Vyacheslav V. Zhukov — Candidate of Sciences (Medicine), Deputy Chief Physician for Medical Activities

Ekaterinburg

f61@livehiv.ruСвердловский областной центр профилактики и борьбы со СПИДРоссияSverdlovsk Regional Centre for AIDS Prevention and ControlRussian FederationУральский государственный медицинский университетРоссияUral State Medical UniversityRussian Federation202411072024233715Copyright © Балыкчинова Т.В., Сабитов А.У., Жуков В.В., 20242024Балыкчинова Т.В., Сабитов А.У., Жуков В.В.Balykchinova T.V., Sabitov A.U., Zhukov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1530Введение

Введение. Исследования свидетельствуют о высоких рисках развития вторичных заболеваний и неблагоприятных событий, не связанных с вирусом иммунодефицита человека (ВИЧ), у пациентов с иммунологической неэффективностью антиретровирусной терапии (АРТ). Обсуждается влияние коморбидной патологии на восстановление CD4+.

Цель работы — оценить влияние коморбидных заболеваний на рост CD4+ и вероятность развития иммунологической неэффективности АРТ.

Материалы и методы

Материалы и методы. Проведено ретроспективное исследование, включавшее ВИЧ-инфицированных пациентов с CD4+ на начало лечения <200 клеток/мкл. Сформированы две группы: основная — пациенты с иммунологической неэффективностью АРТ (281 человек); контрольная — пациенты с иммунологическим успехом АРТ (188 человек).

Результаты

Результаты. Шансы наличия иммунологической неэффективности у пациентов с туберкулезом была выше в 1,7 раз (отношение шансов (ОШ) — 1,7, 95 % доверительный интервал (ДИ) — 1,0–2,9); у пациентов с хроническим вирусным гепатитом C (ХВГC) — выше в 1,8 раз (ОШ — 1,8; 95 % ДИ — 2,6–1,2). Шансы заболевания сердечно-сосудистой системы в основной группе была в 2 раза выше (ОШ — 2,3; 95 % ДИ — 1,0–5,4). Обсуждение. В структуре коморбидной патологии в группе пациентов с иммунологической неэффективностью АРТ достоверно чаще регистрировались туберкулез, ХВГC и заболевания сердечно-сосудистой системы. Вопросы влияния коинфекций на рост CD4+-Т-лимфоцитов требуют дальнейшего изучения и проведения более крупного обсервационного исследования.

Заключение

Заключение. По результатам настоящего исследования сделан вывод, что ВИЧ-инфицированные пациенты с коинфекциями ХВГC и туберкулеза имеют более высокие шансы наличия иммунологической неэффективности АРТ наряду с иными известными факторами риска развития этого состояния.

Introduction

Introduction. Studies indicate high risks of secondary diseases and adverse events not related to HIV in patients with immunological inefficiency of antiretroviral therapy (ART). The effect of comorbidity on the increase of CD4+ is detected.

The aim of the study is assessing the effect of comorbidity on CD4+ growth and the probability of developing immunological inefficiency of ART.

Materials and methods

Materials and methods. A retrospective study was conducted that included HIV-infected patients with CD4+ at the beginning of treatment <200 cells/µl. Two groups were formed: the main group — patients with immunological inefficiency of ART (281 people); the control group — patients with sufficient immunological response on ART (188 people). Results. The probability of developing immunological inefficiency in patients with tuberculosis was 1.7 times higher (odds ratio (OR) — 1.7; 95 % confidence interval (CI) — 1.0–2.9); in patients with HCV-infection — 1.8 times higher (OR — 1.8; 95 % CI — 2.6–1.2). The probability of cardiovascular disease in the main group was 2 times higher (OR — 2.3; 95 % CI — 1.0–5.4).

Discussion

Discussion. Tuberculosis, HCV-infection and cardiovascular diseases frequently registered in the structure comorbidity in the main group of patients.

Conclusion

Conclusion. According to the results of this study, HIV-infected patients with HCV and tuberculosis co-infection have a higher chance of developing immunological inefficiency of ART.

ВИЧ-инфекцияантиретровирусная терапияиммунологическая неэффективностькоморбидная патологияHIV infectionantiretroviral therapyimmunological inefficiencycomorbidityReferencesEgger M, May M, Chêne G, Phillips AN, Ledergerber B, Dabis F, et. al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: A collaborative analysis of prospective studies. The Lancet. 2002;360(9327):119–129. DOI: https://doi.org/10.1016/S0140-6736(02)09411-4.Egger M, May M, Chêne G, Phillips AN, Ledergerber B, Dabis F, et. al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: A collaborative analysis of prospective studies. The Lancet. 2002;360(9327):119–129. DOI: https://doi.org/10.1016/S0140-6736(02)09411-4.Costagliola D, Lacombe JM, Ghosn J, Delaugerre C, Pialoux G, Cuzin L, et al. CD4+ cell count recovery in naïve patients initiating cART, who achieved and maintained plasma HIV-RNA suppression. Journal of the International AIDS Society. 2014;17(4 Suppl 3):19481. DOI: https://doi.org/10.7448/IAS.17.4.19481.Costagliola D, Lacombe JM, Ghosn J, Delaugerre C, Pialoux G, Cuzin L, et al. CD4+ cell count recovery in naïve patients initiating cART, who achieved and maintained plasma HIV-RNA suppression. Journal of the International AIDS Society. 2014;17(4 Suppl 3):19481. DOI: https://doi.org/10.7448/IAS.17.4.19481.Pilcher CD, Ospina-Norvell C, Dasgupta A, Jones D, Hartogensis W, Torres S, et. al The effect of sameday observed initiation of antiretroviral therapy on HIV viral load and treatment outcomes in a US Public Health Setting. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2017;74(1):44–51. DOI: https://doi.org/10.1097/QAI.0000000000001134.Pilcher CD, Ospina-Norvell C, Dasgupta A, Jones D, Hartogensis W, Torres S, et. al The effect of sameday observed initiation of antiretroviral therapy on HIV viral load and treatment outcomes in a US Public Health Setting. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2017;74(1):44–51. DOI: https://doi.org/10.1097/QAI.0000000000001134.Yang X, Su B, Zhang X, Liu Y, Wu H, Zhang T. Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders. Journal of Leukocyte Biology. 2020;107(4):597–612. DOI: https://doi.org/10.1002/JLB.4MR1019-189R.Yang X, Su B, Zhang X, Liu Y, Wu H, Zhang T. Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders. Journal of Leukocyte Biology. 2020;107(4):597–612. DOI: https://doi.org/10.1002/JLB.4MR1019-189R.Shmagel KV. Discordant response of CD4+ T-lymphocytes to antiretroviral therapy. HIV Infection and Immunosuppression. 2019;11(1):16–30. (In Russ.). DOI: https://doi.org/10.22328/2077-9828-2019-11-1-16-30.Shmagel KV. Discordant response of CD4+ T-lymphocytes to antiretroviral therapy. HIV Infection and Immunosuppression. 2019;11(1):16–30. (In Russ.). DOI: https://doi.org/10.22328/2077-9828-2019-11-1-16-30.Kelly C, Gaskell KM, Richardson M, Klein N, Garner P, MacPherson P. Discordant immune response with antiretroviral therapy in HIV-1: A systematic review of clinical outcomes. PloS ONE. 2016;11(6):e0156099. DOI: https://doi.org/10.1371/journal.pone.0156099.Kelly C, Gaskell KM, Richardson M, Klein N, Garner P, MacPherson P. Discordant immune response with antiretroviral therapy in HIV-1: A systematic review of clinical outcomes. PloS ONE. 2016;11(6):e0156099. DOI: https://doi.org/10.1371/journal.pone.0156099.Rb-Silva R, Goios A, Kelly C, Teixeira P, João C, Horta A, et al. Definition of immunological nonresponse to antiretroviral therapy: A systematic review. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2019;82(5):452–461. DOI: https://doi.org/10.1097/QAI.0000000000002157.Rb-Silva R, Goios A, Kelly C, Teixeira P, João C, Horta A, et al. Definition of immunological nonresponse to antiretroviral therapy: A systematic review. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2019;82(5):452–461. DOI: https://doi.org/10.1097/QAI.0000000000002157.Zoufaly A, Cozzi-Lepri A, Reekie J, Kirk O, Lundgren J, Reiss P, et al. Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe. PloS ONE. 2014;9(1):e87160. DOI: https://doi.org/10.1371/journal.pone.0087160.Zoufaly A, Cozzi-Lepri A, Reekie J, Kirk O, Lundgren J, Reiss P, et al. Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe. PloS ONE. 2014;9(1):e87160. DOI: https://doi.org/10.1371/journal.pone.0087160.Lapadula G, Cozzi-Lepri A, Marchetti G, Antinori A, Chiodera A, Nicastri E, et. al. Risk of clinical progression among patients with immunological nonresponse despite virological suppression after combination antiretroviral treatment. AIDS. 2013;27(5):769–779. DOI: https://doi.org/10.1097/QAD.0b013e32835cb747.Lapadula G, Cozzi-Lepri A, Marchetti G, Antinori A, Chiodera A, Nicastri E, et. al. Risk of clinical progression among patients with immunological nonresponse despite virological suppression after combination antiretroviral treatment. AIDS. 2013;27(5):769–779. DOI: https://doi.org/10.1097/QAD.0b013e32835cb747.May MT, Vehreschild JJ, Trickey A, Obel N, Reiss P, Bonnet F, et. al. Mortality according to CD4 count at start of combination antiretroviral therapy among HIV-infected patients followed for up to 15 years after start of treatment: Collaborative cohort study. Clinical Infectious Diseases. 2016;62(12):1571–1577. DOI: https://doi.org/10.1093/cid/ciw183.May MT, Vehreschild JJ, Trickey A, Obel N, Reiss P, Bonnet F, et. al. Mortality according to CD4 count at start of combination antiretroviral therapy among HIV-infected patients followed for up to 15 years after start of treatment: Collaborative cohort study. Clinical Infectious Diseases. 2016;62(12):1571–1577. DOI: https://doi.org/10.1093/cid/ciw183.Zoufaly A, Cozzi-Lepri A, Reekie J, Kirk O, Lundgren J, Reiss P, et. al. Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe. PloS ONE. 2014;9(1):e87160. DOI: https://doi.org/10.1371/journal.pone.0087160.Zoufaly A, Cozzi-Lepri A, Reekie J, Kirk O, Lundgren J, Reiss P, et. al. Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe. PloS ONE. 2014;9(1):e87160. DOI: https://doi.org/10.1371/journal.pone.0087160.Christensen-Quick A, Massanella M, Frick A, Rawlings SA, Spina C, Vargas-Meneses M, et. al. Subclinical cytomegalovirus DNA is associated with CD4 T cell activation and impaired CD8 T cell CD107a expression in people living with HIV despite early antiretroviral therapy. Journal of Virology. 2019;93(13): e00179-19. DOI: https://doi.org/10.1128/JVI.00179-19.Christensen-Quick A, Massanella M, Frick A, Rawlings SA, Spina C, Vargas-Meneses M, et. al. Subclinical cytomegalovirus DNA is associated with CD4 T cell activation and impaired CD8 T cell CD107a expression in people living with HIV despite early antiretroviral therapy. Journal of Virology. 2019;93(13): e00179-19. DOI: https://doi.org/10.1128/JVI.00179-19.Barrett L, Stapleton SN, Fudge NJ, Grant MD. Immune resilience in HIV-infected individuals seronegative for cytomegalovirus. AIDS. 2014;28(14):2045–2049. DOI: https://doi.org/10.1097/QAD.0000000000000405.Barrett L, Stapleton SN, Fudge NJ, Grant MD. Immune resilience in HIV-infected individuals seronegative for cytomegalovirus. AIDS. 2014;28(14):2045–2049. DOI: https://doi.org/10.1097/QAD.0000000000000405.Chen M, Wong WW, Law MG, Kiertiburanakul S, Yunihastuti E, Merati TP, et. al. Hepatitis B and C co-infection in HIV patients from the TREAT Asia HIV observational database: Analysis of risk factors and survival. PLoS ONE. 2016;11(3): e0150512. DOI: https://doi.org/10.1371/journal.pone.0150512.Chen M, Wong WW, Law MG, Kiertiburanakul S, Yunihastuti E, Merati TP, et. al. Hepatitis B and C co-infection in HIV patients from the TREAT Asia HIV observational database: Analysis of risk factors and survival. PLoS ONE. 2016;11(3): e0150512. DOI: https://doi.org/10.1371/journal.pone.0150512.Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord; Lewden C, Bouteloup V, De Wit S, Sabin C, Mocroft A, Wasmuth JC, van Sighem A, et al. All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm3 compared with the general population: Evidence from a large European observational cohort collaboration. International Journal of Epidemiology. 2012;41(2):433–445. DOI: https://doi.org/10.1093/ije/dyr164.Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord; Lewden C, Bouteloup V, De Wit S, Sabin C, Mocroft A, Wasmuth JC, van Sighem A, et al. All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm3 compared with the general population: Evidence from a large European observational cohort collaboration. International Journal of Epidemiology. 2012;41(2):433–445. DOI: https://doi.org/10.1093/ije/dyr164.Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A, et. al. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: An analysis of a national observational cohort. The Lancet Public Health. 2017;2(1):e35–e46. DOI: https://doi.org/10.1016/S2468-2667(16)30020-2.Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A, et. al. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: An analysis of a national observational cohort. The Lancet Public Health. 2017;2(1):e35–e46. DOI: https://doi.org/10.1016/S2468-2667(16)30020-2.Hoffmann C, Rockstroh JK (eds.). HIV 2014/2015. Hamburg: Medizin Focus Verlag, 2015. 756 p.Hoffmann C, Rockstroh JK (eds.). HIV 2014/2015. Hamburg: Medizin Focus Verlag, 2015. 756 p.Pokrovsky VV (ed.). HIV infection and AIDS: A national guide. 2nd ed. Moscow: GEOTAR-Media, 2020. 696 p. (In Russ.). DOI: https://doi.org/10.33029/9704-5421-3-2020-VIC-1-696.Pokrovsky VV (ed.). HIV infection and AIDS: A national guide. 2nd ed. Moscow: GEOTAR-Media, 2020. 696 p. (In Russ.). DOI: https://doi.org/10.33029/9704-5421-3-2020-VIC-1-696.Appay VР, Kelleher A. Immune activation and immune aging in HIV infection. Current Opinion in HIV and AIDS. 2016;11(2):242–249. DOI: https://doi.org/10.1097/COH.0000000000000240.Appay VР, Kelleher A. Immune activation and immune aging in HIV infection. Current Opinion in HIV and AIDS. 2016;11(2):242–249. DOI: https://doi.org/10.1097/COH.0000000000000240.Cingolani A, Cozzi Lepri A, Castagna A, Goletti D, De Luca A, Scarpellini P, et al. Impaired CD4 T-cell count response to combined antiretroviral therapy in antiretroviral-naive HIV-infected patients presenting with tuberculosis as AIDS-defining condition. Clinical Infectious Diseases. 2012;54(6):853–861. DOI: https://doi.org/10.1093/cid/cir900.Cingolani A, Cozzi Lepri A, Castagna A, Goletti D, De Luca A, Scarpellini P, et al. Impaired CD4 T-cell count response to combined antiretroviral therapy in antiretroviral-naive HIV-infected patients presenting with tuberculosis as AIDS-defining condition. Clinical Infectious Diseases. 2012;54(6):853–861. DOI: https://doi.org/10.1093/cid/cir900.Skogmar S, Schön T, Balcha TT, Jemal ZH, Tibesso G, Björk J, et al. CD4 cell levels during treatment for tuberculosis (TB) in Ethiopian adults and clinical markers associated with CD4 lymphocytopenia. PloS ONE. 2013;8(12):e83270. DOI: https://doi.org/10.1371/journal.pone.0083270.Skogmar S, Schön T, Balcha TT, Jemal ZH, Tibesso G, Björk J, et al. CD4 cell levels during treatment for tuberculosis (TB) in Ethiopian adults and clinical markers associated with CD4 lymphocytopenia. PloS ONE. 2013;8(12):e83270. DOI: https://doi.org/10.1371/journal.pone.0083270.Reepalu A, Balcha TT, Sturegård E, Medstrand P, Björkman P. Long-term outcome of antiretroviral treatment in patients with and without concomitant tuberculosis receiving health center — Based care — Results from a prospective cohort study. Open Forum Infectious Diseases. 2017;4(4):219. DOI: https://doi.org/10.1093/ofid/ofx219.Reepalu A, Balcha TT, Sturegård E, Medstrand P, Björkman P. Long-term outcome of antiretroviral treatment in patients with and without concomitant tuberculosis receiving health center — Based care — Results from a prospective cohort study. Open Forum Infectious Diseases. 2017;4(4):219. DOI: https://doi.org/10.1093/ofid/ofx219.Gupta RK, Brown AE, Zenner D, Rice B, Yin Z, Thomas HL, et. al. CD4+ cell count responses to antiretroviral therapy are not impaired in HIV-infected individuals with tuberculosis co-infection. AIDS. 2015;29(11):1363–1368. DOI: https://doi.org/10.1097/QAD.0000000000000685.Gupta RK, Brown AE, Zenner D, Rice B, Yin Z, Thomas HL, et. al. CD4+ cell count responses to antiretroviral therapy are not impaired in HIV-infected individuals with tuberculosis co-infection. AIDS. 2015;29(11):1363–1368. DOI: https://doi.org/10.1097/QAD.0000000000000685.Soeters HM, Napravnik S, Patel MR, Eron JJ Jr, Van Rie A. The effect of tuberculosis treatment on virologic and CD4 count response to combination antiretroviral therapy: A systematic review. AIDS. 2014;28(2):244– 255. DOI: https://doi.org/10.1097/01.aids.0000434936.57880.cd.Soeters HM, Napravnik S, Patel MR, Eron JJ Jr, Van Rie A. The effect of tuberculosis treatment on virologic and CD4 count response to combination antiretroviral therapy: A systematic review. AIDS. 2014;28(2):244– 255. DOI: https://doi.org/10.1097/01.aids.0000434936.57880.cd.Sulkowski MS. Management of acute and chronic HCV infection in persons with HIV coinfection. Journal of Hepatology. 2014;61(1 Suppl):S108–S119. DOI: https://doi.org/10.1016/j.jhep.2014.08.006.Sulkowski MS. Management of acute and chronic HCV infection in persons with HIV coinfection. Journal of Hepatology. 2014;61(1 Suppl):S108–S119. DOI: https://doi.org/10.1016/j.jhep.2014.08.006.Potter M, Odueyungbo A, Yang H, Saeed S, Klein MB; Canadian Co-infection Cohort Study Investigators. Impact of hepatitis C viral replication on CD4+ T-lymphocyte progression in HIV-HCV coinfection before and after antiretroviral therapy. AIDS. 2010;24(12):1857–1865. DOI: https://doi.org/10.1097/QAD.0b013e32833adbb5.Potter M, Odueyungbo A, Yang H, Saeed S, Klein MB; Canadian Co-infection Cohort Study Investigators. Impact of hepatitis C viral replication on CD4+ T-lymphocyte progression in HIV-HCV coinfection before and after antiretroviral therapy. AIDS. 2010;24(12):1857–1865. DOI: https://doi.org/10.1097/QAD.0b013e32833adbb5.Peters L, Mocroft A, Soriano V, Rockstroh JK, Losso M, Valerio L, et al. Hepatitis C virus coinfection does not influence the CD4 cell recovery in HIV-1-infected patients with maximum virologic suppression. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2009;50(5):457–463. DOI: https://doi.org/10.1097/QAI.0b013e318198a0e1.Peters L, Mocroft A, Soriano V, Rockstroh JK, Losso M, Valerio L, et al. Hepatitis C virus coinfection does not influence the CD4 cell recovery in HIV-1-infected patients with maximum virologic suppression. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2009;50(5):457–463. DOI: https://doi.org/10.1097/QAI.0b013e318198a0e1.Fuping G, Wei L, Yang H, Zhifeng Q, Lingyan Z, Yanling L, et al. Impact of hepatitis C virus coinfection on HAART in HIV-infected individuals: Multicentric observation cohort. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2010;54(2):137–142. DOI: https://doi.org/10.1097/QAI.0b013e3181cc5964.Fuping G, Wei L, Yang H, Zhifeng Q, Lingyan Z, Yanling L, et al. Impact of hepatitis C virus coinfection on HAART in HIV-infected individuals: Multicentric observation cohort. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2010;54(2):137–142. DOI: https://doi.org/10.1097/QAI.0b013e3181cc5964.Portocarrero Nuñez JA, Gonzalez-Garcia J, Berenguer J, Gallego MJV, Loyarte JAI, Metola L, et al. Impact of co-infection by hepatitis C virus on immunological and virological response to antiretroviral therapy in HIV-positive patients. Medicine. 2018;97(38):e12238. DOI: https://doi.org/10.1097/MD.0000000000012238.Portocarrero Nuñez JA, Gonzalez-Garcia J, Berenguer J, Gallego MJV, Loyarte JAI, Metola L, et al. Impact of co-infection by hepatitis C virus on immunological and virological response to antiretroviral therapy in HIV-positive patients. Medicine. 2018;97(38):e12238. DOI: https://doi.org/10.1097/MD.0000000000012238.Alonso A, Barnes AE, Guest JL, Shah A, Shao IY, Marconi V. HIV infection and incidence of cardiovascular diseases: an analysis of a large healthcare database. Journal of the American Heart Association. 2019;8(14): e012241. DOI: https://doi.org/10.1161/JAHA.119.012241.Alonso A, Barnes AE, Guest JL, Shah A, Shao IY, Marconi V. HIV infection and incidence of cardiovascular diseases: an analysis of a large healthcare database. Journal of the American Heart Association. 2019;8(14): e012241. DOI: https://doi.org/10.1161/JAHA.119.012241.So-Armah K, Benjamin LA, Bloomfield GS, Feinstein MJ, Hsue P, Njuguna B, et. al. HIV and cardiovascular disease. The Lancet HIV. 2020;7(4):279–293. DOI: https://doi.org/10.1016/S2352-3018(20)30036-9.So-Armah K, Benjamin LA, Bloomfield GS, Feinstein MJ, Hsue P, Njuguna B, et. al. HIV and cardiovascular disease. The Lancet HIV. 2020;7(4):279–293. DOI: https://doi.org/10.1016/S2352-3018(20)30036-9.Anand A, Rachel G, Parthasarathy D. HIV proteins and endothelial dysfunction: implications in cardiovascular disease. Frontiers in Cardiovascular Medicine. 2018;5(1):185. DOI: https://doi.org/10.3389/fcvm.2018.00185.Anand A, Rachel G, Parthasarathy D. HIV proteins and endothelial dysfunction: implications in cardiovascular disease. Frontiers in Cardiovascular Medicine. 2018;5(1):185. DOI: https://doi.org/10.3389/fcvm.2018.00185.

The authors declare that there are no conflicts of interest present.