Time-dependent changes in extra-domain A-fibronectin concentration and relative amounts of fibronectin-fibrin complexes in plasma of patients with peripheral arterial disease after endovascular revascularisation.

Fibronectin (FN) may be involved in time- and stage-dependent and inter-related controlled processes of inflammation, coagulation, and wound healing accompanying peripheral arterial disease (PAD). In the present study, FN and FN-containing extra-domain A (EDA-FN), macromolecular FN-fibrin complexes, and FN monomer were analysed in the plasma of 142 PAD patients, including 37 patients with restenosis, for 37 months after revascularisation. FN concentration increased significantly in the plasma of PAD patients within 7 to 12 months after revascularisation, whereas the high concentration of EDA-FN was maintained up to 24 months, significantly higher in the group 7 to 12 months after revascularisation with recurrence of stenosis and lower in the PAD groups 1 to 3 months and 4 to 6 months after revascularisation with comorbid diabetes and ulceration, respectively. The relative amounts of FN-fibrin complexes up to 1600 kDa and FN monomer were significantly higher, within intervals of 4 to 24 months and 4 to 6 months after revascularisation, respectively. Moreover, the relative amounts of 750 to 1600 kDa FN-fibrin complexes within 13 to 24 months after revascularisation were higher in comparison with those in the group without restenosis. In conclusion, high levels of EDA-FN and FN-fibrin complexes could have potential diagnostic value in the management of PAD patients after revascularisation, predicting restenosis risk.

Kidney microcirculation response to adenosine stimulation in renal artery stenosis.

The purpose of this study was to assess the vasoconstrictive effects of adenosine in the kidney microcirculation in hypertensive patients with renal artery stenosis (RAS). Twelve patients with resistant hypertension and moderate RAS were selected for the study. In all patients, systolic, diastolic and mean translesional pressure gradients, distal pressure (Pd), aortic pressure (Pa) and Pd/Pa ratio were measured using a pressure guidewire at baseline and after intrarenal bolus administration of 400 µg adenosine. We observed significant changes in mean translesional pressure gradient and systolic Pd after pharmacological stimulation. The results suggest that in hypertensive patients with RAS, vasomotor activity of the kidney microcirculation may be preserved.

Deep vein thrombosis of the lower limbs in intravenous drug users.

BACKGROUND: Addiction to intravenously administered drugs has been a serious epidemiological problem for years. Among the related health complications, deep vein thrombosis (DVT) is one of the most important. This paper provides an illustrative presentation of DVT in intravenous drug users (IDUs), HIV-positive subjects among them. METHODS: We searched PubMed, Ovid Journals, Scopus, ScienceDirect, Cochrane Library, Google Scholar and references from articles obtained. The main terms used to identify appropriate studies of DVT in IDUs were 'intravenous drug users', 'substance-related disorders' and 'deep vein thrombosis'. RESULTS: No guidelines exist for DVT in intravenous drug users. As many as 47.6% of IDUs report having suffered from DVT. IDUs may constitute approx. 50% of patients under 40 years of age with DVT, this being promoted by multiple vein punctures, groin injections, lack of sterility, insoluble microparticles and other factors. The clinical appearance is more complex than in the general population, which also makes prognosis more difficult. HIV infection can worsen DVT. It often appears as proximal iliofemoral thrombosis, accompanied by local and general complications. Ultrasound with a compression test is an objective method of choice, but must often be complemented with computed tomography. Antithrombotic therapy in IDUs needs to be applied individually. The optimal method is supervised therapy at addiction treatment services. CONCLUSIONS: Individual and public preventive measures, among them locally prepared guidelines for DVT in IDUs, may be the most important processes capable of effectively reducing the morbidity of septic and non-septic DVT.

[Overweight, obesity and underweight in HIV infected patients]. / Wystepowanie nadwagi, otylosci i niedoboru masy ciala u pacjentów zakazonych HIV.

INTRODUCTION: The history of HIV infection has always been associated with patient nutritional problems, initially in the form of wasting syndrome, and since the introduction of highly active antiretroviral therapy such metabolic disorders as lipodystrophy, obesity, insulin resistance, dyslipidemia that are risk factors for cardiovascular diseases have been observed. AIM: evaluation of nutritional disorders in HIV infected patients using anthropometric parameters: waist circumference, BMI (body mass index) and WHR (waist-hip ratio). MATERIAL AND METHODS: the study included 72 HIV infected patients (48 men, 24 women, average age 39.4). The control group comprised 27 not infected subjects, matched for age and sex. Physical examination with measurements of body mass, height, waist and hip circumference was performed and the values of two anthropometric parameters--body mass index and waist/hip ratio were calculated. RESULTS: BMI in the group of HIV infected patients was significantly lower than in the control group (23.6 vs. 25.6 kg/m2, p = 0.01). These BMI values are normal, but significantly lower in HIV-infected men compared with not infected, and no differences were found between women. Infected men are less likely to be overweight and obese than not infected ones. Underweight was noted in 6.8% of patients from the study group (6% of men and 4% of women). WHR was significantly higher in the study group comparing with the healthy subjects (0.92 vs. 0.86 p = 0.002), which resulted from significantly lower hip circumference among the infected patients (93.0 vs. 98.3, p = 0.002). Waist circumference was similar in both groups (85.1 vs. 84.0). The WHR value in the infected women was a result of insignificantly higher waist circumference and lower hip circumference. HIV infected women have significantly more often too large waist circumference comparing with not infected ones (46% vs 0%, p = 0.01). In the group of infected men, the WHR value was significantly affected only by low hip circumference, and larger waist circumference was observed with the same frequency as in the control group. According to IDF criteria the central obesity was more frequent in HIV infected than in not infected patients. According to the WHO criteria it was more often diagnosed in infected women compared with not infected ones, which was not recorded in the male group. CONCLUSIONS: The prevalence of overweight or obesity in the studied cohort of HIV infected patients is significantly lower than among the not infected people. At the same time the HIV infection is significantly more often accompanied by features of central obesity, expressed as abnormal waist circumference value. HIV infected patients have significantly lower BMI and higher WHR values. Higher WHR in the infected group is due to low hip circumference. HIV infected women usually have normal body weight and are significantly more likely than not infected women to show the features of central obesity as a result of increased waist circumference and low hip circumference. Men infected with HIV, compared with not infected ones, are characterized by lower, normal body weight, and their significantly higher WHR is determined by low value of hip circumference. Waist circumference seems to be an appropriate diagnostic criterion for central obesity in the studied population.

Subclinical carotid atherosclerosis and cardiovascular risk factors in HIV-infected patients.

BACKGROUND: HIV infected patients, especially those treated with antiretroviral (ARV) drugs, show an increased risk and incidence of cardiovascular disease. OBJECTIVES: The aim of this study was to evaluate the progression of subclinical atherosclerosis in the carotid arteries, expressed as the value of carotid intima-media thickness (cIMT) and the amount of atherosclerotic plaques, and to analyze the correlation between cIMT and risk factors for cardiovascular diseases in a cohort of HIV infected patients. METHODS: The analysis included 72 HIV infected patients, mean age 39.4 years, and 27 healthy HIV negative individuals, matched for age and sex. The data collected included evaluation of the infection, ARV treatment, past cardiovascular events, assessment of traditional and nontraditional risk factors for cardiovascular diseases, cIMT measurements and amount of atherosclerotic plaques in the carotid arteries. RESULTS: HIV infected patients show more advanced subclinical atherosclerosis in the carotid arteries (cIMT and plaques incidence). The cardiovascular risk profile of the HIV infected patients is significantly different from HIV negative people. Among the HIV positive group lower body mass index (BMI) and higher waist/hip ratio (WHR) are observed. The concentration of all cholesterol fractions is lower, whereas the concentration of triglycerides is higher. Cigarette smoking is more common among HIV-infected individuals. A strong statistical correlation between cIMT and age, hypertension, non-high-density lipoprotein (non-HDL) cholesterol and ARV time were found. Total and LDL cholesterol, and lifetime smoking exposure also affect the cIMT. The relationship between cIMT and current HIV RNA may indicate the impact of the current infection status on the cIMT dynamics in this subpopulation.

The role of the tissue factor and its inhibitor in the development of subclinical atherosclerosis in people living with HIV.

INTRODUCTION: HIV infection is associated with an increased risk of cardiovascular disease in connection with atherosclerosis and thromboembolic complications. The pathogenesis of atherosclerosis is still unclear in this group of patients. Studies on pathogenesis of atherosclerosis in the general population emphasize the role of the extrinsic pathway of blood coagulation, particularly the tissue factor (TF) and tissue factor pathway inhibitor (TFPI). The effect of persistent activation of the immune system on enhanced expression of TF on the surface of monocytes in subjects infected with HIV is known to be correlated with the level of HIV RNA in blood serum. STUDY AIM: The aim of this study was to evaluate the concentration of TF and its inhibitor TFPI in blood plasma, the impact of traditional and non-traditional cardiovascular risk factors on their concentration and the impact of both markers of haemostasis on the severity of subclinical atherosclerosis as assessed by the intima-media measurement of the carotid artery in HIV infected patients. MATERIALS: The study included 121 HIV-infected people with known clinical, immunological and virological status. The control group consisted of 42 healthy individuals, selected in terms of age and sex. RESULTS AND CONCLUSIONS: Higher concentrations of TF occurred in HIV-infected patients with a low current plasma HIV RNA level, nadir CD4+ T-cell count and longer duration of cumulative antiretroviral treatment. In multivariate analysis, it was the length of cumulative NRTI treatment that impacted on the concentration of TF. The determinants of cardiovascular disease (CVD) risk factors and inflammatory markers did not show any effect on the concentrations of TF. The TFPI level in HIV-infected patients was significantly higher than in the control group and was negatively correlated with the current level of HIV RNA and nadir CD4+ T-cell count, being higher in patients subjected to antiretroviral treatment. It was shown that the higher the cardiovascular risk and the higher the levels of total cholesterol, low-density lipoprotein cholesterol (LDL) and non-high-density lipoprotein cholesterol (non-HDL), the higher the concentrations of TFPI observed. The levels of TF and TFPI were positively correlated with carotid intima media thickness (cIMT); in the multivariate analysis, TF, non-HDL cholesterol and lifetime smoking (pack-years) independently affected the growth of cIMT. A similar effect on cIMT was demonstrated by TFPI.

Peripheral arterial disease and ankle-brachial index abnormalites in young and middle-aged HIV-positive patients in lower Silesia, Poland.

BACKGROUND: Peripheral arterial disease (PAD) is a clinical manifestation of atherosclerosis and mainly refers to elderly patients, having a negative impact on their functionality and quality of life. The findings of previous studies in HIV-infected patients have shown that cardiovascular risk is higher and PAD occurs more frequently than in the general population. There are also contradictory observations. Much less is known about the ankle-brachial index (ABI) value in asymptomatic HIV-infected patients. The aim of this study was to evaluate the prevalence of PAD and ankle-brachial index abnormalities as well as to determine risk factors related to the disease in a group of Polish HIV-positive patients. METHODS AND FINDINGS: One hundred and eleven young to middle aged HIV-positive subjects and 40 noninfected subjects were enrolled into the study. Resting ABI measurements were performed and cardiovascular risk was analysed as well. Subgroups were created according to the ABI values: low (PAD), borderline, normal, high and altered ABI. Symptomatic PAD was observed in 2 HIV-positive patients, asymptomatic PAD was not diagnosed. The ABI value is lower and more varied, in 22.5% of the study group altered ABI values were found. Six subjects demonstrated borderline ABI, and 15 high ABI, including >1.4. In the control group no low or very high values were reported. A relation between low ABI and cardiovascular family history and between altered ABI and high-density-lipoprotein cholesterol (HDL-C) level was demonstrated. CONCLUSIONS: In young and middle-aged HIV-positive patients, symptomatic PAD prevalence is comparable to that observed in the overall population. Among asymptomatic patients PAD is not reported. The ABI value in HIV-positive patients is more varied compared to the HIV-negative subjects; the altered ABI shows a strong relation with low HDL-C levels and metabolic syndrome.