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. 2017 Jan 13;12(1):e0169986.
doi: 10.1371/journal.pone.0169986. eCollection 2017.

Association between Immune Markers and Surrogate Markers of Cardiovascular Disease in HIV Positive Patients: A Systematic Review

Alinda G Vos  1   2   3 , Annelieke Hulzebosch  1 , Diederick E Grobbee  1 , Roos E Barth  2 , Kerstin Klipstein-Grobusch  1   4
Affiliations

Association between Immune Markers and Surrogate Markers of Cardiovascular Disease in HIV Positive Patients: A Systematic Review

Alinda G Vos et al. PLoS One. .

Abstract

Background: HIV infection is associated with an increased risk of cardiovascular disease (CVD). Chronic low-grade immune activation is likely one of the driving mechanisms. This systematic review provides an overview of the evidence addressing the relation between immune markers and surrogate markers of CVD (except CIMT) in HIV infection.

Methods: A systematic search was performed in PubMed, Embase and Cochrane Library identifying all articles from 1996 to April 2015. It addressed the relation between immune markers and surrogate markers of CVD (except Carotid Intima-media Thickness) in HIV-positive adults. Two authors, using predefined criteria, independently conducted the selection of articles, critical appraisal and extraction of the data. Analysis focused on immune markers that were assessed most frequently. The review was conducted according to the PRISMA guideline and performed as part of an overarching review registered with PROSPERO (CRD42014010516).

Findings: Twenty-nine articles were selected, describing 34 immune markers and nine different CVD surrogate outcomes: coronary calcium score (13 times) and flow-mediated dilation (10 times) were used most frequently. Twenty-seven studies had a cross-sectional design. CRP, IL-6 and sVCAM-1 were assessed most frequently. None of the immune markers were clearly associated with any of the surrogate CVD outcomes. No effect estimate could be calculated due to marked heterogeneity in study populations, immune markers, outcomes and statistical approaches.

Interpretation: This review could not identify a clear association between any of the immune markers and surrogate CVD outcomes. This may reflect a true lack of association, or may be explained by heterogeneity across studies and lack of follow-up data. Future research should focus on longitudinal studies measuring a select set of immune markers and surrogate CVD outcomes awaiting the primary outcome of clinical cardiovascular events.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart inclusion.
CIMT: carotid intima media thickness, CVD: cardiovascular disease.
Fig 2
Fig 2. Risk of bias assessment.
Fig 3
Fig 3. Association of immune markers with surrogate CVD outcomes.
CVD: cardiovascular disease.
Fig 4
Fig 4. Association of immune markers with coronary angiography, coronary calcium score and arterial stiffness.
See this image and copyright information in PMC

References

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