S-42-3: HIV INFECTION AND ANTIRETROVIRAL THERAPY ARE ASSOCIATED WITH INCREASED ARTERIAL STIFFNESS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Objective: Incidence of cardiovascular disease (CVD) in people living with human immunodeficiency virus (HIV) infection has increased as overall survival has improved due to combination antiretroviral therapy (cART). Arterial stiffness is a composite indicator of CVD risk independent of traditional risk factors. We therefore aimed to synthesize the evidence on the effect of HIV and of cART on arterial stiffness. Design and Methods: We conducted a systematic review of Medline/PubMed, Embase, CINAHL, and the Cochrane Library, searched independently by two reviewers using a predefined search strategy, for studies relating HIV/cART to arterial stiffness until June 2019. Studies were limited to humans and publication in English or French. A standardized extraction form was used to collect data from published reports. Random-effects meta-analyses were performed to produce standardized mean differences (SMDs) and 95% confidence intervals (CIs) from studies reporting carotid-femoral pulse wave velocity. Results: We retrieved 995 citations. Seventy-four studies (N = 18,711 participants/13,119 with HIV) were included: 59 cross-sectional, 9 cohort studies and 6 randomized controlled trials. In meta-analyses of 17 studies, arterial stiffness was found to be increased overall in individuals with HIV relative to healthy controls (SMD 0.44 m/s; 95% CI, 0.25–0.63) and in cART-treated versus untreated individuals with HIV (SMD 0.35 m/s; 95% CI, 0.13–0.57). Several studies suggested that cumulative exposure to cART is associated with a continual increase in arterial stiffness. However, early initiation of treatment might improve arterial stiffness later in life by negating the effect of the HIV. Conclusions: Evidence suggests that HIV infection is associated with increased arterial stiffness, while cART is linked to a further increase, highlighting the need for monitoring of CVD risk in this population, and the need for development of novel treatments. The cross-sectional nature of most studies (59/74) mainly allowed for the exploration of associations. Large longitudinal studies are needed to confirm the observed relationships and establish causality between HIV/cART and arterial stiffness.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.030 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.034 |
| Bibliometrics | 0.011 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".