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Pregnancy-associated plasma protein-a is associated with subclinical atherosclerosis in men with HIV infection
  1. Suleyman Sezai Yildiz1,
  2. Sukru Cetin1,
  3. Kudret Keskin1,
  4. Alper Gunduz2,
  5. Gokhan Cetinkal1,
  6. Goncagul Bulbun3,
  7. Serhat Sigirci1,
  8. Saadet Pilten4,
  9. Kadriye Orta Kilickesmez1
  1. 1Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
  2. 2Infectious Diseases, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
  3. 3Radiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
  4. 4Medical Biochemistry, University of Health Science, Bagcilar Training and Research Hospital, Istanbul, Turkey
  1. Correspondence to Dr Suleyman Sezai Yildiz, Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; sezai04{at}yahoo.com

Abstract

The pathophysiology of an early and accelerated atherosclerotic process is complex and multifactorial in HIV-infected men compared with HIV-non-infected men. Several biomarkers have been well studied in the detection of the early stage of atherosclerosis, but studies are limited in HIV-infected men. The objective of this study was to investigate the association between serum pregnancy-associated plasma protein-A (PAPP-A) and carotid intima-media wall thickness (CIMT) in asymptomatic HIV-infected men. This a case–control study group comprising 118 HIV-infected men and 60 age-matched and gender-matched HIV-non-infected men. Serum PAPP-A was measured using an ELISA kit and carotid IMT was evaluated by Doppler ultrasonography in all subjects. Statistical analysis included receiver-operating characteristic (ROC) analysis, Pearson correlation and logistic regression analysis. Serum PAPP-A level was significantly higher in HIV +CIMT+ group compared with HIV +CIMT group and HIV–CIMT- group. We found a positive correlation between PAPP-A and increased CIMT (r=0.737, p<0.0001), and a negative correlation between nadir CD4 T cell counts and increased CIMT (r=−0.526, p<0.001). In multivariate logistic regression analyses, PAPP-A, nadir CD4 T cell count and age were significantly associated with subclinical atherosclerosis (p<0.001, p=0.006 and p=0.032, respectively). In ROC analysis, PAPP-A levels of >3.70 µg/mL were associated with subclinical atherosclerosis in HIV+ men with a specificity of 100% and a sensitivity of 71% (area under the curve: 0.949, 95% CI 0.875 to 1.000, p<0.001). Serum PAPP-A level was strongly correlated with increased CIMT in HIV-infected men. PAPP-A might be used as an early biomarker to identify atherosclerosis in asymptomatic HIV-infected men.

  • arteriosclerosis
  • carotid artery, common
  • inflammation

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Footnotes

  • Contributors All authors read and accepted this paper for submission. SSY, SC, AG, SS, KK, GB and SP contributed to the planning, analyzing and reporting of this work. GC, SS and KK participated in the acquisition and interpretation of data. SSY and KOK wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was performed according to the recommendations of the Declaration of Helsinki on Biomedical Research Involving Human Subjects and the Good Clinical Practice Guidelines. The study protocol was approved by the ethics committee at our institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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