Markers of inflammation and endothelial activation in black South Africans with HIV and acute coronary syndromes

Abstract

HIV infection is associated with a pro-inflammatory and thrombophilic state but little is known about the 
link between inflammation and thrombosis in treatment-naïve patients with acute coronary syndromes 
(ACS). Prospective single centre study was conducted in Soweto, South Africa, comparing markers of 
inflammation and endothelial cell activation in highly active anti- retroviral therapy-naïve HIV positive 
and negative patients presenting with ACS. Between March 2004 and February 2008, 30 consecutive 
black South African HIV patients with ACS were compared to 30 black HIV negative patients with ACS. 
The HIV patients were younger (43 ± 7 vs. 54 ± 13, p = 0.004) and besides smoking (73% vs. 33%, p = 
0.002) and lower HDL levels (0.8 ± 0.3 vs. 1.1 ± 0.4, p = 0.001) had fewer risk factors than the control 
group. At baseline, HIV patients had higher levels of tumour necrosis factor- [5.8 (1.7 - 15.0) vs. 0.19 
(0.19 - 19.8) ng/ml, p = 0.0004] and vascular cell adhesion molecule-1 [263.3 (0.38 - 778.5) vs. 151.3 (80.6 - 416.3) ng/ml, p = 0.007] compared to HIV negative patients as well as higher levels of macrophage 
chemoattractant protein-1 at six months [70 (30 -130) vs. 50 (30 - 90) ng/L, p = 0.004]. Treatment-naïve 
black South African patients with HIV and ACS have evidence of a pro-inflammatory state and greater 
degree of endothelial cell activation compared to HIV negative patients, both of which may play a direct 
role in the pathogenesis of ACS in this otherwise low risk population. MCP-1 may play an important role 
in HIV-associated coronary artery disease.