Effets de la rosuvastatine sur les marqueurs d'athéromatose subclinique en imagerie et l'inflammation systémique chez les adultes VIH – Un essai clinique contrôlé randomisé: phase pilote

 

Carl Chartrand-Lefebvre

Centre hospitalier de l'Université de Montréal [CHUM]

 

Domaine : maladies infectieuses et immunitaires

Programme recherches en radiologie

Concours 2017-2018

In spite of adequate viral suppression with antiretroviral therapy, systemic inflammation persists and seems to play a crucial role in the increasing cardiovascular burden in individuals living with HIV, such as coronary artery disease or stroke.  Statins are lipid-lowering drugs but also have important anti-inflammatory effects; statins have proven to be effective in reducing cardiovascular events in non HIV patients with normal blood cholesterol.

In this study, we propose to assess the effect of 2-year treatment with a statin (rosuvastatin) on the progression of atherosclerotic changes in carotid and coronary arteries in HIV patients.  We will also assess the effect on an inflammation marker, the cytokin IL-32.  Noninvasive assessment of the biomechanical characteristics of the wall of the carotid arteries will be done with ultrasound elastography.  Coronary arteries will be assessed with computed tomography.

Participants eligible for recruitment will be HIV-infected men and women ≥ 40 years of age, on antiretroviral therapy, with control of the virus, normal blood cholesterol and low to moderate cardiovascular risk.  Participants will be randomly assigned to receive either rosuvastatin or placebo.

Elastography should improve our ability to detect early functional abnormalities in the arterial walls before the apparition of plaque in HIV individuals, and provide a tool for follow-up.  For individuals already with plaques, vulnerable plaque imaging with elastography and CT should provide additional data related to mechanical stresses promoting plaque vulnerability, as well as markers of high-risk plaque, respectively.  Knowledge of the relation of IL-32 changes to "normal" arterial wall and plaque evolution should help to guide treatment monitoring in the specific HIV population.