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Open Access 01-12-2021 | Human Immunodeficiency Virus | Study protocol

COVID-19 and its effects on endothelium in HIV-positive patients in sub-Saharan Africa: Cardiometabolic risk, thrombosis and vascular function (ENDOCOVID STUDY)

Authors: Nandu Goswami, Per Morten Fredriksen, Knut E. A. Lundin, Chidozie Agu, Simiat Olanike Elias, Keolebogile Shirley Motaung, Bianca Brix, Gerhard Cvirn, Harald Sourij, Evelyn Stelzl, Harald H. Kessler, Adam Saloň, Benedicta Nkeh-Chungag

Published in: BMC Infectious Diseases | Issue 1/2021

Abstract

Background

COVID-19 has affected almost every country in the world, especially in terms of health system capacity and economic burden. People from sub-Saharan Africa (SSA) often face interaction between human immunodeficiency virus (HIV) infection and non-communicable diseases such as cardiovascular disease. Role of HIV infection and anti-retroviral treatment (ART) in altered cardiovascular risk is questionable and there is still need to further carry out research in this field. However, thus far it is unclear, what impact the COVID-19 co-infection in people living with HIV (PLHIV), with or without therapy will have. The ENDOCOVID project aims to investigate whether and how HIV-infection in COVID-19 patients modulates the time course of the disease, alters cardiovascular risk, and changes vascular endothelial function and coagulation parameters/ thrombosis risk.

Methods

A total of 1026 patients will be included into this study. Cardiovascular research PLHIV with (n = 114 in each of the three recruiting centers) - or without - ART (n = 114 in each of the three recruiting centers) with COVID-19 and HIV-negative with COVID-19 (n = 114 in each of the three recruiting centers) will be carried out via clinical and biochemical measurements for cardiovascular risk factors and biomarkers of cardiovascular disease (CVD). Vascular and endothelial function will be measured by brachial artery flow-mediated dilatation (FMD), carotid intima-media thickness (IMT) assessments, and retinal blood vessel analyses, along with vascular endothelial biomarkers and cogualation markers. The correlation between HIV-infection in COVID-19 PLHIV with or without ART and its role in enhancement of cardiovascular risk and endothelial dysfunction will be assessed at admission, weekly, at discharge and, 4 weeks post-discharge (if possible).

Impact of project

The ENDOCOVID project aims to evaluate in the long-term the cardiovascular risk and vascular endothelial function in PLHIV thus revealing an important transitional cardiovascular phenotype in COVID-19. The study was registered under clinicaltrials.gov (NCT04709302).

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Pavelić K, Kraljević Pavelić S, Brix B, Goswami N. A Perspective on COVID-19 Management. J Clin Med. 2021;10(8):1586-9. https://doi.org/10.3390/jcm10081586.

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama. 2020;323(13):1239–42. https://doi.org/10.1001/jama.2020.2648.CrossRefPubMed

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–43.CrossRefPubMed

Phua J, Weng L, Ling L, Egi M, Lim C-M, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020;8(5):506–17. https://doi.org/10.1016/S2213-2600(20)30161-2.CrossRefPubMedPubMedCentral

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England). 2020;395(10229):1054–62.CrossRefPubMed

Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. 2020;173(2):100–9.CrossRefPubMed

Harmer D, Gilbert M, Borman R, Clark KL. Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS Lett. 2002;532(1–2):107–10. https://doi.org/10.1016/S0014-5793(02)03640-2.CrossRefPubMed

Xie Y, Wang X, Yang P, Zhang S. COVID-19 complicated by acute pulmonary embolism. Radiology. 2020;2(2):e200067. https://doi.org/10.1148/ryct.2020200067.CrossRefPubMedPubMedCentral

Tibazarwa K, Ntyintyane L, Sliwa K, Gerntholtz T, Carrington M, Wilkinson D, et al. A time bomb of cardiovascular risk factors in South Africa: results from the heart of Soweto study “heart awareness days”. Int J Cardiol. 2009;132(2):233–9. https://doi.org/10.1016/j.ijcard.2007.11.067.CrossRefPubMed

10.

Marincowitz C, Genis A, Goswami N, De Boever P, Nawrot TS, Strijdom H. Vascular endothelial dysfunction in the wake of HIV and ART. Febs J. 2019;286(7):1256-70. https://doi.org/10.1111/febs.14657.

11.

Deanfield JE, Halcox JP, Rabelink TJ. Endothelial function and dysfunction: testing and clinical relevance. Circulation. 2007;115(10):1285–95. https://doi.org/10.1161/CIRCULATIONAHA.106.652859.CrossRefPubMed

12.

Strijdom H, De Boever P, Nawrot T, Goswami N. HIV/AIDS: Emerging threat to cardiovascular health in sub-Saharan Africa. SAMJ. 2016;106(6).

13.

Brix B, Apich G, Ure C, Roessler A, Goswami N. Physical therapy affects endothelial function in lymphedema patients. Lymphology. 2020;53(3):109–17.PubMed

14.

Nkeh-Chungag BN, Goswami N, Engwa GA, Sewani-Rusike CR, Mbombela V, Webster I, et al. Relationship between Endothelial Function, Antiretroviral Treatment and Cardiovascular Risk Factors in HIV Patients of African Descent in South Africa: A Cross-Sectional Study. J Clin Med. 2021;10(3):392.CrossRefPubMedPubMedCentral

15.

Letswalo BP, Schmid-Zalaudek K, Brix B, Matjuda EN, Klosz F, Obernhumer N, et al. Cardiometabolic risk factors and early indicators of vascular dysfunction: a cross-sectional cohort study in south African adolescents. BMJ Open. 2021;11(3):e042955. https://doi.org/10.1136/bmjopen-2020-042955.CrossRefPubMedPubMedCentral

16.

Lo J, Abbara S, Rocha-Filho JA, Shturman L, Wei J, Grinspoon SK. Increased epicardial adipose tissue volume in HIV-infected men and relationships to body composition and metabolic parameters. Aids. 2010;24(13):2127–30. https://doi.org/10.1097/QAD.0b013e32833c055a.CrossRefPubMed

17.

Lo J, Plutzky J. The biology of atherosclerosis: general paradigms and distinct pathogenic mechanisms among HIV-infected patients. J Infect Dis. 2012;205(Suppl 3):S368–74. https://doi.org/10.1093/infdis/jis201.CrossRefPubMedPubMedCentral

18.

Lang S, Mary-Krause M, Cotte L, Gilquin J, Partisani M, Simon A, et al. Increased risk of myocardial infarction in HIV-infected patients in France, relative to the general population. Aids. 2010;24(8):1228–30. https://doi.org/10.1097/QAD.0b013e328339192f.CrossRefPubMed

19.

Hemkens LG, Bucher HC. HIV infection and cardiovascular disease. Eur Heart J. 2014;35(21):1373–81. https://doi.org/10.1093/eurheartj/eht528.CrossRefPubMed

20.

Bavinger C, Bendavid E, Niehaus K, Olshen RA, Olkin I, Sundaram V, et al. Risk of cardiovascular disease from antiretroviral therapy for HIV: a systematic review. PLoS One. 2013;8(3):e59551. https://doi.org/10.1371/journal.pone.0059551.CrossRefPubMedPubMedCentralADS

21.

WHO. Q&A on COVID-19, HIV and antiretrovirals 2020 Available from: https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-hiv-and-antiretrovirals.

22.

Katusic ZS. Mechanisms of endothelial dysfunction induced by aging: role of arginase I. Circ Res. 2007;101(7):640–1. https://doi.org/10.1161/CIRCRESAHA.107.162701.CrossRefPubMed

23.

Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023–6. https://doi.org/10.1111/jth.14810.CrossRefPubMedPubMedCentral

24.

Lax SF, Skok K, Zechner P, Kessler HH, Kaufmann N, Koelblinger C, et al. Pulmonary arterial thrombosis in COVID-19 with fatal outcome: results from a prospective, Single-Center, Clinicopathologic Case Series. Ann Intern Med. 2020;173(5):350–61.CrossRefPubMed

25.

Tomashefski JF Jr, Davies P, Boggis C, Greene R, Zapol WM, Reid LM. The pulmonary vascular lesions of the adult respiratory distress syndrome. Am J Pathol. 1983;112(1):112–26.PubMedPubMedCentral

26.

Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet (London, England). 2020;395(10234):1417–8.CrossRefPubMed

27.

Idell S. Coagulation, fibrinolysis, and fibrin deposition in acute lung injury. Crit Care Med. 2003;31(4 Suppl):S213–20. https://doi.org/10.1097/01.CCM.0000057846.21303.AB.CrossRefPubMed

28.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (London, England). 2020;395(10223):507–13.CrossRefPubMed

29.

Wichmann D, Sperhake JP, Lutgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med. 2020;173(4):268–77.CrossRefPubMed

30.

Baum C, Johannsen SS, Zeller T, Atzler D, Ojeda FM, Wild PS, et al. ADMA and arginine derivatives in relation to non-invasive vascular function in the general population. Atherosclerosis. 2016;244:149–56. https://doi.org/10.1016/j.atherosclerosis.2015.10.101.CrossRefPubMed

31.

Kwiatkowska W, Knysz B, Arczyńska K, Drelichowska J, Czarnecki M, Gąsiorowski J, et al. Peripheral arterial disease and ankle-brachial index abnormalites in young and middle-aged HIV-positive patients in lower Silesia. Poland PloS one. 2014;9(12):e113857. https://doi.org/10.1371/journal.pone.0113857.CrossRefPubMedADS

32.

Mercie P, Thiebaut R, Aurillac-Lavignolle V, Pellegrin JL, Yvorra-Vives MC, Cipriano C, et al. Carotid intima-media thickness is slightly increased over time in HIV-1-infected patients. HIV Med. 2005;6(6):380–7. https://doi.org/10.1111/j.1468-1293.2005.00324.x.CrossRefPubMed

33.

Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC, Hesse V, et al. Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschrift Kinderheilkunde. 2001;149(8):807–18. https://doi.org/10.1007/s001120170107.CrossRef

34.

Stewart A, Marfell-Jones M, Olds T, Ridder H. International Standards for Anthropometric Assessment. Lower Hutt: ISAK; 2011.

35.

Muller W, Lohman TG, Stewart AD, Maughan RJ, Meyer NL, Sardinha LB, et al. Subcutaneous fat patterning in athletes: selection of appropriate sites and standardisation of a novel ultrasound measurement technique: ad hoc working group on body composition, health and performance, under the auspices of the IOC medical commission. Br J Sports Med. 2016;50(1):45–54. https://doi.org/10.1136/bjsports-2015-095641.CrossRefPubMed

36.

Störchle P, Müller W, Sengeis M, Ahammer H, Fürhapter-Rieger A, Bachl N, et al. Standardized ultrasound measurement of subcutaneous fat patterning: high reliability and accuracy in groups ranging from lean to obese. Ultrasound Med Biol. 2017;43(2):427–38. https://doi.org/10.1016/j.ultrasmedbio.2016.09.014.CrossRefPubMed

37.

Schmid-Zalaudek K, Brix B, Sengeis M, Jantscher A, Fürhapter-Rieger A, Müller W, Matjuda EN, Mungamba MM, Nkeh-Chungag B, Fredriksen PM, et al. Subcutaneous Adipose Tissue Measured by B-Mode Ultrasound to Assess and Monitor Obesity and Cardio–Metabolic Risk in Children and Adolescents. Biology. 2021;10(5):449.

38.

Charakida M, Masi S, Lüscher TF, Kastelein JJ, Deanfield JE. Assessment of atherosclerosis: the role of flow-mediated dilatation. Eur Heart J. 2010;31(23):2854–61. https://doi.org/10.1093/eurheartj/ehq340.CrossRefPubMed

39.

Strijdom H, De Boever P, Walzl G, Essop MF, Nawrot TS, Webster I, et al. Cardiovascular risk and endothelial function in people living with HIV/AIDS: design of the multi-site, longitudinal EndoAfrica study in the Western Cape Province of South Africa. BMC Infect Dis. 2017;17(1):41. https://doi.org/10.1186/s12879-016-2158-y.CrossRefPubMedPubMedCentral

40.

Vaes AW, Spruit MA, Theunis J, Goswami N, Vanfleteren LE, Franssen FME, et al. Looking into the eye of patients with chronic obstructive pulmonary disease: an opportunity for better microvascular profiling of these complex patients. Acta Ophthalmol. 2018;96(6):539–49. https://doi.org/10.1111/aos.13765.CrossRefPubMed

41.

Strijdom H, Charania S, Goswami N, De Boever P, Nawrot T, Mashele N, et al. Cardiovascular Health and Flow-mediated dilatation (FMD) in a South African Cohort of HIV-infected participants - Findings from the ENDOAFRICA Study. Atherosclerosis. 2017;263:E141.CrossRef

42.

Vaes AW, Spruit MA, Theunis J, Goswami N, Vanfleteren LE, Franssen FME, et al. Endothelial function in patients with chronic obstructive pulmonary disease: a systematic review of studies using flow mediated dilatation. Expert Rev Respir Med. 2017;11(12):1021–31. https://doi.org/10.1080/17476348.2017.1389277.CrossRefPubMed

43.

Bauer M, Caviezel S, Teynor A, Erbel R, Mahabadi AA, Schmidt-Trucksäss A. Carotid intima-media thickness as a biomarker of subclinical atherosclerosis. Swiss Med Wkly. 2012;142:w13705.PubMed

44.

Bruno RM, Bianchini E, Faita F, Taddei S, Ghiadoni L. Intima media thickness, pulse wave velocity, and flow mediated dilation. Cardiovasc Ultrasound. 2014;12:34.CrossRefPubMedPubMedCentral

45.

Ciccone MM, Scicchitano P, Zito A, Agati L, Gesualdo M, Mandolesi S, et al. Correlation between coronary artery disease severity, left ventricular mass index and carotid intima media thickness, assessed by radio-frequency. Cardiovasc Ultrasound. 2011;9(1):32. https://doi.org/10.1186/1476-7120-9-32.CrossRefPubMedPubMedCentral

46.

Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography carotid intima-media thickness task force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21(2):93–111 quiz 89-90.CrossRefPubMed

47.

Koivistoinen T, Virtanen M, Hutri-Kahonen N, Lehtimaki T, Jula A, Juonala M, et al. Arterial pulse wave velocity in relation to carotid intima-media thickness, brachial flow-mediated dilation and carotid artery distensibility: the cardiovascular risk in young Finns study and the health 2000 survey. Atherosclerosis. 2012;220(2):387–93. https://doi.org/10.1016/j.atherosclerosis.2011.08.007.CrossRefPubMed

48.

Hickson SS, Butlin M, Broad J, Avolio AP, Wilkinson IB, McEniery CM. Validity and repeatability of the Vicorder apparatus: a comparison with the SphygmoCor device. Hypertens Res. 2009;32(12):1079–85. https://doi.org/10.1038/hr.2009.154.CrossRefPubMed

49.

McGreevy C, Barry M, Bennett K, Williams D. Repeatability of the measurement of aortic pulse wave velocity (aPWV) in the clinical assessment of arterial stiffness in community-dwelling older patients using the Vicorder(®) device. Scand J Clin Lab Invest. 2013;73(4):269–73. https://doi.org/10.3109/00365513.2013.770162.CrossRefPubMed

50.

Pucci G, Cheriyan J, Hubsch A, Hickson SS, Gajendragadkar PR, Watson T, et al. Evaluation of the Vicorder, a novel cuff-based device for the noninvasive estimation of central blood pressure. J Hypertens. 2013;31(1):77–85. https://doi.org/10.1097/HJH.0b013e32835a8eb1.CrossRefPubMed

51.

Wilkinson I, McEniery C, Schillaci G, Boutouyrie P, Segers P, Donald A, et al. ARTERY society guidelines for validation of non-invasive haemodynamic measurement devices: part 1, arterial pulse wave velocity. Artery Res. 2010;4(2):34–40. https://doi.org/10.1016/j.artres.2010.03.001.CrossRef

52.

Kis E, Cseprekal O, Kerti A, Salvi P, Benetos A, Tisler A, et al. Measurement of pulse wave velocity in children and young adults: a comparative study using three different devices. Hypertens Res. 2011;34(11):1197–202. https://doi.org/10.1038/hr.2011.103.CrossRefPubMed

53.

Louwies T, Int Panis L, Alders T, Bonne K, Goswami N, Nawrot TS, et al. Microvascular reactivity in rehabilitating cardiac patients based on measurements of retinal blood vessel diameters. Microvasc Res. 2019;124:25–9. https://doi.org/10.1016/j.mvr.2019.02.006.CrossRefPubMed

54.

Liew G, Wang JJ, Mitchell P, Wong TY. Retinal vascular imaging: a new tool in microvascular disease research. Circ Cardiovasc Imaging. 2008;1(2):156–61. https://doi.org/10.1161/CIRCIMAGING.108.784876.CrossRefPubMed

55.

McClintic BR, McClintic JI, Bisognano JD, Block RC. The relationship between retinal microvascular abnormalities and coronary heart disease: a review. Am J Med. 2010;123(4):374.e1–7.CrossRefPubMed

56.

Wong TY, Wong T, Mitchell P. The eye in hypertension. Lancet (London, England). 2007;369(9559):425–35.CrossRefPubMed

57.

Sehestedt TH, Olsen M. Chapter 21 - Traditional Versus New Models of Risk Prediction. In: Nilsson PM, Olsen MH, Laurent S, editors. Early Vascular Aging (EVA). Boston: Academic Press; 2015. p. 213–23.CrossRef

58.

Wang JJ, Liew G, Klein R, Rochtchina E, Knudtson MD, Klein BE, et al. Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations. Eur Heart J. 2007;28(16):1984–92. https://doi.org/10.1093/eurheartj/ehm221.CrossRefPubMed

59.

Prabhakar P, Zhang H, Chen D, Faber JE. Genetic variation in retinal vascular patterning predicts variation in pial collateral extent and stroke severity. Angiogenesis. 2015;18(1):97–114. https://doi.org/10.1007/s10456-014-9449-y.CrossRefPubMed

60.

Simundic AM, Bölenius K, Cadamuro J, Church S, Cornes MP, van Dongen-Lases EC, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med. 2018;56(12):2015–38. https://doi.org/10.1515/cclm-2018-0602.CrossRefPubMed

61.

Hornig M, Montoya JG, Klimas NG, Levine S, Felsenstein D, Bateman L, et al. Distinct plasma immune signatures in ME/CFS are present early in the course of illness. Sci Adv. 2015;1(1):e1400121.CrossRefPubMedPubMedCentralADS

62.

Montoya JG, Holmes TH, Anderson JN, Maecker HT, Rosenberg-Hasson Y, Valencia IJ, et al. Cytokine signature associated with disease severity in chronic fatigue syndrome patients. Proc Natl Acad Sci U S A. 2017;114(34):E7150–e8. https://doi.org/10.1073/pnas.1710519114.CrossRefPubMedPubMedCentralADS

63.

Leonard-Lorant I, Delabranche X, Severac F, Helms J, Pauzet C, Collange O, et al. Acute pulmonary embolism in COVID-19 patients on CT angiography and relationship to D-dimer levels. Radiology. 2020;296(3):E189–E19.CrossRefPubMed

64.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. https://doi.org/10.1016/j.jbi.2008.08.010.CrossRefPubMed

65.

Friis-Moller N, Weber R, Reiss P, Thiebaut R, Kirk O, d'Arminio Monforte A, et al. Cardiovascular disease risk factors in HIV patients--association with antiretroviral therapy. Results from the DAD study. Aids. 2003;17(8):1179–93. https://doi.org/10.1097/00002030-200305230-00010.CrossRefPubMed

66.

Matsuura E, Hughes GR, Khamashta MA. Oxidation of LDL and its clinical implication. Autoimmun Rev. 2008;7(7):558–66. https://doi.org/10.1016/j.autrev.2008.04.018.CrossRefPubMed

Title: COVID-19 and its effects on endothelium in HIV-positive patients in sub-Saharan Africa: Cardiometabolic risk, thrombosis and vascular function (ENDOCOVID STUDY)
Authors: Nandu Goswami
Per Morten Fredriksen
Knut E. A. Lundin
Chidozie Agu
Simiat Olanike Elias
Keolebogile Shirley Motaung
Bianca Brix
Gerhard Cvirn
Harald Sourij
Evelyn Stelzl
Harald H. Kessler
Adam Saloň
Benedicta Nkeh-Chungag
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Human Immunodeficiency Virus
COVID-19
Thrombosis
Published in: BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-021-06426-8

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