Skin advanced glycation end products in HIV infection are increased and predictive of development of cardiovascular events

Objective: HIV-1 infection is associated with an increased cardiovascular disease (CVD) risk. Advanced glycation end products are formed as stable markers of glycaemic and oxidative stress. Skin autofluorescence (SAF) as marker of accumulated advanced glycation end products is increased and predictive of CVD events in diabetes mellitus, chronic kidney disease (CKD), and preexisting CVD. We determined SAF levels in HIV-1 infected patients, testing the hypothesis that SAF predicts CVD events in HIV infection. Design: Single-centre prospective cohort study. Methods: In 2010–2011, SAF was measured in 91 patients. Development of CVD events was monitored during a median follow-up of 4.8 years. SAF values of the patients were expressed as a ratio (rSAF) to expected SAF levels in age-matched healthy volunteers. Results: Seventy-nine men and 12 women were included, mean age 47 years; 81 patients were on combination antiretroviral therapy. With a mean rSAF of 1.155, SAF levels in patients were 15.5% higher than predicted for their age (95% confidence interval, 10.0–20.0; P < 0.001). In multivariate regression analysis, rSAF was associated with nadir CD4+ cell count less than 200 cells/&mgr;l (&bgr; −0.274; P = 0.01), smoking (&bgr; 0.240; P = 0.03), and men who have sex with men (MSM) (&bgr; 0.202; P = 0.07). CVD events occurred in six patients (7%). In Cox regression analysis including age, SAF, smoking, diabetes, hypertension and CKD, SAF (P = 0.01), and (Wet Medisch-wetenschappelijk Onderzoek met mensen; WMO) CKD (P = 0.03) remained as independent predictors of CVD events. Conclusion: SAF is increased in HIV-infected patients, and related with smoking, low nadir CD4+ cell count, and MSM. Larger studies are needed to confirm whether SAF is an independent predictor of CVD events.