Higher plasma concentrations of von Willebrand factor in women than in men during both the acute and chronic phases of HIV infection.

Objectives: Chronic HIV infection is associated with increased cardiovascular risk, presumably due to the impact of chronic inflammation and immune activation on the vascular endothelium. We explored endothelial activation markers in chronically infected people with HIV (PWH) under antiretroviral therapy (ART) or with spontaneous viral control.

Design: Studies on 50 samples collected from HIV controllers (HIC), 50 ART-treated participants (ART) (median duration of infection: 8 years) enrolled in cohort studies and 50 uninfected individuals. Forty-five additional samples collected during primary HIV infection (PHI) were also included.

Method: The plasma levels of endothelial activation markers (vWF, sICAM-1, sVCAM-1, sE-Selectin, angiopoietin-1, angiopoietin-2) were determined by ELISA. Multivariate analyses were performed with adjustment for traditional confounding factors for cardiovascular diseases.

Results: In univariate analysis, vWF and sICAM-1 concentrations were higher in PWH than in uninfected individuals. A sex-stratified analysis revealed higher vWF levels in ART-treated women than in HIC and uninfected women and ART-treated men. A sex-specific profile was also observed for sVCAM-1 that was higher in ART-treated women than in HIC and uninfected women, whereas no such pattern was observed in men. sICAM-1 levels were higher in male and female PWH, but this effect was essentially modulated by confounding factors. A sex-related impact on vWF and sVCAM-1 concentrations was also detected in PHI.

Conclusion: vWF concentrations were higher in ART-treated women but not in men. This may reflect sex-differences in the sensitivity of the vascular endothelium during HIV infection. These results argue for closer cardiovascular monitoring in women living with HIV.