Low plasma levels of the soluble receptor for advanced glycation end products in HIV-infected patients with subclinical carotid atherosclerosis receiving combined antiretroviral therapy

Objective: Combined antiretroviral therapy (cART) has significantly improved the survival rate and quality of life for HIV-infected subjects, but it contributes to the development of metabolic complications including coronary artery disease (CAD). Recent studies have reported that high plasma levels of the soluble receptor for advanced glycation end products (sRAGE) were associated with a lower incidence of CAD in non-HIV infected patients. However, there has been no report of an association of sRAGE and subclinical carotid atherosclerosis in HIV-infected patients receiving cART. Methods: We examined the association of circulating sRAGE in HIV-infected patients with carotid intima-media thickness (IMT) and other metabolic variables. We prospectively enrolled 76 HIV-infected patients receiving cART for ≥6 months. Results: sRAGE had a significantly negative correlation with body mass index (r= -0.324, p= 0.005), waist-to-hip ratio (r= -0.335, p= 0.003), systolic blood pressure (BP) (r= -0.359, p= 0.002), diastolic BP (r= -0.343, p= 0.004), total cholesterol (r= -0.240, p= 0.037), low-density lipoprotein-cholesterol (r= -0.284, p= 0.024), log(homeostasis model assessment of insulin resistance [HOMA-IR]) (r= -0.380, p= 0.002) and carotid IMT including max-IMT and mean-IMT (r= -0.358, p= 0.001 and r= -0.329, p= 0.004, respectively). By the use of multiple stepwise regression analyses, systolic BP (p= 0.001) and log[HOMA-IR] (p= 0.001) remained significant independently. Conclusions: These results suggest that sRAGE may have a protective effect against subclinical atherosclerosis by preventing inflammatory responses mediated by the activation of cell surface RAGE in HIV-infected patients receiving cART.