Allie Walpert, MSN, FNP-BC

Pronouns

She/Her/Hers

Rank

Nurse Practitioner

Institution

MGH

BWH-MGH Title

Clinical Research Nurse Practitioner

Department

Medicine

Authors

Allie WALPERT, MSN*, Suman SRINIVASA, MD, Daniel HUCK, MD, Marcelo F. DICARLI, MD, Sanjna IYENGAR, BS, Grace SHEN, BS, Teressa S. THOMAS, MBBCh, Gail K. ADLER, MD, PhD, Steven K. GRINSPOON, MD

Coronary Microvascular Dysfunction is Present Among Well-Treated Asymptomatic Persons with HIV, Similar to Those with Diabetes

WMSS 2022

Participating in the WMSS is important because the fields of medicine and science are historically male dominated. In contrast, the MGH Metabolism Unit is comprised predominantly of female research MDs, NPs, and trainees, and thus it would be exemplary to showcase our work. While medical advances have extended the life expectancy of those living with HIV through effective antiretroviral therapy, the risk of heart disease remains high, even among individuals who are virologically suppressed. I have helped lead critical collaborative science as a co-investigator at MGH and BWH, which highlight a novel finding indicating increased microvascular disease in well-treated HIV.

Background

Persons with HIV (PWH) who are well-treated on antiretroviral therapies (ART) have a 1.5-2.0 fold increased risk of cardiovascular disease (CVD) compared to persons without HIV (PWOH). We assessed coronary microvascular function among those with HIV, comparing to those without HIV and with diabetes (DM).

Methods

39 PWH with no known history of CVD or DM underwent coronary ¹³N-ammonia PET/CT to evaluate coronary flow reserve (CFR). CFR was corrected using the rate pressure product. Comparisons of CFR were made to PWOH from a database of higher risk clinical referrals who were matched approximately 2:1 based on demographics and traditional risk factors and to those with diabetes and no known history of CVD recruited as part of a prior study evaluating CFR.

Results

CFR was significantly different among groups (median, IQR): PWOH 2.76(2.37,3.36), PWH 2.47(1.92,2.93), DM 2.31(1.98,2.84), overall P=0.003. CFR was significantly reduced when comparing PWH to PWOH(P=0.02) and DM to PWOH(P=0.001) and did not differ when comparing PWH to DM(P=0.68).

Conclusions

Subclinical coronary microvascular dysfunction is present among asymptomatic, chronically infected PWH on ART who demonstrate good immunological control. This study demonstrates for the first time CFR is reduced compared with higher risk PWOH and comparable to those with DM.

Allie Walpert, MSN, FNP-BC

Coronary Microvascular Dysfunction is Present Among Well-Treated Asymptomatic Persons with HIV, Similar to Those with Diabetes

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