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Cattelan AM, Mazzitelli M, Presa N, Cozzolino C, Sasset L, Leoni D, Bragato B, Scaglione V, Baldo V, Parisi SG. Changing Prevalence of AIDS and Non-AIDS-Defining Cancers in an Incident Cohort of People Living with HIV over 28 Years. Cancers (Basel) 2023; 16:70. [PMID: 38201498 PMCID: PMC10777974 DOI: 10.3390/cancers16010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The introduction and evolution of antiretrovirals has changed the panorama of comorbidities in people living with HIV (PLWH) by reducing the risk of AIDS-defining cancers (ADC). By contrast, due to ageing and persistent inflammation, the prevalence and incidence of non-AIDS-defining cancers have significantly increased. Therefore, we aimed at describing cancer epidemiology in our cohort over 28 years. METHODS We retrospectively included all PLWH in our clinic who ever developed cancers, considering features of ADC and NADC, from January 1996 to March 2023. Demographic, clinical characteristics, and survival were analyzed, comparing three observation periods (1996-2003, 2004-2013, and 2014-2023). RESULTS A total of 289 PLWH developed 308 cancers over the study period; 77.9% were male, the mean age was 49.6 years (SD 12.2), and 57.4% PLWH developed NADC and 41.5% ADC. Kaposi (21.8%) and non-Hodgkin lymphoma (20.1%) were the most frequent cancers. Age at the time of cancer diagnosis significantly increased over time (41.6 years in the first period vs. 54.4 years in the third period, p < 0.001). In the first period compared with the last, a simultaneous diagnosis of HIV infection and cancer occurred in a higher proportion of persons (42.7 vs. 15.3, p < 0.001). While viro-immunological control at cancer diagnosis significantly improved over time, the proportions of cancer progression/remission remained stable. Overall survival significantly increased, but this trend was not confirmed for ADC. CONCLUSIONS The probability of survival for ADC did not decrease as significantly as the number of ADC diagnoses over time. By contrast, NADC dramatically increased, in line with epidemiological studies and other literature data. The changing patterns of malignancies from ADC to NADC underline the need for public health interventions and the fostering of screening programs aimed at the prevention and early detection of NADC in PLWH.
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Affiliation(s)
- Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Nicolò Presa
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Claudia Cozzolino
- Department of Cardiothoracic and Vascular Sciences and Public Health, Padua University, 35122 Padua, Italy; (C.C.)
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Davide Leoni
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Beatrice Bragato
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Vincenzo Baldo
- Department of Cardiothoracic and Vascular Sciences and Public Health, Padua University, 35122 Padua, Italy; (C.C.)
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Ramirez HC, Monroe AK, Byrne M, O'Connor LF. Examining the Association Between a Modified Quan-Charlson Comorbidity Index and HIV Viral Suppression: A Cross-Sectional Analysis of DC Cohort Participants. AIDS Res Hum Retroviruses 2023; 39:662-670. [PMID: 37392022 PMCID: PMC10712358 DOI: 10.1089/aid.2022.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023] Open
Abstract
With the advancement of effective antiretroviral therapy, people with HIV live longer, and many are developing non-AIDS comorbidities. It is important to assess how comorbidities are associated with HIV-related health outcomes, such as viral suppression (VS). The aim of this study was to analyze the association between comorbidity burden, measured using a modified Quan-Charlson Comorbidity Index (QCCI), and VS (viral load result of <200 copies/mL). We hypothesized that an increase in QCCI score, indicating a higher risk for mortality, would correlate with lower likelihood of VS because of the burden of comorbidity treatment, possibly leading to worse antiretroviral adherence. Our analysis included participants from the DC Cohort Longitudinal HIV Study in Washington, DC. Eligible participants were aged ≥18 years and enrolled in the cohort as of January 1, 2018 (n = 2,471). A modified QCCI score, which weighs selected comorbidities (not including HIV/AIDS) and predicts mortality, was calculated using International Classification of Disease-9/10 codes from electronic health records. Multivariable logistic regressions were used to characterize the association between QCCI composite scores and VS. Participants were predominantly virally suppressed (89.6%), male (73.9%), non-Hispanic Black (74.7%), and between 18 and 55 years (59.3%). The median QCCI score was 1 (range = 1-12, interquartile range = 0-2), demonstrating predominately low mortality risk. We did not establish a statistically significant association between QCCI score and VS (adjusted odds ratio = 1.06, 95% confidence interval 0.96-1.17). Our findings suggest that a higher QCCI score was not associated with lower VS in this population, which may be partly due to the high retention in care among cohort participants.
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Affiliation(s)
- Hasmin C. Ramirez
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Anne K. Monroe
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Morgan Byrne
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Lauren F. O'Connor
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
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Elizaldi SR, Verma A, Ma ZM, Ott S, Rajasundaram D, Hawes CE, Lakshmanappa YS, Cottrell ML, Kashuba ADM, Ambrose Z, Lifson JD, Morrison JH, Iyer SS. Deep analysis of CD4 T cells in the rhesus CNS during SIV infection. PLoS Pathog 2023; 19:e1011844. [PMID: 38060615 PMCID: PMC10729971 DOI: 10.1371/journal.ppat.1011844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/19/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Virologic suppression with antiretroviral therapy (ART) has significantly improved health outcomes for people living with HIV, yet challenges related to chronic inflammation in the central nervous system (CNS)-known as Neuro-HIV- persist. As primary targets for HIV-1 with the ability to survey and populate the CNS and interact with myeloid cells to co-ordinate neuroinflammation, CD4 T cells are pivotal in Neuro-HIV. Despite their importance, our understanding of CD4 T cell distribution in virus-targeted CNS tissues, their response to infection, and potential recovery following initiation of ART remain limited. To address these gaps, we studied ten SIVmac251-infected rhesus macaques using an ART regimen simulating suboptimal adherence. We evaluated four macaques during the acute phase pre-ART and six during the chronic phase. Our data revealed that HIV target CCR5+ CD4 T cells inhabit both the brain parenchyma and adjacent CNS tissues, encompassing choroid plexus stroma, dura mater, and the skull bone marrow. Aligning with the known susceptibility of CCR5+ CD4 T cells to viral infection and their presence within the CNS, high levels of viral RNA were detected in the brain parenchyma and its border tissues during acute SIV infection. Single-cell RNA sequencing of CD45+ cells from the brain revealed colocalization of viral transcripts within CD4 clusters and significant activation of antiviral molecules and specific effector programs within T cells, indicating CNS CD4 T cell engagement during infection. Acute infection led to marked imbalance in the CNS CD4/CD8 ratio which persisted into the chronic phase. These observations underscore the functional involvement of CD4 T cells within the CNS during SIV infection, enhancing our understanding of their role in establishing CNS viral presence. Our findings offer insights for potential T cell-focused interventions while underscoring the challenges in eradicating HIV from the CNS, particularly in the context of sub-optimal ART.
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Affiliation(s)
- Sonny R. Elizaldi
- Graduate Group in Immunology, UC Davis, California, United States of America
| | - Anil Verma
- Department of Pathology, School of Medicine, University of Pittsburgh, Pennsylvania, United States of America
| | - Zhong-Min Ma
- California National Primate Research Center, UC Davis, California, United States of America
| | - Sean Ott
- California National Primate Research Center, UC Davis, California, United States of America
| | - Dhivyaa Rajasundaram
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pennsylvania, United States of America
| | - Chase E. Hawes
- Graduate Group in Immunology, UC Davis, California, United States of America
| | | | - Mackenzie L. Cottrell
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Angela D. M. Kashuba
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Zandrea Ambrose
- Department of Microbiology and Molecular Genetics, School of Medicine, University of Pittsburgh, Pennsylvania, United States of America
| | - Jeffrey D. Lifson
- AIDS and Cancer Virus Program, Frederick National Laboratory, Frederick, Maryland, United States of America
| | - John H. Morrison
- California National Primate Research Center, UC Davis, California, United States of America
- Department of Neurology, School of Medicine, UC Davis, California, United States of America
| | - Smita S. Iyer
- Department of Pathology, School of Medicine, University of Pittsburgh, Pennsylvania, United States of America
- California National Primate Research Center, UC Davis, California, United States of America
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, UC Davis, California, United States of America
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Rohani R, Malakismail J, Njoku E. Pharmacological and Behavioral Interventions to Mitigate Premature Aging in Patients with HIV. Curr HIV/AIDS Rep 2023; 20:394-404. [PMID: 37917387 DOI: 10.1007/s11904-023-00677-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE OF REVIEW We sought to review pharmacological and behavioral interventions that have been publicly presented, published, or are currently ongoing to prevent or mitigate the effect of premature HIV-associated comorbidities. RECENT FINDINGS Multiple studies have been conducted in hopes of finding an effective intervention. While the choice of antiretroviral regimen influences recovery of immune function, several drugs used as adjunct treatments have proven effective to mitigate premature aging. Additionally, few behavioral interventions have exhibited some efficacy. Statins, angiotensin-receptor blockers, and anti-hyperglycemic agents as well as optimal adherence, exercise, and intermittent fasting among others have had beneficial impact on markers of immune activation and levels of inflammatory biomarkers. However, several investigations had inconclusive outcomes so further studies with larger sample sizes are warranted.
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Affiliation(s)
- Roxane Rohani
- Discipline of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road BSB 3.266, North Chicago, IL, USA.
- Department of Pharmacy, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA.
| | - Jacob Malakismail
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Emmanuel Njoku
- Section of Infectious Disease, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA
- Discipline of Internal Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Zhang H, Wu P, Li J, Li M. Prevalence and analysis of acquired and transmitted integrase strand transfer inhibitor-associated HIV-1 drug resistance in Chongqing, China. Virulence 2023; 14:2278254. [PMID: 37941373 PMCID: PMC10653698 DOI: 10.1080/21505594.2023.2278254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
In this study, we examined the occurrence of acquired and transmitted drug resistance to integrase strand transfer inhibitor (INSTI) in HIV-1 strains in Chongqing (China) for guiding for the routine testing of INSTI-associated HIV-1 genotype resistance. Plasma samples were obtained from HIV-1 patients at Chongqing Public Health Medical Center from July 2019 to August 2022. Besides, amplification, sequence, and analysis of the portion of the HIV-1 pol gene that encodes the integrase protein were implemented to identify INSTI resistance. Integrase sequence data was harvested for a comprehensive cohort of 1032 patients infected with HIV-1. This cohort consisted of 564 ART-naive patients, 465 ART-treated patients, and 3 patients with an unknown treatment history. Within the study group, we identified INSTI resistance in 21 patients (2.03%, 21/1032), including 17 ART-treated patients (3.66%, 17/465). Among the ART-treated patients, 12 were INSTI-treated (11.76%, 12/102), 5 were INSTI-naive (1.38%, 5/363), and 4 were ART-ineffective patients (0.71%, 4/564). The prevalent major resistance mutation was Q148R (0.48%, 5/1032), while the most prevalent accessory resistance mutation was E157Q (1.65%, 17/1032). In light of the above, it is recommended that the incidence of accessory genotype analysis should be considered before starting any future INSTI-based therapy, especially in patients with drug resistance to NRTIs and NNRTIs and the reduction of INSTI sensitivity should be carefully monitored and investigated. Regular monitoring for resistance should be implemented after the use of INSTIs, and, importantly, ongoing monitoring of the decreasing susceptibility to INSTIs is crucial following the initiation of treatment with INSTIs.
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Affiliation(s)
- Huizheng Zhang
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Ping Wu
- Department of Tuberculosis, Chongqing Public Health Medical Center, Chongqing, China
| | - Jungang Li
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Mei Li
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
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Xia H, Ge Z, Zhang D, Wu Y, Ma P. Pretreatment integrase strand transfer inhibitor resistance in Tianjin, China. Chin Med J (Engl) 2023; 136:2735-2737. [PMID: 37920909 PMCID: PMC10684190 DOI: 10.1097/cm9.0000000000002898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Huan Xia
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Zhangwen Ge
- Department of Laboratory Medicine, Guizhou Provincial People's Hospital, Affiliated Hospital of Guizhou University, Guiyang, Guizhou 550499, China
| | - Defa Zhang
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Yue Wu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
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Wu X, Zhang L, Lu Z, Li Y, He Y, Zhao F, Peng Q, Zhou X, Wang H, Zou H. Longitudinal trajectories of weight changes among people living with HIV on antiretroviral therapy: A group-based study. iScience 2023; 26:108259. [PMID: 38026178 PMCID: PMC10665799 DOI: 10.1016/j.isci.2023.108259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/07/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Weight changes vary among people living with HIV (PLHIV) on different antiretroviral therapy (ART) regimens. Here, we performed multi-trajectory modeling fitting growth mixture models (GMM) to identify longitudinal weight change trajectories of PLHIV. Multiple logistic regression was used to assess correlates of rapid weight gains; 12,683 PLHIV (median age: 34 years [interquartile range 29-42], 91.1% male) who initiated ART at the Third People's Hospital of Shenzhen, China, between January 2003 and September 2022 were included. We identified two trajectories: slow (70.5%) and rapid weight gains (29.5%). PLHIV who initiated ART with dolutegravir- (adjusted odds ratio [aOR] 2.46, 1.92-3.15), raltegravir- (2.74, 1.96-3.82), and lopinavir (1.62, 1.36-1.94)-based regimens were more likely to have rapid weight gains compared with efavirenz-based regimen. The monitoring of nutritional status should be strengthened for PLHIV who initiated these regimens during regular ART follow-ups.
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Affiliation(s)
- Xinsheng Wu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Lukun Zhang
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuwei Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yun He
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Fang Zhao
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Qiaoli Peng
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xinyi Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China
- School of Public Health, Southwest Medical University, Luzhou, China
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Mbatia RJ, Mtisi EL, Ismail A, Henjewele CV, Moshi SJ, Christopher AK, Nsanzugwanko NW, Bukuku AG, Msimbe RA, Kirato AR, Nyabukene FS, Mmari EJ, Rwebembera AA, Masanja BN, Kailembo A, Matiko EJ. Interruptions in treatment among adults on anti-retroviral therapy before and after test-and-treat policy in Tanzania. PLoS One 2023; 18:e0292740. [PMID: 37967039 PMCID: PMC10651022 DOI: 10.1371/journal.pone.0292740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The World Health Organization recommended the initiation of antiretroviral therapy (ART) for people living with HIV (PLHIV) regardless of CD4 cell counts. Tanzania adopted this recommendation known as test-and-treat policy in 2016. However, programmatic implementation of this policy has not been assessed since its initiation. The objective of the study was to assess the impact of this policy in Tanzania. METHODS This was a cross-sectional study among PLHIV aged 15 years and older using routinely collected program data. The dependent variable was interruption in treatment (IIT), defined as no clinical contact for at least 90 days after the last clinical appointment. The main independent variable was test-and-treat policy status which categorized PLHIV into the before and after groups. Co-variates were age, sex, facility type, clinical stage, CD4 count, ART duration, and body mass index. The associations were assessed using the generalized estimating equation with inverse probability weighting. RESULTS The study involved 33,979 PLHIV-14,442 (42.5%) and 19,537 (57.5%) were in the before and after the policy groups, respectively. Among those who experienced IIT, 4,219 (29%) and 7,322 (38%) were in the before and after the policy groups respectively. Multivariable analysis showed PLHIV after the policy was instated had twice [AOR 2.03; 95%CI 1.74-2.38] the odds of experiencing IIT than those before the policy was adopted. Additionally, higher odds of experiencing IIT were observed among younger adults, males, and those with advanced HIV disease. CONCLUSION Demographic and clinical status variables were associated with IIT, as well as the test-and-treat policy. To achieve epidemic control, programmatic adjustments on continuity of treatment may are needed to complement the programmatic implementation of the policy.
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Affiliation(s)
| | - Expeditho L. Mtisi
- Department of General Studies, Dar es Salaam Institute of Technology, Dar es Salaam, Tanzania
| | - Abbas Ismail
- US Center for Disease Control and Prevention (CDC), Tanzania Country Office, Dar es Salaam, Tanzania
| | | | - Sisty J. Moshi
- Tanzania Health Promotion Support (THPS), Dar es Salaam, Tanzania
| | | | | | | | - Rehema A. Msimbe
- Tanzania Health Promotion Support (THPS), Dar es Salaam, Tanzania
| | - Agnes R. Kirato
- Tanzania Health Promotion Support (THPS), Dar es Salaam, Tanzania
| | | | - Eunice J. Mmari
- US Center for Disease Control and Prevention (CDC), Tanzania Country Office, Dar es Salaam, Tanzania
| | - Anath A. Rwebembera
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | - Alexander Kailembo
- US Center for Disease Control and Prevention (CDC), Tanzania Country Office, Dar es Salaam, Tanzania
| | - Eva J. Matiko
- US Center for Disease Control and Prevention (CDC), Tanzania Country Office, Dar es Salaam, Tanzania
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Weng YW, Lee SSJ, Tsai HC, Hsu CH, Lin SH. Prediction of incidence of neurological disorders in HIV-infected persons in Taiwan: a nested case-control study. BMC Infect Dis 2023; 23:759. [PMID: 37924043 PMCID: PMC10625280 DOI: 10.1186/s12879-023-08761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Neurological disorders are still prevalent in HIV-infected people. We aimed to determine the prevalence of neurological disorders and identify their risk factors in HIV-infected persons in Taiwan. METHODS We identified 30,101 HIV-infected people between 2002 and 2016 from the National Health Insurance Research Database in Taiwan, and analyzed the incidence of neurological disorders. We applied a retrospective, nested case-control study design. The individuals with (case group) and without (control group) a neurological disorder were then matched by age, sex and time. Factors associated with neurological disorders were analyzed using a conditional logistic regression model, and a nomogram was generated to estimate the risk of developing a neurological disorder. RESULTS The incidence of neurological disorders was 13.67 per 1000 person-years. The incidence remained stable during the observation period despite the use of early treatment and more tolerable modern anti-retroviral therapy. The conditional logistic regression model identified nine clinical factors and comorbidities that were associated with neurological disorders, namely age, substance use, traumatic brain injury, psychiatric illness, HIV-associated opportunistic infections, frequency of emergency department visits, cART adherence, urbanization, and monthly income. These factors were used to establish the nomogram. CONCLUSION Neurological disorders are still prevalent in HIV-infected people in Taiwan. To efficiently identify those at risk, we established a nomogram with nine risk factors. This nomogram could prompt clinicians to initiate further evaluations and management of neurological disorders in this population.
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Affiliation(s)
- Ya-Wei Weng
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hung-Chin Tsai
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chih-Hui Hsu
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Li S, Tan T, Xiang D, Bai C, Zhou L, Wu G. Sexual dilemma among elderly men living with HIV/AIDS: a cross-sectional survey of the sexual needs and behaviours among HIV-positive men aged ≥50 years. Public Health 2023; 224:113-117. [PMID: 37742584 DOI: 10.1016/j.puhe.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/21/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES This study aimed to explore the factors associated with the sexual needs and behaviours among elderly men living with HIV/AIDS in Chongqing, China. STUDY DESIGN The study used a cross-sectional design. METHODS Data were collected through face-to-face interviews using a structured questionnaire by convenience sampling from July to December 2021. The chi-squared test and logistic regression were conducted to identify factors associated with sexual needs and behaviours. RESULTS In total, 63.70% of participants (493/774) reported having sexual needs. Individuals aged 50-59 years (odds ratio [OR] = 7.257, 95% confidence interval [CI]: 4.620, 11.401) and those who were married or cohabiting (OR = 1.595, 95% CI: 1.133, 2.246) reported high sexual needs. Among those with sexual needs, 69.17% (341/493) reported having sex in the past year. In total, 11.37% (40/341) and 9.68% (33/341) reported having commercial and casual sex, respectively. Participants aged 60-69 years (OR = 2.175, 95% CI: 1.128, 4.193), those who were married or cohabiting (OR = 3.371, 95% CI: 2.192, 5.184) and individuals who were employed (OR = 2.301, 95% CI: 1.339, 3.954) had higher odds of engaging in sexual behaviour, while participants with an awareness of AIDS-related knowledge (OR = 0.504, 95% CI: 0.307, 0.829) and those who had ≥1 year of antiretroviral therapy (ART) (ART 1-2 years: OR = 0.374, 95% CI: 0.176, 0.795; ART ≥3 years: OR = 0.429, 95% CI: 0.218, 0.846) had a lower likelihood of engaging in sexual behaviour. CONCLUSIONS The sexual needs and behaviours of elderly men living with HIV/AIDS in Chongqing, China, remain at a high level. There was a discrepancy between sexual needs and behaviours among elderly men living with HIV/AIDS. Continuous dissemination of sexual health education and the promotion of condom use are necessary.
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Affiliation(s)
- Shan Li
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China
| | - TianYu Tan
- Chongqing Center for Disease Control and Prevention, Chongqing 400042, China
| | - DongWu Xiang
- Chongqing Association of STD and AIDS Prevention and Control, Chongqing 400042, China
| | - ChongYang Bai
- Chongqing Center for Disease Control and Prevention, Chongqing 400042, China
| | - Li Zhou
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China.
| | - GuoHui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing 400042, China.
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Sigel K, Silverberg MJ, Crothers K, Park L, Lishchenko I, Han X, Leyden W, Kale M, Stone K, Sigel C, Wisnivesky J, Kong CY. Comparison of Stage I Non-Small-Cell Lung Cancer Treatments for Patients Living With HIV: A Simulation Study. Clin Lung Cancer 2023; 24:e259-e267.e8. [PMID: 37407294 PMCID: PMC10719420 DOI: 10.1016/j.cllc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/31/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Non-small-cell lung cancer (NSCLC) is a leading cause of death for people living with HIV (PWH). Nevertheless, there are no clinical trial data regarding the management of early-stage lung cancer in PWH. Using data from large HIV and cancer cohorts we parameterized a simulation model to compare treatments for stage I NSCLC according to patient characteristics. MATERIALS AND METHODS To parameterize the model we analyzed PWH and NSCLC patient outcomes and quality of life data from several large cohort studies. Comparative effectiveness of 4 stage I NSCLC treatments (lobectomy, segmentectomy, wedge resection, and stereotactic body radiotherapy) was estimated using evidence synthesis methods. We then simulated trials comparing treatments according to quality adjusted life year (QALY) gains by age, tumor size and histology, HIV disease characteristics and major comorbidities. RESULTS Lobectomy and segmentectomy yielded the greatest QALY gains among all simulated age, tumor size and comorbidity groups. Optimal treatment strategies differed by patient sex, age, and HIV disease status; wedge resection was among the optimal strategies for women aged 80 to 84 years with tumors 0 to 2 cm in size. Stereotactic body radiotherapy was included in some optimal strategies for patients aged 80 to 84 years with multimorbidity and in sensitivity analyses was a non-inferior option for many older patients or those with poor HIV disease control. CONCLUSION In simulated comparative trials of treatments for stage I NSCLC in PWH, extensive surgical resection was often associated with the greatest projected QALY gains although less aggressive strategies were predicted to be non-inferior in some older, comorbid patient groups.
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Affiliation(s)
- Keith Sigel
- Icahn School of Medicine at Mount Sinai, New York, NY.
| | | | - Kristina Crothers
- VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, WA
| | - Lesley Park
- Stanford University School of Medicine, Palo Alto, CA
| | | | | | - Wendy Leyden
- Kaiser Permanente Northern California, Oakland, CA
| | - Minal Kale
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Carlie Sigel
- Memorial Sloan Kettering Cancer Center, New York, NY
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Rathbun RC, Lewis MM, Yuet WC, Woo S, Miller JL, Skrepnek GH. The Medication Possession Ratio as a Predictor of Longitudinal HIV-1 Viral Suppression. Ann Pharmacother 2023; 57:1264-1272. [PMID: 36946586 DOI: 10.1177/10600280231156624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Antiretroviral adherence is essential to achieve viral suppression and limit HIV-related morbidity and mortality; however, antiretroviral adherence thresholds to achieve viral suppression in clinical practice have not been fully characterized using administrative claims data. OBJECTIVE The purpose of this study was to assess the relationship between medication adherence and viral suppression among adult persons with HIV/AIDS (PWH) receiving antiretroviral therapy (ART) for ≥6 months. METHODS This historical cohort, real-world investigation assessed maintenance of viral load suppression and viral load area-under-the-curve (vAUC) in PWH ≥18 years of age based on ART adherence. A marginal effects model was used to determine the predicted probabilities of final plasma HIV-1 RNA <50 copies/mL or vAUC <1,000 copy-days/mL according to the medication possession ratio (MPR), estimated using a Jackknife model variance estimator and a delta-method for marginal effects standard error. Tests for statistical significance used a Šidák method to correct for multiple comparisons. RESULTS The mean MPR for ART was 86.7% (95% CI: 85.0%-88.4%) for the 372 PWH included in the study. The marginal effects analysis indicated that an MPR ≥82% was associated with a predicted probability of viral suppression <50 copies/mL (P < 0.05). Significant predicted probabilities for vAUC <1,000 copy-days/mL were observed with an MPR ≥90% (P < 0.05). CONCLUSION AND RELEVANCE Medication possession ratio as a proxy for drug exposure was significantly and consistently associated with viral suppression using a longitudinal measure of HIV viremia. These findings can aid clinicians in the clinical management of PWH and inform future studies of adherence-viral suppression relationships with contemporary antiretroviral regimens.
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Affiliation(s)
- R Chris Rathbun
- Department of Pharmacy: Clinical & Administrative Sciences, College of Pharmacy, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michelle M Lewis
- Section of Infectious Diseases, Department of Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Sukyung Woo
- Department of Pharmaceutical Sciences, School of Pharmacy & Pharmaceutical Sciences, The State University of New York, Buffalo, NY, USA
| | - Jamie L Miller
- Department of Pharmacy: Clinical & Administrative Sciences, College of Pharmacy, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Grant H Skrepnek
- Department of Pharmacy: Clinical & Administrative Sciences, College of Pharmacy, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Fisher MC, Fazzari MJ, Felsen UR, Hanna DB, Tappan N, Wyatt CM, Abramowitz MK, Ross MJ. Association of HIV and viral suppression status with hospital acute kidney injury in the era of antiretroviral therapy. Kidney Int 2023; 104:1008-1017. [PMID: 37598853 DOI: 10.1016/j.kint.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023]
Abstract
In the modern era, it is unknown if people that are virally suppressed with HIV (PWH) are at increased risk for acute kidney injury (AKI) compared to people without HIV and no studies have compared the risk of AKI by viral suppression status. Here, we determined the associations of HIV status and AKI among PWH with and without viral suppression compared to people without HIV. An observational cohort study of PWH and people without HIV hospitalized in a large New York City health system between 2010-2019 was conducted. Multivariable Cox proportional hazards models were used to determine associations between HIV status and risk of AKI, severe AKI and development of chronic kidney disease (CKD). Among 173,884 hospitalized patients, 4,718 had HIV; 2,532 (53.7%) were virally suppressed and 2,186 (46.3%) were not suppressed. Compared to people without HIV, PWH with and without viral suppression were at increased risk of AKI (adjusted hazard ratio 1.27, 95% confidence interval 1.15, 1.40 and 1.73, 1.58, 1.90, respectively) and AKI requiring kidney replacement therapy (1.89, 1.27, 2.84 and 1.87, 1.23, 2.84, respectively). Incremental, graded associations were observed between HIV status and Stage 2 or 3 AKI, and among AKI survivors, and incident CKD. The elevated risk of AKI across ages of PWH was similar in magnitude to older people without HIV. Thus, regardless of virologic control, HIV is an independent risk factor for AKI among hospitalized patients. Future studies should determine the mechanisms by which HIV increases susceptibility to AKI and identify strategies to prevent AKI in PWH.
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Affiliation(s)
- Molly C Fisher
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA.
| | - Melissa J Fazzari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Uriel R Felsen
- Division of Infectious Diseases, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Nataliya Tappan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Christina M Wyatt
- Division of Nephrology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Matthew K Abramowitz
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Michael J Ross
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA; Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA
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Buysman EK, Kumar P, McNiff K, Goswami S, Paudel M, Prajapati G, Tadese BK. Antiretroviral therapy among people with HIV with comorbidities in the United States: a retrospective cohort study. Curr Med Res Opin 2023; 39:1451-1462. [PMID: 37766585 DOI: 10.1080/03007995.2023.2262379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES To describe patterns of antiretroviral medications among people with HIV (PWH) who also have common comorbid conditions in a United States cohort. METHODS This retrospective cohort study used Optum Research Database claims data from 01/01/2017 through 01/31/2019 to identify adult PWH (≥18 years) based on pharmacy claims for ART during 2018. The index date was defined as the first date of an ART claim. Study inclusion required ≥1 HIV/AIDS diagnosis code during the study period, and continuous health plan enrollment 12 months prior to and at least 30 days after the index date. Descriptive statistics were used to report study results. RESULTS The study population consisted of 17,694 PWH; mean (SD) age 52.2 (12.8) years; 62.0% were ≥ 50 years old. About 50.6% of the study sample had ≥2 comorbidities at baseline. The most prevalent comorbid conditions were hypertension (33.2%), hyperlipidemia (29.7%), neuropsychiatric conditions (26.9%), and cardiovascular disease (11.5%). Most (93.5%) of PWH received a nucleotide reverse transcriptase inhibitor (NRTI) backbone regimen, including tenofovir alafenamide (41.6%), tenofovir disoproxil fumarate (28.1%), and abacavir (22.0%). The most commonly used anchor agents, 62.6%, were integrase strand transfer inhibitors (INSTIs): dolutegravir (30.4%), elvitegravir (24.2%), and raltegravir (7.3%). The proportion of PWH using specific ARTs did not vary significantly with the presence and type of comorbidities. CONCLUSION From our analyses, ART prescribing did not appear to vary with the presence of comorbidities and potential medication contraindications. ART regimens may have comparable efficacy profiles; however, selection should be guided by each patient's comorbidities to prevent potential comedication drug toxicities.
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Affiliation(s)
| | - Princy Kumar
- Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Misti Paudel
- Optum HEOR, Eden Prairie, MN, USA (at time of study)
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Ermakov AM, Afanasyeva VA, Lazukin AV, Shlyapnikov YM, Zhdanova ES, Kolotova AA, Blagodatski AS, Ermakova ON, Chukavin NN, Ivanov VK, Popov AL. Synergistic Antimicrobial Effect of Cold Atmospheric Plasma and Redox-Active Nanoparticles. Biomedicines 2023; 11:2780. [PMID: 37893152 PMCID: PMC10604215 DOI: 10.3390/biomedicines11102780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Cold argon plasma (CAP) and metal oxide nanoparticles are well known antimicrobial agents. In the current study, on an example of Escherichia coli, a series of analyses was performed to assess the antibacterial action of the combination of these agents and to evaluate the possibility of using cerium oxide and cerium fluoride nanoparticles for a combined treatment of bacterial diseases. The joint effect of the combination of cold argon plasma and several metal oxide and fluoride nanoparticles (CeO2, CeF3, WO3) was investigated on a model of E. coli colony growth on agar plates. The mutagenic effect of different CAP and nanoparticle combinations on bacterial DNA was investigated, by means of a blue-white colony assay and RAPD-PCR. The effect on cell wall damage, using atomic force microscopy, was also studied. The results obtained demonstrate that the combination of CAP and redox-active metal oxide nanoparticles (RAMON) effectively inhibits bacterial growth, providing a synergistic antimicrobial effect exceeding that of any of the agents alone. The combination of CAP and CeF3 was shown to be the most effective mutagen against plasmid DNA, and the combination of CAP and WO3 was the most effective against bacterial genomic DNA. The analysis of direct cell wall damage by atomic force microscopy showed the combination of CAP and CeF3 to be the most effective antimicrobial agent. The combination of CAP and redox-active metal oxide or metal fluoride nanoparticles has a strong synergistic antimicrobial effect on bacterial growth, resulting in plasmid and genomic DNA damage and cell wall damage. For the first time, a strong antimicrobial and DNA-damaging effect of CeF3 nanoparticles has been demonstrated.
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Affiliation(s)
- Artem M. Ermakov
- Hospital of the Pushchino Scientific Center of the Russian Academy of Sciences, 142290 Pushchino, Russia (V.A.A.); (E.S.Z.)
- Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, 142290 Pushchino, Russia; (Y.M.S.); (A.A.K.); (A.S.B.); (O.N.E.); (N.N.C.)
- ANO Engineering Physics Institute, 142210 Serpukhov, Russia
| | - Vera A. Afanasyeva
- Hospital of the Pushchino Scientific Center of the Russian Academy of Sciences, 142290 Pushchino, Russia (V.A.A.); (E.S.Z.)
- Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, 142290 Pushchino, Russia; (Y.M.S.); (A.A.K.); (A.S.B.); (O.N.E.); (N.N.C.)
| | - Alexander V. Lazukin
- Troitsk Institute of Innovative and Thermonuclear Research (JSC “SSC RF TRINITY”), 108840 Moscow, Russia;
| | - Yuri M. Shlyapnikov
- Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, 142290 Pushchino, Russia; (Y.M.S.); (A.A.K.); (A.S.B.); (O.N.E.); (N.N.C.)
| | - Elizaveta S. Zhdanova
- Hospital of the Pushchino Scientific Center of the Russian Academy of Sciences, 142290 Pushchino, Russia (V.A.A.); (E.S.Z.)
- Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, 142290 Pushchino, Russia; (Y.M.S.); (A.A.K.); (A.S.B.); (O.N.E.); (N.N.C.)
| | - Anastasia A. Kolotova
- Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, 142290 Pushchino, Russia; (Y.M.S.); (A.A.K.); (A.S.B.); (O.N.E.); (N.N.C.)
| | - Artem S. Blagodatski
- Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, 142290 Pushchino, Russia; (Y.M.S.); (A.A.K.); (A.S.B.); (O.N.E.); (N.N.C.)
| | - Olga N. Ermakova
- Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, 142290 Pushchino, Russia; (Y.M.S.); (A.A.K.); (A.S.B.); (O.N.E.); (N.N.C.)
| | - Nikita N. Chukavin
- Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, 142290 Pushchino, Russia; (Y.M.S.); (A.A.K.); (A.S.B.); (O.N.E.); (N.N.C.)
- Scientific and Educational Center, State University of Education, 105005 Moscow, Russia
| | - Vladimir K. Ivanov
- Kurnakov Institute of General and Inorganic Chemistry, Russian Academy of Sciences, 119991 Moscow, Russia;
| | - Anton L. Popov
- Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, 142290 Pushchino, Russia; (Y.M.S.); (A.A.K.); (A.S.B.); (O.N.E.); (N.N.C.)
- Scientific and Educational Center, State University of Education, 105005 Moscow, Russia
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Tegene Y, Mengesha S, Kassa A, Toma A, Spigt M. Physical activity and survival in chronic comorbidity among adult HIV patients in Ethiopia: a prospective cohort study. BMC Infect Dis 2023; 23:666. [PMID: 37805463 PMCID: PMC10559655 DOI: 10.1186/s12879-023-08651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Antiretroviral therapy enables people living with HIV to live long lives, and these advances have transformed HIV infection from an acute to a chronic disease. Many non-communicable diseases, including type 2 diabetes, heart disease, and stroke, are influenced by physical inactivity. Therefore, the aim of this study was to assess the level of physical activity and survival in chronic co-morbidity among adult people living with HIV in Ethiopia. METHODS An institution-based prospective cohort study of adult people living with HIV was conducted between 2019 and 2021. We included 422 people living with HIV at baseline. After the baseline visit, 364 patients without hypertension or diabetes, were followed up for two years. Nine trained nurses used a pre-tested, structured questionnaire to collect data during routine care consultations in three hospitals in southern Ethiopia. STATA version 15 was used to analyze the data. To estimate the survival probability of developing chronic comorbidities, a Kaplan-Meier survival curve was used. A Cox proportional hazards model was fitted to identify the predictors of the development of chronic comorbidities. RESULT In the current study, 39% of the participants were found to have a low level of physical activity. Those who had self-management skills to maintain physical activity (p = 0.023), considered physical activity an important aspect of their HIV management (p = 0.003), and regularly attended social support groups (p = 0.002) had significantly higher levels of physical activity. The risk of chronic comorbidity increased over time, with a rate of 10.83 chronic comorbidities per 1000 persons per month. Lack of regular exercise [AHR: 2.04; 95% CI: (1.03, 5.13)], low physical activity [AHR: 2.01; 95% CI: (1.03, 7.89)], BMI greater than 25 kg/m2 [AHR: 2.74; 95% CI: (1.31, 5.12)] and low fruit and vegetable intake [AHR = 2.57; 95% CI: (1.28, 6.49)] were all associated with the development of chronic comorbidity. CONCLUSION The prevalence of physical inactivity is high in the study population. A physical activity program for people living with HIV should be considered, and the promotion of self-management skills should be integrated into HIV care programs.
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Affiliation(s)
- Yadessa Tegene
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia.
| | - Selamawit Mengesha
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Andargachew Kassa
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Alemayehu Toma
- School of Medicine, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Mark Spigt
- School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Qiao S, Zhang J, Liang C, Li X. Using All of Us data to examine the mental health change during COVID-19 pandemic among people living with HIV: A longitudinal study protocol. BMJ Open 2023; 13:e071285. [PMID: 37788923 PMCID: PMC10551941 DOI: 10.1136/bmjopen-2022-071285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has negatively affected people's mental health around the globe. Such effects may be especially compounded among some vulnerable populations such as people living with HIV (PLWH). However, large-scale data on mental health outcomes among PLWH are limited. Few studies have also identified potential protective factors for mental health outcomes. METHODS AND ANALYSIS Guided by theories of resilience and socioecology, we will leverage multiple datasets from National Institutes of Health's Cloud-based All of Us Programme including electronic health records (EHRs), a series of COVID-19 Participant Experience (COPE) Surveys conducted from May 2020 to February 2021, and other self-reported survey data to achieve two specific aims: (1) to examine the mental health outcome changes during COVID-19 pandemic among PLWH by employing both EHR data (2018-2022) and survey data (2020-2021) in the All of Us Programme; and (2) to identify potential protective factors based on COPE Survey data for mental health outcomes at multiple socioecological levels including individual level (eg, coping strategy), interpersonal level (eg, social support) and health institutional level (eg, health service accessibility), adjusting for pre-existing health conditions including psychiatric disorders and other relevant factors (eg, COVID-19 infection). Interaction terms will be included in the multivariable analysis to identify different socially disadvantaged or stigmatised subgroups. ETHICS AND DISSEMINATION The study has been approved by the institutional review board at the University of South Carolina (Pro00124044). Study findings will be disseminated through presentations at academic conferences and publications in peer-reviewed journals.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion Education and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Chen Liang
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
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O’Neil DS, Ayeni OA, Farrow HA, Chen WC, Demetriou G, Buccimazza I, Čačala S, Stopforth LW, Joffe M, Antoni MH, Lopes G, Pumpalova YS, Mapanga W, Jacobson JS, Crew KD, Neugut AI, Ruff P, Cubasch H. The Impact of HIV Infection on Neoadjuvant and Adjuvant Chemotherapy Relative Dose Intensity in South African Patients with Breast Cancer. Oncologist 2023; 28:e921-e929. [PMID: 36943395 PMCID: PMC10546819 DOI: 10.1093/oncolo/oyad056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/07/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION In the South African Breast Cancer and HIV Outcomes (SABCHO) study, we previously found that breast cancer patients living with HIV and treated with neoadjuvant chemotherapy achieve lower rates of complete pathologic response than patients without HIV. We now assess the impact of comorbid HIV on receipt of timely and complete neoadjuvant and adjuvant chemotherapy. MATERIALS AND METHODS Since June 2015, the SABCHO study has collected data on women diagnosed with breast cancer at 6 South African hospitals. We selected a sample of participants with stages I-III cancer who received ≥2 doses of neoadjuvant or adjuvant chemotherapy. Data on chemotherapies prescribed and received, filgrastim receipt, and laboratory values measured during treatment were captured from patients' medical records. We calculated the mean relative dose intensity (RDI) for all prescribed chemotherapies. We tested for association between full regimen RDI and HIV status, using linear regression to control for demographic and clinical covariates, and for association of HIV with laboratory abnormalities. RESULTS The 166 participants living with HIV and 159 without HIV did not differ in median chemotherapy RDI: 0.89 (interquartile range (IQR) 0.77-0.95) among those living with HIV and 0.87 (IQR 0.77-0.94) among women without HIV. Patients living with HIV experienced more grade 3+ anemia and leukopenia than those without HIV (anemia: 10.8% vs. 1.9%, P = .001; leukopenia: 8.4% vs. 1.9%, P = .008) and were more likely to receive filgrastim (24.7% vs. 10.7%, P = .001). CONCLUSIONS HIV status did not impact neoadjuvant or adjuvant chemotherapy RDI, although patients with breast cancer living with HIV experienced more myelotoxicity during treatment.
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Affiliation(s)
- Daniel S O’Neil
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, Yale University, New Haven, CT, USA
| | - Oluwatosin A Ayeni
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hayley A Farrow
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Wenlong Carl Chen
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Georgia Demetriou
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ines Buccimazza
- Department of Specialized Surgery, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu-Natal, Empangeni, South Africa
| | - Sharon Čačala
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Department of Surgery, Ngwelezana Hospital, University of KwaZulu-Natal, Empangeni, South Africa
| | - Laura W Stopforth
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Maureen Joffe
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Michael H Antoni
- Department of Psychology and Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yoanna S Pumpalova
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Witness Mapanga
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine D Crew
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Paul Ruff
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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GAO H, ZHANG J, YANG X, CHEN S, MATHEW R, WEISSMAN S, OLATOSI B, LI X. The incidence and dynamic risk factors of chronic kidney disease among people with HIV. AIDS 2023; 37:1783-1790. [PMID: 37467049 PMCID: PMC10529259 DOI: 10.1097/qad.0000000000003662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVES We investigate the incidence of chronic kidney disease (CKD) among people with HIV (PWH) and the dynamic risk factors associated with CKD incidence. DESIGN A population-based cohort study of PWH in South Carolina. METHODS Adults (age ≥18 years) PWH diagnosed between 2006 and 2019 who were CKD-free at baseline were included. The associations of HIV-related risk factors and conventional risk factors with the incidence of CKD were investigated during the overall study period and by different follow-up periods (i.e. 5, 10, and 15 years) by multivariate logistic regression. RESULTS Among 9514 PWH, the incidence of CKD was 12.39 per 1000 person-years. The overall model indicated that conventional risk factors, such as hypertension, dyslipidemia, cardiovascular disease, and diabetes, were significantly associated with a higher risk of developing CKD. HIV-related characteristics, such as high percentage of days with viral suppression, recent CD4 + cell count, and percentage of retention in care, were associated with a lower risk of CKD compared with their counterparts. In the subgroup analysis, the results were similar for the 5-year and 6-10 years follow-up groups. Among patients who did not develop CKD by the 10th year, the risk factors for developing CKD within 11-15 years were dyslipidemia, diabetes, low recent CD4 + cell count, and short duration of retention in care while other predictors vanished. CONCLUSION Diabetes, CD4 + cell count, and retention in care were persistently associated with CKD despite of follow-up duration. Closely monitoring diabetes and improving CD4 + cell count and retention in care are important to lower the risk of CKD in PWH.
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Affiliation(s)
- Haoyuan GAO
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Jiajia ZHANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xueying YANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Shujie CHEN
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Roy MATHEW
- Division of Nephrology, Department of Medicine Loma Linda VA Health Care System. Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Sharon WEISSMAN
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA, 29208
| | - Bankole OLATOSI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xiaoming LI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
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Remch M, Franceschini N, Davy-Mendez T, Floris-Moore M, Napravnik S. Hypertension burden, treatment, and control among people with HIV at a clinical care center in the Southeastern US, 2014-2019. AIDS Care 2023; 35:1594-1603. [PMID: 36524873 PMCID: PMC10272289 DOI: 10.1080/09540121.2022.2148626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
Hypertension management outcomes in people with HIV (PWH) are not well characterized, despite high hypertension burden. We assessed hypertension prevalence, incidence, treatment, and outcomes among patients with HIV at a clinical center in the southeastern US, from 2014 to 2019. To identify characteristics associated with treatment and outcomes, we estimated adjusted risk ratios (aRR) and 95% confidence intervals (CI). Among 2274 patients, 72% were cisgender men, 56% non-Hispanic Black, median age 47 years, 48% MSM, 12% had CD4 cell count <200 cells/μl, 72% HIV RNA level <400 copies/mL and 39% prevalent hypertension. Hypertension incidence rate was 6.3/100 person-years (95% CI, 5.6-7.0). Among incident hypertension cases (n = 275), 16% (95% CI, 11-20) initiated an antihypertensive within one year. Compared to non-Hispanic white patients, Hispanic (aRR, 6.68; 95% CI, 1.50-29.74) and non-Hispanic Black patients (aRR, 2.18; 95% CI, 0.91-5.24) were more likely to initiate an antihypertensive. Among patients initiating an antihypertensive (n = 178), 63% (95% CI 56-70) experienced blood pressure control within one year. Patients with HIV experienced a high burden of hypertension with notable delays in antihypertensive initiation, as well as gaps in achieving blood pressure control, highlighting opportunities for interventions designed to minimize delays in controlling hypertension in this vulnerable population.
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Affiliation(s)
- Molly Remch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Nora Franceschini
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thibaut Davy-Mendez
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA, USA
| | - Michelle Floris-Moore
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sonia Napravnik
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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71
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Zhang DW, Xu XS, Zhou R, Fu Z. Modulation of HIV-1 capsid multimerization by sennoside A and sennoside B via interaction with the NTD/CTD interface in capsid hexamer. Front Microbiol 2023; 14:1270258. [PMID: 37817748 PMCID: PMC10561090 DOI: 10.3389/fmicb.2023.1270258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Small molecules that bind to the pocket targeted by a peptide, termed capsid assembly inhibitor (CAI), have shown antiviral effects with unique mechanisms of action. We report the discovery of two natural compounds, sennoside A (SA) and sennoside B (SB), derived from medicinal plants that bind to this pocket in the C-terminal domain of capsid (CA CTD). Both SA and SB were identified via a drug-screening campaign that utilized a time-resolved fluorescence resonance energy transfer assay. They inhibited the HIV-1 CA CTD/CAI interaction at sub-micromolar concentrations of 0.18 μM and 0.08 μM, respectively. Mutation of key residues (including Tyr 169, Leu 211, Asn 183, and Glu 187) in the CA CTD decreased their binding affinity to the CA monomer, from 1.35-fold to 4.17-fold. Furthermore, both compounds induced CA assembly in vitro and bound directly to the CA hexamer, suggesting that they interact with CA beyond the CA CTD. Molecular docking showed that both compounds were bound to the N-terminal domain (NTD)/CTD interface between adjacent protomers within the CA hexamer. SA established a hydrogen-bonding network with residues N57, V59, Q63, K70, and N74 of CA1-NTD and Q179 of CA2-CTD. SB formed hydrogen bonds with the N53, N70, and N74 residues of CA1-NTD, and the A177and Q179 residues of CA2-CTD. Both compounds, acting as glue, can bring αH4 in the NTD and αH9 in the CTD of the NTD/CTD interface close to each other. Collectively, our research indicates that SA and SB, which enhance CA assembly, could serve as novel chemical tools to identify agents that modulate HIV-1 CA assembly. These natural compounds may potentially lead to the development of new antiviral therapies with unique mechanisms of action.
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Affiliation(s)
- Da-Wei Zhang
- Institute of Bioinformatics and Medical Engineering, School of Electrical and Information Engineering, Jiangsu University of Technology, Changzhou, China
| | - Xiao-Shuang Xu
- Institute of Bioinformatics and Medical Engineering, School of Electrical and Information Engineering, Jiangsu University of Technology, Changzhou, China
| | - Rui Zhou
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiguo Fu
- Department of Orthopedics, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
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Likhtshteyn M, Marzouk E, Arroyo-Mercado FM, Chawla G, Rosengarten S, Lerer R, Ojeda-Martinez H, Thor S. Human immunodeficiency virus patients with low CD4 counts are more likely to have precancerous polyps identified during index colonoscopy. World J Gastrointest Endosc 2023; 15:545-552. [PMID: 37744318 PMCID: PMC10514706 DOI: 10.4253/wjge.v15.i9.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) has improved the life expectancy of patients living with human immunodeficiency virus (HIV). As these patients age, they are at increased risk for developing non-acquired immunodeficiency syndrome defining malignancies (NADMs) such as colon cancers. AIM To determine which factors are associated with the development of precancerous polyps on screening colonoscopy in patients with HIV and to investigate whether HIV disease status, measured by viral load and CD4 count, might influence precancerous polyp development. METHODS A retrospective review of records at two urban academic medical centers was performed for HIV patients who had a screening colonoscopy between 2005-2015. Patients with a history of colorectal cancer or polyps, poor bowel preparation, or inflammatory bowel disease were excluded. Demographic data such as sex, age, race, and body mass index (BMI) as well as information regarding the HIV disease status such as CD4 count, viral load, and medication regimen were collected. Well-controlled patients were defined as those that had viral load < 50 copies, and poorly-controlled patients were those with viral load ≥ 50. Patients were also stratified based on their CD4 count, comparing those with a low CD4 count to those with a high CD4 count. Using colonoscopy reports in the medical record, the size, histology, and number of polyps were recorded for each patient. Precancerous polyps included adenomas and proximal serrated polyps. Data was analyzed using Fisher's exact tests and logistic regression through SAS 3.8 software. RESULTS Two hundred and seven patients met our inclusion criteria. The mean age was 56.13 years, and 58% were males. There were no significant differences in terms of age, race or ethnicity, insurance, and smoking status between patients with CD4 counts above or below 500. BMI was lower in patients with CD4 count < 500 as compared to those with count > 500 (P = 0.0276). In patients with CD4 > 500, 53.85% of patients were female, and 70.87% of patients with CD4 < 500 were male (P = 0.0004). Only 1.92% of patients with CD4 ≥ 500 had precancerous polyps vs 10.68% of patients with CD4 < 500 (P = 0.0102). When controlled for sex, BMI, and ART use, patients with CD4 < 500 were 9.01 times more likely to have precancerous polyps [95% confidence interval (CI): 1.69-47.97; P = 0.0100]. Patients taking non-nucleoside reverse transcriptase inhibitors were also found to be 10.23 times more likely to have precancerous polyps (95%CI: 1.08-97.15; P = 0.0428). There was not a significant difference noted in precancerous polyps between those that had viral loads greater or less than 50 copies. CONCLUSION Patients with low CD4 counts were more likely to have precancerous polyps on their screening colonoscopy although the etiology for this association is unclear. We also found an increased risk of precancerous polyps in patients taking non-nucleoside reverse transcriptase inhibitors, which is contradictory to prior literature showing ART has decreased the risk of development of NADMs. However, there have not been studies looking at colorectal cancer and ART by drug class, to our knowledge. Further prospective studies are needed to determine the effect of HIV control and therapies on polyp development.
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Affiliation(s)
- Michelle Likhtshteyn
- Department of Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Evan Marzouk
- Department of Internal Medicine and Pediatrics, Baystate Medical Center, Springfield, IL 01199, United States
| | - Fray M Arroyo-Mercado
- Department of Gastroenterology, University of New Mexico, Albuquerque, NM 87106, United States
| | - Gurasees Chawla
- Department of Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Sabrina Rosengarten
- Department of Emergency Medicine, New York-Presbyterian Queens Hospital, Queens, NY 11355, United States
| | - Renata Lerer
- Department of Gastroenterology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Hector Ojeda-Martinez
- Department of Infectious Disease, Nuvance Health-Vassar Brothers Medical Center, Poughkeepsie, NY 12601, United States
| | - Savanna Thor
- Department of Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
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Ke S, Fang Q, Lan J, Qiao N, Zhang X, Xie C, Fan Y. Survival times of HIV/AIDS in different AIDS Diagnostic and Treatment Guidelines from 2006 to 2020 in Liuzhou, China. BMC Public Health 2023; 23:1745. [PMID: 37679721 PMCID: PMC10483872 DOI: 10.1186/s12889-023-15662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/12/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND To compare the survival rates of four timing of treatment initiation for people living with HIV/AIDS provided in China in 2006, 2011, 2015, and 2018, and to investigate the factors impacting survival time. METHODS A people living with HIV/AIDS retrospective cohort study was in Liuzhou City from April 2006 to December 2020. The information was obtained from the National Comprehensive AIDS Prevention and Control Information System. Life tables and the Kaplan-Meier method were used to calculate participant survival rates and time. The univariate and multivariate Cox regression models were used to investigate the factors related to survival. RESULTS 18,543 participants were included in this study. In four periods, the 1-year survival rates were 81%, 87%, 95%, and 95%. The 2-year survival rates were 76%, 85%, 93%, and 94%. The 3-year survival rates were 73%, 84%, 92%, and 94%. Results of multivariate Cox regression showed that sex, age of HIV diagnosis, ethnicity, household registration, occupation, marital status, the timing of treatment, education level, route of HIV transmission, whether receiving antiretroviral therapy (ART), and the count of CD4+T cells at baseline (count of CD4+T cells at HIV diagnosis) were factors that are significantly correlated with mortality caused by HIV infection. CONCLUSIONS With the Guidelines updated from 2006 to 2020, the 1-, 2-, and 3-year survival rates of people living with HIV/AIDS in four periods tended to increase. The timing of treatment initiation of the updated edition of the AIDS Diagnostic and Treatment Guidelines (Guidelines) significantly prolonged the survival time of people living with HIV/AIDS.
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Affiliation(s)
- Susu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Quan Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Jianguo Lan
- Liuzhou Center for Disease Control and Prevention, 1 Tanzhongxi Road, Liuzhou, 545000, Guangxi Zhuang Autonomous Region, China
| | - Nini Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Xinhong Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Changping Xie
- Liuzhou Center for Disease Control and Prevention, 1 Tanzhongxi Road, Liuzhou, 545000, Guangxi Zhuang Autonomous Region, China.
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.
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Trickey A, Ingle SM, Boyd A, Gill MJ, Grabar S, Jarrin I, Obel N, Touloumi G, Zangerle R, Rauch A, Rentsch CT, Satre DD, Silverberg MJ, Bonnet F, Guest J, Burkholder G, Crane H, Teira R, Berenguer J, Wyen C, Abgrall S, Hessamfar M, Reiss P, d’Arminio Monforte A, McGinnis KA, Sterne JAC, Wittkop L. Contribution of alcohol use in HIV/hepatitis C virus co-infection to all-cause and cause-specific mortality: A collaboration of cohort studies. J Viral Hepat 2023; 30:775-786. [PMID: 37338017 PMCID: PMC10526649 DOI: 10.1111/jvh.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
Among persons with HIV (PWH), higher alcohol use and having hepatitis C virus (HCV) are separately associated with increased morbidity and mortality. We investigated whether the association between alcohol use and mortality among PWH is modified by HCV. Data were combined from European and North American cohorts of adult PWH who started antiretroviral therapy (ART). Self-reported alcohol use data, collected in diverse ways between cohorts, were converted to grams/day. Eligible PWH started ART during 2001-2017 and were followed from ART initiation for mortality. Interactions between the associations of baseline alcohol use (0, 0.1-20.0, >20.0 g/day) and HCV status were assessed using multivariable Cox models. Of 58,769 PWH, 29,711 (51%), 23,974 (41%) and 5084 (9%) self-reported alcohol use of 0 g/day, 0.1-20.0 g/day, and > 20.0 g/day, respectively, and 4799 (8%) had HCV at baseline. There were 844 deaths in 37,729 person-years and 2755 deaths in 443,121 person-years among those with and without HCV, respectively. Among PWH without HCV, adjusted hazard ratios (aHRs) for mortality were 1.18 (95% CI: 1.08-1.29) for 0.0 g/day and 1.84 (1.62-2.09) for >20.0 g/day compared with 0.1-20.0 g/day. This J-shaped pattern was absent among those with HCV: aHRs were 1.00 (0.86-1.17) for 0.0 g/day and 1.64 (1.33-2.02) for >20.0 g/day compared with 0.1-20.0 g/day (interaction p < .001). Among PWH without HCV, mortality was higher in both non-drinkers and heavy drinkers compared with moderate alcohol drinkers. Among those with HCV, mortality was higher in heavy drinkers but not non-drinkers, potentially due to differing reasons for not drinking (e.g. illness) between those with and without HCV.
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Affiliation(s)
- Adam Trickey
- Population Health SciencesUniversity of BristolBristolUK
| | | | - Anders Boyd
- Stichting HIV MonitoringAmsterdamThe Netherlands
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCUniversity of Amsterdam, Infectious DiseasesAmsterdamThe Netherlands
| | - M. John Gill
- South Alberta HIV Clinic, Department of MedicineUniversity of CalgaryCalgaryCanada
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP)ParisFrance
- Department of Public HealthAP‐HP, St Antoine HospitalParisFrance
| | - Inma Jarrin
- National Centre of EpidemiologyCarlos III Health InstituteMadridSpain
- CIBER de Enfermedades InfecciosasInstituto de Salud Carlos III
| | - Niels Obel
- Department of Infectious DiseasesCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS)Medizinische Universität InnsbruckInnsbruchAustria
| | - Andri Rauch
- Department of Infectious Diseases, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Christopher T. Rentsch
- Yale School of Medicine and VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Derek D. Satre
- Department of Psychiatry and Behavioral SciencesWeill Institute for Neurosciences, University of CaliforniaSan FranciscoUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | | | - Fabrice Bonnet
- Institut Bergonié, BPH, U1219, CIC‐EC 1401, INSERM, Univ. BordeauxBordeauxFrance
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, INSERMInstitut Bergonié Hôpital St‐André, CIC‐EC 1401BordeauxFrance
| | - Jodie Guest
- Atlanta VA Medical CenterDecaturGeorgiaUSA
- Rollins School of Public Health at Emory UniversityAtlantaGeorgiaUSA
| | | | - Heidi Crane
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Ramon Teira
- Servicio de Medicina InternaHospital Universitario de SierrallanaTorrelavegaSpain
| | - Juan Berenguer
- Hospital General Universitario Gregorio MarañónMadridSpain
| | - Christoph Wyen
- Department I for Internal MedicineUniversity Hospital of CologneCologneGermany
| | - Sophie Abgrall
- APHP, Service de Médecine Interne, Hôpital BéclèreClamartFrance
- CESP, INSERM U1018, Université Paris‐Saclay, UVSQ, Le Kremlin‐BicêtreVillejuifFrance
| | - Mojgan Hessamfar
- Institut Bergonié, BPH, U1219, CIC‐EC 1401, INSERM, Univ. BordeauxBordeauxFrance
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, INSERMInstitut Bergonié Hôpital St‐André, CIC‐EC 1401BordeauxFrance
| | - Peter Reiss
- Stichting HIV MonitoringAmsterdamThe Netherlands
- Department of Global HealthAmsterdam University Medical CentersAmsterdamThe Netherlands
- Amsterdam Institute for Global Health and DevelopmentAmsterdamThe Netherlands
| | - Antonella d’Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health SciencesASST Santi Paolo e Carlo, University HospitalMilanItaly
| | - Kathleen A. McGinnis
- Yale School of Medicine and VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Jonathan A. C. Sterne
- Population Health SciencesUniversity of BristolBristolUK
- NIHR Bristol Biomedical Research CentreBristolUK
- Health Data Research UK South‐WestBristolUK
| | - Linda Wittkop
- Institut Bergonié, BPH, U1219, CIC‐EC 1401, INSERM, Univ. BordeauxBordeauxFrance
- INRIA SISTM TeamTalenceFrance
- CHU de Bordeaux, Service d'information Médicale, INSERMInstitut Bergonié, CIC‐EC 1401BordeauxFrance
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Mostert CM, Ngugi A, Muchungi K, Shah J, Bosire E, Merali Z, Kumar M. Streamlining Global and Local Data on HIV: Underscoring Role of Institutions and Ethics in Improving Quality of HIV Research. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1296-1300. [PMID: 37244416 DOI: 10.1016/j.jval.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES There are inconsistencies in the South Africa HIV mortality data reported by Institute of Health Metrics and Evaluation (IHME), Joint United Nations Programme on HIV/AIDS (UNAIDS), and Statistics South Africa (StatsSA) platforms. Between 2006 and 2016, these global data sets (IHME and UNAIDS) show that HIV-related mortalities were improving in South Africa, whereas StatsSA argues the opposite. We explain the causes of this differing stands and highlight areas that may be improved to address such inconsistencies. METHODS This observational analysis uses data from IHME, UNAIDS, and StatsSA platforms. RESULTS We demonstrate that IHME and UNAIDS data sets are based on a mathematical compartmental model, which is not dynamic to all HIV epidemiological aspects. Such limitation may cause inflated improvement in HIV mortality outcomes that are not in line with HIV mortality evidence recorded at the household level as demonstrated by StatsSA. CONCLUSION There is a need to streamline the IHME, UNAIDS, and StatsSA data on HIV to improve the quality of HIV research and programming in South Africa.
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Affiliation(s)
- Cyprian M Mostert
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya; Department of Population Health, Aga Khan University, Nairobi, Kenya.
| | - Antony Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Kendi Muchungi
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Edna Bosire
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Zul Merali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Elizaldi SR, Verma A, Ma ZM, Ott S, Rajasundaram D, Cottrell ML, Kashuba ADM, Ambrose Z, Lifson JD, Morrison JH, Iyer SS. CD4 T cell Responses in the CNS during SIV infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.24.554055. [PMID: 37662237 PMCID: PMC10473718 DOI: 10.1101/2023.08.24.554055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Virologic suppression with antiretroviral therapy (ART) has significantly improved health outcomes for people living with HIV, yet challenges related to chronic inflammation in the central nervous system (CNS) - known as Neuro-HIV- persist. As primary targets for HIV-1 with the ability to survey and populate the CNS and interact with myeloid cells to co-ordinate neuroinflammation, CD4 T cells are pivotal in Neuro-HIV. Despite their importance, our understanding of CD4 T cell distribution in virus-targeted CNS tissues, their response to infection, and potential recovery following initiation of ART remain limited. To address these gaps, we studied ten SIVmac251-infected rhesus macaques using an ART regimen simulating suboptimal adherence. We evaluated four macaques during the acute phase pre-ART and six during the chronic phase. Our data revealed that HIV target CCR5+ CD4 T cells inhabit both the brain parenchyma and adjacent CNS tissues, encompassing choroid plexus stroma, dura mater, and the skull bone marrow. Aligning with the known susceptibility of CCR5+ CD4 T cells to viral infection and their presence within the CNS, high levels of viral RNA were detected in the brain parenchyma and its border tissues during acute SIV infection. Single-cell RNA sequencing of CD45+ cells from the brain revealed colocalization of viral transcripts within CD4 clusters and significant activation of antiviral molecules and specific effector programs within T cells, indicating CNS CD4 T cell engagement during infection. Despite viral suppression with ART, acute infection led to significant depletion of CNS CD4 T cells, persisting into the chronic phase. These findings underscore the functional involvement of CD4 T cells within the CNS during SIV infection, enhancing our understanding of their role in establishing CNS viral presence. Our results offer insights for potential T cell-focused interventions while also underscoring the challenges in eradicating HIV from the CNS, even with effective ART.
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Affiliation(s)
| | - Anil Verma
- Department of Pathology, School of Medicine, University of Pittsburgh, PA, USA
| | - Zhong-Min Ma
- California National Primate Research Center, UC Davis, CA, USA
| | - Sean Ott
- California National Primate Research Center, UC Davis, CA, USA
| | | | | | - Angela D M Kashuba
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Zandrea Ambrose
- Department of Microbiology and Molecular Genetics, School of Medicine, University of Pittsburgh, PA, USA
| | - Jeffrey D Lifson
- AIDS and Cancer Virus Program, Frederick National Laboratory, Frederick, MD, USA
| | - John H Morrison
- California National Primate Research Center, UC Davis, CA, USA
- Department of Neurology, School of Medicine, UC Davis, CA,USA
| | - Smita S Iyer
- Department of Pathology, School of Medicine, University of Pittsburgh, PA, USA
- California National Primate Research Center, UC Davis, CA, USA
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, UC Davis, CA,USA
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Bekker LG, Beyrer C, Mgodi N, Lewin SR, Delany-Moretlwe S, Taiwo B, Masters MC, Lazarus JV. HIV infection. Nat Rev Dis Primers 2023; 9:42. [PMID: 37591865 DOI: 10.1038/s41572-023-00452-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
The AIDS epidemic has been a global public health issue for more than 40 years and has resulted in ~40 million deaths. AIDS is caused by the retrovirus, HIV-1, which is transmitted via body fluids and secretions. After infection, the virus invades host cells by attaching to CD4 receptors and thereafter one of two major chemokine coreceptors, CCR5 or CXCR4, destroying the host cell, most often a T lymphocyte, as it replicates. If unchecked this can lead to an immune-deficient state and demise over a period of ~2-10 years. The discovery and global roll-out of rapid diagnostics and effective antiretroviral therapy led to a large reduction in mortality and morbidity and to an expanding group of individuals requiring lifelong viral suppressive therapy. Viral suppression eliminates sexual transmission of the virus and greatly improves health outcomes. HIV infection, although still stigmatized, is now a chronic and manageable condition. Ultimate epidemic control will require prevention and treatment to be made available, affordable and accessible for all. Furthermore, the focus should be heavily oriented towards long-term well-being, care for multimorbidity and good quality of life. Intense research efforts continue for therapeutic and/or preventive vaccines, novel immunotherapies and a cure.
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Affiliation(s)
- Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, RSA, Cape Town, South Africa.
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | | | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Mazzitelli M, Sasset L, Gardin S, Leoni D, Trunfio M, Scaglione V, Mengato D, Agostini E, Vania E, Putaggio C, Cattelan A. Real-Life Experience on Dolutegravir and Lamivudine as Initial or Switch Therapy in a Silver Population Living with HIV. Viruses 2023; 15:1740. [PMID: 37632082 PMCID: PMC10459453 DOI: 10.3390/v15081740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Clinical trials and real-life studies have granted the efficacy and safety of dolutegravir and lamivudine (DTG/3TC) in naïve and experienced people living with HIV (PLWH), but there are no long-term data in elderly people. We herein describe our real-life cohort of PLWH who were ≥65 years of age (PLWH ≥ 65) who started or were switched to DTG/3TC, single-tablet regimen, or DTG plus 3TC. METHODS We considered laboratory/clinical parameter changes from the baseline to the last follow-up time point available for each person by the paired Wilcoxon test and analyzed factors associated with virological failure (VF) and discontinuation. RESULTS We included 112 PLWH with a median age of 66 (IQR: 65-70) years, 77.6% males; 84.8% of people had multimorbidity, 34.8% were on polypharmacy, and only 5.4% were naïve to treatment. Reasons to be switched to DTG/3TC were: abacavir removal (38.7%), treatment simplification (33.1%), and PI discontinuation (28.2%). The median treatment durability was 6 (IQR: 5.4-7) years. No significant changes were detected in metabolic, renal, immunological, or cardiovascular biomarkers during follow-up. HIV RNA undetectability was maintained in 104 (92.8%) individuals for whom follow-up evaluation was available. We observed eight discontinuations (two deaths, two VFs, two early intolerances, one significant weight gain, and one switch to long-acting therapy). No factors were significantly associated with VF or discontinuation. CONCLUSIONS This is the first study on DTG/3TC in PLWH ≥ 65 with a follow-up longer than 5 years. DTG/3TC was found to be safe and effective, neutral on metabolic parameters, and with a low discontinuation rate for toxicity or VF.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Samuele Gardin
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Davide Leoni
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Mattia Trunfio
- Infectious Diseases Unit, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy;
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Daniele Mengato
- Hospital Pharmacy Unit, Padua University Hospital, 35128 Padua, Italy
| | - Elena Agostini
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Eleonora Vania
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
- Infectious Disease Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Cristina Putaggio
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
- Department of Molecular Medicine, University of Padua, 35131 Padua, Italy
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79
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Abie A, Damessa M. The Influence of Age-Associated Comorbidities on Responses to Combination Antiretroviral Therapy Among People Living with HIV, at the ART Clinic of Jimma Medical Center, Ethiopia: A Hospital-Based Nested Case-Control Study. HIV AIDS (Auckl) 2023; 15:457-475. [PMID: 37583543 PMCID: PMC10423692 DOI: 10.2147/hiv.s421523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Despite the high prevalence of age-associated comorbidities in HIV patients in sub-Saharan Africa, there is a lack of data on their influence on treatment outcomes in HIV patients. Therefore, this study aimed to assess the impact of age-associated comorbidities on responses to antiretroviral therapy (ART) among people living with HIV. Methods A hospital-based nested case-control study was conducted among adult HIV-infected patients at the Jimma Medical Center from January 3 to June 2, 2022. Data were recorded by interviewing the patients and their medical chart and analyzed using The Statistical Package for Social Science (SPSS) v. 23, and at p <0.05. The Results The overall immunological and virologic failure rates were 13.8% and 13.4%, respectively. Being male [AOR = 3.079,95% CI (1.139-8.327)], having age-associated comorbidity [AOR:10.57,95% CI (2.810-39.779)], age ≥ 50 years [AOR = 2.855, 95% CI (1.023-7.9650)], alcohol intake [AOR = 3.648,95% CI (1.118-11.897)], and having a baseline CD4+ count of < 200 cells/uL [AOR:3.862, 95% CI (1.109-13.456) were an independent predictor of immunological failure; Whereas Being alcoholic [AOR:3.11, 95% CI (1.044-9.271)], having a baseline CD4+ count of < 200 cells/uL [AOR:5.11, 95% CI (1.547-16.892)], a low medication adherence [AOR:5.92, 95% CI (1.81-19.36)], bedridden baseline functional status [AOR:3.902, 95% CI (1.237-12.307)], and lack of cotrimoxazole prophylaxis [AOR:2.735,95% CI (1.084-6.902)] were found to be an independent predictor of virologic treatment failure, but being younger (age < 50 years) was protective for virologic failure. Conclusion Out of the eight patients who were treated for HIV at least one patient had developed immunological and/or virological failure. Age-associated comorbid chronic non-communicable diseases highly influence immunological outcomes compared with virological outcomes. Health providers should pay attention to age-associated comorbidities, encourage lifestyle modifications, and counsel on medication adherence to improve clinical outcomes in patients with HIV.
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Affiliation(s)
- Abebaw Abie
- Department of Pharmacy, College of Medicine and Health Science, Debre-Markos University, Debre-Markos, Ethiopia
| | - Mekonnen Damessa
- Department of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Chalouni M, Trickey A, Ingle SM, Sepuvelda MA, Gonzalez J, Rauch A, Crane HM, Gill MJ, Rebeiro PF, Rockstroh JK, Franco RA, Touloumi G, Neau D, Laguno M, Rappold M, Smit C, Sterne JAC, Wittkop L. Impact of hepatitis C cure on risk of mortality and morbidity in people with HIV after antiretroviral therapy initiation. AIDS 2023; 37:1573-1581. [PMID: 37199601 DOI: 10.1097/qad.0000000000003594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Hepatitis C virus (HCV) co-infection is associated with increased morbidity and mortality in people with HIV (PWH). Sustained virological response (SVR) decreases the risk of HCV-associated morbidity. We compared mortality, risk of AIDS-defining events, and non-AIDS nonliver (NANL) cancers between HCV-co-infected PWH who reached SVR and mono-infected PWH. DESIGN Adult PWH from 21 cohorts in Europe and North America that collected HCV treatment data were eligible if they were HCV-free at the time of ART initiation. METHODS Up to 10 mono-infected PWH were matched (on age, sex, date of ART start, HIV acquisition route, and being followed at the time of SVR) to each HCV-co-infected PWH who reached SVR. Cox models were used to estimate relative hazards (hazard ratio) of all-cause mortality, AIDS-defining events, and NANL cancers after adjustment. RESULTS Among 62 495 PWH, 2756 acquired HCV, of whom 649 reached SVR. For 582 of these, at least one mono-infected PWH could be matched, producing a total of 5062 mono-infected PWH. The estimated hazard ratios comparing HCV-co-infected PWH who reached SVR with mono-infected PWH were 0.29 [95% confidence interval (CI) 0.12-0.73] for mortality, 0.85 [0.42-1.74] for AIDS-defining events, and 1.21 [0.86-1.72] for NANL cancer. CONCLUSION PWH who reached SVR a short time after HCV acquisition were not at higher risk of overall mortality compared with mono-infected PWH. However, the apparent higher risk of NANL cancers in HCV-co-infected PWH who reached SVR after a DAA-based treatment compared with mono-infected PWH, though compatible with a null association, suggests a need for monitoring of those events following SVR.
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Affiliation(s)
- Mathieu Chalouni
- University Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux
- INRIA SISTM Team, Talence, France
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Suzanne M Ingle
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Juan Gonzalez
- HIV Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Peter F Rebeiro
- Department of Medicine & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Ricardo A Franco
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Giota Touloumi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Didier Neau
- CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, INSERM, U1219, Pl. Amélie Raba Léon, Bordeaux, France
| | | | - Michaela Rappold
- Department of Dermatology and Venereology, Medical University of Innsbruck
- Austrian HIV Cohort Study, Innsbruck, Austria
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | | | - Linda Wittkop
- University Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux
- INRIA SISTM Team, Talence, France
- CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
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81
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Moreno S, Rivero A, Ventayol P, Falcó V, Torralba M, Schroeder M, Neches V, Vallejo-Aparicio LA, Mackenzie I, Turner M, Harrison C. Cabotegravir and Rilpivirine Long-Acting Antiretroviral Therapy Administered Every 2 Months is Cost-Effective for the Treatment of HIV-1 in Spain. Infect Dis Ther 2023; 12:2039-2055. [PMID: 37452174 PMCID: PMC10505114 DOI: 10.1007/s40121-023-00840-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Current antiretroviral therapies (ARTs) have improved outcomes for people living with HIV. However, the requirement to adhere to lifelong daily oral dosing may be challenging for some people living with HIV, leading to suboptimal adherence and therefore reduced treatment effectiveness. Treatment with long-acting (LA) ART may improve adherence and health-related quality of life. The objective of this study was to evaluate the cost-effectiveness of cabotegravir + rilpivirine (CAB+RPV) LA administered every 2 months (Q2M) compared with current ART administered as daily oral single-tablet regimens (STRs) from a Spanish National Healthcare System perspective. METHODS A hybrid decision-tree and Markov state-transition model was used with pooled data from three phase III/IIIb trials (FLAIR, ATLAS, and ATLAS-2M) over a lifetime horizon, with health states defined by viral load and CD4+ cell count. Direct costs (in €) were taken from Spanish public sources from 2021 and several deterministic and probabilistic analyses were carried out. An annual 3% discount rate was applied to both costs and utilities. RESULTS Over the lifetime horizon, CAB+RPV LA Q2M was associated with an additional 0.27 quality-adjusted life years (QALYs) and slightly greater lifetime costs (€4003) versus daily oral ART, leading to an incremental cost-effectiveness ratio of €15,003/QALY, below the commonly accepted €30,000/QALY willingness-to-pay threshold in Spain. All scenario analyses showed consistent results, and the probabilistic sensitivity analysis showed cost-effectiveness compared with daily oral STRs in 62.4% of simulations, being dominant in 0.3%. CONCLUSION From the Spanish National Health System perspective, CAB+RPV LA Q2M is a cost-effective alternative compared with the current options of daily oral STR regimens for HIV treatment. CLINICAL TRIALS REGISTRATION ATLAS, NCT02951052; ATLAS-2M, NCT03299049; FLAIR, NCT02938520.
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Affiliation(s)
- Santiago Moreno
- Hospital Ramón y Cajal, CIBERINFEC, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | | | | | | | | | | | - Victoria Neches
- Market Access, GSK, P.T.M Severo Ochoa, 2-28760, Tres Cantos, Madrid, Spain.
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Fisher MC, Hoover DR, Shi Q, Sharma A, Estrella MM, Adimora A, Alcaide M, Collins LF, French A, Gao W, Koletar SL, Mcfarlane SI, Mckay H, Dionne JA, Palella F, Sarkar S, Spence A, Witt MD, Ross MJ. Association of marijuana, tobacco and alcohol use with estimated glomerular filtration rate in women living with HIV and women without HIV. AIDS 2023; 37:1555-1564. [PMID: 37352493 PMCID: PMC10859004 DOI: 10.1097/qad.0000000000003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Marijuana, tobacco and alcohol use are prevalent among people with HIV and may adversely affect kidney function in this population. We determined the association of use of these substances with estimated glomerular filtration rate (eGFR) among women with HIV (WWH) and women without HIV. DESIGN We undertook a repeated measures study of 1043 WWH and 469 women without HIV within the United States Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-seropositive and HIV-seronegative women. METHODS We quantified substance exposures using semi-annual questionnaires. Using pooled eGFR data from 2009 to 2019, we used linear regression models with multivariable generalized estimating equations to ascertain associations between current and cumulative substance use exposures with eGFR, adjusting for sociodemographics, chronic kidney disease risk factors and HIV-related factors. RESULTS Marijuana use of 1-14 days/month versus 0 days/month was associated with 3.34 ml/min per 1.73 m 2 [95% confidence interval (CI) -6.63, -0.06] lower eGFR and marijuana use of >0.02-1.6 marijuana-years versus 0-0.2 marijuana-years was associated with 3.61 ml/min per 1.73 m 2 (95% CI -5.97, -1.24) lower eGFR. Tobacco use was not independently associated with eGFR. Alcohol use of seven or more drinks/week versus no drinks/week was associated with 5.41 ml/min per 1.73 m 2 (95% CI 2.34, 8.48) higher eGFR and alcohol use of >0.7-4.27 drink-years and >4.27 drink-years versus 0-0.7 drink-years were associated with 2.85 ml/min per 1.73 m 2 (95% CI 0.55, 5.15) and 2.26 ml/min per 1.73 m 2 (95% CI 0.33, 4.20) higher eGFR, respectively. CONCLUSION Among a large cohort of WWH and women without HIV, marijuana use was associated with a lower eGFR while alcohol use was associated with a higher eGFR.
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Affiliation(s)
- Molly C. Fisher
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
| | - Donald R. Hoover
- Department of Statistics and Institute for Health, Healthcare Policy and Aging Research, Rutgers University, Piscataway, New Jersey
| | - Qiuhu Shi
- Department of Public Health, New York Medical College, Valhalla
| | - Anjali Sharma
- Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York
| | - Michelle M. Estrella
- Division of Nephrology and Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center and University of California, San Francisco, California
| | - Adaora Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Maria Alcaide
- University of Miami Miller School of Medicine, Miami, Florida
| | - Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Susan L. Koletar
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Samy I. Mcfarlane
- State University of New York, Downstate Health Science University, Brooklyn, New York
| | - Heather Mckay
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jodie A. Dionne
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Frank Palella
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sudipa Sarkar
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda Spence
- Department of Medicine, Division of Infectious Disease and Tropical Medicine, Georgetown University, Washington, DC
| | - Mallory D. Witt
- Lundquist Research Institute at Harbor, UCLA Medical Center, Torrance, California, USA
| | - Michael J. Ross
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
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Aoki M, Aoki-Ogata H, Bulut H, Hayashi H, Takamune N, Kishimoto N, Tanaka H, Higashi-Kuwata N, Hattori SI, Das D, Venkateswara Rao K, Iwama K, Davis DA, Hasegawa K, Murayama K, Yarchoan R, Ghosh AK, Pau AK, Machida S, Misumi S, Mitsuya H. GRL-142 binds to and impairs HIV-1 integrase nuclear localization signal and potently suppresses highly INSTI-resistant HIV-1 variants. SCIENCE ADVANCES 2023; 9:eadg2955. [PMID: 37436982 PMCID: PMC10337902 DOI: 10.1126/sciadv.adg2955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/08/2023] [Indexed: 07/14/2023]
Abstract
Nuclear localization signal (NLS) of HIV-1 integrase (IN) is implicated in nuclear import of HIV-1 preintegration complex (PIC). Here, we established a multiclass drug-resistant HIV-1 variant (HIVKGD) by consecutively exposing an HIV-1 variant to various antiretroviral agents including IN strand transfer inhibitors (INSTIs). HIVKGD was extremely susceptible to a previously reported HIV-1 protease inhibitor, GRL-142, with IC50 of 130 femtomolar. When cells were exposed to HIVKGD IN-containing recombinant HIV in the presence of GRL-142, significant decrease of unintegrated 2-LTR circular cDNA was observed, suggesting that nuclear import of PIC was severely compromised by GRL-142. X-ray crystallographic analyses revealed that GRL-142 interacts with NLS's putative sequence (DQAEHLK) and sterically blocks the nuclear transport of GRL-142-bound HIVKGD's PIC. Highly INSTI-resistant HIV-1 variants isolated from heavily INSTI-experienced patients proved to be susceptible to GRL-142, suggesting that NLS-targeting agents would serve as salvage therapy agents for highly INSTI-resistant variant-harboring individuals. The data should offer a new modality to block HIV-1 infectivity and replication and shed light on developing NLS inhibitors for AIDS therapy.
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Affiliation(s)
- Manabu Aoki
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Medical Technology, Kumamoto Health Science University, Kumamoto, Japan
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
| | - Hiromi Aoki-Ogata
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
| | - Haydar Bulut
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hironori Hayashi
- Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of infectious Diseases, International Research Institute of Disaster Science, Tohoku University, Miyagi, Japan
| | - Nobutoki Takamune
- Department of Environmental and Molecular Health Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoki Kishimoto
- Department of Environmental and Molecular Health Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Tanaka
- Department of Structural Virology, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
| | - Nobuyo Higashi-Kuwata
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
| | - Shin-ichiro Hattori
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
| | - Debananda Das
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Kazuya Iwama
- Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of infectious Diseases, International Research Institute of Disaster Science, Tohoku University, Miyagi, Japan
| | - David A. Davis
- Viral Oncology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kazuya Hasegawa
- Structural Biology Division, Japan Synchrotron Radiation Research Institute, Hyogo, Japan
| | - Kazutaka Murayama
- Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering, Tohoku University, Miyagi, Japan
| | - Robert Yarchoan
- Viral Oncology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arun K. Ghosh
- Departments of Chemistry and Medicinal Chemistry, Purdue University, West Lafayette, IN, USA
| | - Alice K. Pau
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Shinichi Machida
- Department of Structural Virology, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
| | - Shogo Misumi
- Department of Environmental and Molecular Health Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroaki Mitsuya
- Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
- Division of Clinical Sciences, Kumamoto University Hospital, Kumamoto, Japan
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Filipkowski AM, Kundu S, Eden SK, Alcorn CW, Justice AC, So-Armah KA, Tindle HA, Wells QS, Beckman JA, Freiberg MS, Aday AW. Association of HIV Infection and Incident Abdominal Aortic Aneurysm Among 143 001 Veterans. Circulation 2023; 148:135-143. [PMID: 37226738 PMCID: PMC10443901 DOI: 10.1161/circulationaha.122.063040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND People with HIV (PWH) have an increased risk of cardiovascular disease. Previous cross-sectional data suggest there is a higher prevalence of abdominal aortic aneurysm (AAA) in PWH than in those without HIV. Whether PWH have an increased risk of incident AAA compared with those without HIV is unknown. METHODS We analyzed data among participants without prevalent AAA from the Veterans Aging Cohort Study, a prospective, observational, longitudinal cohort of veterans with HIV matched 1:2 with veterans without HIV infection. We calculated AAA rates by HIV status and assessed the association between HIV infection and incident AAA using Cox proportional hazards models. We defined AAA using the International Classification of Diseases, 9th or 10th revision, or Current Procedural Terminology codes and adjusted all models for demographic characteristics, cardiovascular disease risk factors, and substance use. Secondary analyses examined the association between time-varying CD4+ T-cell count or HIV viral load and incident AAA. RESULTS Among 143 001 participants (43 766 with HIV), over a median follow-up of 8.7 years, there were 2431 incident AAA events (26.4% among PWH). Rates of incident AAA per 1000 person-years were similar among PWH (2.0 [95% CI, 1.9-2.2]) and people without HIV (2.2 [95% CI, 2.1-2.3]). There was no evidence that HIV infection increased the risk of incident AAA compared with no HIV infection (adjusted hazard ratio, 1.02 [95% CI, 0.92-1.13]). In adjusted analyses with time-varying CD4+ T-cell counts or HIV viral load, PWH with CD4+ T-cell counts <200 cells/mm3 (adjusted hazard ratio, 1.29 [95% CI, 1.02-1.65]) or HIV viral load ≥500 copies/mL (adjusted hazard ratio, 1.29 [95% CI, 1.09-1.52]) had an increased risk of AAA compared with those without HIV. CONCLUSIONS HIV infection is associated with an increased risk of AAA among those with low CD4+ T-cell counts or elevated HIV viral load over time.
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Affiliation(s)
| | - Suman Kundu
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Svetlana K. Eden
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charles W. Alcorn
- University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Amy C. Justice
- Veterans Affairs Connecticut Healthcare System, CT, USA
- Department of Internal Medicine, Yale School of Medicine, West Haven, CT, USA
| | - Kaku A. So-Armah
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hilary A. Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn S. Wells
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua A. Beckman
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew S. Freiberg
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Aaron W. Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Taiwo BO, Kuhns LM, Omigbodun O, Awolude O, Kuti KM, Adetunji A, Berzins B, Janulis P, Akanmu S, Agbaji O, David AN, Akinbami A, Adekambi AF, Johnson AK, Okonkwor O, Oladeji BD, Cervantes M, Adewumi OM, Kapogiannis B, Garofalo R. A randomized stepped wedge trial of an intensive combination approach to roll back the HIV epidemic in Nigerian adolescents: iCARE Nigeria treatment support protocol. PLoS One 2023; 18:e0274031. [PMID: 37418498 PMCID: PMC10328338 DOI: 10.1371/journal.pone.0274031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/26/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Nigeria is one of six countries with half the global burden of youth living with HIV. Interventions to date have been inadequate as AIDS-related deaths in Nigeria's youth have remained unchanged in recent years. The iCARE Nigeria HIV treatment support intervention, a combination of peer navigation and SMS text message medication reminders to promote viral suppression, demonstrated initial efficacy and feasibility in a pilot trial among youth living with HIV in Nigeria. This paper describes the study protocol for the large-scale trial of the intervention. METHODS The iCARE Nigeria-Treatment study is a randomized stepped wedge trial of a combination (peer navigation and text message reminder) intervention, delivered to youth over a period of 48 weeks to promote viral suppression. Youth receiving HIV treatment at six clinical sites in the North Central and South Western regions of Nigeria were recruited for participation. Eligibility criteria included registration as a patient at participating clinics, aged 15-24 years, on antiretroviral therapy for at least three months, ability to understand and read English, Hausa, Pidgin English, or Yoruba, and intent to remain a patient at the study site during the study period. The six clinic sites were divided into three clusters and randomized to a sequence of control and intervention periods for comparison. The primary outcome is plasma HIV-1 viral load suppression, defined as viral load ≤ 200 copies/mL, in the intervention period versus the control period at 48 weeks of intervention. DISCUSSION Evidence-based interventions to promote viral load suppression among youth in Nigeria are needed. This study will determine efficacy of a combination intervention (peer navigation and text message reminder) and collect data on potential implementation barriers and facilitators to inform scale-up if efficacy is confirmed. TRIAL REGISTRATION ClinicalTrials.gov number, NCT04950153, retrospectively registered July 6, 2021, https://clinicaltrials.gov/.
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Affiliation(s)
- Babafemi O. Taiwo
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, IL, Unites States of America
| | - Lisa M. Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, Unites States of America
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, Unites States of America
| | - Olayinka Omigbodun
- Department of Child and Adolescent Psychiatry, and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olutosin Awolude
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kehinde M. Kuti
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Staff Medical Services Department, University College Hospital, Ibadan, Nigeria
| | - Adedotun Adetunji
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, IL, Unites States of America
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, Unites States of America
| | | | - Oche Agbaji
- Department of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | | | | | - Abiodun Folashade Adekambi
- Department of Paediatrics, Olabisi Onabanjo University and Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Amy K. Johnson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, Unites States of America
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, Unites States of America
| | - Ogochukwu Okonkwor
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, IL, Unites States of America
| | | | - Marbella Cervantes
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, Unites States of America
| | - Olubusuyi M. Adewumi
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, Unites States of America
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, Unites States of America
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, Unites States of America
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Izquierdo R, Rava M, Moreno-García E, Blanco JR, Asensi V, Cervero M, Curran A, Rubio R, Iribarren JA, Jarrín I. HIV medical care interruption among people living with HIV in Spain, 2004-2020. AIDS 2023; 37:1277-1284. [PMID: 36939068 DOI: 10.1097/qad.0000000000003552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE We estimated the incidence rate of HIV medical care interruption (MCI) and its evolution over a 16-year-period, and identified associated risk factors among HIV-positive individuals from the Cohort of the Spanish AIDS Research Network in 2004-2020. DESIGN We included antiretroviral-naive individuals aged at least 18 years at enrolment, recruited between January 1, 2004, and August 30, 2019, and followed-up until November 30, 2020. METHODS Individuals with any time interval of at least 15 months between two visits were defined as having a MCI. We calculated the incidence rate (IR) of having at least one MCI and used multivariable Poisson regression models to identify associated risk factors. RESULTS Of 15 274 individuals, 5481 (35.9%) had at least one MCI. Of those, 2536 (46.3%) returned to HIV care after MCI and 3753 (68.5%) were lost to follow-up at the end of the study period. The incidence rate (IR) of MCI was 7.2/100 person-years (py) [95% confidence interval (CI): 7.0-7.4]. The annual IR gradually decreased from 20.5/100 py (95% CI: 16.4-25.6) in 2004 to 4.9/100 py (95% CI: 4.4-5.5) in 2014, a slight increase was observed between 2015 and 2018, reaching 9.3/100 py (95% CI: 8.6-10.2) in 2019. Risk factors for MCI included younger age, lower educational level, having contracted HIV infection through injecting drug use or heterosexual intercourse, having been born outside of Spain, and CD4 + cell count >200 cell/μl, viral load <100 000 and co-infection with hepatitis C virus at enrolment. CONCLUSIONS Around a third of individuals had at least one MCI during the follow-up. Identified predictors of MCI can help health workers to target and support most vulnerable individuals.
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Affiliation(s)
- Rebeca Izquierdo
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
| | - Marta Rava
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
| | | | | | - Víctor Asensi
- Infectious Diseases - HIV Unit, Internal Medicine, Hospital Universitario Central de Asturias, Oviedo University School of Medicine, Translational Research in Infective Pathology Lab, ISPA-FINBA
| | - Miguel Cervero
- Internal Medicine Department, Hospital Universitario Severo Ochoa, Leganés
| | - Adrian Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona
| | - Rafael Rubio
- HIV Unit, Internal Medicine Department, Biomedical Research Institute Imas12, Hospital Universitario 12 de Octubre. Medicine Department. Universidad Complutense de Madrid, Madrid
| | - José Antonio Iribarren
- Department of Infectious Diseases, Donostia University Hospital, IIS Biodonostia, San Sebastián, Spain
| | - Inmaculada Jarrín
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
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Abstract
PURPOSE OF REVIEW The aim of this study was to provide an overview of the burden, pathogenesis, and recent recommendations for treating hypertension among people living with HIV (PLWH). This review is relevant because of the increase in the prevalence of HIV as a chronic disease and the intersection of the increasing prevalence of hypertension. RECENT FINDINGS The contribution of HIV to the pathogenesis of hypertension is complex and still incompletely understood. Evidence suggests that chronic inflammation from HIV, antiretroviral treatment (ART), and comorbidities such as renal disease and insulin resistance contribute to developing hypertension in PLWH. Treatment is not distinct from guidelines for HIV-noninfected people. Nonpharmacological guidelines such as decreasing blood pressure by promoting a healthy lifestyle emphasizing exercise, weight loss, and smoking cessation are still recommended in the literature. The pharmacological management of hypertension in PLWH is similar, but special attention must be given to specific drugs with potential interaction with ART regimens. Further research is needed to investigate the pathways and effects of hypertension on HIV. SUMMARY There are different pathways to the pathogenesis of hypertension in PLWH. Clinicians should take it into consideration to provide more precise management of hypertension in PLWH. Further research into the subject is still required.
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Affiliation(s)
- Ileana De Anda-Duran
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Alexander D. Kimbrough
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Internal Medicine, Ochsner Health System, New Orleans, Louisiana, USA
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Requena MB, Grabar S, Lanoy E, Pialoux G, Billaud E, Duvivier C, Merle P, Piroth L, Tattevin P, Salmon D, Weiss L, Costagliola D, Lacombe K. Mortality in hepatitis C virus-cured vs. hepatitis C virus-uninfected people with HIV. AIDS 2023; 37:1297-1306. [PMID: 37070541 DOI: 10.1097/qad.0000000000003569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE It is unknown whether hepatitis C virus (HCV)-cured people with HIV (PWH) without cirrhosis reached the same mortality risk as HCV-uninfected PWH. We aimed to compare mortality in PWH cured of HCV by direct-acting antivirals (DAAs) to mortality in individuals with HIV monoinfection. DESIGN Nationwide hospital cohort. METHODS HIV-controlled participants without cirrhosis and HCV-cured by DAAs started between September 2013 and September 2020, were matched on age (±5 years), sex, HIV transmission group, AIDS status, and body mass index (BMI) (±1 kg/m 2 ) to up to 10 participants with a virally suppressed HIV monoinfection followed at the time of HCV cure ±6 months. Poisson regression models with robust variance estimates were used to compare mortality in both groups after adjusting for confounders. RESULTS The analysis included 3961 HCV-cured PWH (G1) and 33 872 HCV-uninfected PWH (G2). Median follow-up was 3.7 years in G1 [interquartile range (IQR): 2.0-4.6], and 3.3 years (IQR: 1.7-4.4) in G2. Median age was 52.0 years (IQR: 47.0-56.0), and 29 116 (77.0%) were men. There were 150 deaths in G1 [adjusted incidence rate (aIR): 12.2/1000 person-years] and 509 (aIR: 6.3/1000 person-years) in G2, with an incidence rate ratio (IRR): 1.9 [95% confidence interval (CI), 1.4-2.7]. The risk remained elevated 12 months post HCV cure (IRR: 2.4 [95% CI, 1.6-3.5]). Non-AIDS/non-liver-related malignancy was the most common cause of death in G1 (28 deaths). CONCLUSIONS Despite HCV cure and HIV viral suppression, after controlling on factors related to mortality, DAA-cured PWH without cirrhosis remain at higher risk of all-cause mortality than people with HIV monoinfection. A better understanding of the determinants of mortality is needed in this population.
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Affiliation(s)
- Maria-Bernarda Requena
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
| | - Sophie Grabar
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
- AP-HP, Public Health Unit, Saint-Antoine Hospital
| | - Emilie Lanoy
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
| | - Gilles Pialoux
- Sorbonne Université, AP-HP, Department of Infectious Diseases, Tenon Hospital, Paris
| | - Eric Billaud
- Université de Nantes, INSERM UIC 1413, Department of Infectious Diseases, CHU Hôtel Dieu, Nantes
| | - Claudine Duvivier
- Université de Paris Cité, AP-HP, Necker Hospital, Department of Infectious Diseases, INSERM, U1016, Institut Cochin, CNRS, UMR8104, Necker-Pasteur Infectiology Center, IHU Imagine, Institut Pasteur, Necker-Pasteur Infectiology Center, Paris
| | - Philippe Merle
- Université Lyon 1, Department of Hepatology, de la Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon
| | - Lionel Piroth
- University of Bourgogne-Franche-Comté, INSERM, Clinical Epidemiology unit CIC1432, Department of Infectious Diseases, Dijon University Hospital, Dijon
| | - Pierre Tattevin
- Department of Infectious Diseases and Intensive Care Medicine, CHU de Rennes, Rennes
| | - Dominique Salmon
- Université Paris Cité, Department of Immunology and Infectious Diseases, AP-HP Hôtel-Dieu
| | - Laurence Weiss
- Université Paris Cité, Department of Immunology and Infectious Diseases, AP-HP Hôtel-Dieu
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
| | - Karine Lacombe
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
- AP-HP, Department of Infectious Diseases, Saint-Antoine Hospital, Paris, France
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De Vincentis S, Rochira V. Update on acquired hypogonadism in men living with HIV: pathogenesis, clinic, and treatment. Front Endocrinol (Lausanne) 2023; 14:1201696. [PMID: 37455928 PMCID: PMC10338827 DOI: 10.3389/fendo.2023.1201696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023] Open
Abstract
Hypogonadism is a frequent finding among men living with HIV (MLWH) and it seems to occur earlier in comparison with the general male population. Although the prevalence of hypogonadism in MLWH has significantly lowered thanks to advancements in medical management, it remains high if compared with age-matched HIV-uninfected men, ranging from 13% to 40% in the age group of 20-60 years. Signs and symptoms of low serum testosterone (T) in MLWH are cause of concern since they are non-specific, of mild-to-moderate degree, and often overlapping with those of infection per se. For these reasons, hypogonadism can be underestimated in the absence of targeted laboratory blood examinations. With regard to the etiological factors involved in the T decrease, emerging evidence has suggested the functional nature of hypogonadism in MLWH, pointing out the mutual relationship between sex steroids, health status, comorbidities, and HIV-related factors. In agreement with this hypothesis, a therapeutic approach aiming at improving or reversing concomitant diseases through lifestyle changes (e.g. physical activity) rather than pharmacological T treatment should be theoretically considered. However, considering both patient's barriers to lifestyle changes to be maintained overtime and the lack of evidence-based data on the efficacy of lifestyle changes in normalizing serum T in MLWH, T therapy remains an option when other non-pharmacological interventions are ineffective as well as for all other functional forms of hypogonadism. From this perspective, the traditional therapeutic management of male hypogonadism in MLWH, especially the role of T supplementation, should be revised in the light of the probable functional nature of hypogonadism by considering a good balance between benefits and harmful. This narrative review presents an overview of current knowledge on hypogonadism in MLWH, deepening the factors driving and taking part in T decrease, providing advice for the clinical approach, and underlining the importance of individualized treatment aiming at optimizing non-gonadal comorbidities and thus avoiding over-, or even unnecessary, treatment with T.
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Affiliation(s)
- Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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90
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Penner J, Ombajo LA, Otieno D, Nkuranga J, Mburu M, Wahome S, Pozniak A, Bhagani S. High rates of kidney impairment among older people (≥ 60 years) living with HIV on first-line antiretroviral therapy at screening for a clinical trial in Kenya. PLoS One 2023; 18:e0285787. [PMID: 37352206 PMCID: PMC10289444 DOI: 10.1371/journal.pone.0285787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/29/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND There is a paucity of data on kidney impairment among older people living with HIV (PLWH). We evaluated kidney function among PLWH age ≥ 60 years on first-line antiretroviral (ARV) therapy during screening for a clinical trial in Kenya. METHODS The bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) Elderly Study is an open-label, randomized, active-controlled, non-inferiority trial conducted at two sites in Kenya. Potential participants were screened for study entry if they were at least 60 years old, had been on ARVs for at least 24 weeks and had no history of treatment failure. At screening, participants had samples collected for serum creatinine and estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration 2021 equation. RESULTS Between January and April 2022, 714 participants were screened and had creatinine measured. All participants were black, 54.1% were female and the median age was 64 years (range 60 to 87 years). Most participants (666 [93.3%]) were on tenofovir disoproxil fumarate-containing regimens, 711 (99.6%) were on dolutegravir-containing regimens, and only 2 (0.3%) were on a regimen with a ritonavir-boosted protease inhibitor. Most participants (686 [96.6%]) were virally suppressed. Treatment for comorbidities was common, with 175 (24.5%) on treatment for hypertension and 39 (5.5%) on treatment for diabetes mellitus. The median eGFR was 64.7 mL/min/1.73m2, and 289 (40.5%) participants had an eGFR < 60 mL/min/1.73m2. In multivariate analysis, factors associated with lower eGFR were female gender (p<0.001), being on treatment for hypertension (p<0.001) and nadir CD4 count < 50 cells/μL (p = 0.008). CONCLUSIONS Our study identified high rates of impaired kidney function among elderly PLHW in Kenya, which highlights the importance of routine assessment of kidney function and the need to address modifiable risk factors, use of appropriate ARVs, and management of kidney disease in this population.
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Affiliation(s)
- Jeremy Penner
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Loice Achieng Ombajo
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Davies Otieno
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Joseph Nkuranga
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Margaret Mburu
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | | | - Anton Pozniak
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sanjay Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free London Foundation Trust, London, United Kingdom
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Tanaka H, Satoh M, Takigawa M, Onoda T, Ishii T. Characteristics of adverse event reports among people living with human immunodeficiency virus (HIV) in Japan: Data mining of the Japanese Adverse Drug Event Report database. Drug Discov Ther 2023:2023.01007. [PMID: 37331810 DOI: 10.5582/ddt.2023.01007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The development of new anti-HIV drugs and advances in antiretroviral therapy (ART) regimens have enabled longer and more effective treatments in people living with HIV (PLWH). However, the aging of PLWHs is another issue that needs to be addressed. In addition to ART, many PLWHs frequently receive medications for various comorbidities. However, real-world data on the occurrence of adverse events in PLWHs and their causative drugs are rare. Therefore, this study aimed to clarify the characteristics of adverse event reports among PLWHs in Japan. PLWH cases with adverse events were comprehensively searched and analyzed using the Japanese Adverse Drug Event Report database (JADER). Despite changes in guideline-recommended ART regimens, anti-HIV drugs were the main cause of adverse events in PLWHs throughout the study period. However, considerable variations have been observed in the reporting rate of anti-HIV drug classes registered as causative drugs in JADER, especially for anchor drugs. In other words, the reporting rate of integrase strand transfer inhibitors has increased in recent years, while that of protease inhibitors and non-nucleoside reverse transcriptase inhibitors has decreased. Immune reconstitution inflammatory syndrome was the most reported adverse event and was frequently noticed by healthcare providers managing patients with HIV infections. The trends in adverse event reports for female and older patients differed from those for the overall population. This study may provide insights that can help in the establishment of optimal management strategies for PLWHs.
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Affiliation(s)
- Hiroyuki Tanaka
- Department of Practical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Mitsutoshi Satoh
- Department of Toxicology and Pharmacology, Division of Pharmacy Practice, Meiji Pharmaceutical University, Tokyo, Japan
| | - Masaki Takigawa
- Department of Practical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
- Department of Pharmacy, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Toshihisa Onoda
- Department of Practical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Toshihiro Ishii
- Department of Practical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
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Toljić B, Milašin J, De Luka SR, Dragović G, Jevtović D, Maslać A, Ristić-Djurović JL, Trbovich AM. HIV-Infected Patients as a Model of Aging. Microbiol Spectr 2023; 11:e0053223. [PMID: 37093018 PMCID: PMC10269491 DOI: 10.1128/spectrum.00532-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
We appraised the relationship between the biological and the chronological age and estimated the rate of biological aging in HIV-infected patients. Two independent biomarkers, the relative telomere length and iron metabolism parameters, were analyzed in younger (<35) and older (>50) HIV-infected and uninfected patients (control group). In our control group, telomeres of younger patients were significantly longer than telomeres of older ones. However, in HIV-infected participants, the difference in the length of telomeres was lost. By combining the length of telomeres with serum iron, ferritin, and transferrin iron-binding capacity, a new formula for determination of the aging process was developed. The life expectancy of the healthy population was related to their biological age, and HIV-infected patients were biologically older. The effect of antiretroviral HIV drug therapies varied with respect to the biological aging process. IMPORTANCE This article is focused on the dynamics of human aging. Moreover, its interdisciplinary approach is applicable to various systems that are aging.
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Affiliation(s)
- Boško Toljić
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Milašin
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia
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Gifford DR, Berríos-Caro E, Joerres C, Suñé M, Forsyth JH, Bhattacharyya A, Galla T, Knight CG. Mutators can drive the evolution of multi-resistance to antibiotics. PLoS Genet 2023; 19:e1010791. [PMID: 37311005 DOI: 10.1371/journal.pgen.1010791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/18/2023] [Indexed: 06/15/2023] Open
Abstract
Antibiotic combination therapies are an approach used to counter the evolution of resistance; their purported benefit is they can stop the successive emergence of independent resistance mutations in the same genome. Here, we show that bacterial populations with 'mutators', organisms with defects in DNA repair, readily evolve resistance to combination antibiotic treatment when there is a delay in reaching inhibitory concentrations of antibiotic-under conditions where purely wild-type populations cannot. In populations of Escherichia coli subjected to combination treatment, we detected a diverse array of acquired mutations, including multiple alleles in the canonical targets of resistance for the two drugs, as well as mutations in multi-drug efflux pumps and genes involved in DNA replication and repair. Unexpectedly, mutators not only allowed multi-resistance to evolve under combination treatment where it was favoured, but also under single-drug treatments. Using simulations, we show that the increase in mutation rate of the two canonical resistance targets is sufficient to permit multi-resistance evolution in both single-drug and combination treatments. Under both conditions, the mutator allele swept to fixation through hitch-hiking with single-drug resistance, enabling subsequent resistance mutations to emerge. Ultimately, our results suggest that mutators may hinder the utility of combination therapy when mutators are present. Additionally, by raising the rates of genetic mutation, selection for multi-resistance may have the unwanted side-effect of increasing the potential to evolve resistance to future antibiotic treatments.
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Affiliation(s)
- Danna R Gifford
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Earth and Environmental Sciences, School of Natural Sciences, Faculty of Science and Engineering, The University of Manchester, Manchester, United Kingdom
| | - Ernesto Berríos-Caro
- Department of Physics and Astronomy, School of Natural Sciences, Faculty of Science and Engineering, The University of Manchester, Manchester, United Kingdom
- Department of Evolutionary Theory, Max Planck Institute for Evolutionary Biology, Plön, Germany
- Department of Evolutionary Ecology and Genetics, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Christine Joerres
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Marc Suñé
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Jessica H Forsyth
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Anish Bhattacharyya
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tobias Galla
- Department of Physics and Astronomy, School of Natural Sciences, Faculty of Science and Engineering, The University of Manchester, Manchester, United Kingdom
- Instituto de Física Interdisciplinar y Sistemas Complejos, IFISC (CSIC-UIB), Campus Universitat Illes Balears, Palma de Mallorca, Spain
| | - Christopher G Knight
- Department of Earth and Environmental Sciences, School of Natural Sciences, Faculty of Science and Engineering, The University of Manchester, Manchester, United Kingdom
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94
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Baek J, Kim HS, Kim NJ, Yoo JJ. Midterm Results of Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Human Immunodeficiency Virus-Infected Patients in South Korea. Clin Orthop Surg 2023; 15:367-372. [PMID: 37274489 PMCID: PMC10232321 DOI: 10.4055/cios22142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 06/06/2023] Open
Abstract
Background Studies have reported that osteonecrosis of the femoral head (ONFH) is more prevalent in patients with human immunodeficiency virus (HIV). Total hip arthroplasty (THA) is considered reasonable management of ONFH. However, only scarce data exist on the outcomes of THA for HIV-infected patients in South Korea. The purpose of this study was to evaluate the midterm results of HIV-positive patients who underwent THA for ONFH. Methods We performed a retrospective review of HIV-infected patients with ONFH who underwent THA in our institution from 2005 to 2021. Twenty-two hips in 15 patients underwent THAs with cementless implants. The clinical and radiographic evaluation was performed at each follow-up, and any complication was recorded. Results The mean follow-up period was 5.2 years (range, 1.0-16.0 years). The mean age of the HIV infected patients with osteonecrosis at the time of surgery was 44.7 ± 11.6 years. ONFH occurred 9.8 ± 3.7 years after the initial diagnosis of HIV infection. The average modified Harris hip score improved from 58.3 ± 14.8 to 95.2 ± 11.3 at the latest follow-up. Surgical complications such as infection, nerve injury, or dislocation were not present. The radiographic evidence of stable fixation by bone ingrowth without migration was seen in all implants. Conclusions Our data suggest that THA is a safe and valid option of treatment for ONFH in well-controlled HIV-infected patients in Korea. Further large-scale nationwide studies are warranted.
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Affiliation(s)
- Jonghyuk Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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95
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Yu X, Kuo YF, Raji MA, Berenson AB, Baillargeon J, Giordano TP. Dementias Among Older Males and Females in the U.S. Medicare System With and Without HIV. J Acquir Immune Defic Syndr 2023; 93:107-115. [PMID: 36881792 PMCID: PMC10293071 DOI: 10.1097/qai.0000000000003184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Despite the growing concern that people with HIV (PWH) will experience a disproportionate burden of dementia as they age, very few studies have examined the sex-specific prevalence of dementia, including Alzheimer disease and related dementias (AD/ADRD) among older PWH versus people without HIV (PWOH) using large national samples. METHODS We constructed successive cross-sectional cohorts including all PWH aged 65+ years from U.S. Medicare enrollees and PWOH in a 5% national sample of Medicare data from 2007 to 2019. All AD/ADRD cases were identified by ICD-9-CM/ICD-10-CM diagnosis codes. Prevalence of AD/ADRD was calculated for each calendar year by sex-age strata. Generalized estimating equations were used to assess factors associated with dementia and calculate the adjusted prevalence. RESULTS PWH had a higher prevalence of AD/ADRD, which increased over time compared with PWOH, especially among female beneficiaries and with increasing age. For example, among those aged 80+ years, the prevalence increased from 2007 to 2019 (females with HIV: 31.4%-44.1%; females without HIV: 27.4%-29.9%; males with HIV: 26.2%-33.3%; males without HIV: 21.0%-23.5%). After adjustment for demographics and comorbidities, the differences in dementia burden by HIV status remained, especially among older age groups. CONCLUSIONS Older Medicare enrollees with HIV had an increased dementia burden over time compared with those without HIV, especially women and older subjects. This underscores the need to develop tailored clinical practice guidelines that facilitate the integration of dementia and comorbidity screening, evaluation, and management into the routine primary care of aging PWH.
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Affiliation(s)
- Xiaoying Yu
- Department of Biostatistics & Data Science, University of Texas Medical Branch at Galveston (UTMB), Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, UTMB
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, University of Texas Medical Branch at Galveston (UTMB), Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, UTMB
| | | | - Abbey B. Berenson
- Center for Interdisciplinary Research in Women’s Health, UTMB
- Department of Obstetrics & Gynecology, UTMB
| | | | - Thomas P. Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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96
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Slama L, Hardy WD, Quiñones-Mateu ME, Kuritzkes DR. Alternative options for treatment-experienced people with HIV. AIDS 2023; 37:1165-1166. [PMID: 37139652 DOI: 10.1097/qad.0000000000003550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Laurence Slama
- Department of Infectious Diseases, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
| | - W David Hardy
- Division of Infectious Diseases, Los Angeles County-University of Southern California Medical Center and Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Miguel E Quiñones-Mateu
- Department of Pathology & Laboratory Medicine, Schulich Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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97
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Hidalgo-Tenorio C, Calle-Gómez I, Moya-Megías R, Rodríguez-Granges J, Omar M, López Hidalgo J, García-Martínez C. HPV Infection of the Oropharyngeal, Genital and Anal Mucosa and Associated Dysplasia in People Living with HIV. Viruses 2023; 15:v15051170. [PMID: 37243256 DOI: 10.3390/v15051170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The main objectives were to describe the prevalence of HPV, its genotypes and HPV-associated dysplastic lesions in the oropharyngeal mucosa of PLHIV and related factors. MATERIAL AND METHODS This cross-sectional prospective study consecutively enrolled PLHIV attending our specialist outpatient units. At visit, HIV-related clinical and analytical variables were gathered, and oropharyngeal mucosa exudates were taken to detect HPV and other STIs by polymerase chain reaction. Samples were also taken from the anal canal of all participants and from the genital mucosa of the women for HPV detection/genotyping and cytological study. RESULTS The 300 participants had a mean age of 45.1 years; 78.7% were MSM and 21.3% women; 25.3% had a history of AIDS; 99.7% were taking ART; and 27.3% had received an HPV vaccine. HPV infection prevalence in the oropharynx was 13%, with genotype 16 being the most frequent (2.3%), and none had dysplasia. Simultaneous infection with Treponema pallidum (HR: 4.02 (95% CI: 1.06-15.24)) and a history of anal HSIL or SCCA (HR: 21.52 (95% CI: 1.59-291.6)) were risk factors for oropharyngeal HPV infection, whereas ART duration (8.8 vs. 7.4 years) was a protective factor (HR: 0.989 (95% CI: 0.98-0.99)). CONCLUSIONS The prevalence of HPV infection and dysplasia was low in the oropharyngeal mucosae. A higher exposure to ART was protective against oral HPV infection.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Inmaculada Calle-Gómez
- Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Raquel Moya-Megías
- Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Javier Rodríguez-Granges
- Microbiology Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Mohamed Omar
- Unit of Infectious Diseases, Complejo Hospitalario de Jaen, 23007 Jaen, Spain
| | - Javier López Hidalgo
- Pathology Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
| | - Carmen García-Martínez
- Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
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98
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Kim K, Jang S, Rim HD, Kim SW, Chang HH, Woo J. Attachment Insecurity and Stigma as Predictors of Depression and Anxiety in People Living With HIV. Psychiatry Investig 2023; 20:418-429. [PMID: 37253467 DOI: 10.30773/pi.2022.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/26/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine whether attachment insecurity, stigma, and certain demographic and medical factors predict depression and anxiety in people living with HIV (PLWH). METHODS Participants were 147 PLWH who visited the outpatient infection clinic in Kyungpook National University Hospital (KNUH; Daegu, South Korea) between June 2020 and January 2021. We measured HIV-related stigma, attachment anxiety and avoidance, depressive symptoms, and anxiety symptoms. RESULTS Logistic regression analysis showed that unemployment, longer time receiving antiretroviral therapy, higher attachment avoidance, and higher attachment anxiety were significant predictors of depression. Results also showed that longer time receiving antiretroviral therapy, higher attachment anxiety, and concern with public attitudes were significant predictors of anxiety. CONCLUSION In addition to education to reduce public stigma, interventions to reduce PLWH's self-stigma should continue. We suggest attachment-based psychotherapy as an effective intervention to improve PLWH's mental health.
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Affiliation(s)
- Kyungmin Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seoyoung Jang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyo-Deog Rim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jungmin Woo
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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99
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Trickey A, Sabin CA, Burkholder G, Crane H, d'Arminio Monforte A, Egger M, Gill MJ, Grabar S, Guest JL, Jarrin I, Lampe FC, Obel N, Reyes JM, Stephan C, Sterling TR, Teira R, Touloumi G, Wasmuth JC, Wit F, Wittkop L, Zangerle R, Silverberg MJ, Justice A, Sterne JAC. Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: a collaborative analysis of cohort studies. Lancet HIV 2023; 10:e295-e307. [PMID: 36958365 PMCID: PMC10288029 DOI: 10.1016/s2352-3018(23)00028-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The life expectancy of people with HIV taking antiretroviral therapy (ART) has increased substantially over the past 25 years. Most previous studies of life expectancy were based on data from the first few years after starting ART, when mortality is highest. However, many people with HIV have been successfully treated with ART for many years, and up-to-date prognosis data are needed. We aimed to estimate life expectancy in adults with HIV on ART for at least 1 year in Europe and North America from 2015 onwards. METHODS We used data for people with HIV taking ART from the Antiretroviral Therapy Cohort Collaboration and the UK Collaborative HIV Cohort Study. Included participants started ART between 1996 and 2014 and had been on ART for at least 1 year by 2015, or started ART between 2015 and 2019 and survived for at least 1 year; all participants were aged at least 16 years at ART initiation. We used Poisson models to estimate the associations between mortality and demographic and clinical characteristics, including CD4 cell count at the start of follow-up. We also estimated the remaining years of life left for people with HIV aged 40 years who were taking ART, and stratified these estimates by variables associated with mortality. These estimates were compared with estimates for years of life remaining in a corresponding multi-country general population. FINDINGS Among 206 891 people with HIV included, 5780 deaths were recorded since 2015. We estimated that women with HIV at age 40 years had 35·8 years (95% CI 35·2-36·4) of life left if they started ART before 2015, and 39·0 years (38·5-39·5) left if they started ART after 2015. For men with HIV, the corresponding estimates were 34·5 years (33·8-35·2) and 37·0 (36·5-37·6). Women with CD4 counts of fewer than 49 cells per μL at the start of follow-up had an estimated 19·4 years (18·2-20·5) of life left at age 40 years if they started ART before 2015 and 24·9 years (23·9-25·9) left if they started ART after 2015. The corresponding estimates for men were 18·2 years (17·1-19·4) and 23·7 years (22·7-24·8). Women with CD4 counts of at least 500 cells per μL at the start of follow-up had an estimated 40·2 years (39·7-40·6) of life left at age 40 years if they started ART before 2015 and 42·0 years (41·7-42·3) left if they started ART after 2015. The corresponding estimates for men were 38·0 years (37·5-38·5) and 39·2 years (38·7-39·7). INTERPRETATION For people with HIV on ART and with high CD4 cell counts who survived to 2015 or started ART after 2015, life expectancy was only a few years lower than that in the general population, irrespective of when ART was started. However, for people with low CD4 counts at the start of follow-up, life-expectancy estimates were substantially lower, emphasising the continuing importance of early diagnosis and sustained treatment of HIV. FUNDING US National Institute on Alcohol Abuse and Alcoholism and UK Medical Research Council.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, University College London, London, UK
| | - Greer Burkholder
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Heidi Crane
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Matthias Egger
- Population Health Sciences, University of Bristol, Bristol, UK; Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada; Southern Alberta Clinic, Calgary, AB, Canada
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France; Department of Public Health, Assistance Publique-Hôpitaux de Paris, St Antoine Hospital, Paris, France
| | - Jodie L Guest
- Atlanta VA Medical Center, Decatur, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Inma Jarrin
- National Centre of Epidemiology and CIBER de Enfermedades Infecciosas, Carlos III Health Institute, Madrid, Spain
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Juliana M Reyes
- El Centre d'Estudis Epidemiològics sobre infecciones de transmision sexual y el VIH/SIDA de Catalunya, Badalona, Spain
| | - Christoph Stephan
- Infectious Diseases, Department of Internal Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ramon Teira
- Servicio de Medicina Interna, Hospital Universitario de Sierrallana, Torrelavega, Cantabria, Spain
| | - Giota Touloumi
- Department of Hygiene, Epidemiology & Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ferdinand Wit
- Stichting HIV Monitoring, Amsterdam, Netherlands; Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands
| | - Linda Wittkop
- University of Bordeaux, Bordeaux, France; INRIA SISTM, Talence, France; Service d'information médicale, Institut Bergonié, INSERM, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Robert Zangerle
- Department of Dermatology, Venereology, and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | | | - Amy Justice
- VA Connecticut Healthcare System, West Haven, CT, USA; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan A C Sterne
- Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
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100
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Pérez-López FR, Fernández-Alonso AM, Mezones-Holguín E, Vieira-Baptista P. Low genitourinary tract risks in women living with the human immunodeficiency virus. Climacteric 2023:1-7. [PMID: 37054721 DOI: 10.1080/13697137.2023.2194528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
This review analyzes the clinical associations between specific low genitourinary tract clinical circumstances in perimenopausal and postmenopausal women living with human immunodeficiency virus (WLHIV). Modern antiretroviral therapy (ART) improves survival and reduces opportunistic infections and HIV transmission. Despite appropriate ART, WLHIV may display menstrual dysfunction, risk of early menopause, vaginal microbiome alterations, vaginal dryness, dyspareunia, vasomotor symptoms and low sexual function as compared to women without the infection. They have increased risks of intraepithelial and invasive cervical, vaginal and vulvar cancers. The reduced immunity capacity may also increase the risk of urinary tract infections, side-effects or toxicity of ARTs, and opportunistic infections. Menstrual dysfunction and early menopause may contribute to the early onset of vascular atherosclerosis and plaque formation, and increased osteoporosis risks requiring specific early interventions. On the other hand, the association between being postmenopausal and having a low sexual function is significant and related to low adherence to ART. WLHIV deserve a specific approach to manage different low genitourinary risks and complications related to hormone dysfunction and early menopause.
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Affiliation(s)
- F R Pérez-López
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
- Obstetrics and Reproduction, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | | | - E Mezones-Holguín
- Centro de Estudios Económicos y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - P Vieira-Baptista
- Department of Gynecology-Obstetrics and Pediatrics, Hospital Lusíadas Porto, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
- Department of Gynecology-Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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