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Rasmussen LD, Helleberg M, May MT, Afzal S, Kronborg G, Larsen CS, Pedersen C, Gerstoft J, Nordestgaard BG, Obel N. Myocardial infarction among Danish HIV-infected individuals: population-attributable fractions associated with smoking. Clin Infect Dis 2015; 60:1415-23. [PMID: 25595744 DOI: 10.1093/cid/civ013] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/18/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus-infected individuals have increased risk of myocardial infarction (MI); however, the contribution from smoking and potentiating effects of HIV are controversial. METHODS From the Danish HIV Cohort Study and the Copenhagen General Population Study, we identified 3251 HIV-infected individuals and 13 004 population controls matched on age and gender. Data on MI were obtained from the National Hospital Registry and the National Registry of Causes of Death. We calculated adjusted incidence rate ratios (aIRR) for risk of MI and population-attributable fractions (PAF) of MI associated with smoking. RESULTS In never smokers, HIV was not associated with an increased risk of MI (aIRR, 1.01; 95% confidence interval [CI], .41-2.54). In previous and current smokers, HIV was associated with a substantially increased risk of MI (aIRR, 1.78; 95% CI, .75-4.24 and aIRR, 2.83; 95% CI, 1.71-4.70). The PAF associated with ever smoking (previous or current) was 72% (95% CI, 55%-82%) for HIV-infected individuals and 24% (95% CI, 3%-40%) for population controls. If all current smokers stopped smoking, 42% (95% CI, 21%-57%) and 21% (95% CI, 12%-28%) of all MIs could potentially be avoided in these 2 populations. CONCLUSIONS Smoking is associated with a higher risk of MI in the HIV-infected population than in the general population. Approximately 3 of 4 MIs among HIV-infected individuals are associated with ever smoking compared with only 1 of 4 MIs among population controls. Smoking cessation could potentially prevent more than 40% of MIs among HIV-infected individuals, and smoking cessation should be a primary focus in modern HIV care.
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Affiliation(s)
| | - Marie Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Shoaib Afzal
- The Copenhagen General Population Study Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev Hospital
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital
| | - Carsten S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Børge G Nordestgaard
- The Copenhagen General Population Study Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev Hospital
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
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102
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Beltrán LM, Rubio-Navarro A, Amaro-Villalobos JM, Egido J, García-Puig J, Moreno JA. Influence of immune activation and inflammatory response on cardiovascular risk associated with the human immunodeficiency virus. Vasc Health Risk Manag 2015; 11:35-48. [PMID: 25609975 PMCID: PMC4293933 DOI: 10.2147/vhrm.s65885] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients infected with the human immunodeficiency virus (HIV) have an increased cardiovascular risk. Although initially this increased risk was attributed to metabolic alterations associated with antiretroviral treatment, in recent years, the attention has been focused on the HIV disease itself. Inflammation, immune system activation, and endothelial dysfunction facilitated by HIV infection have been identified as key factors in the development and progression of atherosclerosis. In this review, we describe the epidemiology and pathogenesis of cardiovascular disease in patients with HIV infection and summarize the latest knowledge on the relationship between traditional and novel inflammatory, immune activation, and endothelial dysfunction biomarkers on the cardiovascular risk associated with HIV infection.
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Affiliation(s)
- Luis M Beltrán
- Metabolic-Vascular Unit, Fundación IdiPAZ-Hospital Universitario La Paz, Madrid, Spain
| | - Alfonso Rubio-Navarro
- Vascular, Renal, and Diabetes Research Lab, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jesús Egido
- Vascular, Renal, and Diabetes Research Lab, IIS-Fundación Jiménez Díaz, Madrid, Spain ; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain ; Fundación Renal Iñigo Alvarez de Toledo-Instituto Reina Sofía de Investigaciones Nefrológicas (FRIAT-IRSIN), Madrid, Spain
| | - Juan García-Puig
- Metabolic-Vascular Unit, Fundación IdiPAZ-Hospital Universitario La Paz, Madrid, Spain
| | - Juan Antonio Moreno
- Vascular, Renal, and Diabetes Research Lab, IIS-Fundación Jiménez Díaz, Madrid, Spain
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Torres TS, Luz PM, Derrico M, Velasque L, Grinsztejn E, Veloso VG, Cardoso SW, Santini-Oliveira M, Grinsztejn B, De Boni RB. Factors associated with tobacco smoking and cessation among HIV-infected individuals under care in Rio de Janeiro, Brazil. PLoS One 2014; 9:e115900. [PMID: 25536064 PMCID: PMC4275249 DOI: 10.1371/journal.pone.0115900] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 11/30/2014] [Indexed: 11/25/2022] Open
Abstract
Worldwide the prevalence of smoking among people living with HIV/AIDS is elevated compared to the general population. This probably reflects the cluster of individual characteristics that have shared risk factors for HIV infection and smoking. A cross-sectional study, enrolling a convenience sample from a Brazilian HIV clinical cohort was conducted to evaluate the prevalence of tobacco smoking and the factors associated with current smoking and abstinence. A total of 2,775 HIV-infected individuals were interviewed: 46.2% have never smoked, 29.9% were current smokers and 23.9% were former smokers. Current smokers had a higher prevalence of alcohol and illicit drug use when compared to the other two groups. A higher proportion of heterosexual individuals were former smokers or never smokers while among men who have sex with men (MSM) a higher proportion were current smokers. Former smokers had been more frequently diagnosed with high blood pressure, diabetes mellitus, cardiovascular diseases and depression, while for current smokers lung diseases were more frequent. Former smokers and current smokers were more likely to have had any hospital admission (42.0% and 41.2%, respectively) than participants who never smoked (33.5%) (p<0.001). Multivariate model results showed that current smokers (versus never smokers) were more likely to be less educated, to report the use of alcohol, crack and cocaine and to present clinical comorbidities. Former smokers (versus current smokers) were more likely to be older, to have smoked for a shorter amount of time and to have smoked >31 cigarettes/day. MSM (compared to heterosexuals) and cocaine users (versus non-users) had lower odds of being former smokers. Considering our results, smoking cessation interventions should be tailored to younger individuals, MSM and substance users.
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Affiliation(s)
- Thiago S. Torres
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
- * E-mail:
| | - Paula M. Luz
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
| | - Monica Derrico
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
- Departamento de Matemática, Universidade Federal do Estado do Rio de Janeiro (UniRio), Brazil
| | - Eduarda Grinsztejn
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
| | - Valdiléa G. Veloso
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
| | - Sandra W. Cardoso
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
| | - Marília Santini-Oliveira
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
| | - Raquel Brandini De Boni
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, HIV/AIDS Clinical Research Center, Rio de Janeiro, Brazil
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104
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Effects of an education and home-based pedometer walking program on ischemic heart disease risk factors in people infected with HIV: a randomized trial. J Acquir Immune Defic Syndr 2014; 67:268-76. [PMID: 25140908 DOI: 10.1097/qai.0000000000000299] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE People infected with the human immunodeficiency virus are at an increased risk of developing ischemic heart disease (IHD); however, the effects of an education and home-based pedometer walking program on risk factors of IHD are not known. METHODS We conducted a 12-month randomized study of an education and home-based pedometer walking program in 84 human immunodeficiency virus-infected individuals with risk factors of IHD. RESULTS Pedometer step count of the control and intervention groups improved significantly (P = 0.03 for both groups) at 6 months but was not significant at 12 months (P = 0.33 and 0.21, respectively). Significant between-group effects were observed in 6-minute walk test distance (P = 0.01), waist to hip ratio (P = 0.00), glucose (P = 0.00), and high-density lipoprotein (P = 0.01) over the 12-month period. The program did not result in change in high-sensitivity C-reactive protein as it was associated with perceived stress (r = 0.23; P = 0.03), weight (r = 0.28; P = 0.01), body mass index (r = 0.35; P < 0.00), waist (r = 0.28; P = 0.01) and hip circumference (r = 0.28; P = 0.01). Multivariate generalized estimation equation analysis demonstrated an inverse association between interaction and perceived stress (logB = -0.01; 95% confidence interval: -0.02 to -0.01; P <0.00) and body mass index (logB = -0.02; 95% confidence interval: -0.03 to -0.002; P = 0.02) at group level. CONCLUSION An education and home-based pedometer walking program improves physical activity levels, and beneficial changes in other IHD risk factors were noted.
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105
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Mendes L, Silva D, Miranda C, Sá J, Duque L, Duarte N, Brito P, Bernardino L, Poças J. Impact of HIV infection on cardiac deformation. Rev Port Cardiol 2014; 33:501-9. [PMID: 25242674 DOI: 10.1016/j.repc.2013.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 09/16/2013] [Accepted: 12/20/2013] [Indexed: 10/24/2022] Open
Abstract
AIM The aim of this study was to detect abnormalities in left ventricular myocardial function due to HIV (human immunodeficiency virus) infection without established cardiovascular disease. METHODS An echocardiogram was performed in 50 asymptomatic HIV-infected patients (age 41 ± 6 years, 64% male) and in 20 healthy individuals. Conventional echocardiography and pulsed tissue Doppler imaging (TDI) were performed according to the guidelines. The strain rate of the basal segments was obtained with color tissue Doppler and used to evaluate systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA). Longitudinal, radial and circumferential strain were assessed by 2D speckle tracking. RESULTS The mean duration of HIV infection was 10 ± 5 years, CD4 count was 579 ± 286 cells/mm³, 32% had detectable viral load, and 86% were under treatment. Of the HIV-infected patients, one had grade 1 diastolic dysfunction. The groups were not different except for E wave (HIV 0.72 ± 0.17 m/s vs. control 0.84 ± 0.16 m/s, p=0.01), longitudinal strain (-19.5 ± 1.9% vs. -21 ± 2%, p=0.005), SRS (-1.1 ± 0.28 s⁻¹ vs. -1.3 ± 0.28 s⁻¹, p=0.02) and SRE (1.8 ± 0.4 s⁻¹ vs. 2.2 ± 0.4 s⁻¹, p<0.001), but only SRS (p=0.03, 95% CI 0.036; 0.67) and SRE (p=0.001, 95% CI -0.599; -0.168) had independent value. CONCLUSION In an HIV-infected population without established cardiovascular disease, myocardial deformation abnormalities can be detected with strain and strain rate, revealing markers of myocardial injury.
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Affiliation(s)
- Lígia Mendes
- Cardiology Department, Hospital de São Bernardo, Setúbal, Portugal.
| | - Daniela Silva
- Cardiology Department, Hospital Militar, Lisboa, Portugal
| | - Carla Miranda
- Cardiology Department, Hospital de São Bernardo, Setúbal, Portugal
| | - Joana Sá
- Infectious Disease Department, Hospital de São Bernardo, Setúbal, Portugal
| | - Luís Duque
- Infectious Disease Department, Hospital de São Bernardo, Setúbal, Portugal
| | - Nelson Duarte
- Infectious Disease Department, Hospital de São Bernardo, Setúbal, Portugal
| | - Paula Brito
- Infectious Disease Department, Hospital de São Bernardo, Setúbal, Portugal
| | | | - José Poças
- Infectious Disease Department, Hospital de São Bernardo, Setúbal, Portugal
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106
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Tron L, Lert F, Spire B, Dray-Spira R. Tobacco smoking in HIV-infected versus general population in france: heterogeneity across the various groups of people living with HIV. PLoS One 2014; 9:e107451. [PMID: 25202968 PMCID: PMC4159331 DOI: 10.1371/journal.pone.0107451] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/12/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although the various groups of people living with HIV (PLWHIV) considerably differ regarding socioeconomic and behavioral characteristics, their specificities regarding tobacco smoking have been poorly investigated. We aimed to assess patterns of tobacco consumption across the various groups of PLWHIV and to compare them to the general population, accounting for the specific socioeconomic profile of PLWHIV. METHODS We used data of the ANRS-Vespa2 study, a national representative survey on PLWHIV conducted in France in 2011. Prevalence of past and current tobacco consumption, heavy smoking and strong nicotine dependence were assessed among the various groups of PLWHIV as defined by transmission category, gender and geographic origin, and compared to the French general population using direct standardization and multivariate Poisson regression models, accounting for gender, age, education and geographic origin. RESULTS Among the 3,019 participants aged 18-85 years (median time since HIV diagnosis: 12 years), 37.5% were current smokers and 22.1% were past smokers, with marked differences across the various groups of PLWHIV. Compared to the general population, the prevalence of regular smoking was increased among HIV-infected men who have sex with men (MSM) (adjusted prevalence rate ratio (aPRR): 1.19, 95% confidence interval (95% CI): 1.07-1.32), French-native women (aPRR: 1.32, 95% CI: 1.10-1.57), and heterosexual French-native men (although not significantly, aPRR: 1.19, 95% CI: 0.98-1.45). Additionally, HIV-infected MSM were significantly less likely to be ex-smokers (aPRR: 0.73, 95% CI: 0.64-0.82) than the general population and similar trends were observed among heterosexual French-native men (aPRR: 0.89, 95% CI: 0.78-1.02) and women (aPRR: 0.84, 95% CI: 0.70-1.01). HIV-infected sub-Saharan African migrants were less likely to be regular smokers than the general population. CONCLUSIONS Smoking constitutes a major concern in various groups of PLWHIV in France including MSM and heterosexual French-natives, probably resulting from PLWHIV being less likely to quit smoking than their counterparts in the general population.
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Affiliation(s)
- Laure Tron
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Paris, France
- * E-mail:
| | - France Lert
- INSERM, U1018, Center for Research in Epidemiology and Population Health, Department of epidemiology of Occupational and Social Determinants of Health, Villejuif, France
- Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
| | - Bruno Spire
- INSERM, UMR912, Economics and Social Sciences Applied to Health and Analysis of Medical Information (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Rosemary Dray-Spira
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Paris, France
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Batista JDL, Militão de Albuquerque MDFP, Ximenes RADA, Miranda-Filho DDB, Lacerda de Melo HR, Maruza M, Moura LV, Pinto da Costa Ferraz EJS, Rodrigues LC. Prevalence and socioeconomic factors associated with smoking in people living with HIV by sex, in Recife, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 16:432-43. [PMID: 24142014 DOI: 10.1590/s1415-790x2013000200018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 05/23/2012] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Smoking is the leading cause of preventable death in the world. The prevalence of smoking is higher in people infected with HIV than in the general population. Although it is biologically plausible that smoking increases the morbidity and mortality of people living with HIV/AIDS, few studies in developing countries have analyzed the determinants and consequences of smoking in HIV infected people. OBJECTIVE To estimate the prevalence of smoking and identify the socioeconomic factors associated with smoking and smoking cessation in patients with HIV by sex. METHODS A cross-sectional study was conducted with baseline data, obtained from an ongoing prospective cohort study of patients with HIV attending two referral centers in Recife, Northeast Region of Brazil, between July 2007 and October 2009. RESULTS The prevalence of current smoking was 28.9%. For both sexes, smoking was independently associated with heavy alcohol drinking and marijuana use. Among women, smoking was associated with living alone, not being married and illiteracy; and among men, being 40 years or older, low income and using crack. Compared with ex-smokers, current smokers were younger and more likely to be unmarried, heavy drinkers and marijuana users. CONCLUSIONS It is important to incorporate smoking cessation interventions for the treatment of heavy alcohol drinkers and marijuana users with HIV/AIDS, which may increase life expectancy and quality of life, as smoking is related to risk of death, relapse of tuberculosis, and non communicable diseases.
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108
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Impact of HIV infection on cardiac deformation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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109
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Schierl M, Patel D, Ding W, Kochhar A, Adhami K, Zhou XK, Dannenberg AJ, Granstein RD. Tobacco smoke-induced immunologic changes may contribute to oral carcinogenesis. J Investig Med 2014; 62:316-23. [PMID: 24322330 DOI: 10.2310/jim.0000000000000031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study was to determine if tobacco smoke (TS), a risk factor for cancers of the aerodigestive tract, may contribute to oral carcinogenesis, in part, by suppressing local immunity. METHODS Mice were placed in Plexiglas holders in which they breathed TS through the nose and mouth for 1 hour daily for 21 days. Control mice breathed room air in the same manner. One day after the last exposure, mice were immunized by application of oxazolone to each buccal mucosa. Control mice were mock immunized by application of vehicle alone. Five days later, all mice were challenged on the ears with oxazolone, and 24-hour ear swelling assessed as contact hypersensitivity. RESULTS Mice exposed to TS had a significantly smaller contact hypersensitivity response compared with controls. When subsequently reimmunized on the glabrous skin, mice originally primed through TS-exposed mucosa could not be fully immunized, indicating induction of immunologic tolerance by exposure to hapten through TS-perturbed mucosa. Immunocompetent mice exposed to TS in this manner and challenged by submucosal placement of a syngeneic malignant tumor had significantly increased tumor growth over time compared with controls. No difference in growth rate was observed when the experiment was performed with natural killer cell-deficient, SCID (severe combined immunodeficiency) mice. In addition, exposure of epidermal Langerhans cells in vitro to an aqueous extract of TS impaired their ability to undergo maturation and to present antigen to responsive T cells. CONCLUSIONS Immunologic changes induced in the oral cavity by exposure to TS may play a role in the development of oral cancers.
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Affiliation(s)
- Michael Schierl
- From the Departments of *Dermatology and †Medicine, Weill Cornell Medical College, New York, NY ‡Department of Surgery (Head and Neck Service), Memorial Sloan-Kettering Cancer Center, New York, NY; §Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD; and ∥Department of Public Health, Weill Cornell Medical College, New York, NY
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Prevalence of ischemic heart disease and management of coronary risk in daily clinical practice: results from a Mediterranean cohort of HIV-infected patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:823058. [PMID: 25170515 PMCID: PMC4142151 DOI: 10.1155/2014/823058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/10/2014] [Accepted: 07/13/2014] [Indexed: 01/16/2023]
Abstract
Background. There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) in HIV-infected patients. Methods. We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results. We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus). Other CVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol (P = 0.025) and LDL-cholesterol (P = 0.004) was observed. However, the percentage of patients who maintained LDL-cholesterol > 100 mg/dL remained stable (from 46% to 41%, P = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time (P = 0.028). Conclusions. The prevalence of coronary events in our cohort is low. CVRF prevalence is high and their management is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.
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111
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Hessamfar M, Colin C, Bruyand M, Decoin M, Bonnet F, Mercié P, Neau D, Cazanave C, Pellegrin JL, Dabis F, Morlat P, Chêne G. Severe morbidity according to sex in the era of combined antiretroviral therapy: the ANRS CO3 Aquitaine Cohort. PLoS One 2014; 9:e102671. [PMID: 25076050 PMCID: PMC4116171 DOI: 10.1371/journal.pone.0102671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/22/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To describe trends and determinants of severe morbidity in HIV-infected women and men. DESIGN A French prospective cohort of HIV-infected patients of both sexes and all transmission categories. METHODS We used hospital admission data from January 2000 to December 2008. A severe morbid event (SME) was defined as a clinical event requiring hospitalization for ≥48 h, several events could be reported during hospitalization. Yearly incidence rates of SME were estimated and compared using Generalized Estimating Equations. RESULTS Among 4,987 patients (27% women), followed for a median of 8.7 years, 1,473 (30%) were hospitalized (3,049 hospitalizations for 5,963 SME). The yearly incidence rate of hospitalization decreased in men, from 155 in 2000 to 80/1,000 person-years (PY) in 2008 and in women, from 125 to 71/1,000 PY, (p<0.001). This trend was observed for all SME except for hepatic events, stable in men (15 to 13/1,000 PY) and increasing in women (2.5 to 11.5), cardiovascular events increasing in men (6 to 10/1,000 PY) and in women (6 to 14) and non-AIDS non-hepatic malignancies increasing in men (4 to 7/1,000 PY) and stable in women (2.5). Intraveneous drug users, age >50 years, HIV RNA >10,000 copies, CD4 <500/mm3, AIDS stage, hepatitis C co-infection and cardiovascular risk factors (diabetes, high blood pressure, and tobacco use) were associated with SME. CONCLUSIONS HIV-infected individuals in care in France require less and less frequently hospitalization. Women are now presenting with severe hepatic and cardio-vascular events. Disparities in SME between men and women are primarily explained by different exposure patterns to risk factors. Women should be targeted to benefit cardiovascular prevention policies as well as men.
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Affiliation(s)
- Mojgan Hessamfar
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
| | - Céline Colin
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
| | - Mathias Bruyand
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
| | - Madeleine Decoin
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
| | - Fabrice Bonnet
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
| | - Patrick Mercié
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Immunologie Clinique, Bordeaux, France
| | - Didier Neau
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU de Bordeaux, Fédération des Maladies Infectieuses et Tropicales, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Charles Cazanave
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU de Bordeaux, Fédération des Maladies Infectieuses et Tropicales, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Jean-Luc Pellegrin
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - François Dabis
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
| | - Philippe Morlat
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
| | - Geneviève Chêne
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
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Escárcega RO, Franco JJ, Mani BC, Vyas A, Tedaldi EM, Bove AA. Cardiovascular disease in patients with chronic human immunodeficiency virus infection. Int J Cardiol 2014; 175:1-7. [DOI: 10.1016/j.ijcard.2014.04.155] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 03/10/2014] [Accepted: 04/13/2014] [Indexed: 01/11/2023]
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113
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Pacek LR, Latkin C, Crum RM, Stuart EA, Knowlton AR. Current cigarette smoking among HIV-positive current and former drug users: associations with individual and social characteristics. AIDS Behav 2014; 18:1368-77. [PMID: 24287787 PMCID: PMC4037399 DOI: 10.1007/s10461-013-0663-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cigarette smoking is endemic among HIV-positive populations and is related to substantial morbidity and mortality. Research has largely focused on individual-level characteristics associated with smoking, with less attention to social factors. We aimed to explore individual- and social-level characteristics associated with current cigarette smoking among people living with HIV. Data came from 358 individuals on antiretroviral therapy interviewed in a study on informal HIV caregiving, conducted in Baltimore, MD, USA. Most participants (75 %) were current smokers and 45 % reported current illegal drug use. In adjusted logistic regression analyses, current drug use (aOR 2.90, 95 % CI 1.58-5.30), 12-step program participation (aOR 1.74, 95 % CI 1.02-2.97), and having a main Supporter who is a current smoker (aOR 1.93, 95 % CI 1.12-3.33) were associated with current smoking. Findings suggest the importance of social-level factors in cigarette smoking among HIV seropositive drug users and have implications for developing targeted smoking cessation interventions for smokers living with HIV.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA,
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114
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D'Ascenzo F, Cerrato E, Appleton D, Moretti C, Calcagno A, Abouzaki N, Vetrovec G, Lhermusier T, Carrie D, Das Neves B, Escaned J, Cassese S, Kastrati A, Chinaglia A, Belli R, Capodanno D, Tamburino C, Santilli F, Parodi G, Vachiat A, Manga P, Vignali L, Mancone M, Sardella G, Fedele F, DiNicolantonio JJ, Omedè P, Bonora S, Gaita F, Abbate A, Zoccai GB. Prognostic indicators for recurrent thrombotic events in HIV-infected patients with acute coronary syndromes: use of registry data from 12 sites in Europe, South Africa and the United States. Thromb Res 2014; 134:558-64. [PMID: 25064035 DOI: 10.1016/j.thromres.2014.05.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 02/08/2023]
Abstract
AIMS Limited data are available on prognostic indicators for HIV patients presenting with ACS. METHODS AND RESULTS Data on consecutive patients with HIV infection receiving standard highly active antiretroviral therapy (HAART) presenting with ACS between January 2001 and September 2012 were collected. Cardiac death and myocardial infarction (MI) were the primary end-points. 10,050 patients with ACS were screened, and among them a total of 201 patients (179 [89%] males and a median age of 53 [47-62] years) were included, 48% of them admitted for ST-elevation myocardial infarction and 14% having left ventricular systolic dysfunction (LVSD) at discharge. CD4+ counts less than 200 cells/mm(3) were reported in 18 patients (9%), and 136 patients (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 months (10-41), 30 patients (15%) died, 12 (6%) for cardiac reasons, 20 (10%) suffered a MI, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval [CI]: 1.6-26: p=0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio=9.9 [95% CI: 2.1-46: p=0.03); a CD4 cell count <200 cells/mm(3) was the only predictor of MI (hazard ratio=5.9 [95% CI: 1.4-25: p=0.016]). CONCLUSIONS HIV patients presenting with ACS are at significantly increased risk for cardiac death if not treated with NRTI, and at significantly increased risk of MI if their CD4 cell count is <200 cells/mm(3), suggesting that the stage of HIV disease (and lack of NRTI treatment) may contribute to cardiovascular instability.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | - Enrico Cerrato
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy; Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Claudio Moretti
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Division of Cardiology, Maria VittoriaHospital, Turin, Italy; Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | | | | | | | - Didier Carrie
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | | | - Javier Escaned
- Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | | | - Alessandra Chinaglia
- Division of Cardiology, Maria VittoriaHospital, Turin, Italy; Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Riccardo Belli
- Division of Cardiology, Maria VittoriaHospital, Turin, Italy
| | | | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | - Francesca Santilli
- Division of Cardiology, Università degli Studi 'G. d'Annunzio' Chieti e Pescara, Italy
| | - Guido Parodi
- Division of Cardiology, Università degli Studi 'G. d'Annunzio' Chieti e Pescara, Italy; Division of Cardiology, Careggi Hospital, Florence, Italy
| | - Ahmed Vachiat
- University of Witwatersrand Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology
| | - Pravin Manga
- University of Witwatersrand Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology
| | - Luigi Vignali
- Department of Cardiology, University of Parma, Italy
| | - Massimo Mancone
- Department of Cardiovascular and Pulmonary Sciences, Policlinico Umberto I "Sapienza", University of Rome, Italy
| | - Gennaro Sardella
- Department of Cardiovascular and Pulmonary Sciences, Policlinico Umberto I "Sapienza", University of Rome, Italy
| | - Francesco Fedele
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | | | - Pierluigi Omedè
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | - Stefano Bonora
- Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | | | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
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Trøseid M, Manner IW, Pedersen KK, Haissman JM, Kvale D, Nielsen SD. Microbial translocation and cardiometabolic risk factors in HIV infection. AIDS Res Hum Retroviruses 2014; 30:514-22. [PMID: 24521167 DOI: 10.1089/aid.2013.0280] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The widespread access to antiretroviral treatment during the past decades has transformed HIV infection from a lethal disease to a chronic condition, in which the relative burden of non-AIDS-related chronic disorders such as cardiovascular disease, malignancy, renal, liver, and bone disease has increased. The adjusted relative risk for myocardial infarction is reported to be around 2-fold compared to that of the general population, which over time is likely to translate into increased absolute risk in an aging population. Thus, delineating potentially HIV-specific pathogenetic mechanisms is crucial in order to tailor novel strategies for prophylaxis and treatment. This review will focus on advances in the field that possibly link HIV-induced alterations of the gut mucosa and consequent microbial translocation to cardiometabolic risk factors in HIV infection. Recent work suggests that markers of microbial translocation are closely associated with several cardiovascular risk factors such as dyslipidemia, insulin resistance, hypertension, coagulation abnormalities, endothelial dysfunction, and carotid atherosclerosis. Future studies should investigate whether associations between microbial translocation and cardiovascular risk factors will translate into increased risk of acute events, and whether strategies to target gut microbiota and microbial translocation might reduce such a risk.
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Affiliation(s)
- Marius Trøseid
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Inflammation Research Center, University of Oslo, Oslo, Norway
| | | | - Karin K. Pedersen
- Viro-Immunology, Department of Infectious Diseases, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Judith M. Haissman
- Viro-Immunology, Department of Infectious Diseases, Copenhagen University Rigshospitalet, Copenhagen, Denmark
| | - Dag Kvale
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Inflammation Research Center, University of Oslo, Oslo, Norway
| | - Susanne D. Nielsen
- Viro-Immunology, Department of Infectious Diseases, Copenhagen University Rigshospitalet, Copenhagen, Denmark
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Plasma plasminogen activator inhibitor-1 predicts myocardial infarction in HIV-1-infected individuals. AIDS 2014; 28:1171-9. [PMID: 24566095 DOI: 10.1097/qad.0000000000000247] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Biomarkers of endothelial dysfunction, inflammation and coagulation are associated with atherosclerosis and cardiovascular disease, but their association and possible predictive value remain controversial among HIV-1-infected individuals. We sought to investigate the association of seven biomarkers with first-time myocardial infarction (MI) in an HIV-1-infected population. DESIGN A matched case-control study of 54 cases and 54 controls. METHODS We compared 54 HIV-1-infected patients with verified first-time MI and 54 HIV-1-infected controls matched for age, duration of antiretroviral therapy, sex, smoking and no known cardiovascular disease. Levels of high-sensitivity C-reactive protein, soluble endothelial selectin, soluble vascular cell adhesion molecule, soluble intercellular adhesion molecule, matrix metalloprotease 9, myeloperoxidase, and plasminogen activator inhibitor 1 (PAI-1) were measured using a Luminex assay in plasma samples from routine visits both 12 and 2 months prior to the case patient's MI. RESULTS The two groups had similar HIV characteristics and traditional cardiovascular risk factors. In univariate analysis, PAI-1 levels were associated with MI, whereas none of the other markers showed any association.In multivariate analyses adjusting for the D:A:D risk score, HIV viral load and high-sensitivity C-reactive protein, PAI-1 levels in the highest quartile were associated with a six to seven-fold increased risk of MI in both samples. CONCLUSION High levels of PAI-1 were associated with risk of first-time MI in HIV-1-infected individuals independently of cardiovascular risk factors, HIV parameters and antiretroviral therapy. Therefore PAI-1 may be used for risk stratification and prediction of CHD, but further studies are needed.
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Fabbiani M, Grima P, Borghetti A, Colafigli M, D'Avino A, Mondi A, Gagliardini R, De Luca A, Cauda R, Di Giambenedetto S. Ophthalmic artery resistance index is increased in HIV-Infected patients and is influenced by protease inhibitors exposure. J Infect 2014; 68:500-3. [DOI: 10.1016/j.jinf.2014.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Identifying immunologic mechanisms that contribute to premature cardiovascular disease (CVD) among HIV-positive patients will inform prevention strategies. METHODS Coronary artery calcium (CAC) progression was studied in an HIV cohort. Immunophenotypes were measured on baseline cryopreserved peripheral blood mononuclear cells using multicolor flow cytometry. Logistic regression identified predictors of CAC progression after adjusting for traditional and HIV-related risk factors. RESULTS Baseline characteristics for the analysis cohort (n=436) were median age 42 years, median CD4 cell count 481 cells/μl, and 78% receiving antiretroviral therapy. Higher frequencies of CD16 monocytes were associated with greater likelihood of CAC progression, after adjusting for traditional and HIV risk factors [odds ratio per doubling was 1.66 for CD14/CD16 (P=0.02), 1.36 for CD14/CD16 (P=0.06), and 1.69 for CD14/CD16 (P=0.01)]. Associations for CD16 monocytes persisted when restricted to participants with viral suppression. We found no significant associations for CAC progression with other cellular phenotypes, including T-cell activation and senescence markers. CONCLUSION Circulating CD16 monocytes, potentially reflecting a more pro-atherogenic subpopulation, independently predicted greater CAC progression among HIV-infected persons at low risk for AIDS. In contrast to T-cell abnormalities classically associated with AIDS-related disease progression, these data highlight the potential role of monocyte activation in HIV-related CVD risk.
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119
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Ipp H, Zemlin AE, Erasmus RT, Glashoff RH. Role of inflammation in HIV-1 disease progression and prognosis. Crit Rev Clin Lab Sci 2014; 51:98-111. [PMID: 24479745 DOI: 10.3109/10408363.2013.865702] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammation and immune activation have been thrust to center stage in the understanding of HIV-1 disease pathogenesis and progression. Early work demonstrated that heightened levels of immune activation correlated with the extent of CD4 + T cell death in lymphoid tissue; however, this concept was not incorporated into the general view of disease pathogenesis. Since these early studies, the extension of life for patients on combination antiretroviral therapies (cART) has heralded a new era of non-AIDS-related diseases and incomplete restoration of immune function. The common link appears to be ongoing inflammation and immune activation. Thus, despite good control of viral loads, persons living with HIV (PLWH) remain at increased risk of inflammatory-associated complications such as cardiovascular disease and certain cancers. HIV-specific mechanisms as well as non-specific generalized responses to infection contribute to ongoing activation of the immune system. An early loss of gastrointestinal (GI) tract mucosal integrity, the pro-inflammatory cytokine milieu, co-infections and marked destruction of lymph node architecture are all factors contributing to the ongoing activation of the immune system as well as impaired immune recovery. It is becoming increasingly evident that the CD4 count and viral load do not provide a complete picture of the underlying state of the immune system. Heightened levels of inflammatory markers have been shown to predict increased mortality and other adverse events. Therefore, it will be important to incorporate these markers into management algorithms as soon as possible. This is particularly relevant in resource-poor countries where difficulties in cART roll-out and access are still encountered and, therefore, a mechanism for prioritizing individuals for therapy would be of value. This review will focus on the closely inter-related concepts of immune activation and inflammation. Both are broad concepts involving the interaction of various key players in the immune system. Importantly, immune activation promotes inflammation and thrombosis and similarly, inflammation and thrombosis induce immune activation. These concepts are thus intricately linked. Studies highlighting the potentially harmful effects of ongoing inflammation/immune activation are reviewed and the contributions of the GI tract "damage" and other co-infections such as CMV are explored. The complications resulting from persistent immune activation include enhanced CD4 + T cell death, lymphoid tissue destruction, and various pathologies related to chronic inflammation. Ultimately, we envision that the long-term management of the disease will incorporate both the identification and the amelioration of the potentially harmful effects of ongoing immune activation and inflammation.
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120
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Grigoletti SS, Guindani G, Moraes RS, Ribeiro JP, Sprinz E. Short-term folinic acid supplementation improves vascular reactivity in HIV-infected individuals: a randomized trial. Nutrition 2014; 29:886-91. [PMID: 23660169 DOI: 10.1016/j.nut.2013.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 01/12/2013] [Accepted: 01/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE HIV-infected individuals present a cluster of conditions that activate or injure the vascular endothelium. The administration of folates may exert beneficial effects on endothelial function in different populations at risk for cardiovascular disease. The aim of this study was to determine the effects of 4 wk of folinic acid supplementation on forearm vascular responses during reactive hyperemia in HIV-infected patients under highly active antiretroviral therapy. METHODS This was a prospective, randomized, double-blind, placebo-controlled trial to compare the effects of 4 wk of daily ingestion of 5 mg of folinic acid (n = 15) or placebo (n = 15). Participants had to have been on antiretroviral therapy (ART) for at least 6 mo before enrollment, with undetectable viral load, and CD4 cell count >200 cells/mm(3). Vascular function was evaluated with venous occlusion plethysmography at baseline and after 4 wk, for the determination of brachial artery reactive hyperemia, and after isosorbide dinitrate administration. RESULTS The groups were comparable. The mean age of patients was 45 y; there were eight women in each group. There was no difference regarding ART regimen. The supplementation of folinic acid produced a significant improvement in reactive hyperemia (from 14.9 to 21.2 mL•min•100 mL). The same was not observed in placebo group (from 15.3 to 14.6 mL•min•100 mL; group P, 0.017; time P < 0.001; interaction P < 0.001). Endothelium-independent responses remained unchanged. CONCLUSIONS Short-term folinic acid supplementation improved vascular reactivity in HIV-infected individuals enrolled in the studied. As folate supplementation is safe and relatively inexpensive, long-term clinical trials should be conducted.
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Affiliation(s)
- Shana S Grigoletti
- Exercise Pathophysiology Research Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Viganò A, Pattarino G, Cerini C, Zuccotti GV. What happens to children growing up with HIV infection? It’s time for a HAART to heart. Expert Rev Anti Infect Ther 2014; 7:495-8. [DOI: 10.1586/eri.09.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dimodi HT, Etame LS, Nguimkeng BS, Mbappe FE, Ndoe NE, Tchinda JN, Ebene JJA, Ntentié FR, Kingue GBA, Angie MAM, Paka GD, Kouanfack C, Ngondi JL, Enyong JO. Prevalence of Metabolic Syndrome in HIV-Infected Cameroonian Patients. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wja.2014.41011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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123
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Hsu DC, Sereti I, Ananworanich J. Serious Non-AIDS events: Immunopathogenesis and interventional strategies. AIDS Res Ther 2013; 10:29. [PMID: 24330529 PMCID: PMC3874658 DOI: 10.1186/1742-6405-10-29] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/26/2013] [Indexed: 12/14/2022] Open
Abstract
Despite the major advances in the management of HIV infection, HIV-infected patients still have greater morbidity and mortality than the general population. Serious non-AIDS events (SNAEs), including non-AIDS malignancies, cardiovascular events, renal and hepatic disease, bone disorders and neurocognitive impairment, have become the major causes of morbidity and mortality in the antiretroviral therapy (ART) era. SNAEs occur at the rate of 1 to 2 per 100 person-years of follow-up. The pathogenesis of SNAEs is multifactorial and includes the direct effect of HIV and associated immunodeficiency, underlying co-infections and co-morbidities, immune activation with associated inflammation and coagulopathy as well as ART toxicities. A number of novel strategies such as ART intensification, treatment of co-infection, the use of anti-inflammatory drugs and agents that reduce microbial translocation are currently being examined for their potential effects in reducing immune activation and SNAEs. However, currently, initiation of ART before advanced immunodeficiency, smoking cessation, optimisation of cardiovascular risk factors and treatment of HCV infection are most strongly linked with reduced risk of SNAEs or mortality. Clinicians should therefore focus their attention on addressing these issues prior to the availability of further data.
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Edward AO, Oladayo AA, Omolola AS, Adetiloye AA, Adedayo PA. Prevalence of traditional cardiovascular risk factors and evaluation of cardiovascular risk using three risk equations in nigerians living with human immunodeficiency virus. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:680-8. [PMID: 24404550 PMCID: PMC3877529 DOI: 10.4103/1947-2714.123251] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Reports from middle- and high-income countries suggest that the improved health outcome from highly active antiretroviral therapy (HAART) in people living with human immunodeficiency virus (PLWHIV) is being mitigated by increase in deaths from cardiovascular disease (CVD). AIMS This study was to determine the prevalence of traditional cardiovascular risk factors (CVRFs) and the 10-year cardiovascular risk using three risk equations in PLWHIV with no overt vascular disease. MATERIALS AND METHODS This cross-sectional study involved 265 PLWHIV. We classified the subjects as having low, moderate or high cardiovascular risk using the Framingham, World Health Organization/International Society of Hypertension (WHO/ISH) and Systematic Coronary Risk Evaluation (SCORE) equations. RESULTS The mean age of the cohort was 38.7 ± 8.7 years; 179 (67.5%) were females and 214 (80.8%) were on HAART. The prevalent traditional CVRFs in our cohort were low physical activity (66%), low HDL-C (49.1%), hypercholesterolaemia (33.6%), BMI ≥ 25 kg/m(2) (32.8%) and elevated LDL-C (28.3%). The prevalence of smoking was very low (1.9%). The prevalence of moderate to high 10-year coronary risk was 11.7, 12.8, and 12.8% according to the Framingham, WHO/ISH and SCORE risk equations, respectively. CONCLUSION Most of our patients had low overall cardiovascular risk according to the three risk equations.
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Affiliation(s)
- Ayodele Olugbenga Edward
- Department of Medicine, Ladoke Akintola University of Technology/Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Akinboro Adeolu Oladayo
- Department of Medicine, Ladoke Akintola University of Technology/Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Akinyemi Suliat Omolola
- People Living with HIV/AIDS Clinic, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
| | - Adepeju Akinlawon Adetiloye
- Department of Chemical Pathology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
| | - Popoola Adetoun Adedayo
- Department of Nursing, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
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Lavolé A, Toper C, Belmont L, Ruppert AM, Wislez M, Cadranel J. [Lung cancer and HIV infection]. Rev Mal Respir 2013; 31:133-41. [PMID: 24602680 DOI: 10.1016/j.rmr.2013.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/11/2013] [Indexed: 01/18/2023]
Abstract
AIDS was the cause of the majority of deaths from HIV infection before 1996 but since the introduction of antiretroviral therapies the causes of mortality have changed considerably. In 2010, 75 % of deaths were due to diseases other than AIDS, the majority being cancers. Lung cancer is the most common in terms of both incidence and mortality. It shows specific features when compared to the general population: there is an excess risk due to heavy smoking but also probably due to immunosuppression. The age of onset is younger and the prognosis worse than in the general population. Management is difficult, partly due to the aggressive nature of the tumor and partly to co-morbidities and potential interactions between anticancer and antiretroviral therapies. A phase II therapeutic trial (IFCT-CHIVA 1001) is under way nationally.
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Affiliation(s)
- A Lavolé
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France.
| | - C Toper
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - L Belmont
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| | - A-M Ruppert
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| | - M Wislez
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
| | - J Cadranel
- Service de pneumologie et réanimation, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France
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Discrepant coagulation profile in HIV infection: elevated D-dimer but impaired platelet aggregation and clot initiation. AIDS 2013; 27:2749-58. [PMID: 23842126 DOI: 10.1097/01.aids.0000432462.21723.ed] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES In HIV infection, cardiovascular disease (CVD) has emerged as a clinical problem, and elevated D-dimer has been reported. The pathophysiologic mechanisms underlying this remain unclear. We aimed to investigate whether untreated HIV-infected individuals display evidence of functional coagulopathy and whether this was associated with microbial translocation. DESIGN The study population consisted of 50 HIV-infected untreated individuals and 50 HIV-infected individuals on combination antiretroviral therapy (cART). Groups were matched for age, sex and current CD4cell count. METHODS Coagulation analyses included D-dimer and the functional haemostatic whole blood tests, thromboelastography (TEG) and platelet aggregation (Multiplate, impedance aggregometry). Microbial translocation was assessed by plasma levels of lipopolysaccharide (LPS). RESULTS A larger proportion of untreated individuals compared with treated individuals had D-dimer above normal reference range (27.7 vs. 2.2%, P = 0.001). In both treated and untreated individuals, delayed clot initiation with TEG R-time above upper reference range (18 and 28%, respectively, both P < 0.001) and TEG angle below lower reference range [14% (P = 0.004) and 24% (P < 0.001), respectively] was found. In untreated individuals, 64.6% had aggregation response below threshold in at least two of four tests compared with 36.7% in treated individuals (P = 0.010). Untreated individuals with increased D-dimer levels were relatively hypercoagulable by thromboelastography. Furthermore, in untreated patients, a negative association between microbial translocation and platelet aggregation was found. CONCLUSION Elevated D-dimer in untreated HIV-infected individuals was confirmed. However, in both untreated and treated individuals, reduced platelet aggregation and clot initiation was found. The impact of reduced platelet function in HIV infection and a potential role of microbial translocation warrant further investigation.
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O’Halloran JA, Satchell CS, Mallon PWG. Dyslipidemia, atherosclerosis and cardiovascular disease: an increasingly important triad in an aging population living with HIV. Future Virol 2013. [DOI: 10.2217/fvl.13.87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
As a result of major advances in the management of HIV over the last two decades, patients living with HIV are now encountering comorbidities commonly associated with aging. Cardiovascular disease is the leading cause of death worldwide. As the population living with HIV ages, understanding cardiovascular disease in the setting of HIV is of increasing importance. This review examines the complex interplay between cardiovascular disease, HIV infection and the drugs used to treat it, with particular emphasis on the contribution of dyslipidemia.
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Affiliation(s)
- Jane A O’Halloran
- HIV Molecular Research Group, University College Dublin School of Medicine and Medical Science, Catherine McAuley Education & Research Centre, Nelson Street, Dublin 7, Ireland
| | - Claudette S Satchell
- Justice Health Research Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Patrick WG Mallon
- HIV Molecular Research Group, University College Dublin School of Medicine and Medical Science, Catherine McAuley Education & Research Centre, Nelson Street, Dublin 7, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
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129
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Krauskopf K, Van Natta ML, Danis RP, Gangaputra S, Ackatz L, Addessi A, Federman AD, Branch AD, Meinert CL, Jabs DA. Correlates of hypertension in patients with AIDS in the era of highly active antiretroviral therapy. J Int Assoc Provid AIDS Care 2013; 12:325-33. [PMID: 23764503 PMCID: PMC4100586 DOI: 10.1177/2325957413491432] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is unclear whether HIV-related factors modify risk of hypertension (HTN). In a cohort of patients with AIDS, the authors determined HTN incidence and prevalence and assessed associated traditional, HIV-specific, and retinal vasculature factors. METHODS Prospective observational cohort included 2390 patients with AIDS (1998-2011). Univariate analysis was used to assess the impact of traditional- and AIDS-related risk factors for HTN prevalence and incidence. Multivariate regression analyses were used to evaluate the adjusted impact of these factors. RESULTS Hypertension prevalence was 22%(95% confidence interval [CI] 21%-24%) and was associated with traditional HTN risk factors (age, black race, and higher weight) as well as diabetes, hyperlipidemia, time since AIDS diagnosis, and higher CD4 counts. Hypertension incidence was 64.1 per 1000 person-years (95% CI 58.7/1000-69.9/1000). Age, race, weight, and diabetes were associated with incident HTN but HIV-specific factors were not. CONCLUSIONS Hypertension, a prevalent cardiovascular risk factor in patients with AIDS, is associated with traditional and metabolic risk factors.
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Affiliation(s)
- Katherine Krauskopf
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY
| | - Mark L. Van Natta
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ronald P. Danis
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Sapna Gangaputra
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Lori Ackatz
- Department of Ophthalmology, Northwestern Medical Faculty Foundation, Chicago, IL
| | - Adrienne Addessi
- Department of Ophthalmology and Department of Pediatrics, Division of Infectious Diseases, New York University School of Medicine, New York, NY
| | - Alex D. Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY
| | - Andrea D. Branch
- Division of Liver Diseases, Mount Sinai School of Medicine, New York, NY
| | - Curtis L. Meinert
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Douglas A. Jabs
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Division of Rheumatology, Department of Medicine, Mount Sinai School of Medicine, New York, NY
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY
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Kim SB, Kim YC, Kim MH, Song JE, Oh DH, Ahn JY, Ku NS, Kim HW, Jeong SJ, Han SH, Song YG, Choi JY, Kim JM. A comparison of the predicted risk for cardiovascular disease between HIV-infected and uninfected persons in Korea. ACTA ACUST UNITED AC 2013; 45:855-62. [PMID: 23968223 DOI: 10.3109/00365548.2013.813064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The introduction of highly active antiretroviral therapy (HAART) has extended the life expectancy of persons infected with the human immunodeficiency virus type 1 (HIV-1). However, cardiovascular disease (CVD) is currently an increasing concern for HIV-infected persons. METHODS We conducted a cross-sectional case-control study to evaluate and compare the 10-y cardiovascular risk of HIV-infected Koreans who had been receiving HAART for over 6 months and age- and sex-matched uninfected persons who visited a health promotion center, by calculating Framingham risk scores (FRS). RESULTS The average 10-y risk for cardiovascular events (FRS) was 7.07% (2-45) in the HIV group and 6.87% (1-37) in the control group (p = 0.77), corresponding to the very low risk group. Among HIV patients, the FRS was above 10% (low to moderate cardiovascular risk) in 19.9% of the patients, and above 20% (high risk) in 1.7% of the patients. In the healthy control group, the FRS was above 10% in 16.8% and above 20% in 2.7% (p = 0.57). The FRS was not significantly different for HIV-infected patients treated with protease inhibitor (PI)-based HAART and those treated with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART (7.26 ± 6.3 and 6.81 ± 4.4, respectively, p = 0.69). CONCLUSIONS The predicted cardiovascular risk of HIV-infected Koreans on HAART by FRS equation was low and similar to that of age- and sex-matched healthy control persons. However, the possibility remains that actual cardiovascular events could be underestimated. The next step for predicting the cardiovascular risk is to calculate the Data Collection of Adverse Events of Anti-HIV Drugs (D:A:D) equation risks.
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Affiliation(s)
- Sun Bean Kim
- From the Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine , Seoul , Republic of Korea
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Maloberti A, Giannattasio C, Dozio D, Betelli M, Villa P, Nava S, Cesana F, Facchetti R, Giupponi L, Castagna F, Sabbatini F, Bandera A, Gori A, Grassi G, Mancia G. Metabolic syndrome in human immunodeficiency virus-positive subjects: prevalence, phenotype, and related alterations in arterial structure and function. Metab Syndr Relat Disord 2013; 11:403-11. [PMID: 23885973 DOI: 10.1089/met.2013.0008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection itself and highly active antiretroviral treatment (HAART) have been proposed to be associated with a higher prevalence of metabolic syndrome, but, to date, prevalence and phenotype of metabolic syndrome among HIV subjects and the related structural and functional vascular alterations are not conclusively defined. METHODS We analyzed the data of 108 HIV-infected subjects without known cardiovascular risk factors: 72 were on HAART (group A, age 46.5±7.5 years, clinical blood pressure 125.7/74.9±11.6/7.8 mmHg) and there 36 in a naïve group (group B, age 40.7±7.9 years, blood pressure 126/75.8±9.8/7.7 mmHg). A total of 224 healthy subjects served as controls (group C, age 44.9±6.9 years, blood pressure 123.7/75.7±9.8/7.1 mmHg). Arterial stiffness was measured by aorto-femoral pulse wave velocity (PWV, sfigmocor), and carotid intima media thickness (IMT) was measured by a semiautomatic echotracking system (Esaote-WTS). RESULTS Metabolic syndrome was more frequent in HIV-positive subjects than in controls (19.4%, 13.8%, 4.5% for groups A, B, and C; P<0.001), with no significant difference between HAART and naïve. In metabolic syndrome subjects, group A displayed lipid profile alterations more frequently (91%, 50%, 57% for groups A, B, and C; P<0.05), whereas others metabolic syndrome components were equally represented in the three groups. In metabolic syndrome subjects, IMT was similar [556±108, 542±164, and 564±110.4 μm for groups A, B, and C; P=not significant (NS)], whereas PWV was significantly greater in HAART subjects when compared with controls (10.8±1.8, 9.±1.1, 9.3±1 cm/sec for groups A, B, and C; P=0.02 for A vs. C). Moreover, in this group (metabolic syndrome+HAART), PWV was higher than in subjects on HAART but without metabolic syndrome. CONCLUSIONS HIV subjects showed a higher prevalence and a different pattern of metabolic syndrome components. HAART, more than HIV infection per se, appeared to be responsible for the increased prevalence of metabolic syndrome and arterial function derangement.
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Pinto Neto LFDS, Milanez MDC, Golub JE, Miranda AEB. Malignancies in HIV/AIDS patients attending an outpatient clinic in Vitória, State of Espírito Santo, Brazil. Rev Soc Bras Med Trop 2013; 45:687-90. [PMID: 23295869 DOI: 10.1590/s0037-86822012000600006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/19/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The present study investigated cancer prevalence and associated factors among HIV-infected individuals attending an AIDS outpatient clinic in Vitória, State of Espírito Santo, Brazil. METHODS A sectional study was conducted among HIV infected adults attending an AIDS outpatient clinic in Vitória, State of Espírito Santo, Brazil. Demographic, epidemiological and clinical data were abstracted from medical records, including cancer diagnoses; nadir and current CD4 cell count, HIV viral load, time on antiretroviral treatment (ART), type of ART and smoking status. RESULTS A total of 730 (91.3%) patients were included in the study. Median age was 44.0 [interquartile range (IQR): 35-50.3] years; median time since HIV diagnosis was 5.5 years (IQR: 2-10); 60% were male; and 59% were white. Thirty (4.1%) cases of cancer were identified of which 16 (53%) were AIDS defining cancers and 14 (47%) were non-AIDS defining malignancies. Patients diagnosed with cancer presented higher chance of being tobacco users [OR 2.2 (95% CI: 1.04-6.24)]; having nadir CD4 ≤200 cells/mm³ [OR 3.0 (95% CI: 1.19-7.81)] and higher lethality [OR 13,3 (95% CI: 4,57-38,72)]. CONCLUSIONS These results corroborate the importance of screening for and prevention of non-AIDS defining cancers focus in HIV-infected population, as these cancers presented with similar frequency as AIDS defining cancers.
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Lichtenstein KA, Armon C, Buchacz K, Chmiel JS, Buckner K, Tedaldi E, Wood K, Holmberg SD, Brooks JT. Provider compliance with guidelines for management of cardiovascular risk in HIV-infected patients. Prev Chronic Dis 2013; 10:E10. [PMID: 23347705 PMCID: PMC3557014 DOI: 10.5888/pcd10.120083] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Compliance with National Cholesterol Education Program Adult Treatment Panel III (NCEP) guidelines has been shown to significantly reduce incident cardiovascular events. We investigated physicians’ compliance with NCEP guidelines to reduce cardiovascular disease (CVD) risk in a population infected with HIV. Methods We analyzed HIV Outpatient Study (HOPS) data, following eligible patients from January 1, 2002, or first HOPS visit thereafter to calculate 10-year cardiovascular risk (10yCVR), until September 30, 2009, death, or last office visit. We categorized participants into four 10yCVR strata, according to guidelines determined by NCEP, the Infectious Disease Society of America, and the Adult AIDS Clinical Trials Group. We calculated percentages of patients treated for dyslipidemia and hypertension, calculated percentages of patients who achieved recommended goals, and categorized them by 10yCVR stratum. Results Of 2,005 patients analyzed, 33.7% had fewer than 2 CVD risk factors. For patients who had 2 or more risk factors, 10yCVR was less than 10% for 28.2%, 10% to 20% for 18.2%, and higher than 20% for 20.0% of patients. Of patients eligible for treatment, 81% to 87% were treated for elevated low-density lipoprotein cholesterol/non–high-density lipoprotein cholesterol (LDL-C/non–HDL-C), 2% to 11% were treated for low HDL-C, 56% to 91% were treated for high triglycerides, and 46% to 69% were treated for hypertension. Patients in higher 10yCVR categories were less likely to meet treatment goals than patients in lower 10yCVR categories. Conclusion At least one-fifth of contemporary HOPS patients have a 10yCVR higher than 20%, yet a large percentage of at-risk patients who were eligible for pharmacologic treatment did not receive recommended interventions and did not reach recommended treatment goals. Opportunities exist for CVD prevention in the HIV-infected population.
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Lorgis L, Cottenet J, Molins G, Benzenine E, Zeller M, Aube H, Touzery C, Hamblin J, Gudjoncik A, Cottin Y, Quantin C. Outcomes After Acute Myocardial Infarction in HIV-Infected Patients. Circulation 2013; 127:1767-74. [DOI: 10.1161/circulationaha.113.001874] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
We aimed to assess in-hospital case fatality and 1-year prognosis in HIV-infected patients with acute myocardial infarction.
Methods and Results—
From the PMSI (Program de Medicalisation des Systèmes d’informatique) database, data from 277 303 consecutive acute myocardial infarction patients hospitalized from January 1, 2005, to December 31, 2009, were analyzed. Surviving patients were followed up for 1 year after discharge. HIV-infected patients were compared with uninfected patients. Among the cohort, HIV-infected patients (n=608) accounted for 0.22%. All-cause hospital and 1-year mortality rates were lower in the HIV-infected group than in uninfected patients (3.1% versus 8.1% [
P
<0.001] and 1.4% versus 5.5% [
P
<0.001], respectively). From the database, we then analyzed a cohort derived from a matching procedure, with 1 HIV patient matched with 2 patients without HIV, based on age and sex (n=1824). Ischemic cardiomyopathy was more frequent in the HIV group (7.6% versus 4.2%,
P
=0.003). Hospitalization and 1-year mortality rates were similar in the 2 groups (3.1% versus 2.1% [
P
=0.168] and 1.4% versus 1.7% [
P
=0.642], respectively). However, at 12 months, hospitalizations for episodes of heart failure were significantly more frequent in HIV-infected than in uninfected patients (3.3% versus 1.4%, respectively;
P
=0.020). HIV infection, diabetes mellitus, history of ischemic cardiomyopathy, and undergoing percutaneous coronary intervention were associated in univariate analysis with occurrence of heart failure. By multivariable analysis, HIV infection (odds ratio 2.82, 95% confidence interval 1.32–6.01), diabetes mellitus, and undergoing percutaneous coronary intervention remained independent predictors of heart failure.
Conclusions—
The present study demonstrates that after acute myocardial infarction, HIV status influences long-term risk, although the short-term risk in HIV patients is comparable to that in uninfected patients.
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Affiliation(s)
- Luc Lorgis
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Jonathan Cottenet
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Guillaume Molins
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Eric Benzenine
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Marianne Zeller
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Hervé Aube
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Claude Touzery
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Joelle Hamblin
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Aurélie Gudjoncik
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Yves Cottin
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Catherine Quantin
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
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Riedel DJ, Mwangi EIW, Fantry LE, Alexander C, Hossain MB, Pauza CD, Redfield RR, Gilliam BL. High cancer-related mortality in an urban, predominantly African-American, HIV-infected population. AIDS 2013; 27:1109-17. [PMID: 23262503 PMCID: PMC3820581 DOI: 10.1097/qad.0b013e32835dc068] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine mortality associated with a new cancer diagnosis in an urban, predominantly African-American, HIV-infected population. DESIGN Retrospective cohort study. METHODS All HIV-infected patients diagnosed with cancer between 1 January 2000 and 30 June 2010 were reviewed. Mortality was examined using Kaplan-Meier estimates and Cox proportional hazards models. RESULTS There were 470 cases of cancer among 447 patients. Patients were predominantly African-American (85%) and male (79%). Non-AIDS-defining cancers (NADCs, 69%) were more common than AIDS-defining cancers (ADCs, 31%). Cumulative cancer incidence increased significantly over the study period. The majority (55.9%) was taking antiretroviral therapy (ART) at cancer diagnosis or started afterward (26.9%); 17.2% never received ART. Stage 3 or 4 cancer was diagnosed in 67%. There were 226 deaths during 1096 person years of follow-up, yielding an overall mortality rate of 206 per 1000 person years. The cumulative mortality rate at 30 days, 1 year, and 2 years was 6.5, 32.2, and 41.4%, respectively. Mortality was similar between patients on ART whether they started before or after the cancer diagnosis but was higher in patients who never received ART. In patients with a known cause of death, 68% were related to progression of the underlying cancer. CONCLUSION In a large cohort of urban, predominantly African-American patients with HIV and cancer, many patients presented with late-stage cancer. There was substantial 30-day and 2-year mortality, although ART had a significant mortality benefit. Deaths were most often caused by progression of cancer and not from another HIV-related or AIDS-related event.
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Affiliation(s)
- David J Riedel
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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137
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Atrial fibrillation and atrial flutter in human immunodeficiency virus-infected persons: incidence, risk factors, and association with markers of HIV disease severity. J Am Coll Cardiol 2013; 61:2288-95. [PMID: 23563125 DOI: 10.1016/j.jacc.2013.03.022] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 01/30/2013] [Accepted: 03/03/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the associations of traditional risk factors and longitudinal measures of human immunodeficiency virus (HIV) disease severity with risk of incident atrial fibrillation (AF) in a contemporary cohort of HIV-infected individuals. BACKGROUND Cardiovascular disease is common in HIV-infected persons; however, the most common cardiac arrhythmia, AF, has not been adequately studied in this population. METHODS We studied a national sample of 30,533 HIV-infected veterans followed in the Veterans Affairs HIV Clinical Case Registry from 1996 to 2011. We examined the independent associations of demographic characteristics, time-updated comorbidities, and time-updated clinical measurements including CD4(+) cell count and viral load with the outcome of incident AF using proportional hazards regression for multivariable analysis. RESULTS Over a median follow-up of 6.8 years, 780 (2.6%) patients developed AF. After multivariable adjustment for traditional risk factors, a lower CD4(+) cell count (<200 compared with >350 cells/mm(3); hazard ratio [HR]: 1.4; 95% confidence interval [CI]: 1.1 to 1.8; p = 0.018) and higher viral load (>100,000 compared with <500 copies/ml; HR: 1.7; 95% CI: 1.2 to 2.4; p = 0.002) were independently associated with increased risk of incident AF. Additional risk factors independently associated with risk of AF included older age, White race, coronary artery disease, congestive heart failure, alcoholism, proteinuria, reduced kidney function, and hypothyroidism. CONCLUSIONS In a large HIV-infected cohort, markers of HIV disease severity represented by low CD4(+) cell count and high viral load, assessed by multiple time-updated measures, were independently associated with development of AF.
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Boccara F, Lang S, Meuleman C, Ederhy S, Mary-Krause M, Costagliola D, Capeau J, Cohen A. HIV and coronary heart disease: time for a better understanding. J Am Coll Cardiol 2013; 61:511-23. [PMID: 23369416 DOI: 10.1016/j.jacc.2012.06.063] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 05/21/2012] [Accepted: 06/19/2012] [Indexed: 11/28/2022]
Abstract
Cardiovascular disease, and particularly coronary heart disease, is an emerging area of concern in the HIV population. Since the advent of efficient antiretroviral therapies and the consequent longer patient life span, an increased risk for myocardial infarction has been observed in HIV-infected patients compared with the general population in Western countries. The pathophysiology of this accelerated atherosclerotic process is complex and multifactorial. Traditional cardiovascular risk factors-overrepresented in the HIV population-associated with uncontrolled viral replication and exposure to antiretroviral drugs (per se or through lipid and glucose disturbances) could promote acute ischemic events. Thus, despite successful antiviral therapy, numerous studies suggest a role of chronic inflammation, together with immune activation, that could lead to vascular dysfunction and atherothrombosis. It is time for physicians to prevent coronary heart disease in this high-risk population through the use of tools employed in the general population. Moreover, the lower median age at which acute coronary syndromes occur in HIV-infected patients should shift prevention to include patients <45 years of age. Available cardiovascular risk scores in the general population usually fail to screen young patients at risk for myocardial infarction. Moreover, the novel vascular risk factors identified in HIV-related atherosclerosis, such as chronic inflammation, immune activation, and some antiretroviral agents, are not taken into account in the available risk scores, leading to underestimation of cardiovascular risk in the HIV population. Cardiovascular prevention in HIV-infected patients is a challenge for both cardiologists and physicians involved in HIV care. We require new tools to assess this higher risk and studies to determine whether intensive primary prevention is warranted.
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Affiliation(s)
- Franck Boccara
- Department of Cardiology, Saint Antoine Hospital, University of Paris, Paris, France.
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139
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Gutierrez J, Elkind MSV, Marshall RS. Cardiovascular profile and events of US adults 20-49 years with HIV: results from the NHANES 1999-2008. AIDS Care 2013; 25:1385-91. [PMID: 23425303 DOI: 10.1080/09540121.2013.769493] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The incidence of vascular events in HIV-infected individuals is increasing. We investigated whether there is a higher prevalence of vascular risk factors in the adult US population with HIV compared to uninfected controls that could explain some of the increased vascular events. We obtained prevalence estimates of vascular risk factors, stratified by the HIV status, in sampled adults aged 20-49 years from the 1999 to 2008 National Health and Nutrition Examination Survey. Estimates were weighted to account for oversampling and nonresponse. Logistic regression models with adjustment for demographic and socioeconomic status were created to adjust for confounders. The analysis included 12,339 US adults, 76 with HIV infection. The weighted seroprevalence of HIV was 0.48% (95% CI 0.33-0.65). In univariate analysis, HIV infection was more prevalent in non-Hispanic blacks (odds ratio [OR] 7.4, 95% CI 3.6-15.2), men (OR 2.6, 95% CI 1.42-4.89), the physically inactive (OR 1.8, 95% CI 1.0-3.0), and current smokers (OR 2.4, 95% CI 1.3-4.4). Increased waist circumference (OR 0.5, 95% CI 0.3-1.0) was less common in HIV-infected individuals, although controlling for sex and ethnicity differences, this difference became nonsignificant (OR 0.6, 95% CI 0.3-1.2). Further controlling for differences in income and education rendered the associations with smoking and physical inactivity nonsignificant, but revealed associations of HIV infection with hypertension (OR 2.4, 95% CI 1.0-6.0) and diabetes (OR 4.1, 95% CI 1.1-16.1). These results underscore the need to further investigate the role of cardiovascular risk factors in the growing HIV population.
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Affiliation(s)
- Jose Gutierrez
- a Stroke Division, Department of Neurology , Columbia University Medical Center , New York , USA
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140
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Abstract
HIV + patients face a heightened risk of cardiovascular disease (CVD), which cannot be fully explained by traditional risk factors or antiretroviral therapy (ART)-related cardiotoxicity. Increasing evidence suggests a significant contribution of HIV-specific immune dysregulation to atherosclerosis. HIV-specific immune dysregulation may have the following atherogenic effects: 1) activation of endothelial and immune cells; 2) enhancement of the percentage of circulating atherogenic immune cell subsets; and 3) modification of lipid function. Efforts are underway to link immune dysregulation markers with validated CVD endpoints and to identify genetic predispositions for HIV-induced atherogenesis. Moreover, immune suppressants are under evaluation in HIV + patients to attempt modification of immune-mediated CVD risk. Taken together, these studies will enhance understanding of CVD risk stratification and reduction strategies in HIV.
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141
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Mariano-Goulart D, Jacquet JM, Molinari N, Bourdon A, Benkiran M, Sainmont M, Cornillet L, Macia JC, Reynes J, Ben Bouallègue F. Should HIV-infected patients be screened for silent myocardial ischaemia using gated myocardial perfusion SPECT? Eur J Nucl Med Mol Imaging 2012; 40:271-9. [DOI: 10.1007/s00259-012-2262-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/21/2012] [Indexed: 11/28/2022]
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142
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Sustained efficacy and safety of raltegravir after 5 years of combination antiretroviral therapy as initial treatment of HIV-1 infection: final results of a randomized, controlled, phase II study (Protocol 004). J Acquir Immune Defic Syndr 2012; 61:73-7. [PMID: 22743596 DOI: 10.1097/qai.0b013e318263277e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Raltegravir as initial HIV therapy was examined in a double-blind study; 160 patients were randomized to raltegravir (400 mg bid after dose-ranging), 38 to efavirenz, both with tenofovir/lamivudine. At week 240, HIV-RNA remained <50 copies per milliliter in 68.8% (raltegravir) versus 63.2% (efavirenz), and CD4 increases were 302 versus 276 cells per microliter, respectively. Early HIV-RNA decline predicted later CD4 increases in both groups. Raltegravir resistance was observed in 3 of 10 raltegravir recipients with virologic failure. Few drug-related adverse events were reported after week 48. Raltegravir had minimal effect on laboratory values, including lipids. Raltegravir with tenofovir/lamivudine showed durable efficacy and good tolerability over 5 years.
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143
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Manner IW, Trøseid M, Oektedalen O, Baekken M, Os I. Low nadir CD4 cell count predicts sustained hypertension in HIV-infected individuals. J Clin Hypertens (Greenwich) 2012; 15:101-6. [PMID: 23339727 DOI: 10.1111/jch.12029] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hypertension is associated with cardiovascular disease in the human immunodeficiency virus (HIV)-infected population. The authors aimed to test the hypothesis whether advanced immunosuppression with low nadir CD4 lymphocyte cell count is a predictor of sustained hypertension in HIV-infected individuals. In a longitudinal study of an HIV cohort of 434 patients (43±11 years, 72% men, 71% Caucasians), standardized blood pressure was measured in duplicate during 3 clinical visits both at baseline and after 3.4±0.8 years. The lowest CD4 cell count in the individual history was recorded as nadir CD4. Both nadir CD4 cell count<50 cells/μL and duration of antiretroviral therapy (ART) were associated with sustained hypertension, and the highest proportion of hypertensive patients was observed in those who had both nadir CD4 cell count<50 cells/μL and prolonged ART duration. Nadir CD4 cell-count<50 cells/μL was an independent predictor of hypertension (adjusted odds ratio [OR], 2.48; 95% confidence interval [CI], 1.27-4.83), as was ART duration (adjusted OR, 1.13; 95% CI, 1.03-1.24). The predictive power of ART duration was more pronounced in patients with nadir CD4 cell count<50 cells/μL. Delaying ART initiation until a state of advanced immunosuppression might add to and even fuel the cardiovascular risk associated with ART.
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Affiliation(s)
- Ingjerd W Manner
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, and the Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway.
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144
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Oka F, Naito T, Oike M, Saita M, Inui A, Uehara Y, Mitsuhashi K, Isonuma H, Hisaoka T, Shimbo T. Influence of smoking on HIV infection among HIV-infected Japanese men. J Infect Chemother 2012; 19:542-4. [PMID: 23073649 PMCID: PMC3682097 DOI: 10.1007/s10156-012-0489-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
Abstract
We performed a cross-sectional study that included 100 HIV-infected Japanese men without hemophilia to examine the influence of smoking on HIV infection. History of smoking was obtained using a questionnaire. The percentage of current smokers was 40 % and was the highest (50 %) among men in their forties. The mean Brinkman index (BI, number of cigarettes smoked per day multiplied by years of smoking) was 450. The percentage of patients with a BI ≥600 was significantly higher in patients with an AIDS-defining event than in those without an AIDS-defining event. A BI ≥600 was associated with an AIDS-defining event. Reducing smoking appears to be critical to enhancing disease management efforts in Japanese men with HIV.
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Affiliation(s)
- Fukuko Oka
- Department of General Medicine, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Hongo, Tokyo, 113-8421, Japan
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145
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Merlini E, Luzi K, Suardi E, Barassi A, Cerrone M, Martínez JS, Bai F, D'Eril GVM, Monforte AD, Marchetti G. T-cell phenotypes, apoptosis and inflammation in HIV+ patients on virologically effective cART with early atherosclerosis. PLoS One 2012; 7:e46073. [PMID: 23029393 PMCID: PMC3459872 DOI: 10.1371/journal.pone.0046073] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/27/2012] [Indexed: 11/21/2022] Open
Abstract
Objective We investigated the potential relationship between T-cell phenotype, inflammation, endotoxemia, and atherosclerosis evaluated by carotid intima-media thickness (IMT) in a cohort of HIV-positive patients undergoing long-term virologically suppressive combination antiretroviral therapy (cART). Design We studied 163 patients receiving virologically suppressive cART. Methods We measured IMT (carotid ultrasound); CD4+/CD8+ T-cell activation (CD38, CD45R0), differentiation (CD127), apoptosis (CD95), and senescence (CD28, CD57) (flow cytometry); plasma sCD14, IL-6, TNF- α, sVCAM-1, hs-CRP, anti-CMV IgG (ELISA); LPS (LAL). The results were compared by Mann-Whitney, Kruskal-Wallis or Chi-square tests, and factors associated with IMT were evaluated by multivariable logistic regression. Results Of 163 patients, 112 demonstrated normal IMT (nIMT), whereas 51 (31.3%) had pathological IMT (pIMT: ≥1 mm). Of the patients with pIMT, 22 demonstrated an increased IMT (iIMT), and 29 were shown to have plaques. These patient groups had comparable nadir and current CD4+, VLs and total length of time on cART. Despite similar proportions of CD38-expressing CD8+ cells (p = .95), pIMT patients exhibited higher activated memory CD8+CD38+CD45R0+ cells (p = .038) and apoptotic CD4+CD95+ (p = .01) and CD8+CD95+ cells (p = .003). In comparison to nIMT patients, iIMT patients tended to have lower numbers of early differentiated CD28+CD57− memory CD4+ (p = .048) and CD28–CD57−CD8+ cells (p = .006), both of which are associated with a higher proliferative potential. Despite no differences in plasma LPS levels, pIMT patients showed significantly higher circulating levels of sCD14 than did nIMT patients (p = .046). No differences in anti-CMV IgG was shown. Although circulating levels of sCD14 seemed to be associated with a risk of ATS in an unadjusted analysis, this effect was lost after adjusting for classical cardiovascular predictors. Conclusions Despite the provision of full viral suppression by cART, a hyperactivated, pro-apoptotic T-cell profile characterizes HIV-infected patients with early vascular damage, for whom the potential contribution of subclinical endotoxemia and anti-CMV immunity should be investigated further.
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Affiliation(s)
- Esther Merlini
- Clinic of Infectious Diseases and Tropical Medicine, Department of Health Sciences, University of Milan, San Paolo Hospital, Italy
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146
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Triant VA. HIV infection and coronary heart disease: an intersection of epidemics. J Infect Dis 2012; 205 Suppl 3:S355-61. [PMID: 22577208 DOI: 10.1093/infdis/jis195] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Patients with human immunodeficiency virus (HIV) infection are at increased risk of developing coronary heart disease (CHD). Although factors potentially contributing to this elevated risk include traditional CHD risk factors and antiretroviral medications, more recent data support a role for inflammatory and immunologic factors as central to a complex mechanism. Decreasing CHD risk among HIV-infected patients is likely to involve modification of inflammatory and immunologic factors through antiretroviral therapy or other novel strategies as well as targeted treatment of traditional CHD risk factors. This review will highlight epidemiologic data investigating the association between HIV and CHD outcomes. An overview of potential mechanistic factors associated with CHD in HIV infection and of strategies for managing CHD risk in HIV-infected patients is also included. Specific cardiovascular and metabolic risk factors, CHD risk prediction, and the immunologic basis for CHD in HIV-infected patients will be discussed in separate reviews.
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Affiliation(s)
- Virginia A Triant
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
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147
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Lang S, Mary-Krause M, Simon A, Partisani M, Gilquin J, Cotte L, Boccara F, Costagliola D. HIV replication and immune status are independent predictors of the risk of myocardial infarction in HIV-infected individuals. Clin Infect Dis 2012; 55:600-7. [PMID: 22610928 DOI: 10.1093/cid/cis489] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Individuals infected by human immunodeficiency virus (HIV) have a higher risk of cardiovascular disease than the general population. The specific effects of virological and immunological parameters on the risk of myocardial infarction (MI) in HIV-infected individuals are debated. METHODS We conducted a nested case-control study within the French Hospital Database on HIV. Case patients (n = 289) were patients who, between January 2000 and December 2006, had a prospectively recorded and validated first MI. Up to 5 HIV-infected controls (n = 884) matched for age, sex, and clinical center were selected, at random with replacement, among patients with no history of MI. Conditional logistic regression models were used to identify predictors of the risk of MI. RESULTS Plasma HIV-1 RNA levels >50 copies/mL, a low CD4 T-cell nadir, and a high CD8 T-cell count were independently associated with an increased risk of MI, with respective odds ratios of 1.51 (95% confidence interval, 1.09-2.10), 0.90 (.83-.97) per log(2) unit, and 1.48 (1.01-2.18) for the highest tertile of CD8 T-cell counts (>1150 cells/mm(3)) compared with the lowest (≤760 cells/mm(3)). CONCLUSIONS Independently of cardiovascular risk factors and antiretroviral therapy, HIV replication, a low CD4 T-cell nadir and a high current CD8 T-cell count are associated with an increased risk of MI in HIV-infected individuals. This suggests new paths for interventions to diminish the risk of MI in HIV-infected patients.
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148
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Knudsen A, Kristoffersen US, Kjær A, Lebech AM. Cardiovascular disease in patients with HIV. Future Virol 2012. [DOI: 10.2217/fvl.12.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The introduction of combination antiretroviral therapy (cART) has substantially decreased mortality among the HIV-infected population. In this setting, cardiovascular disease (CVD) has become a leading cause of morbidity and mortality. Compared with the general population, higher rates of myocardial infarction as well as a high prevalence of subclinical coronary atherosclerosis have been found in the HIV-infected population. It has been suggested that in HIV-infected patients, the atherosclerotic burden is not based solely on traditional cardiovascular risk factors. The interplay of other mechanisms such as chronic inflammation, effects of cART or immune activation after initiation of cART may predispose to accelerated and increased risk of CVD. Effective treatment are available today to reduce CVD in at-risk patients, and therefore early detection of subclinical coronary atherosclerosis is important. However, the mechanisms behind the development of CVD in HIV-infected patients may limit the usefulness of the traditional noninvasive screening tools for CVD used in the general population. This review will focus on the different plausible mechanisms behind the increased risk of CVD and the noninvasive methods by which atherosclerosis may be assessed in the HIV-infected population.
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Affiliation(s)
- Andreas Knudsen
- Department of Infectious Diseases, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet University Hospital & Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Sloth Kristoffersen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet University Hospital & Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet University Hospital & Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
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Estébanez-Muñoz M, Soto-Abánades CI, Ríos-Blanco JJ, Arribas JR. Updating Our Understanding of Pulmonary Disease Associated With HIV Infection. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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150
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Phillips JC, Oliffe JL, Ensom MH, Bottorff JL, Bissell LJ, Boomer J, O’Brien KM, Howard T, Khara M. An overlooked majority: HIV-positive gay men who smoke. JOURNAL OF MENS HEALTH 2012. [DOI: 10.1016/j.jomh.2011.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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