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Daultrey H, Oliver NS, Wright J, Levett TJ, Chakera AJ. What Is the Influence of HIV Serostatus on HbA1c? A Prospective Analysis Using Continuous Glucose Monitoring. Diabetes Care 2024; 47:1379-1385. [PMID: 38805493 DOI: 10.2337/dc24-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/01/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Type 2 diabetes (T2D) is reported to be more common in people living with HIV (PLWH). Clinical guidelines recommend screening for diabetes in PLWH, but there is no agreed method due to studies reporting HbA1c is falsely low in PLWH. These studies were performed in the early HIV era when participants were taking older preparations of antiretroviral therapy that are rarely used today. We aimed to investigate whether HIV serostatus influences HbA1c. RESEARCH DESIGNS AND METHODS We conducted a prospective cohort study of PLWH and age- and sex-matched HIV-negative participants who were purposely recruited from clinics in Brighton, U.K. Each participant wore a Dexcom G6 continuous glucose monitor (CGM) for up to 10 days, had glucose measured during an oral glucose tolerance test, and fructosamine and paired HbA1c were measured. We performed regression analysis to assess the influence of HIV on HbA1c and used a separate model for CGM glucose, venous glucose, and fructosamine. In addition, we included predictor variables used in previous studies that explored HbA1c discrepancy. RESULTS We recruited 60 PLWH (90% men, 50% with T2D, mean ± SD age 57 ± 10.7 years, 100% undetectable viral load) and 48 people without HIV (92% men, 30% with T2D, mean age 57.7 ± 8.9 years). We found that HIV serostatus did not have a significant influence on HbA1c within the regression models. CONCLUSIONS We performed a comprehensive assessment of glycemia to assess whether HIV serostatus influences HbA1c. We did not find any strong evidence that HIV serostatus influenced HbA1c. The results of our study support incorporating HbA1c into routine clinical blood work in PLWH.
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Affiliation(s)
| | - Nick S Oliver
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, U.K
| | | | - Tom J Levett
- Brighton and Sussex Medical School, Brighton, East Sussex, U.K
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MOHAMMAD GS, YANG X, GAO H, CHEN S, ZHANG J, OLATOSI B, LI X. Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors. AIDS 2024; 38:1057-1065. [PMID: 38329087 PMCID: PMC11062823 DOI: 10.1097/qad.0000000000003856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND OBJECTIVE The risk factors of diabetes mellitus (DM) in people with HIV (PWH) may be dynamic in a life course manner. This study aimed to describe incidence of DM and investigate the trajectory of changes in risk factor associated with DM incidence over around 15 years among a statewide cohort of PWH in South Carolina (SC). DESIGN This is a population-based cohort study. METHODS Data were retrieved from the integrated statewide electronic health records between 2006 and 2020 in SC. Separate subgroup analysis was conducted according to the patients' different follow up duration (i.e., 5, 10, and 15 years) to observe the evolving risk factors of DM development, using multivariable logistic regressions. RESULTS The DM incidence among a total of 9115 PWH was 8.9 per 1000 person-years. In the overall model, being >60 years old, hypertension, and obesity were positively associated with DM while alcohol consumption, years of HIV diagnosis and high percentage days of viral suppression were negatively associated with the outcome. In the subgroup analyses, similar risk factors were observed. The odds of DM increased in a graded fashion with age. Hypertension was positively associated with DM in all groups and retention to care was negatively associated with the outcome in groups 1 and 3. CONCLUSION This large-scale population-based study has revealed a relatively lower incidence of DM among PWH than some other US States. The evolving risk factors over time underline the need for maintaining retention to care to prevent the occurrence of DM.
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Affiliation(s)
- Gazi Sakir MOHAMMAD
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
| | - Xueying YANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Haoyuan GAO
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Shujie CHEN
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Jiajia ZHANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Bankole OLATOSI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina
| | - Xiaoming LI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
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Zino L, Qing Chen R, Deden L, Hazebroek E, Richel O, Colbers A, Burger DM. Efficacy and Safety of Bariatric Surgery in Dutch People Living with HIV: a Retrospective Matched Cohort Analysis. Obes Surg 2024; 34:1584-1589. [PMID: 38436918 PMCID: PMC11031456 DOI: 10.1007/s11695-024-07126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Obesity is rising among people with HIV (PLWH), sparking interest in bariatric surgery (BS) for this group. Yet, large-scale comparative research on BS outcomes in PLWH is lacking. METHODS We performed a retrospective, matched cohort analysis in PLWH and HIV uninfected controls. Subjects were retrieved from the Dutch Audit for Treatment of Obesity (DATO) registry. Matching (1:7 ratio) included age (± 5-years), sex, body-mass index (BMI) of ± 3 kg/m2, surgery type, and associated health problems (AHPs) at baseline. The primary endpoint was total weight loss percentage (%TWL) ≥ 20% achieved at 1-year post-BS. Secondary endpoints were cumulative %TWL achieved at 2-years post-BS, a reported remission or improvement in AHPs post-BS, and surgical complications, both at 1-year post-BS. Comparisons were performed using conditional logistic regression. RESULTS Twenty-seven PLWH and 168 controls were included. At 1-year post-BS, 89% PLWH achieved ≥ 20%TWL, compared to 94% of controls (p = 0.4). Cumulative %TWL at 2-years post-BS were 82% and 92% in PLWH and controls, respectively (p = 0.2). Improvement rates in hypertension and type 2 diabetes mellitus were 50% and 86% in PLWH, versus 87% and 87% in controls. Full remission occurred in 20% and 71% of PLHIV, versus 49% and 44% of controls, respectively. No improvement or remission was observed for dyslipidaemia in PLHIV compared to 54% improvement and 29% remission in controls. Surgical complications were 0% in PLHIV and 13% (n = 21) in controls. CONCLUSION Efficacy and safety outcomes of BS were similar between PLWH and controls except for the lack of improvement in dyslipidaemia in PLWH.
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Affiliation(s)
- Leena Zino
- Department of Pharmacy and Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, 864 Radboudumc, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
| | - Rou Qing Chen
- Department of Pharmacy and Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, 864 Radboudumc, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Laura Deden
- Department of Bariatric Surgery, Vitalys Clinic, Rijnstate Hospital, Arnhem, The Netherlands
| | - Eric Hazebroek
- Department of Bariatric Surgery, Vitalys Clinic, Rijnstate Hospital, Arnhem, The Netherlands
| | - Olivier Richel
- Department of Internal Medicine and Radboudumc, Division Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela Colbers
- Department of Pharmacy and Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, 864 Radboudumc, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy and Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, 864 Radboudumc, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
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Daultrey H, Levett T, Oliver N, Vera J, Chakera AJ. HIV and type 2 diabetes: An evolving story. HIV Med 2024; 25:409-423. [PMID: 38111214 DOI: 10.1111/hiv.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 11/17/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Diabetes is widely reported to be more common in people living with HIV (PLWH). Much of the data supporting this originated during the earlier HIV era. The perceived increased risk of type 2 diabetes is reflected in HIV clinical guidelines that recommend screening for diabetes in PLWH on anti-retroviral therapy (ART). However, international HIV clinical guidelines do not agree on the best marker of glycaemia to screen for diabetes. This stems from studies that suggest HbA1c underestimates glycaemia in PLWH. METHODS Within this review we summarise the literature surrounding the association of HIV and type 2 diabetes and how this has changed over time. We also present the evidence on HbA1c discrepancy in PLWH. CONCLUSION We suggest there is no basis to any international guidelines to restrict HbA1c based on HIV serostatus. We recommend, using the current evidence, that PLWH should be screened annually for diabetes in keeping with country specific guidance. Finally, we suggest future work to elucidate phenotype and natural history of type 2 diabetes in PLWH across all populations.
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Affiliation(s)
| | - Tom Levett
- Brighton and Sussex Medical School, Brighton, UK
| | | | - Jaime Vera
- Brighton and Sussex Medical School, Brighton, UK
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Montes ML, Busca C, Espinosa N, Bernardino JI, Ibarra-Ugarte S, Martín-Carbonero L, Moreno C, Macias J, Rivero A, Cervero-Jiménez M, González-García J. Incidence of Diabetes Mellitus and Associated Factors in the Era of Antiretroviral Drugs With a Low Metabolic Toxicity Profile. Open Forum Infect Dis 2024; 11:ofae112. [PMID: 38560607 PMCID: PMC10981392 DOI: 10.1093/ofid/ofae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Objective The incidence of type 2 diabetes mellitus (T2DM) has risen dramatically. Among people living with HIV (PLHIV), chronic disease (now >15 cases/1000 in the general population worldwide) and long-term exposure to antiretroviral therapy (ART) can alter metabolic processes early, favoring insulin resistance and T2DM. We retrospectively studied the incidence of T2DM and associated factors in the Cohort of the Spanish AIDS Research Network, a prospective cohort of PLHIV enrolled at diagnosis and before initiation of ART. Methods PLHIV were aged >18 years and ART naive at inclusion. The incidence of new diagnoses of T2DM after initiation of ART (per 1000 person-years) was calculated. Predictors of a diagnosis of T2DM were identified by a Cox proportional hazards model adjusted for statistically significant and clinically relevant variables. Results Cumulative incidence was 5.9 (95% CI, 5.1-6.7) per 1000 person-years, increasing significantly in persons aged >50 years to 14.4 (95% CI, 10.4-19.3). Median time to diagnosis of T2DM was 27 months. Only age and higher education were significant. Interestingly, higher education was associated with a 33% reduction in the incidence of T2DM. Having received tenofovir disoproxil fumarate + (lamivudine or emtricitabine) + rilpivirine was almost significant as a protective factor (hazard ratio, 0.49; 95% CI, .24-1.01; P = .05). Conclusions The incidence of T2DM in PLHIV in Spain was high, especially in persons aged >50 years. Age was the factor most closely associated with onset, and educational level was the factor most associated with reduced risk. We highlight the lack of association between HIV-related factors and T2DM and show that, within nonnucleoside reverse transcriptase inhibitors, rilpivirine could prove more benign for metabolic comorbidities.
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Affiliation(s)
- Maria Luisa Montes
- Unidad VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Institute for Health Research, Madrid, Spain
- Centre for Biomedical Research on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Busca
- Unidad VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Institute for Health Research, Madrid, Spain
- Centre for Biomedical Research on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Espinosa
- Infectious Diseases and Microbiology Clinical Unit, Instituto de Biomedicina de Sevilla, University Hospital Virgen del Rocío, CSIC, Universidad de Sevilla, Seville, Spain
| | - José Ignacio Bernardino
- Unidad VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Institute for Health Research, Madrid, Spain
- Centre for Biomedical Research on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sofia Ibarra-Ugarte
- Servicio de Enfermedades Infecciosas, Hospital Universitario Basurto, Bilbao, Spain
| | - Luz Martín-Carbonero
- Unidad VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Institute for Health Research, Madrid, Spain
| | - Cristina Moreno
- Centre for Biomedical Research on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Macias
- Centre for Biomedical Research on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina, IBiS, Universidad de Sevilla, Hospital Universitario Virgen de Valme, Seville, Spain
| | - Antonio Rivero
- Centre for Biomedical Research on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimonides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Cordoba, Spain
| | | | - Juan González-García
- Unidad VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Institute for Health Research, Madrid, Spain
- Centre for Biomedical Research on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Gerber A, Fischetti B, Popova O, Longo M. Glycemic Control in Patients Living With HIV Initiated on Integrase Inhibitor-Based Three-Drug Antiretroviral Therapy. J Pharm Technol 2024; 40:85-91. [PMID: 38525088 PMCID: PMC10959087 DOI: 10.1177/87551225231221059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Background: The increased risk of cardio-metabolic disorders associated with people living with human immunodeficiency virus (HIV) is of growing importance. Given the broad adoption of integrase strand-transfer inhibitor (INSTI)-based antiretroviral therapy (ART) as first-line therapy for HIV, additional data are needed regarding the metabolic effects of these regimens. Objective: The purpose of this study is to assess glycemic control in patients started on INSTI-based 3-drug regimens over a 2-year period. Methods: A retrospective study was conducted on patients seen in the Brooklyn Hospital Center. Men and nonpregnant, nonlactating women aged 18 years or older with a diagnosis of HIV who were initiated on or switched to an ART consisting of 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an INSTI were included in the analysis. The primary endpoint is change in A1C from baseline (pre-INSTI initiation) to 2 years after initiation. Results: Two hundred fifty-one patients were eligible based on specified inclusion and exclusion criteria. Overall, a statistically significant increase in A1C was seen in all patients started on INSTI-based regimen (95% CI, 0.10-0.36; P < 0.001). Primarily patients on both elvitegravir-based and bictegravir-based regimens saw the most significant increase in A1C: 0.16% (95% CI, 0.04-0.27; P = 0.006) and 0.39% (95% CI, 0.02-0.76; P = 0.038), respectively. Conclusion and Relevance: Integrase strand-transfer inhibitor-based 3-drug ART was associated with a small but statistically significant increase in A1C over a 2-year period, requiring additional monitoring by clinicians.
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Affiliation(s)
- Anthony Gerber
- New York City Health + Hospital/Bellevue, New York, NY, USA
- The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Briann Fischetti
- The Brooklyn Hospital Center, Brooklyn, NY, USA
- Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
| | - Olga Popova
- Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Maria Longo
- The Brooklyn Hospital Center, Brooklyn, NY, USA
- Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
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Nazari I, Feinstein MJ. Evolving mechanisms and presentations of cardiovascular disease in people with HIV: implications for management. Clin Microbiol Rev 2024; 37:e0009822. [PMID: 38299802 PMCID: PMC10938901 DOI: 10.1128/cmr.00098-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
People with HIV (PWH) are at elevated risk for cardiovascular diseases (CVDs), including myocardial infarction, heart failure, and sudden cardiac death, among other CVD manifestations. Chronic immune dysregulation resulting in persistent inflammation is common among PWH, particularly those with sustained viremia and impaired CD4+ T cell recovery. This inflammatory milieu is a major contributor to CVDs among PWH, in concert with common comorbidities (such as dyslipidemia and smoking) and, to a lesser extent, off-target effects of antiretroviral therapy. In this review, we discuss the clinical and mechanistic evidence surrounding heightened CVD risks among PWH, implications for specific CVD manifestations, and practical guidance for management in the setting of evolving data.
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Affiliation(s)
- Ilana Nazari
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J. Feinstein
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology in the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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8
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Qiao NN, Fang Q, Zhang XH, Ke SS, Wang ZW, Tang G, Leng RX, Fan YG. Effects of alcohol on the composition and metabolism of the intestinal microbiota among people with HIV: a cross-sectional study. Alcohol 2024:S0741-8329(24)00019-3. [PMID: 38387693 DOI: 10.1016/j.alcohol.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Alcohol consumption is not uncommon among people with HIV (PWH) and may exacerbate HIV-induced intestinal damage, and further lead to dysbiosis and increased intestinal permeability. This study aimed to determine the changes in the faecal microbiota and its association with alcohol consumption in HIV-infected patients. METHODS A cross-sectional survey was conducted between November 2021 and May 2022, and 93 participants were recruited. To investigate the alterations of alcohol misuse on fecal microbiology in HIV-infected individuals, we performed 16s rDNA gene sequencing on fecal samples from the low to moderate drinking (n=21) and non-drinking (n=72) groups. RESULTS Comparison between groups using alpha and beta diversity showed that the diversity of stool microbiota in the low to moderate drinkinge group did not differ from that of the non-drinking group (all P>0.05). The Linear discriminant Analysis effect size (LEfSe) algorithm was to determine the bacterial taxa associated with alcohol consumption, and the results showed altered fecal bacterial composition in HIV-infected patients who consumed alcohol, with Coprobacillus, Pseudobutyrivibrio and Peptostreptococcaceae enriched, and Pasteurellaceae and Xanthomonadaceae were depleted. In addition, by using the Kyoto Encyclopedia of Genes and Genomes (KEGG) functional microbiome features were also found to be altered in the low to moderate drinking group, showing a reduction in metabolic pathways (P=0.036) and cardiovascular disease pathway (P=0.006). CONCLUSION Low to moderate drinking will change the composition, metabolism and cardiovascular disease pathway of the gut microbiota of HIV-infected patients.
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Affiliation(s)
- Ni-Ni Qiao
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Quan Fang
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Xin-Hong Zhang
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Su-Su Ke
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Zi-Wei Wang
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Gan Tang
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China
| | - Rui-Xue Leng
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China.
| | - Yin-Guang Fan
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei, 230032 Anhui People's Republic of China.
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Khunti K, Chudasama YV, Gregg EW, Kamkuemah M, Misra S, Suls J, Venkateshmurthy NS, Valabhji J. Diabetes and Multiple Long-term Conditions: A Review of Our Current Global Health Challenge. Diabetes Care 2023; 46:2092-2101. [PMID: 38011523 DOI: 10.2337/dci23-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/26/2023] [Indexed: 11/29/2023]
Abstract
Use of effective treatments and management programs is leading to longer survival of people with diabetes. This, in combination with obesity, is thus contributing to a rise in people living with more than one condition, known as multiple long-term conditions (MLTC or multimorbidity). MLTC is defined as the presence of two or more long-term conditions, with possible combinations of physical, infectious, or mental health conditions, where no one condition is considered as the index. These include a range of conditions such as cardiovascular diseases, cancer, chronic kidney disease, arthritis, depression, dementia, and severe mental health illnesses. MLTC has major implications for the individual such as poor quality of life, worse health outcomes, fragmented care, polypharmacy, poor treatment adherence, mortality, and a significant impact on health care services. MLTC is a challenge, where interventions for prevention and management are lacking a robust evidence base. The key research directions for diabetes and MLTC from a global perspective include system delivery and care coordination, lifestyle interventions and therapeutic interventions.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Yogini V Chudasama
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Edward W Gregg
- School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Monika Kamkuemah
- Innovation Africa and Department of Architecture, Faculty of Engineering, Built Environment and Information Technology, University of Pretoria, Pretoria, South Africa
| | - Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Jerry Suls
- Institute for Health System Science, Feinstein Institutes for Medical Research Northwell Health, New York, NY
| | - Nikhil S Venkateshmurthy
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
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Wearne N, Davidson B, Blockman M, Jones J, Ross IL, Dave JA. Management of Type 2 Diabetes Mellitus and Kidney Failure in People with HIV-Infection in Africa: Current Status and a Call to Action. HIV AIDS (Auckl) 2023; 15:519-535. [PMID: 37700755 PMCID: PMC10493098 DOI: 10.2147/hiv.s396949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/13/2023] [Indexed: 09/14/2023] Open
Abstract
There is an increasing global burden of diabetes mellitus (DM) and chronic kidney disease (CKD), coupled with a high burden of people with HIV (PWH). Due to an increased lifespan on ART, PWH are now at risk of developing non-communicable diseases, including DM. Africa has the greatest burden of HIV infection and will experience the greatest increase in prevalence of DM over the next two decades. In addition, there is a rising number of people with CKD and progression to kidney failure. Therefore, there is an urgent need for the early identification and management of all 3 diseases to prevent disease progression and complications. This is particularly important in Africa for people with CKD where there is restricted or no access to dialysis and/or transplantation. This review focuses on the epidemiology and pathophysiology of the interaction between HIV infection and DM and the impact that these diseases have on the development and progression of CKD. Finally, it also aims to review the data on the management, which stems from the growing burden of all three diseases.
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Affiliation(s)
- Nicola Wearne
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Bianca Davidson
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Marc Blockman
- Division of Clinical Pharmacology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Jackie Jones
- Medicines Information Centre, Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ian L Ross
- Division of Endocrinology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Joel A Dave
- Division of Endocrinology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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Abstract
PURPOSE OF REVIEW It is now recognized that SARS-CoV-2 infection can have a long-term impact on health. This review summarizes the current state of knowledge regarding Long COVID in people living with HIV (PLWH). RECENT FINDINGS PLWH may be at elevated risk of experiencing Long COVID. Although the mechanisms contributing to Long COVID are incompletely understood, there are several demographic and clinical factors that might make PLWH vulnerable to developing Long COVID. SUMMARY PLWH should be aware that new or worsening symptoms following SARS-CoV-2 infection might represent Long COVID. HIV providers should be aware of this clinical entity and be mindful that their patients recovering from SARS-CoV-2 infection may be at higher risk.
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Affiliation(s)
- Michael J. Peluso
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA 94110
| | - Annukka A. R. Antar
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
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12
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Punjabi NM, Brown TT, Aurora RN, Patel SR, Stosor V, Hyong-Jin Cho J, D'Souza G, Margolick JB. Prevalence and Predictors of Sleep-Disordered Breathing in Men Participating in the Multicenter AIDS Cohort Study. Chest 2023; 163:687-696. [PMID: 36343689 PMCID: PMC9993338 DOI: 10.1016/j.chest.2022.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Data on the prevalence of sleep-disordered breathing (SDB) in people with HIV are limited. Moreover, whether the associations between SDB and age or BMI differ by HIV status is unknown. RESEARCH QUESTION Is SDB more prevalent in men with HIV than those without HIV, and do the predictors of SDB differ between the two groups? STUDY DESIGN AND METHODS Home polysomnography was used in the Multicenter AIDS Cohort Study to assess SDB prevalence in men with (n = 466; 92% virologically suppressed) and without (n = 370) HIV. SDB was defined using the oxygen desaturation index (ODI) and the apnea-hypopnea index (AHI), using four definitions: ≥ 5 events/h based on an ODI with a 3% (ODI3) or 4% (ODI4) oxygen desaturation, or an AHI with a 3% oxygen desaturation or EEG arousal (AHI3a) or with a 4% oxygen desaturation (AHI4). RESULTS SDB prevalence was similar in men with and without HIV using the ODI3 and AHI3a definitions. However, SDB prevalence was higher in men with than without HIV using the ODI4 (55.9% vs 47.8%; P = .04) and the AHI4 definitions (57.9% vs 50.4%; P = .06). Mild and moderate SDB were more common in men with than without HIV. Associations between SDB prevalence and age, race, and BMI were similar in men with and without HIV. Among men with HIV, viral load, CD4 cell count, and use of antiretroviral medications were not associated with SDB prevalence. INTERPRETATION SDB prevalence was high overall but greater in men with than without HIV using the ODI4 threshold definition. Efforts to diagnose SDB are warranted in people with HIV, given that SDB is associated with daytime sleepiness and impaired quality of life.
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Affiliation(s)
| | - Todd T Brown
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - R Nisha Aurora
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Sanjay R Patel
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Joshua Hyong-Jin Cho
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Gypsyamber D'Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Joseph B Margolick
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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13
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Cattaneo D, Gidaro A, Rossi A, Merlo A, Formenti T, Meraviglia P, Antinori S, Gervasoni C. Management of diabetes mellitus in people living with HIV: A single-center experience. Front Pharmacol 2023; 13:1082992. [PMID: 36712651 PMCID: PMC9873960 DOI: 10.3389/fphar.2022.1082992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Background: Diabetes mellitus (DM) is more common in people living with HIV (PLWH) than in HIV-negative patients. Here we aimed to describe the response of PLWH with DM to glucose-lowering therapies in a reference hospital of northern Italy. Setting: 200 PLWH and DM were identified from the database of our clinic. Methods: Good control of DM was defined as having fasting glucose <130 mg/dl or HbA1c < 53 mmol/mol. The distribution of glucose-lowering therapies in PLWH was compared with that of HIV-negative patients with DM. Results: Mean total fasting glucose and HbA1C were 143 ± 50 mg/dl (51% exceeding the 130 mg/dl cutoff) and 51 ± 16 mmol/mol (30% exceeding the 53 mmol/mol cutoff), respectively. PLWH were less treated with dipeptidyl peptidase-4 inhibitors (1.7% versus 9.6%, p < 0.01) and sulfonylureas (3.3% versus 13.2%, p < 0.01), being conversely more frequently treated with metformin (53.8% versus 37.7%, p < 0.01), glifozins plus metformin (7.1% versus 2.0%, p < 0.05) or insulin plus other glucose-lowering agents (5.5% versus 0.5%, p < 0.01). Conclusion: An underuse of dipeptidyl peptidase-4 inhibitors was found which was, however, counterbalanced by a higher use of combination of drugs (including glifozins). A rational assessment of drug-drug interactions would contribute to a better selection of the best glucose lowering agent for each antiretroviral therapy.
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Affiliation(s)
- Dario Cattaneo
- Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy,Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Andrea Merlo
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy
| | - Tiziana Formenti
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Paola Meraviglia
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Cristina Gervasoni
- Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy,Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy,*Correspondence: Cristina Gervasoni,
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14
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Pereira LL, Veiga Siqueira Amorim D, Brito Sampaio W, Almeida Cruz Azevêdo T, Bispo Pereira Cardoso V, Barreto Lemos F, Silva Chang A, Machado F, Pereira Lima F, Sampaio Neves F, Leal Figueiredo AC. Factors Associated with Periodontitis in Patients with and without HIV. Int J Dent 2023; 2023:9929835. [PMID: 37159593 PMCID: PMC10163962 DOI: 10.1155/2023/9929835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 05/11/2023] Open
Abstract
Purpose The aim of this study was to compare clinical periodontal conditions in HIV-positive people on HAART with an HIV-negative group, in addition to investigating factors associated with periodontitis in the entire sample. Methods This was a cross-sectional study. Data were collected by oral clinical examination for the diagnosis of periodontitis, review of medical records, and application of a questionnaire containing personal data, deleterious habits, and oral hygiene habits for the other variables. The results were analyzed by Pearson's χ 2 test and Student's t-test. A logistic regression model was constructed for the multivariate analysis and periodontitis was defined as a dependent variable. The analysis was performed on the entire sample (HIV+ and HIV-) and also on the group consisting of only people living with HIV. Results Individuals older than 43 years old and with HIV were more likely to develop moderate and severe periodontitis (47.80 and 4.84 times, respectively). When analyzing only HIV+, in addition to age (OR = 2.795; CI = 1.080-7.233), the use of nonnucleoside reverse transcriptase inhibitors (NNRTIs) (OR = 2.841; CI = 1.135-7.112) was also associated with moderate and severe periodontitis. Conclusion It was possible to observe a higher prevalence of periodontitis among individuals with HIV, showing an association between the virus, advanced age, and moderate or severe periodontitis.
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Affiliation(s)
- Luanderson Lopes Pereira
- Postgraduate Program in Dentistry and Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | | | - Willian Brito Sampaio
- Postgraduate Program in Dentistry and Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | | | | | - Felipe Barreto Lemos
- Postgraduate Program in Dentistry and Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Andressa Silva Chang
- Postgraduate Program in Dentistry and Health, Federal University of Bahia (UFBA), Salvador, Brazil
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15
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Rivera AS, Rusie L, Plank M, Siddique J, Beach LB, Lloyd-Jones D, Feinstein MJ. Association of Cumulative Viral Load With the Incidence of Hypertension and Diabetes in People With HIV. Hypertension 2022; 79:e135-e142. [PMID: 36378919 PMCID: PMC9673163 DOI: 10.1161/hypertensionaha.122.19302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND HIV induces several metabolic derangements that contribute to cardiovascular disease, but it is unclear if HIV increases diabetes or hypertension risk. Refining longitudinal relationships between HIV-specific factors and cardiovascular disease risk factors across different care settings may help inform cardiovascular disease prevention among people with HIV (PWH). METHODS We tested the hypothesis that long-term higher cumulative viral load (viremia-copy-year) is associated with higher risk of diabetes and hypertension by analyzing electronic records of PWH from 2 distinct health systems in Chicago (Northwestern Medicine and Howard Brown Health Care) receiving care in 2004 to 2019. We used joint longitudinal-survival models to assess multivariable-adjusted associations. Subgroup analyses per site were also conducted. RESULTS We observed 230 (3.0%) incident diabetes cases in 7628 PWH without baseline diabetes and 496 (6.7%) hypertension cases in 7450 PWH without baseline hypertension. Pooled analysis showed a direct association of viremia-copy-year with incident hypertension (hazards ratio, 1.20 [95% CI, 1.14-1.26]) but not with diabetes (hazards ratio, 1.03 [95% CI, 0.96-1.10]). However, site-specific differences existed whereby the Northwestern-only analysis demonstrated a significant association of viremia-copy-year with hypertension (hazards ratio, 1.29 [95% CI, 1.08-1.32]). Additionally, higher social deprivation index (both sites) and diagnosis of mental health disorder (Howard Brown Health only) was associated with higher diabetes and hypertension risk. CONCLUSIONS Cumulative viral load may be associated with incident hypertension among PWH. Associations of HIV control with cardiovascular disease risk factors among PWH may differ by health care system context.
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Affiliation(s)
- Adovich S. Rivera
- Institute for Public Health and Management, Feinberg School
of Medicine, Northwestern University
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
| | | | | | - Juned Siddique
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
| | - Lauren B. Beach
- Institute for Sexual and Gender Minority Health, Feinberg
School of Medicine, Northwestern University
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
- Department of Medicine, Feinberg School of Medicine,
Northwestern University
| | - Matthew J. Feinstein
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
- Institute for Sexual and Gender Minority Health, Feinberg
School of Medicine, Northwestern University
- Department of Pathology, Feinberg School of Medicine,
Northwestern University
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16
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Wagle A, Goerlich E, Post WS, Woldu B, Wu KC, Hays AG. HIV and Global Cardiovascular Health. Curr Cardiol Rep 2022; 24:1149-1157. [PMID: 35802233 DOI: 10.1007/s11886-022-01741-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Because of effective combination antiretroviral therapy, people living with HIV (PLWH) are living longer but developing chronic age-related conditions including cardiovascular disease (CVD), the leading cause of death globally. This review aims to discuss the epidemiology, mechanisms, and clinical considerations of CVD in PLWH from a global perspective. RECENT FINDINGS PLWH are at greater risk for CVD at chronologically younger ages than those without HIV. Potential underlying mechanisms for CVD in PLWH include systemic inflammation, comorbidities, immune-mediated, or treatment-related mechanisms. There is also risk factor variation based on geographical location, including non-traditional CVD risk factors. CVD is prevalent in PLWH and increasing on a global scale. Further understanding the unique epidemiology, risk factors, and treatment of CVD in this population will improve the care of PLWH.
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Affiliation(s)
- Anjali Wagle
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA
| | - Erin Goerlich
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA
| | - Wendy S Post
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bethel Woldu
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA.,MedStar Heart and Vascular Institute, Baltimore, MD, USA.,Department of Medicine, Division of Cardiology, MedStar Georgetown University, Washington, DC, USA
| | - Katherine C Wu
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison G Hays
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA. .,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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17
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Zuñiga JA, Cuevas H, Jones K, Adiele K, Cebulske L, Frost L, Sannigrahi S, García AA, Heitkemper E. Self-management of the Dual Diagnosis of HIV/AIDS and Diabetes During COVID-19: A Qualitative Study. ANS Adv Nurs Sci 2022; 45:256-273. [PMID: 34966026 PMCID: PMC9237177 DOI: 10.1097/ans.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The purpose of this qualitative secondary analysis research was to describe the impact of the COVID-19 pandemic on self-management behaviors and practices for people living with the dual diagnoses of HIV/AIDS and type 2 diabetes mellitus and to identify early pandemic-specific disruptions or changes to their self-management practices. In-depth interviews conducted in May-June 2020 with 9 participants, and analyzed using content analysis, revealed 5 themes: adjusting to living with HIV/AIDS and diabetes impacts beliefs about COVID-19 risks; COVID-19 information seeking and accuracy; trade-offs in self-managing multiple chronic conditions; balance between safety, relationships, and the society at large; and discordant perceptions and actions. Some participants were resilient from previous experiences. Many received mixed messages about their risk for COVID-19, resulting in inaccurately or inconsistently applying guidelines for social isolation.
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Affiliation(s)
| | | | - Kristian Jones
- The University of Texas at Austin, School of Social Work
| | | | | | - Livia Frost
- The University of Texas at Austin, College of Natural Sciences
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18
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Cervo A, Sebastiani G, Milic J, Krahn T, Mazzola S, Petta S, Cascio A, Guaraldi G, Mazzola G. "Dangerous liaisons: NAFLD and liver fibrosis increase cardiovascular risk in HIV". HIV Med 2022; 23:911-921. [PMID: 35199429 DOI: 10.1111/hiv.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. We aimed to assess the impact of NAFLD and liver fibrosis on intermediate-high cardiovascular risk in people living with HIV. METHODS We included people living with HIV from three cohorts. NAFLD and significant liver fibrosis were defined using transient elastography: controlled attenuation parameter ≥288 dB/m and liver stiffness measurement ≥7.1 kPa, respectively. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator in patients aged between 40 and 75 years and categorised as low if <5%, borderline if 5%-7.4%, intermediate if 7.5%-19.9% and high if ≥20% or with the presence of a previous cardiovascular event. Patients with hepatitis B and/or hepatitis C virus co-infection, alcohol abuse and unreliable transient elastography measurements were excluded. Predictors of intermediate-high cardiovascular risk were investigated in multivariable analysis by logistic regression and also by stratifying according to body mass index (BMI; cut-offs of 25 and 30 kg/m2 ) and age (cut-off of 60 years). RESULTS Of 941 patients with HIV alone included, 423 (45%), 128 (13.6%), 260 (27.6%) and 130 (13.8%) were categorised as at low, borderline, intermediate and high ASCVD risk, respectively. Predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.11; 95% confidence interval [CI] 1.40-3.18; p < 0.001), liver fibrosis (aOR 1.64; 95% CI 1.03-2.59; p = 0.034), duration of HIV (aOR 1.04; 95% CI 1.02-1.06; p < 0.001), and previous exposure to thymidine analogues and/or didanosine (aOR 1.54; 95% CI 1.09-2.18; p = 0.014). NAFLD was also associated with higher cardiovascular risk in normoweight patients (aOR 2.97; 95% CI 1.43-6.16; p = 0.003), in those with BMI <30 kg/m2 (aOR 2.30; 95% CI 1.46-3.61; p < 0.001) and in those aged <60 years (aOR 2.19; 95% CI 1.36-3.54; p = 0.001). CONCLUSION Assessment of cardiovascular disease should be targeted in people living with HIV with NAFLD and/or significant liver fibrosis, even if they are normoweight and young.
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Affiliation(s)
- Adriana Cervo
- Infectious Diseases Unit, PROMISE, University Hospital of Palermo, Palermo, Italy
| | - Giada Sebastiani
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Jovana Milic
- University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Thomas Krahn
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Sergio Mazzola
- Clinical Epidemiology and Cancer Register Unit, University Hospital of Palermo, Palermo, Italy
| | - Salvatore Petta
- Service of Gastroenterology and Hepatology, PROMISE, University Hospital of Palermo, Palermo, Italy
| | - Antonio Cascio
- Infectious Diseases Unit, PROMISE, University Hospital of Palermo, Palermo, Italy
| | - Giovanni Guaraldi
- University of Modena and Reggio Emilia, Modena, Italy.,Infectious Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Giovanni Mazzola
- Infectious Diseases Unit, PROMISE, University Hospital of Palermo, Palermo, Italy
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19
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Ohueri CW, García AA, Zuñiga JA. Counting, Coping, and Navigating the Flux: A Focused Ethnographic Study of HIV and Diabetes Self-Management. QUALITATIVE HEALTH RESEARCH 2022; 32:399-412. [PMID: 34928736 PMCID: PMC8923063 DOI: 10.1177/10497323211064231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Approximately 10-15% of people living with HIV are also diagnosed with diabetes. To manage their two chronic conditions, people must undertake certain activities and adopt behaviors. Due to overlapping symptoms, complex medication regimens, and heavy patient workloads, implementing these self-management practices can be difficult. In this focused ethnography, data were collected from semi-structured interviews and limited participant-observation with a selected subset of participants to gain insight into self-management challenges and facilitators. We conducted interviews and multiple observations with 22 participants with HIV+T2DM over the period of 9 months. Participants experienced numerous barriers to self-management in the areas of diet, medication adherence, and mental health. Social and familial support, as well as consistent access to care, were facilitators for optimal self-management. At the same time participants' lives were in a unique flux shaped by the dual diagnoses, and therefore, required constant mental and physical adjustments, thus illustrating challenges of managing chronicity.
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Affiliation(s)
- Chelsi W Ohueri
- Department of Slavic and Eurasian Studies, 12330The University of Texas at Austin, Austin, TX, USA
| | - Alexandra A García
- School of Nursing, 12330The University of Texas at Austin, Austin, TX, USA
| | - Julie A Zuñiga
- School of Nursing, 12330The University of Texas at Austin, Austin, TX, USA
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20
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Dardano A, Aragona M, Daniele G, Miccoli R, Del Prato S. Efficacy of Dulaglutide in a Patient With Type 2 Diabetes, High Cardiovascular Risk, and HIV: A Case Report. Front Endocrinol (Lausanne) 2022; 13:847778. [PMID: 35295985 PMCID: PMC8918572 DOI: 10.3389/fendo.2022.847778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a common comorbidity in people living with HIV (PLWH). Anti-hyperglycemic treatment in PLWH is still a challenge, and no randomized controlled studies using new glucose-lowering agents are currently available. CASE DESCRIPTION A 55-year-old-women was admitted to our Diabetes Unit because of hyperosmolar hyperglycemic state (HHS) and sepsis. The medical history included HIV infection and insulin-treated diabetes. On clinical examination, the lady appeared dehydrated with dry buccal mucosa, tachycardia, altered mental status, genital infection, and fever. On admission, plasma glucose was 54.5 mmol/L, HbA1c 155 mmol/mol, osmolarity 389.4 mOsm/kg, bicarbonate 24.6 mmol/L with no detectable serum ketones. The patient was treated with i.v. fluid and insulin, and antibiotic therapy commenced. Upon HHS and sepsis resolution, a basal-bolus insulin therapy was implemented that was followed by significant improvement of daily glucose profiles and progressive reduction of insulin requirement until complete discontinuation. A low dose of metformin plus linagliptin was started. Since a severe atherosclerotic disease was diagnosed, a GLP-1 receptor agonist, dulaglutide, was added to metformin upon linagliptin withdrawal with maintenance of good glycemic control, treatment adherence and amelioration of quality of life and no side effects. CONCLUSION This case suggests that GLP-1 receptor agonist therapy may be effective and safe for treatment of T2D with high cardiovascular risk in PLWH, supporting the need of clinical trials directly assessing the safety and the efficacy of GLP-1 receptor agonist in these individuals.
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Affiliation(s)
- Angela Dardano
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Angela Dardano,
| | - Michele Aragona
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Daniele
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Miccoli
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
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