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Kress TC, Ajala P, Jordan CR, Mintz J, MacArthur R, Kennard S, Antonova G, Belin de Chantemèle EJ. 12-week Dolutegravir treatment marginally reduces energy expenditure but does not increase body weight or alter vascular function in a murine model of Human Immunodeficiency Virus infection. Vascul Pharmacol 2024; 155:107288. [PMID: 38428626 PMCID: PMC11189738 DOI: 10.1016/j.vph.2024.107288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
Combination antiretroviral therapy (cART) has markedly increased life expectancy in people with HIV (PWH) but has also resulted in an increased prevalence of cardiometabolic disorders, whose etiopathology remains ill-defined. Notably, the respective contribution of cART and HIV-derived proteins to obesity and vascular alterations remain poorly understood. Therefore, we investigated the individual and combined effects of HIV-proteins and of the integrase strand transfer inhibitor Dolutegravir (DTG) on body composition and vascular reactivity. Male wildtype (WT) and HIV transgenic (Tg26) mice, received DTG or vehicle for 12 weeks. Viral proteins expression in Tg26 mice lowered fat mass, increased heat production, and induced a 2-fold increase in brown adipose tissue (BAT) uncoupling protein 1 (UCP1) expression. DTG increased the expression of markers of adipogenesis in adipocytes in culture, but also reduced heat production and BAT UCP1 and UCP3 expression in Tg26 mice. DTG increased food intake, fat percentage and protected from lean mass reduction in Tg26 mice only. However, DTG did not increase body weight in either WT or Tg26 mice. Viral protein expression reduced acetylcholine (endothelium)-mediated relaxation by 14% in mesenteric arteries preconstricted with phenylephrine. However, DTG did not impair nor improve endothelium-dependent relaxation. Together, these data indicate that DTG's effects on food intake, adipogenesis and energy expenditure are insufficient to increase body weight, even in the presence of HIV-proteins, suggesting that body weight gain in PWH involves additional factors likely including other cART components and pre-existing comorbidities. Moreover, these data rule out DTG as a source of vascular disorders in PWH.
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Affiliation(s)
- Taylor C Kress
- Vascular Biology Center, Medical College of Georgia at Augusta University,United States of America
| | - Priscilla Ajala
- Vascular Biology Center, Medical College of Georgia at Augusta University,United States of America
| | - Coleton R Jordan
- Vascular Biology Center, Medical College of Georgia at Augusta University,United States of America
| | - James Mintz
- Vascular Biology Center, Medical College of Georgia at Augusta University,United States of America
| | - Rodger MacArthur
- Department of Medicine, Medical College of Georgia at Augusta University, United States of America
| | - Simone Kennard
- Vascular Biology Center, Medical College of Georgia at Augusta University,United States of America
| | - Galina Antonova
- Vascular Biology Center, Medical College of Georgia at Augusta University,United States of America
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University,United States of America; Department of Medicine, Medical College of Georgia at Augusta University, United States of America.
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Chen S, Jiang Y, Lin X, Chen H, Wu X, Qian Z, Xu X, Zhong H, Peng J, Cai S. Estimated Pulse Wave Velocity as a Novel Non-Invasive Biomarker for Metabolic Syndrome Among People Living with HIV. Diabetes Metab Syndr Obes 2024; 17:1999-2010. [PMID: 38765471 PMCID: PMC11100516 DOI: 10.2147/dmso.s452498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/04/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose This study aims to investigate the relationship between estimated pulse wave velocity (ePWV) and metabolic syndrome (MetS) in people living with HIV (PLWH), proposing a novel and convenient predictor for early detection of MetS in PLWH. Patients and Methods A total of 485 PLWH were enrolled. These participants were categorized into two groups based on the estimated pulse wave velocity (ePWV) level. Demographic and clinical data were collected to investigate the correlation between ePWV and MetS. Results The cohort of 485 PLWH was categorized into high-ePWV and low-ePWV groups based on ePWV cutoff value of 10 m/s. We observed significant differences in components of MetS including triglycerides (TG, P < 0.05), HDL cholesterol (HDL-C, P < 0.01), systolic blood pressure (SBP, P < 0.001), diastolic blood pressure (DBP, P < 0.05), and fasting plasma glucose (FPG, P < 0.001) between the two groups. Furthermore, we employed receiver operating characteristic (ROC) curves to demonstrate the effectiveness of ePWV as a predictive indicator for MetS in PLWH (AUC = 0.739, P < 0.001). According to the ROC curve, the optimal cut-off value of ePWV was 7.4 m/s, and its sensitivity and specificity in diagnosing MetS in PLWH were 79.03% and 64.07%, respectively. Although the 7.4 m/s cutoff increased the false positive rate compared to the traditional cutoff, it significantly reduced the rate of missed diagnoses, effectively identifying 79.03% of PLWH with MetS. Conclusion ePWV is a non-invasive and convenient novel biomarker with predictive capabilities for MetS in PLWH.
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Affiliation(s)
- Suling Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Yuanhui Jiang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Xiaoli Lin
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Hongjie Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Xiaoxuan Wu
- Department of Communicable and Endemic Disease Control and Prevention, Haizhu District Center for Disease Control and Prevention, Guangzhou, People’s Republic of China
| | - Zhe Qian
- Second Department of Elderly Respiratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People’s Republic of China
| | - Xuwen Xu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Huiqun Zhong
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Shaohang Cai
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
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Lam JO, Leyden WA, Alexeeff S, Lea AN, Hechter RC, Hu H, Marcus JL, Pitts L, Yuan Q, Towner WJ, Horberg MA, Silverberg MJ. Changes in Body Mass Index Over Time in People With and Without HIV Infection. Open Forum Infect Dis 2024; 11:ofad611. [PMID: 38323078 PMCID: PMC10846771 DOI: 10.1093/ofid/ofad611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024] Open
Abstract
Background Excess weight gain is an important health concern among people with HIV (PWH) on antiretroviral therapy (ART). The extent to which ART contributes to body mass index (BMI) changes is incompletely understood. Methods We conducted a retrospective study of PWH initiating ART and demographically matched people without HIV (PWoH). Data on baseline BMI (kg/m2; categorized as underweight/normal, overweight, or obese) and ART class (integrase strand transfer inhibitor [INSTI], non-nucleoside reverse transcriptase inhibitor [NNRTI], protease inhibitor [PI]) were obtained from electronic health records. BMI was evaluated longitudinally using piecewise linear splines in mixed effects models by HIV status, baseline BMI, and ART class. Models were adjusted for sociodemographics, comorbidities, and substance use. Results The study included 8256 PWH and 129 966 PWoH (mean baseline age, 40.9 and 42.2 years, respectively; 88% men). In adjusted models, the average annual change in BMI in the first 2 years after ART initiation was 0.53 for PWH and 0.12 for PWoH (P < .001). BMI increases among PWH were observed for all ART classes: 0.69 for INSTIs, 0.69 for PIs, and 0.40 for NNRTIs vs 0.12 among PWoH. For PWH initiating INSTIs, BMI increases were observed regardless of baseline BMI. Overall BMI changes >2 years after ART initiation were similar by HIV status (0.02 average annual increase for PWH and PWoH). Conclusions PWH initiating ART gained excess weight in the first 2 years, emphasizing the importance of monitoring weight and cardiometabolic health among ART-treated PWH.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Haihong Hu
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Lakecia Pitts
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Qing Yuan
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Michael A Horberg
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Karras SN, Koufakis T, Dimakopoulos G, Zisimopoulou E, Mourampetzis P, Manthou E, Karalazou P, Thisiadou K, Tsachouridou O, Zebekakis P, Makedou K, Metallidis S, Kotsa K. Down regulation of the inverse relationship between parathyroid hormone and irisin in male vitamin D-sufficient HIV patients. J Endocrinol Invest 2023; 46:2563-2571. [PMID: 37245160 DOI: 10.1007/s40618-023-02112-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/13/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Infection with the human immunodeficiency virus (HIV) predisposes to endocrine disorders, manifesting as a metabolic phenotype that affects the entire adipose-musculoskeletal unit (AMS). The present cross-sectional study aimed to investigate differences in irisin and adiponectin concentrations between people living with HIV and healthy controls, as well as to explore potential correlations between the levels of the aforementioned adipokines and markers of calcium homeostasis. METHODS 46 HIV-infected individuals and 39 healthy controls (all men) were included in the study. Anthropometric data, adipokine levels, 25-hydroxyvitamin D [(25(OH)D)] and parathyroid hormone (PTH) concentrations were evaluated in the two groups. Correlations for the relationship between adiponectin, irisin, and PTH levels were examined. The results were adjusted for several confounders, including 25(OH)D levels, anthropometry, physical activity, bone mineral density, testosterone levels, and exposure to ultraviolet B radiation. RESULTS Mean adiponectin concentrations were significantly lower in the HIV group compared to the control group: 5868 ± 3668 vs 9068 ± 4277 ng/mL, p = 0.011. The same was applicable to irisin concentrations: 8.31 ± 8.17 (HIV) vs 29.27 ± 27.23 (controls) ng/mL, p = 0.013. A statistically significant and negative correlation was observed between irisin and PTH in the control group (r = - 0.591; p = 0.033). In contrast, no significant correlation was observed between PTH and irisin in the HIV group (p = 0.898). CONCLUSION Our results are the first to suggest a possible down regulation of the inverse relationship between PTH and irisin in HIV patients and to highlight that AMS dyshomeostasis could be involved in the development of skeletal and adipose HIV-related morbidities.
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Affiliation(s)
- S N Karras
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 1st. Kiriakidi Street, 54636, Thessaloniki, Greece
| | - T Koufakis
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 1st. Kiriakidi Street, 54636, Thessaloniki, Greece
| | - G Dimakopoulos
- BIOSTATS, Epirus Science and Technology Park Campus of the University of Ioannina, Ioannina, Greece
| | - E Zisimopoulou
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 1st. Kiriakidi Street, 54636, Thessaloniki, Greece
| | - P Mourampetzis
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 1st. Kiriakidi Street, 54636, Thessaloniki, Greece
| | - E Manthou
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 1st. Kiriakidi Street, 54636, Thessaloniki, Greece
| | - P Karalazou
- Laboratory of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - K Thisiadou
- Laboratory of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - O Tsachouridou
- Infectious Diseases Division, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - P Zebekakis
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 1st. Kiriakidi Street, 54636, Thessaloniki, Greece
- Infectious Diseases Division, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - K Makedou
- Laboratory of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - S Metallidis
- Infectious Diseases Division, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - K Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 1st. Kiriakidi Street, 54636, Thessaloniki, Greece.
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5
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Blaauw MJT, Berrevoets MAH, Vos WAJW, Groenendijk AL, van Eekeren LE, Vadaq N, Weijers G, van der Ven AJAM, Rutten JHW, Riksen NP. Traditional Cardiovascular Risk Factors Are Stronger Related to Carotid Intima-Media Thickness Than to Presence of Carotid Plaques in People Living With HIV. J Am Heart Assoc 2023; 12:e030606. [PMID: 37804189 PMCID: PMC10757550 DOI: 10.1161/jaha.123.030606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/08/2023] [Indexed: 10/09/2023]
Abstract
Background Cardiovascular disease is a major cause of morbidity and mortality in people living with HIV, who are at higher risk than the general population. We assessed, in a large cohort of people living with HIV, which cardiovascular, HIV-specific, and lipoproteomic markers were associated with carotid intima-media thickness (cIMT) and carotid plaque presence. We also studied guideline adherence on lipid-lowering medication in individuals with high and very high risk for cardiovascular disease. Methods and Results In 1814 individuals with a median (interquartile range) age of 53 (44-60) years, we found a carotid plaque in 909 (50.1%) and a median (interquartile range) intima-media thickness of 0.66 (0.57-0.76) mm. Ultrasonography was used for the assessment of cIMT and plaque presence. Univariable and multivariable regression models were used for associations with cIMT and presence of plaques. Age, Black race, body mass index, type 2 diabetes, and smoking (pack years) were all positively associated with higher cIMT. Levels of high-density lipoprotein cholesterol, specifically medium and large high-density lipoprotein subclasses, were negatively associated with higher cIMT. Only age and prior myocardial infarction were positively related to the presence of a carotid plaque. Lipid-lowering treatment was prescribed in one-third of people living with HIV, who are at high and very high risk for cardiovascular disease. Conclusions Traditional cardiovascular risk factors were significantly associated with higher cIMT but not with carotid plaques, except for age. HIV-specific factors were not associated with both ultrasound measurements. Future studies are needed to elucidate which factors contribute to plaque formation. Improvement of guideline adherence on prescription of lipid-lowering treatment in high- and very high-risk patients for cardiovascular disease is recommended. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03994835.
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Affiliation(s)
- Marc J. T. Blaauw
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
- Department of Internal MedicineElisabeth‐Tweesteden HospitalTilburgthe Netherlands
| | | | - Wilhelm A. J. W. Vos
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
- Department of Internal MedicineOLVGAmsterdamthe Netherlands
| | - Albert L. Groenendijk
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
- Department of Medical Microbiology and Infectious DiseasesErasmus Medical Center (MC)Rotterdamthe Netherlands
| | - Louise E. van Eekeren
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
| | - Nadira Vadaq
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
- Center for Tropical and Infectious Diseases, Faculty of MedicineDiponegoro University, Dr. Kariadi HospitalSemarangIndonesia
| | - Gert Weijers
- Medical UltraSound Imaging Center, Division of Medical ImagingRadboud University Medical CenterNijmegenthe Netherlands
| | - Andre J. A. M. van der Ven
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
| | - Joost H. W. Rutten
- Division of Vascular Medicine, Department of Internal MedicineRadboud University Medical CentreNijmegenthe Netherlands
| | - Niels P. Riksen
- Division of Vascular Medicine, Department of Internal MedicineRadboud University Medical CentreNijmegenthe Netherlands
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Abera W, Wube TB, Alemayehu T. The association of aspartate transaminase-to-alanine transaminase ratio and metabolic syndrome among HIV patients in Sidama Region, South Ethiopia. SAGE Open Med 2023; 11:20503121231196701. [PMID: 37694128 PMCID: PMC10483979 DOI: 10.1177/20503121231196701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Studies on the association of the aspartate transaminase-to-alanine transaminase ratio with the metabolic syndrome and its components among HIV patients were scarce. This study aims to determine the association between the aspartate transaminase-to-alanine transaminase ratio and the metabolic syndrome and its components in adult HIV patients on highly active antiretroviral therapy. Methods This was a cross-sectional study conducted on 302 HIV patients from January 15 to June 30, 2021. Sociodemographic, clinical, and anthropometric data were collected using a structured questionnaire. The patient's medical records were reviewed. Biochemical analysis was performed after 5 ml of venous blood was collected from each study participant. Metabolic syndrome was defined by the third report of the national cholesterol education program-adult treatment panel. Logistic regression was done to assess the association of MetS with the independent variables, and correlation analysis was performed to see the correlation of MetS components with the aspartate aminotransferase-to-alanine aminotransferase ratio. Result 302 HIV-positive patients on highly active antiretroviral therapy were included in this study, and 54.6% were female. The median and interquartile range of the age of the study participants were 41 (35-50) years. The prevalence of metabolic syndrome was 29.5% (confidence interval = 24.5-35.1). Chronic illness (Adjusted odds ratio = 4.8, confidence interval = 2.2-10.9) and aspartate aminotransferase-to-alanine aminotransferase ratio (adjusted odds ratio = 2.5, confidence interval = 1.4-4.4) were significantly associated with Metabolic syndrome among the study participants. The aspartate aminotransferase-to-alanine aminotransferase ratio was significantly correlated with blood pressure. Conclusion This study found the existence of a significant association between the aspartate aminotransferase-to-alanine aminotransferase ratio and metabolic syndrome among HIV patients.
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Affiliation(s)
- Wondwossen Abera
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Temesgen Bizuayehu Wube
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Tsegaye Alemayehu
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Coburn SB, Lang R, Zhang J, Palella FJ, Horberg MA, Castillo-Mancilla J, Gebo K, Galaviz KI, Gill MJ, Silverberg MJ, Hulgan T, Elion RA, Justice AC, Moore RD, Althoff KN. Statins Utilization in Adults With HIV: The Treatment Gap and Predictors of Statin Initiation. J Acquir Immune Defic Syndr 2022; 91:469-478. [PMID: 36053091 PMCID: PMC9649872 DOI: 10.1097/qai.0000000000003083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND We characterized trends in statin eligibility and subsequent statin initiation among people with HIV (PWH) from 2001 to 2017 and identified predictors of statin initiation between 2014 and 2017. SETTING PWH participating in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) enrolled in 12 US cohorts collecting data on statin eligibility criteria/prescriptions from 2001 to 2017. METHODS We determined the annual proportion eligible for statins, initiating statins, and median waiting time (from statin eligibility to initiation). Eligibility was defined using ATP III guidelines (2001-2013) and ACC/AHA guidelines (2014-2017). We assessed initiation predictors in 2014-2017 among statin-eligible PWH using Poisson regression, estimating adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs). RESULTS Among 16,409 PWH, 7386 (45%) met statin eligibility criteria per guidelines (2001-2017). From 2001 to 2013, statin eligibility ranged from 22% to 25%. Initiation increased from 13% to 45%. In 2014, 51% were statin-eligible, among whom 25% initiated statins, which increased to 32% by 2017. Median waiting time to initiation among those we observed declined over time. Per 10-year increase in age, initiation increased 46% (aPR 1.46, 95% CI: 1.29 to 1.67). Per 1-year increase in calendar year from 2014 to 2017, there was a 41% increase in the likelihood of statin initiation (aPR 1.41, 95% CI: 1.25 to 1.58). CONCLUSIONS There is a substantial statin treatment gap, amplified by the 2013 ACC/AHA guidelines. Measures are warranted to clarify reasons we observe this gap, and if necessary, increase statin use consistent with guidelines including efforts to help providers identify appropriate candidates.
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Affiliation(s)
- Sally B. Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
| | - Raynell Lang
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
- Cumming School of Medicine, University of Calgary,
Calgary, Alberta, Canada
| | - Jinbing Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
| | - Frank Joseph Palella
- Division of Infectious Diseases, Northwestern University
Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Jose Castillo-Mancilla
- Division of Infectious Disease, School of Medicine,
University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kelly Gebo
- School of Medicine, Johns Hopkins University, Baltimore,
Maryland, USA
| | - Karla I. Galaviz
- Department of Applied Health Science, Indiana University
School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary,
Canada
| | | | - Todd Hulgan
- Department of Medicine, Division of Infectious Diseases,
Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard A. Elion
- Department of Medicine, George Washington University
School of Medicine and Health Sciences, Washington, DC, USA
| | - Amy C. Justice
- Yale University Schools of Medicine and Public Health
and the Veterans Affairs Connecticut Healthcare System, New Haven, CT, USA
| | - Richard D. Moore
- School of Medicine, Johns Hopkins University, Baltimore,
Maryland, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
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8
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Wondie B, Aragaw A, Worku G, Kassie N. Breast self-examination and its associated factors among women who attended anti-retroviral therapy clinic in Bahir Dar city administration, North West Ethiopia. SAGE Open Med 2022; 10:20503121221124948. [PMID: 36161210 PMCID: PMC9500302 DOI: 10.1177/20503121221124948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 08/16/2022] [Indexed: 12/24/2022] Open
Abstract
Objective: Although breast self-examination has been shown to be the least-expensive, less time-consuming, and non-invasive screening method, still there is a gap in practice. Furthermore, the information among more risky population which attends anti-retroviral therapy is too limited. Therefore, the aim of this study is to assess breast self-examination practices and its associated factors among women who attended the anti-retroviral therapy clinic in Bahir Dar city administration, Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted among 660 women who attended anti-retroviral therapy clinics from March 1 to March 30, 2020. A systematic random sampling technique was used to select study participants. Pre-tested interviewer-administered questionnaires were used to collect data. Data were entered in to EPI data 3.1 and exported to Statistical Package for the Social Sciences version 23.00 software for analysis. A binary logistic regression model was fitted to identify factors associated with self-breast examination. Variables with a p value less than 0.2 in bivariable regression were candidates for multivariable regression. Adjusted odds ratios with a 95% confidence intervals and p values less than 0.05 were used to determine the association between independent and dependent variables. Hosmer–Lemeshow Test was used to determine model fitness. Result: Among 641 study participants, 224 (34.9%) have ever practiced breast self-examination. Women who attended college or above (adjusted odds ratio = 4.04, 95% confidence interval (1.65,9.90)), rich (adjusted odds ratio = 6.64, 95% confidence interval (2.72,16.20)), knowledgeable about signs and symptoms of breast cancer (adjusted odds ratio = 5.13, 95% confidence interval ( 2.55,10.31)), risk factors for breast cancer (adjusted odds ratio = 3.62, 95% confidence interval (1.85,7.07)), positive attitude toward breast self-examination (adjusted odds ratio = 2.76,95% confidence interval (1.41,11.84)), family history of breast cancer (adjusted odds ratio = 3.68,95% confidence interval (1.14,11.84)), and knowledge about breast self-examination technique (adjusted odds ratio = 2.64, 95% confidence interval (1.23,5.66)) had higher odds of breast self-examination practice. Conclusion: The practice of breast self-examination was low. During their regular visits for other issues, education and information dissemination about the benefits and techniques of self-breast examination is recommended.
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Affiliation(s)
- Betelhem Wondie
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amanu Aragaw
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Worku
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Nigus Kassie
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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9
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Jao J, Balmert LC, Sun S, Qiu Y, Kraus TA, Kirmse B, Sperling RS, Abrams EJ, Myer L, Arpadi S, Geffner ME, LeRoith D, Kurland IJ. Distinct cord blood C-peptide, adipokine, and lipidomic signatures by in utero HIV exposure. Pediatr Res 2022; 92:233-241. [PMID: 34446848 PMCID: PMC8881568 DOI: 10.1038/s41390-021-01705-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/14/2021] [Accepted: 08/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Early-life metabolic derangements in HIV-exposed uninfected (HEU) infants have been reported. METHODS Pregnant women with HIV and HIV-uninfected pregnant women were enrolled with their newborns in a US cohort from 2011 to 2015. We measured cord insulin, C-peptide, and metabolic cytokines of HEU and HIV-unexposed uninfected (HUU) newborns using ELISA and metabolites, lipid subspecies, and eicosanoids via liquid chromatography/mass spectrometry. Linear regression was employed to assess the association of intrauterine HIV/ART with insulin and C-peptide. Graphical lasso regression was used to identify differences between metabolite/lipid subspecies networks associated with C-peptide. RESULTS Of 118 infants, 56 were HEU, ART exposed. In adjusted analyses, mean cord insulin (β = 0.295, p = 0.03) and C-peptide (β = 0.522, p < 0.01) were significantly higher in HEU vs. HUU newborns. HEU neonates exhibited primarily positive associations between complex lipids and C-peptide, indicative of fuel storage, and augmented associations between cord eicosanoids and cytokines. HUU neonates exhibited negative associations with lipids and C-peptide indicative of increased fuel utilization. CONCLUSION Higher cord insulin and C-peptide in HEU vs. HUU newborns as well as differences in cord metabolites, metabolic-related cytokines, and eicosanoids may reflect a propensity for fuel storage and an inflammatory milieu suggestive of fetal metabolic changes associated with in utero HIV/ART exposure. IMPACT There is a paucity of studies assessing cord blood and neonatal metabolic health in HIV-exposed uninfected (HEU) newborns, an increasing population worldwide. Compared to HIV-unexposed uninfected (HUU) newborns, HEU newborns exhibit alterations in fuel homeostasis and an inflammatory milieu associated with in utero HIV/antiretroviral therapy (ART) exposure. The long-term implications of these neonatal findings are as yet unknown, but merit continued evaluation as this important and growing population ages into adulthood.
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Affiliation(s)
- Jennifer Jao
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Department of Medicine, Division of Adult Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Lauren C. Balmert
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA, Department of Preventive Medicine, Division of Biostatistics
| | - Shan Sun
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA, Department of Pediatrics, Division of Pediatric Infectious Diseases
| | - Yunping Qiu
- Albert Einstein College of Medicine, Bronx, NY, USA, Department of Medicine, Division of Endocrinology, Fleischer Institute for Diabetes and Metabolism
| | - Thomas A. Kraus
- Icahn School of Medicine at Mount Sinai, New York, NY, USA, Center for Therapeutic Antibody Development
| | - Brian Kirmse
- University of Mississippi Medical Center, Jackson, MS, USA, Department of Medical Genetics
| | - Rhoda S. Sperling
- Icahn School of Medicine at Mount Sinai, New York, NY, USA, Department of Obstetrics, Gynecology, and Reproductive Health
| | - Elaine J. Abrams
- ICAP at Columbia, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA,Vagelos College of Physicians & Surgeons and Mailman School of Public Health, Columbia University, New York, NY, USA, G.H. Sergievsky Center, Department of Pediatrics, Department of Epidemiology
| | - Landon Myer
- University of Cape Town, Cape Town, South Africa, School of Public Health & Family Medicine, Faculty of Health Sciences, Division of Epidemiology & Biostatistics
| | - Stephen Arpadi
- University of Cape Town, Cape Town, South Africa, School of Public Health & Family Medicine, Faculty of Health Sciences, Division of Epidemiology & Biostatistics
| | - Mitchell E. Geffner
- Keck School of Medicine of USC, Los Angeles, CA, USA, The Saban Research Institute of Children’s Hospital Los Angeles
| | - Derek LeRoith
- Icahn School of Medicine at Mount Sinai, New York, NY, USA, Department of Medicine, Division of Endocrinology, Diabetes and Bone Diseases
| | - Irwin J. Kurland
- Albert Einstein College of Medicine, Bronx, NY, USA, Department of Medicine, Division of Endocrinology, Fleischer Institute for Diabetes and Metabolism
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10
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Birabaharan M, Strunk A, Kaelber DC, Smith DM, Martin TC. Sex differences in type 2 diabetes mellitus prevalence among persons with HIV. AIDS 2022; 36:383-389. [PMID: 34750292 PMCID: PMC8795484 DOI: 10.1097/qad.0000000000003127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine whether type 2 diabetes mellitus (T2DM) is more common among women with HIV (WWH) than men with HIV (MWH). DESIGN A cross-sectional analysis of a demographically heterogenous population-based sample of more than 64 million patients in the United States. METHODS Using the Explorys (IBM) database, compare the prevalence of T2DM among men and women without HIV and influence of HIV on T2DM by sex controlling for confounding factors. RESULTS From 19 182 775 persons included in the study, 39 485 were with HIV. Rates of obesity was higher among WWH than MWH (58 vs. 35%). Prevalence of T2DM among WWH was 23% compared with 16% among MWH (P < 0.001). In sex-stratified adjusted analysis, WWH had 1.31 [95% confidence interval (CI), 1.24-1.38] times the odds of having T2DM than women without HIV. Women with HIV was associated with T2DM across all demographic subgroups. In contrast, no association between HIV and T2DM was observed among men (OR 1.01; 95% CI 0.98-1.05). CONCLUSION These data suggest that HIV confers a sex-specific increase in odds of T2DM among women but not men.
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Affiliation(s)
- Morgan Birabaharan
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California, San Diego, La Jolla, California,
USA
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and
Population and Quantitative Health Sciences, School of Medicine, Case Western
Reserve University, Cleveland, Ohio, USA
- Center for Clinical Informatics Research and Education, The
MetroHealth System, Cleveland, Ohio, USA
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California, San Diego, La Jolla, California,
USA
- San Diego Veterans Affairs Healthcare System, San Diego,
CA, USA
| | - Thomas C.S. Martin
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California, San Diego, La Jolla, California,
USA
- San Diego Veterans Affairs Healthcare System, San Diego,
CA, USA
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11
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Mendicin CCP, Moreira Costa AA, da Silva GJ, Braga LP, Rocha GM, Carmo RA, Guimarães MDC, de Pádua CAM. Metabolic comorbidities and systemic arterial hypertension: the challenge faced by HIV patientson long-term use of antiretroviral therapy. Hosp Pract (1995) 2022; 50:75-81. [PMID: 35040377 DOI: 10.1080/21548331.2022.2030564] [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: 10/19/2022]
Abstract
OBJECTIVE Our objective was to estimate the frequency of comorbidities and assess its relationship with exposure factors after a long-term of ART use. METHODS : A cross-sectional study with PLHIV (≥18 years-old), who initiated ART between 2001-2005 and attended an HIV/AIDS public-referral center (Belo Horizonte/Brazil) was performed. Demographic, clinical, therapeutic and lifestyle data were obtained through interviews, medical charts, public database, routine laboratory exams and bone densitometry. The outcome was the number of comorbidities: hyperglycemia, dyslipidemia, systemic arterial-hypertension (SAH) and low bone mineral density (BMD). Absolute/relative frequencies were calculated. Factors associated with the outcome were assessed by quasi-Poisson regression. RESULTS: Of the 98 participants, 53% were male, 79% over 43 years-old. Moderate physical-activity was observed in 82%, overweight/obesity in 50% and 58% used ART based on two nucleoside reverse transcriptase inhibitors (NRTI) plus one non-nucleoside reverse transcriptase inhibitor (NNRTI). After a mean of 15.6 years of ART exposure, 207 comorbidities were identified and 93% participants presented at least one comorbidity (mean=2.1/participant). The most frequent overlapping was composed by two co-occurrences: dyslipidemia+hyperglycemia or dyslipidemia+SAH, n=36 in each co-occurrence. The quasi-Poisson regression showed an increase of 3% in the number of comorbidities per year of age (OR=1.03;95%CI=1.02-1.04) and 84% among PLHIV on moderate physical-activity (ref=heavy physical-activity) (OR=1.84;95%CI=1.08-3.13). CONCLUSIONS Our study shows that the aging slightly contributed to comorbidities. However, the practice of physical-activities is crucial to prevent chronic-diseases. Treatment and preventive measures should be encouraged to diminish the burden of disease and improve quality of life among PLHIV.
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Affiliation(s)
- Cássia Cristina Pinto Mendicin
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
| | | | - Gabriella Jomara da Silva
- Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
| | | | - Gustavo Machado Rocha
- Federal University of São João del-Rei (UFSJ), Divinópolis city, Minas Gerais state, Brazil
| | - Ricardo Andrade Carmo
- Infectious Diseases Reference Center, CTR/DIP Orestes Diniz, Municipal Health Division/ Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
| | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
| | - Cristiane A Menezes de Pádua
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
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12
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Geng ST, Zhang JB, Wang YX, Xu Y, Lu D, Zhang Z, Gao J, Wang KH, Kuang YQ. Pre-Digested Protein Enteral Nutritional Supplementation Enhances Recovery of CD4 + T Cells and Repair of Intestinal Barrier in HIV-Infected Immunological Non-Responders. Front Immunol 2022; 12:757935. [PMID: 35003070 PMCID: PMC8741150 DOI: 10.3389/fimmu.2021.757935] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
AIDS patients with immune non-response are prone to malnutrition, intestinal barrier damage, thus aggravating chronic immune activation and inflammation. However, nutritional interventions targeting malnutrition may be beneficial to restore immune function, improve clinical outcomes, and reduce mortality remains largely unclear. This work aimed to evaluate the efficacy of a nutritional supplement in HIV-infected immune non-responders (INRs). The subjects received oral supplementation of a pre-digested protein nutrition formula for three months. We show that the CD4+ T and CD8+ T cell counts were significantly increased after supplementation of the pre-digested enteral nutritional supplement. Among all pro-inflammatory cytokines in the serum, only IL-1β level was significantly decreased, while TNF-β was significantly increased (P < 0.05). The levels of intestinal mucosal damage markers, diamine oxidase (DAO), D-lactic acid (D-lactate), and lipopolysaccharide (LPS), decreased significantly (P < 0.05) after the nutritional intervention. Moreover, at month 3 after the intervention, the body weight, body mass index, albumin, and hemoglobin of all subjects were significantly increased (P < 0.05). The correlation analysis demonstrated a significantly negative correlation of CD4+ T cell count with levels of DAO (r = -0.343, P = 0.004), D-lactate (r = -0.250, P = 0.037), respectively, and a significantly positive correlation of IL-1β level with levels of DAO (r = 0.445, P < 0.001), D-lactate (r = 0.523, P < 0.001), and LPS (r = 0.622, P < 0.001). We conclude that the pre-digested enteral nutrition supplement is effective for HIV-infected INRs.
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Affiliation(s)
- Shi-Tao Geng
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian-Bo Zhang
- Department of Dermatology, Second People's Hospital of Dali City, Dali, China
| | - Yue-Xin Wang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu Xu
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Danfeng Lu
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zunyue Zhang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ju Gao
- Department of Dermatology, Second People's Hospital of Dali City, Dali, China
| | - Kun-Hua Wang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China.,School of Medicine, Yunnan University, Kunming, China
| | - Yi-Qun Kuang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
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13
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Jao J, Balmert LC, Sun S, McComsey GA, Brown TT, Tien PC, Currier JS, Stein JH, Qiu Y, LeRoith D, Kurland IJ. Distinct Lipidomic Signatures in People Living With HIV: Combined Analysis of ACTG 5260s and MACS/WIHS. J Clin Endocrinol Metab 2022; 107:119-135. [PMID: 34498048 PMCID: PMC8684537 DOI: 10.1210/clinem/dgab663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Disentangling contributions of HIV from antiretroviral therapy (ART) and understanding the effects of different ART on metabolic complications in persons living with HIV (PLHIV) has been challenging. OBJECTIVE We assessed the effect of untreated HIV infection as well as different antiretroviral therapy (ART) on the metabolome/lipidome. METHODS Widely targeted plasma metabolomic and lipidomic profiling was performed on HIV-seronegative individuals and people living with HIV (PLHIV) before and after initiating ART (tenofovir/emtricitabine plus atazanavir/ritonavir [ATV/r] or darunavir/ritonavir [DRV/r] or raltegravir [RAL]). Orthogonal partial least squares discriminant analysis was used to assess metabolites/lipid subspecies that discriminated between groups. Graphical lasso estimated group-specific metabolite/lipid subspecies networks associated with the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Correlations between inflammatory markers and metabolites/lipid subspecies were visualized using heat maps. RESULTS Of 435 participants, 218 were PLHIV. Compared to HIV-seronegative individuals, ART-naive PLHIV exhibited higher levels of saturated triacylglycerols/triglycerides (TAGs) and 3-hydroxy-kynurenine, lower levels of unsaturated TAGs and N-acetyl-tryptophan, and a sparser and less heterogeneous network of metabolites/lipid subspecies associated with HOMA-IR. PLHIV on RAL vs ATV/r or DRV/r had lower saturated and unsaturated TAGs. Positive correlations were found between medium-long chain acylcarnitines (C14-C6 ACs), palmitate, and HOMA-IR for RAL but not ATV/r or DRV/r. Stronger correlations were seen for TAGs with interleukin 6 and high-sensitivity C-reactive protein after RAL vs ATV/r or DRV/r initiation; these correlations were absent in ART-naive PLHIV. CONCLUSION Alterations in the metabolome/lipidome suggest increased lipogenesis for ART-naive PLHIV vs HIV-seronegative individuals, increased TAG turnover for RAL vs ATV/r or DRV/r, and increased inflammation associated with this altered metabolome/lipidome after initiating ART. Future studies are needed to understand cardiometabolic consequences of lipogenesis and inflammation in PLHIV.
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Affiliation(s)
- Jennifer Jao
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Department of Medicine, Division of Adult Infectious Diseases, Chicago, Illinois 60611, USA
| | - Lauren C Balmert
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Division of Biostatistics, Chicago, Illinois 60611, USA
| | - Shan Sun
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Department of Pediatrics, Division of Pediatric Infectious Diseases, Chicago, Illinois 60611, USA
| | - Grace A McComsey
- University Hospitals Cleveland Medical Center and Case Western Reserve University, Department of Pediatrics, Department of Medicine, Cleveland, Ohio 44106, USA
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Phyllis C Tien
- University of California, San Francisco, Department of Medicine and Department of Veterans Affairs Medical Center, Division of Infectious Diseases, San Francisco, California 94121, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California Los Angeles, Los Angeles, California 90095, USA
| | - James H Stein
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Cardiovascular Medicine Division, Madison, Wisconsin 53726, USA
| | - Yunping Qiu
- Stable Isotope and Metabolomics Core Facility, Department of Medicine, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, New York 10461, USA
| | - Derek LeRoith
- Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Endocrinology, New York, New York 10029, USA
| | - Irwin J Kurland
- Stable Isotope and Metabolomics Core Facility, Department of Medicine, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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14
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Guimarães NS, Raposo MA, Greco D, Tupinambás U, Premaor MO. People Living With HIV, Lean Mass, and Sarcopenia: A Systematic Review and Meta-Analysis. J Clin Densitom 2022; 25:113-123. [PMID: 33836973 DOI: 10.1016/j.jocd.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/22/2022]
Abstract
This systematic review aims to estimate the prevalence of sarcopenia in people living with HIV (PLHIV) and to assess whether there is a difference between the muscle mass of PLHIV and people living without HIV. A systematic review of randomized controlled trials, cohort studies, cross-sectional and case-control studies was carried out. PLHIV over 18 years of age and that had their muscle mass evaluated by dual-energy X-ray absorptiometry were included. Overall, 4,376 studies were found, of which 118 had their full texts evaluated. A total of 5,532 people living with HIV and 2,986 people living without HIV were identified in 41 studies. The frequency of sarcopenia defined by low muscle mass (Baumgartner's operational definition) alone was 30.3% (95%CI 24.3%, 37.1%) and the frequency of sarcopenia defined by low muscle mass with low muscle strength (EWGSOP definition) was 4.5% (95%CI 1.3%, 13.9%), p-value = 0.0006. The standardized mean differences of muscle mass between PLHIV and controls was -0.211 units of standard deviation (95%CI -0.419, -0.003). In the meta-regression analysis muscle mass mean difference was associated with BMI, CD4, percentage of subjects on ART, and study design. PLHIV have a lower muscle mass when compared to people living without HIV. This difference appears to be attenuated by higher BMI, CD4 levels, and the percentage of subjects using ART. Furthermore, the frequencies of sarcopenia assessed by the operational definition of Baumgartner and the EWGSOP are not comparable and cannot be interchanged in PLHIV.
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Affiliation(s)
| | | | - Dirceu Greco
- Department of Clinical Medicine, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Unaí Tupinambás
- Department of Clinical Medicine, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Melissa Orlandin Premaor
- Department of Clinical Medicine, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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15
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Predicting the risk of atherosclerotic cardiovascular disease among adults living with HIV/AIDS in Addis Ababa, Ethiopia: A hospital-based study. PLoS One 2021; 16:e0260109. [PMID: 34843544 PMCID: PMC8629213 DOI: 10.1371/journal.pone.0260109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Atherosclerotic Cardiovascular Disease (ASCVD) is an emerging problem among People living with HIV/AIDS (PLWHA). The current study aimed at determining the risk of ASCVD among PLWHA using the Pooled Cohort Equation (PCE) and the Framingham Risk score (FRS). Methods A hospital-based study was carried out from January 2019 to February 2020 in PLWHA. The prevalence of ASCVD risk was determined in individuals aged between 20 to 79 and 40 to 79 years using the FRS and PCE as appropriate. Chi-square, univariate and multivariate logistic regressions were employed for analysis. Results The prevalence of high-risk ASCVD for subjects aged 20 and above using both tools was 11.5 %. For those aged 40 to 79 years, PCE yielded an increased risk (28%) than FRS (17.7%). Using both tools; advanced age, male gender, smoking, and increased systolic blood pressure were associated with an increased risk of ASCVD. Younger age (adjusted odds ratio, AOR) 0.20, 95%CI: 0.004, 0.091; P< 0.001), lower systolic blood pressure (AOR 0.221, 95%CI: 0.074, 0.605 P< 0.004), and lower total cholesterol (AOR 0.270, 95%CI: 0.073, 0.997; p<0.049) were found to be independent predictors of reduced risk of ASCVD. Likewise, younger age (40 to 64 years), female gender, and lower systolic blood pressure were significantly associated with lower risk of ASCVD among patients aged 40 to 79 years using both PCE and FRS. Conclusions A considerable number of PLWHA have been identified to be at risk for ASCVD. ASCVD risk was significantly associated with advanced age, male gender, higher blood pressure, and smoking using both FRS and PCE. These factors should therefore be taken into account for designing management strategies.
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16
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Síndrome metabólica em pessoas vivendo com HIV: prevalência e concordância de critérios. ACTA PAUL ENFERM 2021. [DOI: 10.37689/acta-ape/2021ao00625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Osuna-Padilla IA, Rodríguez-Moguel NC, Aguilar-Vargas A, Rodríguez-Aguirre E, Briceño O, Ávila-Ríos S. Normal weight obesity is associated with hypercholesterolemia and low muscle mass in persons living with HIV on antiretroviral treatment. Nutrition 2021; 94:111515. [PMID: 34844155 DOI: 10.1016/j.nut.2021.111515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/22/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Normal weight obesity (NWO) is defined as a condition of normal body weight, but with high body fat percentage. Clinical and immunologic implications of NWO in persons living with HIV (PLHIV) remain unknown. The aim of this study was to examine NWO prevalence and its associations with metabolic and immunologic measurements in a cohort of PLHIV on antiretroviral treatment (ART). METHODS We enrolled 73 adult PLHIV on ART. Body composition was assessed by dual-energy x-ray absorptiometry. NWO was defined as body mass index 18.5 to 24.9 kg/m2 and body fat ≥25%. We determined triacylglycerols, total cholesterol, high-density lipoprotein, low-density lipoprotein, blood glucose, blood pressure, bone mineral density, inflammatory cytokines (interleukin [IL]-1β, tumor necrosis factor-α and IL-6) and CD4+ and CD8+ T-cell activation. RESULTS The prevalence of NWO was 49% (36 of 73). Participants with NWO showed lower CD4+ T-cell percentage (25 versus 27%, P = 0.03), lower CD4/CD8 ratio (0.62 versus 0.82, P = 0.02), lower muscle mass (6.84 versus 7.11 kg/m2, P = 0.01) and higher prevalence of hypercholesterolemia (26% versus 6%, P = 0.03) than individuals with normal body composition. No differences in inflammation/activation markers were observed between groups (P > 0.05 in all cases). CONCLUSION NWO was frequent in a cohort of Mexican PLHIV on ART and was associated with lower muscle mass, hypercholesterolemia, lower CD4+ T-cell percentage, and lower CD4/CD8 ratio. The incorporation of body fat measurements in the regular physical examination of PLHIV could contribute to early identification of the NWO condition and lead to better management of possible long-term morbidity.
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Affiliation(s)
- Ivan A Osuna-Padilla
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Nadia C Rodríguez-Moguel
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Adriana Aguilar-Vargas
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Edna Rodríguez-Aguirre
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Olivia Briceño
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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18
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Armstrong AJS, Quinn K, Fouquier J, Li SX, Schneider JM, Nusbacher NM, Doenges KA, Fiorillo S, Marden TJ, Higgins J, Reisdorph N, Campbell TB, Palmer BE, Lozupone CA. Systems Analysis of Gut Microbiome Influence on Metabolic Disease in HIV-Positive and High-Risk Populations. mSystems 2021; 6:e01178-20. [PMID: 34006628 PMCID: PMC8269254 DOI: 10.1128/msystems.01178-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/15/2021] [Indexed: 12/20/2022] Open
Abstract
Poor metabolic health, characterized by insulin resistance and dyslipidemia, is higher in people living with HIV and has been linked with inflammation, antiretroviral therapy (ART) drugs, and ART-associated lipodystrophy (LD). Metabolic disease is associated with gut microbiome composition outside the context of HIV but has not been deeply explored in HIV infection or in high-risk men who have sex with men (HR-MSM), who have a highly altered gut microbiome composition. Furthermore, the contribution of increased bacterial translocation and associated systemic inflammation that has been described in HIV-positive and HR-MSM individuals has not been explored. We used a multiomic approach to explore relationships between impaired metabolic health, defined using fasting blood markers, gut microbes, immune phenotypes, and diet. Our cohort included ART-treated HIV-positive MSM with or without LD, untreated HIV-positive MSM, and HR-MSM. For HIV-positive MSM on ART, we further explored associations with the plasma metabolome. We found that elevated plasma lipopolysaccharide binding protein (LBP) was the most important predictor of impaired metabolic health and network analysis showed that LBP formed a hub joining correlated microbial and immune predictors of metabolic disease. Taken together, our results suggest the role of inflammatory processes linked with bacterial translocation and interaction with the gut microbiome in metabolic disease among HIV-positive and -negative MSM.IMPORTANCE The gut microbiome in people living with HIV (PLWH) is of interest since chronic infection often results in long-term comorbidities. Metabolic disease is prevalent in PLWH even in well-controlled infection and has been linked with the gut microbiome in previous studies, but little attention has been given to PLWH. Furthermore, integrated analyses that consider gut microbiome, together with diet, systemic immune activation, metabolites, and demographics, have been lacking. In a systems-level analysis of predictors of metabolic disease in PLWH and men who are at high risk of acquiring HIV, we found that increased lipopolysaccharide-binding protein, an inflammatory marker indicative of compromised intestinal barrier function, was associated with worse metabolic health. We also found impaired metabolic health associated with specific dietary components, gut microbes, and host and microbial metabolites. This study lays the framework for mechanistic studies aimed at targeting the microbiome to prevent or treat metabolic endotoxemia in HIV-infected individuals.
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Affiliation(s)
- Abigail J S Armstrong
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
- Department of Immunology and Microbiology, University of Colorado Denver, Aurora, Colorado, USA
- Center for Advanced Biotechnology and Medicine, Rutgers the State University, Piscataway, New Jersey, USA
| | - Kevin Quinn
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Jennifer Fouquier
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Sam X Li
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | | | - Nichole M Nusbacher
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Katrina A Doenges
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Suzanne Fiorillo
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Tyson J Marden
- Colorado Clinical and Translational Sciences Institute, Aurora, Colorado, USA
| | - Janine Higgins
- Department of Pediatrics, Section of Endocrinology, University of Colorado, Aurora, Colorado, USA
| | - Nichole Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Thomas B Campbell
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Brent E Palmer
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
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Durstenfeld MS, Hsue PY. Mechanisms and primary prevention of atherosclerotic cardiovascular disease among people living with HIV. Curr Opin HIV AIDS 2021; 16:177-185. [PMID: 33843806 PMCID: PMC8064238 DOI: 10.1097/coh.0000000000000681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW To highlight mechanisms of elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLWH), discuss therapeutic strategies, and opportunities for primary prevention. RECENT FINDINGS HIV-associated ASCVD risk is likely multifactorial and due to HIV-specific factors and traditional risk factors even in the setting of treated and suppressed HIV disease. Although a growing body of evidence suggests that inflammation and immune activation are key drivers of atherogenesis, therapies designed to lower inflammation including colchicine and low-dose methotrexate have not improved secondary cardiovascular endpoints among PLWH. Statins continue to be the mainstay of management of hyperlipidemia in HIV, but the impact of newer lipid therapies including proprotein convertase subtilisin/kexin type 9 inhibitors on ASCVD risk among PLWH is under investigation. Aside from the factors mentioned above, healthcare disparities are particularly prominent among PLWH and thus likely contribute to increased ASCVD risk. SUMMARY Our understanding of mechanisms of elevated ASCVD risk in HIV continues to evolve, and the optimal treatment for CVD in HIV aside from targeting traditional risk factors remains unknown. Future studies including novel therapies to lower inflammation, control of risk factors, and implementation science are needed to ascertain optimal ways to treat and prevent ASCVD among PLWH.
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Affiliation(s)
- Matthew S Durstenfeld
- Division of Cardiology, UCSF at Zuckerberg San Francisco General Hospital
- Department of Medicine, University of California, San Francisco, California, USA
| | - Priscilla Y Hsue
- Division of Cardiology, UCSF at Zuckerberg San Francisco General Hospital
- Department of Medicine, University of California, San Francisco, California, USA
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20
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Shi R, Chen X, Lin H, Shen W, Xu X, Zhu B, Xu X, Ding Y, Wong FY, He N. Association of HIV infection with metabolic syndrome among normal or underweight young adults: evidence from the CHART cohort. Biosci Trends 2021; 14:450-456. [PMID: 33328394 DOI: 10.5582/bst.2020.03351] [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: 11/05/2022]
Abstract
Metabolic syndrome (MS) is common among obese people. Little is known about the magnitude and characteristics of MS in people living with HIV (PLWH) in Asian countries in general and China in particular. Using baseline data collected between February 2017 through January 2020 from the Comparative HIV and Aging Research in Taizhou (CHART) cohort in China, we examined MS among 2,227 PLWH and 5,264 matched people without HIV, respectively. MS was defined using the criteria set forth by the International Diabetes Federation (IDF). Approximately 76.7% of PLWH had body mass index (BMI) < 24.0 kg/m2, significantly higher than people without HIV (50.3%). Among participants with BMI < 24.0 kg/m2, PLWH had a significantly higher prevalence of MS than people without HIV (20.6% vs. 14.5%; aOR: 1.41, 95% CI: 1.19-1.68) overall, and at an age of 18-29 (10.4% vs. 3.4%, aOR: 3.49, 95% CI: 1.99-6.11) and 30-44 years (17.3% vs. 8.5%, aOR: 2.03, 95% CI: 1.47-2.81), respectively. Among participants with BMI ≥ 24.0 kg/m2, MS prevalence was not significantly different between PLWH and people without HIV overall, but significantly lower in PLWH than people without HIV for those aged over 60 years (65.9% vs. 77.8%, aOR: 0.53, 95% CI: 0.32-0.88). Among PLWH, MS was significantly associated with older age and higher CD4 cell count, and with stavudine (d4T) use only in the group of BMI < 24.0 kg/m2. Our finding is indicative of a relatively higher risk for early onset of MS among HIV-infected young adults with lower BMI. Research is needed to elucidate the pathogenic mechanism for MS among PLWH.
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Affiliation(s)
- Ruizi Shi
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Haijiang Lin
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Xiaohui Xu
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Bowen Zhu
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaoyi Xu
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yingying Ding
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Frank Y Wong
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Center for Indigenous Nursing Research for Health Equity, Florida State University, Tallahassee, FL, U.S.A.,Department of Psychology, College of Social Sciences, University of Hawai'i at Mānoa, Honolulu, HI, U.S.A.,Department of Population Science, John D. Bower School of Population Health, University of Mississippi Medical Center, MS, U.S.A
| | - Na He
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, China
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21
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Jha NK, Sharma A, Jha SK, Ojha S, Chellappan DK, Gupta G, Kesari KK, Bhardwaj S, Shukla SD, Tambuwala MM, Ruokolainen J, Dua K, Singh SK. Alzheimer's disease-like perturbations in HIV-mediated neuronal dysfunctions: understanding mechanisms and developing therapeutic strategies. Open Biol 2020; 10:200286. [PMID: 33352062 PMCID: PMC7776571 DOI: 10.1098/rsob.200286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/27/2020] [Indexed: 01/10/2023] Open
Abstract
Excessive exposure to toxic substances or chemicals in the environment and various pathogens, including viruses and bacteria, is associated with the onset of numerous brain abnormalities. Among them, pathogens, specifically viruses, elicit persistent inflammation that plays a major role in Alzheimer's disease (AD) as well as dementia. AD is the most common brain disorder that affects thought, speech, memory and ability to execute daily routines. It is also manifested by progressive synaptic impairment and neurodegeneration, which eventually leads to dementia following the accumulation of Aβ and hyperphosphorylated Tau. Numerous factors contribute to the pathogenesis of AD, including neuroinflammation associated with pathogens, and specifically viruses. The human immunodeficiency virus (HIV) is often linked with HIV-associated neurocognitive disorders (HAND) following permeation through the blood-brain barrier (BBB) and induction of persistent neuroinflammation. Further, HIV infections also exhibited the ability to modulate numerous AD-associated factors such as BBB regulators, members of stress-related pathways as well as the amyloid and Tau pathways that lead to the formation of amyloid plaques or neurofibrillary tangles accumulation. Studies regarding the role of HIV in HAND and AD are still in infancy, and potential link or mechanism between both is not yet established. Thus, in the present article, we attempt to discuss various molecular mechanisms that contribute to the basic understanding of the role of HIV-associated neuroinflammation in AD and HAND. Further, using numerous growth factors and drugs, we also present possible therapeutic strategies to curb the neuroinflammatory changes and its associated sequels.
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Affiliation(s)
- Niraj Kumar Jha
- Department of Biotechnology, School of Engineering and Technology (SET), Sharda University, Greater Noida, UP 201310, India
| | - Ankur Sharma
- Department of Life Science, School of Basic Science and Research (SBSR), Sharda University, Greater Noida, UP 201310, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering and Technology (SET), Sharda University, Greater Noida, UP 201310, India
| | - Shreesh Ojha
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, PO Box 17666, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Gaurav Gupta
- School of Phamacy, Suresh Gyan Vihar University, Jagatpura, Mahal Road, Jaipur, India
| | - Kavindra Kumar Kesari
- Department of Applied Physics, School of Science, Aalto University, Espoo 00076, Finland
| | - Shanu Bhardwaj
- Department of Biotechnology, HIMT, Greater Noida, CCS University, UP, India
| | - Shakti D. Shukla
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI) and School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Murtaza M. Tambuwala
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, County Londonderry, BT52 1SA, UK
| | - Janne Ruokolainen
- Department of Applied Physics, School of Science, Aalto University, Espoo 00076, Finland
| | - Kamal Dua
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI) and School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales 2007, Australia
- School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, PO Box 9, Solan, Himachal Pradesh 173229, India
| | - Sandeep Kumar Singh
- Department of Biomedical Research, Centre of Biomedical Research, SGPGI Campus, Lucknow 226014, UP, India
- Biological Science, Indian Scientific Education and Technology Foundation, Lucknow 226002, UP, India
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22
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Geng ST, Zhang ZY, Wang YX, Lu D, Yu J, Zhang JB, Kuang YQ, Wang KH. Regulation of Gut Microbiota on Immune Reconstitution in Patients With Acquired Immunodeficiency Syndrome. Front Microbiol 2020; 11:594820. [PMID: 33193273 PMCID: PMC7652894 DOI: 10.3389/fmicb.2020.594820] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) infection of CD4+ T cells in the gut plays an insidious role in acquired immunodeficiency syndrome (AIDS) pathogenesis. Host immune function is closely related to gut microbiota. Changes in the gut microbiota cause a different immune response. Previous studies revealed that HIV-1 infection caused changes in gut microbiota, which induced immune deficiency. HIV-1 infection results in an abnormal composition and function of the gut microbiota, which may disrupt the intestinal epithelial barrier and microbial translocation, leading to long-term immune activation, including inflammation and metabolic disorders. At the same time, an abnormal gut microbiota also hinders the effect of antiviral therapy and affects the immune reconstruction of patients. However, studies on the impact of the gut microbiota on immune reconstitution in patients with HIV/AIDS are still limited. In this review, we focus on changes in the gut microbiota caused by HIV infection, as well as the impact and regulation of the gut microbiota on immune function and immune reconstitution, while we also discuss the potential impact of probiotics/prebiotics and fecal microbiota transplantation (FMT) on immune reconstitution.
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Affiliation(s)
- Shi-Tao Geng
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zun-Yue Zhang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yue-Xin Wang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Danfeng Lu
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Juehua Yu
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian-Bo Zhang
- Department of Dermatology, Second People's Hospital of Dali City, Dali, China
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kun-Hua Wang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
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23
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Mitchell BI, Laws EI, Chow DC, Sah Bandar IN, Gangcuangco LMA, Shikuma CM, Ndhlovu LC. Increased Monocyte Inflammatory Responses to Oxidized LDL Are Associated with Insulin Resistance in HIV-Infected Individuals on Suppressive Antiretroviral Therapy. Viruses 2020; 12:v12101129. [PMID: 33028018 PMCID: PMC7601436 DOI: 10.3390/v12101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022] Open
Abstract
Despite long term antiretroviral therapy (ART), insulin resistance (IR) is common among people living with HIV/AIDS (PLWHA) exposing this population to a greater risk of cardiometabolic complications when compared to their uninfected counterparts. We previously identified an expansion in monocyte subpopulations in blood that were linked to the degree of IR in persons with HIV on stable ART. In this study, we directly assessed monocyte inflammatory functional properties from PLWHA on ART (n = 33) and HIV-uninfected controls (n = 14) of similar age, gender, and cardiovascular disease risk and determined the relationship with IR (homeostatic model assessment-insulin resistance (HOMA-IR)), calculated from fasting blood glucose and insulin measurements. Peripheral blood mononuclear cells were stimulated with oxidized low-density lipoproteins (oxLDL) and polyfunctional monocyte cytokine responses (IL-1β, IL-6, IL-8, or TNF-α) were determined by flow cytometry. Higher monocyte IL-1β and IL-8 responses to oxLDL were associated with higher IR in PLWHA but not in the control group. We observed that higher basal monocyte cytokine responses were associated with both duration since HIV diagnosis and ART initiation. In the management of IR in chronic HIV, strategies lowering monocyte IL-1β and IL-8 responses should be considered in addition to ART in order to limit adverse cardio-metabolic outcomes.
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24
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Calza L, Colangeli V, Borderi M, Beci G, Esposito F, Bon I, Re MC, Viale P. Rosuvastatin decreases serum inflammatory markers and slows atherosclerosis progression rate in treated HIV-infected patients with metabolic syndrome. Infect Dis (Lond) 2020; 53:81-88. [PMID: 32955957 DOI: 10.1080/23744235.2020.1823468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Metabolic syndrome (MetS) is usually associated in general population with systemic inflammation and higher cardiovascular risk, but data about the effect of statins in patients with HIV infection and MetS are lacking to date. METHODS Prospective cohort study of treated HIV-infected patients, aged from 40 to 60 years, with or without MetS, who started rosuvastatin (10 mg daily), and were followed-up for 12 months. The primary endpoint was change in serum levels of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor-α (TNF-α). The secondary endpoint was change in the carotid intima-media thickness (IMT). RESULTS One hundred and twenty-five patients were enrolled: 61 with MetS (MetS group) and 64 without MetS (control group). After 12 months, rosuvastatin produced a significant decrease in mean serum levels of hsCRP (-0.28 mg/dL; p = .037), IL-6 (-2.1 pg/mL; p = .018) and TNF-α (-6.3 pg/mL; p = .004) in patients with MetS. On the contrary, in controls rosuvastatin did not lead to a significant change in mean levels of all biomarkers. After 12 months, the mean IMT increase at the carotid bifurcation was significantly lower in the MetS group than in the control group at the carotid bifurcation (0.017 vs. 0.031 mm; p = .037) and in all other anatomical sites. CONCLUSION Our findings suggest that rosuvastatin is effective in reducing serum inflammation markers and slowing atherosclerosis progression rate in HIV-infected patients on cART and with MetS, while its effects on serum biomarkers and IMT increase seem to be negligible in those without MetS.
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Affiliation(s)
- Leonardo Calza
- Clinics of Infectious Diseases, 'Alma Mater Studiorum', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Colangeli
- Clinics of Infectious Diseases, 'Alma Mater Studiorum', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Borderi
- Clinics of Infectious Diseases, 'Alma Mater Studiorum', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giacomo Beci
- Clinics of Infectious Diseases, 'Alma Mater Studiorum', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Fabio Esposito
- Clinics of Infectious Diseases, 'Alma Mater Studiorum', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Isabella Bon
- Unit of Microbiology, 'Alma Mater Studiorum', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Carla Re
- Unit of Microbiology, 'Alma Mater Studiorum', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Pierluigi Viale
- Clinics of Infectious Diseases, 'Alma Mater Studiorum', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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25
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Gonzales GB, Njunge JM, Gichuki BM, Wen B, Potani I, Voskuijl W, Bandsma RHJ, Berkley JA. Plasma proteomics reveals markers of metabolic stress in HIV infected children with severe acute malnutrition. Sci Rep 2020; 10:11235. [PMID: 32641735 PMCID: PMC7343797 DOI: 10.1038/s41598-020-68143-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/17/2020] [Indexed: 01/20/2023] Open
Abstract
HIV infection affects up to 30% of children presenting with severe acute malnutrition (SAM) in Africa and is associated with increased mortality. Children with SAM are treated similarly regardless of HIV status, although mechanisms of nutritional recovery in HIV and/or SAM are not well understood. We performed a secondary analysis of a clinical trial and plasma proteomics data among children with complicated SAM in Kenya and Malawi. Compared to children with SAM without HIV (n = 113), HIV-infected children (n = 54) had evidence (false discovery rate (FDR) corrected p < 0.05) of metabolic stress, including enriched pathways related to inflammation and lipid metabolism. Moreover, we observed reduced plasma levels of zinc-α-2-glycoprotein, butyrylcholinesterase, and increased levels of complement C2 resembling findings in metabolic syndrome, diabetes and other non-communicable diseases. HIV was also associated (FDR corrected p < 0.05) with higher plasma levels of inflammatory chemokines. Considering evidence of biomarkers of metabolic stress, it is of potential concern that our current treatment strategy for SAM regardless of HIV status involves a high-fat therapeutic diet. The results of this study suggest a need for clinical trials of therapeutic foods that meet the specific metabolic needs of children with HIV and SAM.
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Affiliation(s)
- Gerard Bryan Gonzales
- Department of Gastroenterology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. .,VIB Inflammation Research Centre, Ghent, Belgium.
| | - James M Njunge
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bonface M Gichuki
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bijun Wen
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Isabel Potani
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Wieger Voskuijl
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.,Global Child Health Group, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands.,Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Robert H J Bandsma
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - James A Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Nuffield Department of Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
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26
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Feasibility and Preliminary Effects of a Telerehabilitation Program for People Living With HIV: A Pilot Randomized Study. J Assoc Nurses AIDS Care 2020; 30:176-185. [PMID: 30822290 DOI: 10.1097/jnc.0000000000000005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We investigated feasibility and preliminary effects of telerehabilitation for people living with HIV (PLWH) and taking antiretroviral therapy. We randomized 25 PLWH to either an endurance and resistance training exercise (ERTE) group or a control group. Endurance and resistance training exercise sessions occurred in a public fitness center, with online guidance and weekly telephone advice. The primary outcome was feasibility (recruitment and retention rates and safety). Secondary outcomes were assessed at baseline and 6 weeks according to the three International Classification of Functioning, Disability, and Health domains. Nine patients completed the ERTE program. Recruitment and retention rates were 93% and 69%, respectively. No adverse events occurred. After 6 weeks, percentage change in D-dimer was lower in the ERTE group, but not significantly after the Bonferroni correction. Other parameters were not different between the groups. Therefore, telerehabilitation is feasible in PLWH taking antiretroviral therapy; however, the performance of the program is still questioned, and future research is warranted.
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27
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Heron JE, Bagnis CI, Gracey DM. Contemporary issues and new challenges in chronic kidney disease amongst people living with HIV. AIDS Res Ther 2020; 17:11. [PMID: 32178687 PMCID: PMC7075008 DOI: 10.1186/s12981-020-00266-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/22/2020] [Indexed: 12/27/2022] Open
Abstract
Chronic kidney disease (CKD) is a comorbidity of major clinical significance amongst people living with HIV (PLWHIV) and is associated with significant morbidity and mortality. The prevalence of CKD is rising, despite the widespread use of antiretroviral therapy (ART) and is increasingly related to prevalent non-infectious comorbidities (NICMs) and antiretroviral toxicity. There are great disparities evident, with the highest prevalence of CKD among PLWHIV seen in the African continent. The aetiology of kidney disease amongst PLWHIV includes HIV-related diseases, such as classic HIV-associated nephropathy or immune complex disease, CKD related to NICMs and CKD from antiretroviral toxicity. CKD, once established, is often relentlessly progressive and can lead to end-stage renal disease (ESRD). Identifying patients with risk factors for CKD, and appropriate screening for the early detection of CKD are vital to improve patient outcomes. Adherence to screening guidelines is variable, and often poor. The progression of CKD may be slowed with certain clinical interventions; however, data derived from studies involving PLWHIV with CKD are sparse and this represent an important area for future research. The control of blood pressure using angiotensin converting enzyme inhibitors and angiotensin receptor blockers, in particular, in the setting of proteinuria, likely slows the progression of CKD among PLWHIV. The cohort of PLWHIV is facing new challenges in regards to polypharmacy, drug-drug interactions and adverse drug reactions. The potential nephrotoxicity of ART is important, particularly as cumulative ART exposure increases as the cohort of PLWHIV ages. The number of PLWHIV with ESRD is increasing. PLWHIV should not be denied access to renal replacement therapy, either dialysis or kidney transplantation, based on their HIV status. Kidney transplantation amongst PLWHIV is successful and associated with an improved prognosis compared to remaining on dialysis. As the cohort of PLWHIV ages, comorbidity increases and CKD becomes more prevalent; models of care need to evolve to meet the new and changing chronic healthcare needs of these patients.
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Affiliation(s)
- Jack Edward Heron
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Corinne Isnard Bagnis
- Nephrology Department, Groupe Hospitalier Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - David M Gracey
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
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Russell E, Albert A, Côté H, Hsieh A, Nesbitt A, Campbell AR, Maan EJ, Brophy J, Pick N, Murray M. Rate of dyslipidemia higher among women living with HIV: A comparison of metabolic and cardiovascular health in a cohort to study aging in HIV. HIV Med 2020; 21:418-428. [PMID: 32168418 DOI: 10.1111/hiv.12843] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Combination antiretroviral therapy has largely restored the lifespan of persons living with HIV. Data suggest early comorbidities of aging in this population. Past studies focused on men; limited data exist regarding the prevalence of dyslipidaemia in women living with HIV (WLWH). We investigated the prevalence of cardiometabolic abnormalities among WLWH and HIV-negative women in the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort, and their relationships to cellular aging markers. METHODS We conducted a cross-sectional analysis of nonpregnant female patients (156 WLWH and 133 HIV-negative controls, aged 12-69 years) enrolled in CARMA between 2013 and 2017. The Framingham risk score (FRS) and the prevalences of hypertension, diabetes, metabolic syndrome and dyslipideamia were determined using self-report, anthropometrics, chart review and laboratory data. Cellular aging was determined by assessing leukocyte telomere length and blood mitochondrial DNA content. Diagnoses were based on current Canadian guidelines and definitions. RESULTS HIV-infected status was associated with dyslipidaemia [odds ratio (OR) 2.89; 95% confidence interval (CI) 1.69-5.01], but not diabetes, higher FRS, hypertension or metabolic syndrome. The median age was 43.5 [interquartile range (IQR) 36.8-50.9] years in WLWH and 46.2 (IQR 30.3-54.9) years in HIV-negative controls. WLWH were less likely to be menopausal or use alcohol, and more often had hepatitis C virus infection or a current or past smoking history. Lower mitochondrial DNA content was associated with metabolic syndrome; no other associations were noted between cardiometabolic abnormalities and markers of cellular aging. CONCLUSIONS Despite their relatively young age, almost two-thirds of WLWH had dyslipidaemia, a significantly greater proportion than in controls. Strategies to address dyslipidaemia and decrease smoking rates may improve long-term outcomes among WLWH.
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Affiliation(s)
- Eab Russell
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ayk Albert
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Hcf Côté
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ayy Hsieh
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Nesbitt
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A R Campbell
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada.,Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - E J Maan
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - J Brophy
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - N Pick
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - McM Murray
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Di Cristo V, Adorni F, Maserati R, Annovazzi Lodi M, Bruno G, Maggi P, Volpe A, Vitiello P, Abeli C, Bonora S, Ferrara M, Cossu MV, Oreni ML, Colella E, Rusconi S. 96-week results of a dual therapy with darunavir/ritonavir plus rilpivirine once a day vs triple therapy in patients with suppressed viraemia: virological success and non-HIV related morbidity evaluation. HIV Res Clin Pract 2020; 21:34-43. [PMID: 32129161 DOI: 10.1080/25787489.2020.1734752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Antiretroviral therapies have been tested with the goal of maintaining virological suppression with a particular attention in limiting drug-related toxicity. With this aim we designed the DUAL study: a randomized, open-label, multicenter, 96 weeks-long pilot exploratory study in virologically suppressed HIV-1+ patients with the aim of evaluating the immunovirological success and the impact on non-HIV related morbidity of switching to a dual therapy with darunavir-ritonavir (DRV/r) and rilpivirine (RPV). We recruited patients who received a PI/r-containing HAART for ≥6 months, HIV-RNA < 50 cp/mL for ≥3 months, eGFR > 60 mL/min/1,73m2, without DRV or RPV RAMs. We randomized patients in arm A: RPV + DRV/r QD or arm B: ongoing triple therapy. The primary endpoint has been defined as the percentage of patients with HIV-RNA < 50 cp/mL at week 48 (ITT). VACS index, Framingham CVD risk (FRS) and urinary RBP (uRBP) were calculated. We used Chi-square or Fisher statistics for categorical variables and Mann-Whitney U for continuous ones. Forty-one patients were enrolled (22 in arm A, 14 in arm B, plus 5 screening failures): 30 patients reached 96 weeks: 100% had HIV-RNA < 50 cp/mL in arm A versus 91.7% in arm B. Similar changes were observed in median CD4/mL between baseline and week 96 (+59 versus - 31, p: n.s.). Thirty-one in arm A and 23 in arm B adverse events took place, whereas only 1 was serious (arm A: turbinate hypertrophy, unrelated to HAART). Among the 6 discontinuations (3 in A, 3 in B), only 1 was related to adverse event (arm A: G3 depression, insomnia, weakness). VACS index, median FRS and median uRBP values did not vary from baseline to week 96. At 96-weeks all patients switched to a QD 2-drug regimen based on DRV/r + RPV maintained HIV-RNA suppression, but a single patient who showed a virological failure at week 4. CD4 counts increased overtime without significant differences between the two arms. The novel dual regimen was well tolerated with the same amount of discontinuation as the control arm. VACS index, FRS and uRBP did not differ between arms at week 96.
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Affiliation(s)
- Valentina Di Cristo
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | | | - Renato Maserati
- Infectious Diseases Unit, Policlinico San Matteo Foundation, IRCCS, Pavia, Italy
| | - Marco Annovazzi Lodi
- Infectious Diseases Unit, Policlinico San Matteo Foundation, IRCCS, Pavia, Italy
| | - Giuseppe Bruno
- Infectious Diseases Unit, University of Bari, Bari, Italy
| | - Paolo Maggi
- Infectious Diseases Unit, University of Bari, Bari, Italy
| | - Anna Volpe
- Infectious Diseases Unit, University of Bari, Bari, Italy
| | - Paola Vitiello
- Infectious Diseases Unit, ASST Valle Olona, Ospedale di Circolo, Busto Arsizio, VA, Italy
| | - Clara Abeli
- Infectious Diseases Unit, ASST Valle Olona, Ospedale di Circolo, Busto Arsizio, VA, Italy
| | - Stefano Bonora
- Infectious Diseases Unit, University of Turin, Turin, Italy
| | - Micol Ferrara
- Infectious Diseases Unit, University of Turin, Turin, Italy
| | | | - Maria Letizia Oreni
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Elisa Colella
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
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Abstract
Antiretroviral therapy has largely transformed HIV infection into a chronic disease condition. As such, physicians and other providers caring for individuals living with HIV infection need to be aware of the potential cardiovascular complications of HIV infection and the nuances of how HIV infection increases the risk of cardiovascular diseases, including acute myocardial infarction, stroke, peripheral artery disease, heart failure and sudden cardiac death, as well as how to select available therapies to reduce this risk. In this Review, we discuss the epidemiology and clinical features of cardiovascular disease, with a focus on coronary heart disease, in the setting of HIV infection, which includes a substantially increased risk of myocardial infarction even when the HIV infection is well controlled. We also discuss the mechanisms underlying HIV-associated atherosclerotic cardiovascular disease, such as the high rates of traditional cardiovascular risk factors in patients with HIV infection and HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection. Finally, we highlight available therapeutic strategies, as well as approaches under investigation, to reduce the risk of cardiovascular disease and lower inflammation in patients with HIV infection.
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Affiliation(s)
- Priscilla Y Hsue
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - David D Waters
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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31
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Olalla J, García de Lomas JM, Chueca N, Pérez-Stachowski X, De Salazar A, Del Arco A, Plaza-Díaz J, De la Torre J, Prada JL, García-Alegría J, Fernández-Sánchez F, García F. Effect of daily consumption of extra virgin olive oil on the lipid profile and microbiota of HIV-infected patients over 50 years of age. Medicine (Baltimore) 2019; 98:e17528. [PMID: 31626113 PMCID: PMC6824693 DOI: 10.1097/md.0000000000017528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Extra virgin olive oil (EVOO) has shown beneficial effects on the lipid profile and inflammatory parameters in general population. Our goal is to analyze these changes together with those of intestinal microbiota in human immunodeficiency virus (HIV)-infected patients over 50 years of age. METHODS Experimental single arm open study. HIV patients over the age of 50 with undetectable viral load were selected. EVOO was distributed among the patients so that each one consumed 50 g daily for 12 weeks. Lipid profile, C-reactive protein (CRP), and intestinal microbiota composition were analyzed at the beginning and at the end of the intervention. RESULTS Total cholesterol decreased significantly (5 mg/dL), and a nonsignificant decrease in low-density lipoprotein cholesterol (12 mg/dL), triglycerides (21 mg/dL), and CRP (1.25 mg/dL) was observed. There was a significant increase in alpha diversity after the intervention in men and a decrease in proinflammatory genera such as Dethiosulfovibrionaceae was observed. Differences were also observed in the microbiota of men and women and according to the type of antiretroviral treatment. CONCLUSION Sustained consumption of 50 g of EVOO in elderly HIV-infected patients might be associated with an improvement in lipid profile and alfa diversity of intestinal microbiota.
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Affiliation(s)
- Julián Olalla
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella
| | | | | | | | | | | | - Julio Plaza-Díaz
- Instituto de Investigación Biosanitaria IBS
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada
- Institute of Nutrition and Food Technology “José Mataix”, Center of Biomedical Research, University of Granada, Granada
| | | | - José Luis Prada
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella
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Park J, Zuñiga JA, García AA. Diabetes negatively impacts the ten-year survival rates of people living with HIV. Int J STD AIDS 2019; 30:991-998. [PMID: 31335273 DOI: 10.1177/0956462419857005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
People living with HIV (PLWH) are dying of non-AIDS associated conditions, including type 2 diabetes and chronic kidney disease (CKD), but the impact of diabetes and CKD on HIV survival rates is unknown. The purpose of this retrospective longitudinal study was to investigate the impact of diabetes and CKD on the survival rates of PLWH, using a secondary analysis of data from the Centers for AIDS Research Network of Integrated Clinical Systems ( N = 10,043 PLWH). The sample was divided into three comorbidity groups: HIV alone, HIV with diabetes, and HIV with diabetes and CKD. Kaplan–Meier analysis was used to examine survival rates; Cox regression was used to assess relationships between variables. Overall mean survival time was 19.7 years (95% CI, 19.57–19.8). For HIV alone ( n = 8266), the mortality rate was 3.6%; for HIV with diabetes ( n = 1720), mortality was almost three times higher (12.0%); and for HIV with diabetes and CKD ( n = 57), survival was less than three times higher (36.8%) than for HIV alone. Knowing that diabetes mellitus decreases survival rates, healthcare providers need to halt or delay the onset of type 2 diabetes by more aggressively assessing for prediabetes and treating it.
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Affiliation(s)
- Jungmin Park
- 1 School of Nursing, CHA University, Pocheon, Korea
| | - Julie A Zuñiga
- 2 School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Alexandra A García
- 2 School of Nursing, The University of Texas at Austin, Austin, TX, USA.,3 Dell Medical School, The University of Texas at Austin
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33
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Muller EV, Gimeno SGA. Risk factors for cardiovascular disease in HIV/AIDS patients treated with highly active antiretroviral therapy (HAART) in the central-southern region of the state of Paraná - Brazil. CIENCIA & SAUDE COLETIVA 2019; 24:1903-1914. [PMID: 31166523 DOI: 10.1590/1413-81232018245.16682017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/30/2017] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to describe metabolic changes in HIV/AIDS patients according to the treatment regimen. It was a retrospective cohort conducted from 2002 to 2014. Researchers surveyed clinical variables and treatment regimen of 538 individuals. They used measures of central tendency and marginal logistic regression to determine the influence of the treatment regimen on clinical variables over time; survival was estimated using Kaplan-Meier curves. 56.2% of patients were male, 82.2% white, 33.8% had 4 to 7 years of study, 49.2% were married, 98.5% had sexual transmission, and 89.0% were heterosexuals. During the study period, 24.4% had hypertension, 18.2% changed cholesterol, 39.7% low HDL, 51.3% high triglycerides and 33.3% hyperglycemia. Treatment regimens with nucleotide reverse transcriptase inhibitors associated with protease inhibitors, and the association of different classes of antiretrovirals have been associated with greater lipid changes. Higher metabolic changes were observed in patients with longer treatment time. It is concluded that preventive measures, as well as early treatment, can contribute to minimize the risks of developing cardiovascular diseases.
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Affiliation(s)
- Erildo Vicente Muller
- Universidade Estadual de Ponta Grossa. Av. General Carlos Cavalcanti 4.748, Uvaranas. 84030-900 Ponta Grossa PR Brasil.
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Melo ES, Costa CRB, Foresto JS, Antonini M, Pontes PS, Reis RK. Análisis de la dislipidemia en adultos que viven con VIH. REVISTA CUIDARTE 2019. [DOI: 10.15649/cuidarte.v10i2.776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introducción: En el contexto de las personas que viven con VIH (PVVIH), la dislipidemia es un tema que se ha venido discutiendo ampliamente, tanto por su origen multifactorial y sus implicaciones cardiovasculares, como por las posibles estrategias de prevención. De este modo, este estudio tiene por objeto evaluar la presencia de la dislipidemia en personas que viven con VIH y su asociación con aspectos sociodemográficos, actitudinales y clínicos. Materiales y Métodos: Estudio analítico, transversal realizado entre 2014 y 2016. Los datos fueron recolectados a través de entrevistas en las que se utilizaban cuestionarios y se consultaban las historias médicas. Para analizar la asociación, se utilizaron las pruebas Chi-Cuadrado y Exacto de Fisher, y la estadística Kappa para análisis de concordancia, con un nivel de significancia de p<0,05. Resultados: Participaron 340 personas en el estudio, de las cuales 59,1%, presentaron valores deseables en términos de colesterol total, 55,9% del HDL y 56,8% de triglicéridos. Las variables asociadas a la dislipidemia fueron: el colesterol total alterado y la edad a partir de 40 años (p=0,02); el HDL-c deseable y el sexo femenino (p=0,007); alteración de los triglicéridos y el tiempo de diagnóstico mayor a diez años (p=0,008); y el HDL-c deseable y la carga viral indetectable (p=0,04). Discusión: Aunque la dislipidemia sea un problema en el contexto del VIH, los valores deseables fueron más prevalentes, lo que se refleja sobre el efecto catalizador de la actividad inflamatoria causada por el VIH sobre las alteraciones lipídicas. Conclusiones: La dislipidemia en las PVVIH presentó, en su gran mayoría, valores deseables para el colesterol total, colesterol HDL y triglicéridos; y hubo una asociación entre los lípidos y los aspectos sociodemográficos y clínicos relacionados con el VIH.
Como citar este artigo: Melo ES, Costa CRB, Foresto JS, Antonini M, Pontes PS, Reis RK. Análise da dislipidemia em adultos vivendo com HIV. Rev Cuid. 2019; 10(2): e776. http://dx.doi.org/10.15649/cuidarte.v10i2.776
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35
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Masenga SK, Toloka P, Chiyenu K, Imasiku I, Mutengo H, Ulungu ON, Mallesu Z, Mulenga E, Mutukwa M, Kamvuma K, Hamooya BM. Type 2 diabetes mellitus prevalence and risk scores in treated PLWHIV: a cross-sectional preliminary study. BMC Res Notes 2019; 12:145. [PMID: 30876484 PMCID: PMC6420761 DOI: 10.1186/s13104-019-4183-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/11/2019] [Indexed: 12/22/2022] Open
Abstract
Objective This was a preliminary study whose objective was to estimate the prevalence and risk of developing type 2 diabetes mellitus (T2DM) among people living with HIV (PLWHIV) based on diabetes risk assessment scores. Results The study was composed of 234 PLWHIV with median age (interquartile range, IQR) of 44 (36, 52) and a female preponderance of 66%. The median risk scores (IQR) for developing T2DM was 5 (2, 9). Based on the risk scores, 5% of PLWHIV were at high risk for developing T2DM close to 3.4% actual prevalence in the study population. This study demonstrated the importance of using a cheap and fast method for identifying high risk individuals for developing T2DM. Electronic supplementary material The online version of this article (10.1186/s13104-019-4183-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sepiso K Masenga
- School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia. .,Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia. .,Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia.
| | - Paul Toloka
- Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Kaseya Chiyenu
- Internal Medicine, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Ilubala Imasiku
- Chikankata College of Biomedical Sciences, Private Bag Sector 2, Mazabuka, Zambia
| | - Hope Mutengo
- Internal Medicine, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Oscar Ngongo Ulungu
- Internal Medicine, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Zangi Mallesu
- Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Eunice Mulenga
- Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Macwañi Mutukwa
- Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Kingsley Kamvuma
- School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Benson M Hamooya
- School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia.,Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia.,School of Public Health, University of Zambia, Lusaka, Zambia
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Abstract
BACKGROUND People with HIV (PLHIV) are aging, and 20% are at risk of developing a neurological complication known as HIV-associated neurocognitive disorder (HAND). Signs and symptoms of HAND may be subtle; however, treatment can improve clinical outcomes. OBJECTIVE The aim of the study was to identify and agree on a risk assessment and monitoring process for the regular review of patients at risk of HAND. METHODS Between March and September 2017, 25 experts from four community healthcare services participated in three rounds of a modified Delphi study to reach consensus on the items, monitoring period, and format of assessment tools to identify risk of HAND in PLHIV in the community. RESULTS More than 80% consensus was reached at all three Delphi rounds. A flow chart, an initial assessment, and an annual monitoring tool were developed for an ongoing assessment of risk of developing HAND. CONCLUSION Twenty percent of PLHIV may develop HAND, a treatable condition. The use of a modified Delphi method led to the successful development of two risk assessment tools to identify those at risk of HAND. The initial assessment tool may be used as a precursor to formal assessment by medical and nursing staff, whereas the annual monitoring tool may assist community-based health professionals in their ongoing assessment of risk of HAND in PLHIV, facilitating early formal medical review for this condition.
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Mechanisms of Cardiovascular Disease in the Setting of HIV Infection. Can J Cardiol 2018; 35:238-248. [PMID: 30825947 DOI: 10.1016/j.cjca.2018.12.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/12/2022] Open
Abstract
Although the initial reports of increased cardiovascular (CV) disease in the setting of advanced AIDS were reported approximately 30 years ago, advances in antiretroviral therapy and immediate initiation of therapy on diagnosis have transformed what was once a deadly infectious disease into a chronic health condition. Accordingly, the types of CV diseases occurring in HIV have shifted from pericardial effusions and dilated cardiomyopathy to atherosclerosis and heart failure. The underlying pathophysiology of HIV-associated CV disease remains poorly understood, partly because of the rapidly evolving nature of HIV treatment and because clinical endpoints take many years to develop. The gut plays an important role in the early pathogenesis of HIV infection as HIV preferentially infects CD4+ T cells, 80% of which are located in gut mucosa. The loss of these T cells damages gut mucosa resulting in increased gut permeability and microbial translocation, which incites chronic inflammation and immune activation. Antiretroviral therapy does not cure HIV infection and immune abnormalities persist. These abnormalities correlate with mortality and CV events. The effects of antiretroviral therapy on CV risk are complex; treatment reduces inflammation and other markers of CV risk but induces lipid abnormalities, most commonly hypertriglyceridemia. On a molecular level, monocytes/macrophages, platelet reactivity, and immune cell activation, which play a role in the general population, may be heightened in the setting of HIV and contribute to HIV-associated atherosclerosis. Chronic inflammation represents an inviting therapeutic target in HIV, as it does in uninfected persons with atherosclerosis.
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Kyaw NTT, Satyanarayana S, Oo HN, Kumar AMV, Harries AD, Aung ST, Kyaw KWY, Phyo KH, Aung TK, Magee MJ. Hyperglycemia and Risk of All-cause Mortality Among People Living With HIV With and Without Tuberculosis Disease in Myanmar (2011-2017). Open Forum Infect Dis 2018; 6:ofy355. [PMID: 30697575 PMCID: PMC6343962 DOI: 10.1093/ofid/ofy355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/09/2018] [Accepted: 12/26/2018] [Indexed: 12/17/2022] Open
Abstract
Background There is limited empirical evidence on the relationship between hyperglycemia, tuberculosis (TB) comorbidity, and mortality in the context of HIV. We assessed whether hyperglycemia at enrollment in HIV care was associated with increased risk of all-cause mortality and whether this relationship was different among patients with and without TB disease. Methods We conducted a retrospective analysis of adult (≥15 years) HIV-positive patients enrolled into HIV care between 2011 and 2016 who had random blood glucose (RBG) measurements at enrollment. We used hazards regression to estimate associations between RBG and rate of all-cause mortality. Results Of 25 851 patients, 43% were female, and the median age was 36 years. At registration, the median CD4 count (interquartile range [IQR]) was 162 (68-310) cell/mm3, the median RBG level (IQR) was 88 (75-106) mg/dL, and 6.2% (95% confidence interval [CI], 6.0%-6.5%) had hyperglycemia (RBG ≥140 mg/dL). Overall 29% of patients had TB disease, and 15% died during the study period. The adjusted hazard of death among patients with hyperglycemia was significantly higher (adjusted hazard ratio [aHR], 1.2; 95% CI, 1.1-1.4) than among those with normoglycemia without TB disease, but not among patients with TB disease (aHR, 1.0; 95% CI, 0.8-1.2). Using 4 categories of RBG and restricted cubic spline regression, aHRs for death were significantly increased in patients with RBG of 110-140 mg/dL (categorical model: aHR, 1.3; 95% CI, 1.2-1.4; restricted spline: aHR, 1.1; 95% CI, 1.0-1.1) compared with those with RBG <110 mg/dL. Conclusions Our findings highlight an urgent need to evaluate hyperglycemia screening and diagnostic algorithms and to ultimately establish glycemic targets for PLHIV with and without TB disease.
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Affiliation(s)
- Nang Thu Thu Kyaw
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
- Correspondence: Nang Thu Thu Kyaw, The Union Myanmar Office, 36, 27th Street, Between 72nd and 73rd Street, Mandalay, Myanmar ()
| | - Srinath Satyanarayana
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi, India
| | - Htun Nyunt Oo
- National HIV/AIDS Program, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Ajay M V Kumar
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Anthony D Harries
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, UK
| | - Si Thu Aung
- National Tuberculosis Program, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Khine Wut Yee Kyaw
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Khaing Hnin Phyo
- Integrated HIV Care Program, International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Thet Ko Aung
- Integrated HIV Care Program, International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Matthew J Magee
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
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Everson F, Genis A, Ogundipe T, De Boever P, Goswami N, Lochner A, Blackhurst D, Strijdom H. Treatment with a fixed dose combination antiretroviral therapy drug containing tenofovir, emtricitabine and efavirenz is associated with cardioprotection in high calorie diet-induced obese rats. PLoS One 2018; 13:e0208537. [PMID: 30517206 PMCID: PMC6281242 DOI: 10.1371/journal.pone.0208537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/18/2018] [Indexed: 12/31/2022] Open
Abstract
HIV-infection, certain antiretroviral drug classes, especially protease inhibitors (PI), and obesity are associated with increased ischaemic heart disease (IHD) risk. However, the effect of PI-free fixed dose combination (FDC) antiretroviral therapy (ART) on hearts exposed to ischaemia-reperfusion injury (I/R) is unknown, particularly in obesity. This is becoming relevant as World Health Organisation guidelines recommend a FDC ART containing (non-) nucleoside reverse transcriptase inhibitors (tenofovir (TDF), emtricitabine (FTC) and efavirenz (EFV)) as first-line HIV treatment. Additionally, obesity rates are rising in HIV-infected populations, not only in ART-experienced individuals, but also at the time of ART initiation, which may further increase the risk of IHD. Therefore, we investigated the effects of PI-free FDC ART in myocardial I/R-exposed hearts from obese rats. Obesity was induced in male wistar rats via a 16-week high calorie diet. At week 10, treatment with a FDC ART drug containing TDF/FTC/EFV was initiated. Biometric and metabolic parameters, as well as myocardial functional recovery and infract size (IS), and myocardial signalling proteins following I/R were assessed after 16 weeks. Obese rats presented with increased body and intraperitoneal fat mass, elevated triglyceride and TBARS levels, whilst the hearts responded to I/R with impaired functional performance and increased IS. The FDC ART treatment did not alter biometric and metabolic parameters in obese rats. In a novel finding, ART protected obese hearts against I/R as shown by improved functional performance and smaller IS vs. untreated obese hearts. Cardioprotection was underscored by increased myocardial phosphorylated endothelial nitric oxide synthase (eNOS) and reduced AMP-kinase levels. In conclusion, these results demonstrate for the first time, that 6-weeks treatment of obese rats with a FDC ART drug specifically containing TDF/FTC/EFV conferred cardioprotection against I/R. The FDC ART-induced cardioprotection was seemingly unrelated to metabolic changes, but rather due to direct cardiac mechanisms including the up-regulation of myocardial eNOS.
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Affiliation(s)
- Frans Everson
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Republic of South Africa
| | - Amanda Genis
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Republic of South Africa
| | - Temitope Ogundipe
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Republic of South Africa
| | - Patrick De Boever
- Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Nandu Goswami
- Department of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Amanda Lochner
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Republic of South Africa
| | - Dee Blackhurst
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Hans Strijdom
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Republic of South Africa
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Waters DD, Hsue PY. Lipid Abnormalities in Persons Living With HIV Infection. Can J Cardiol 2018; 35:249-259. [PMID: 30704819 DOI: 10.1016/j.cjca.2018.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/16/2023] Open
Abstract
Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug-drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.
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Affiliation(s)
- David D Waters
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA
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41
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Savvoulidis P, Butler J, Kalogeropoulos A. Cardiomyopathy and Heart Failure in Patients With HIV Infection. Can J Cardiol 2018; 35:299-309. [PMID: 30621958 DOI: 10.1016/j.cjca.2018.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/25/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022] Open
Abstract
With the advent and widespread use of antiretroviral therapy (ART), the epidemiology of cardiomyopathy and heart failure (HF) associated with HIV infection is changing. Near-normal life expectancy in contemporary HIV-infected populations has been associated with prolonged exposure to increased cardiometabolic burden and chronic immune activation and systemic inflammation. Therefore, the pre-ART phenotype of HIV-associated cardiomyopathy with overt left ventricular systolic dysfunction and poor prognosis has been replaced over time by cardiomyopathy with a more insidious course, more frequent ischemic background, and highly prevalent left ventricular diastolic dysfunction. Patients with HIV are more prone to development of coronary artery disease and development of HF after myocardial infarction. The role of ongoing immune activation and systemic inflammation, despite highly active ART (HAART), appears to be central in this process. The role of HAART toxicity is controversial, as HAART itself appears to be protective for the development of HF, but recent data suggest that protease inhibitors might adversely affect the course of HIV-associated HF. Because of these unique features, the optimal therapeutic approach for HIV-associated cardiomyopathy remains unknown. The current therapeutic approaches are an extrapolation from noninfected populations. Importantly, the significance of the highly prevalent diastolic abnormalities among HIV-infected patients is not known. Therefore, further research is needed to identify its prognostic implications. Considering the prevalence of structural and functional cardiac abnormalities in HIV-infected persons and the lack of evidence on how to best screen and treat these patients, systematic research on this topic is a public health priority.
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Affiliation(s)
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Andreas Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, New York, USA.
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Zuniga JA, Wright C, Fordyce J, West Ohueri C, Garciá AA. Self-Management of HIV and Diabetes in African American Women: A Systematic Review of Qualitative Literature. DIABETES EDUCATOR 2018; 44:419-434. [PMID: 30146937 DOI: 10.1177/0145721718794879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose The purpose of this systematic review of qualitative literature was (1) to identify self-management strategies, (2) to identify women's barriers to self-management, and (3) to compare self-management strategies of diabetes and human immunodeficiency virus (HIV). African American women living with HIV are at high risk for developing diabetes because of genetics, lifestyle, and HIV treatment. Self-management of each of these conditions is critical to decrease morbidity and mortality. Conclusions A literature search resulted in 15 articles: 10 on the topic of HIV and 5 on diabetes. Self-management strategies included spirituality, family and social support, and indulgent self-care. Barriers included depression, stigma, and the role of caregiver. The themes identified for HIV and diabetes self-care barriers and facilitators were exceptionally similar. Themes of spirituality, family support, and indulgent self-care were part of both HIV and diabetes self-care. Women with HIV were less concerned with their independence than women with diabetes, and focused on disclosure of their HIV status and development of a support system.
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Affiliation(s)
- Julie A Zuniga
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Charlotte Wright
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Jonathan Fordyce
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
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Ji Y, Zhang F, Zhang R, Shen Y, Liu L, Wang J, Yang J, Tang Q, Xun J, Qi T, Wang Z, Song W, Tang Y, Chen J, Lu H. Changes in intestinal microbiota in HIV-1-infected subjects following cART initiation: influence of CD4+ T cell count. Emerg Microbes Infect 2018; 7:113. [PMID: 29934497 PMCID: PMC6015051 DOI: 10.1038/s41426-018-0117-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/09/2018] [Accepted: 05/20/2018] [Indexed: 12/17/2022]
Abstract
The roles of immunodeficiency and combined antiretroviral therapy (cART) in shaping the gut microbiota in HIV-1-infected subjects (HISs) have not been described thoroughly by time-series investigations. In this study, 36 antiretroviral-naïve HISs were enrolled to prospectively assess alterations in the fecal microbiota and plasma markers of microbial translocation and inflammation with cART. At baseline, the species α-diversity of the fecal microbiota was significantly lower in HISs with a CD4+ T cell count <300/mm3 than in HISs with a CD4+ T cell count >300/mm3 (Shannon index: Median 2.557 vs. 2.981, P = 0.006; Simpson index: Median 0.168 vs. 0.096, P = 0.004). Additionally, the baseline α-diversity indices correlated with CD4+ T cell counts (Shannon index: r = 0.474, P = 0.004; Simpson index: r = −0.467, P = 0.004) and the specific plasma biomarkers for microbial translocation and inflammation. After cART introduction, the species α-diversity of fecal microbiota in HISs with CD4+ T cell counts <300/mm3 was significantly restored (Shannon index: Median 2.557 vs. 2.791, P = 0.007; Simpson index: Median 0.168 vs. 0.112, P = 0.004), while the variances were insignificant among HISs with CD4+ T cell counts >300/mm3 (Shannon index: Median 2.981 vs. 2.934, P = 0.179; Simpson index: Median 0.096 vs. 0.119, P = 0.082). Meanwhile, with cART introduction, alterations in the gut microbial composition were more significant in the subgroup with CD4+ T cell counts >300/mm3, corresponding to increases in the specific plasma inflammatory markers. These findings implicated the interactive roles of immunodeficiency and cART for affecting gut microbiota in HIV-1-infected individuals, providing new insights into intestinal microbiome dysbiosis related to HIV-1 infection.
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Affiliation(s)
- Yongjia Ji
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Fengdi Zhang
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Renfang Zhang
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Yinzhong Shen
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Li Liu
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Jiangrong Wang
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Junyang Yang
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Qi Tang
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Jingna Xun
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Tangkai Qi
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Zhenyan Wang
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Wei Song
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Yang Tang
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Jun Chen
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.
| | - Hongzhou Lu
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China. .,Department of Infectious Disease, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, China. .,Department of Internal Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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44
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Pinto DSM, da Silva MJLV. Cardiovascular Disease in the Setting of Human Immunodeficiency Virus Infection. Curr Cardiol Rev 2018; 14:25-41. [PMID: 29189172 PMCID: PMC5872259 DOI: 10.2174/1573403x13666171129170046] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Since the introduction of Antiretroviral Therapy (ART), the life expectancy and health quality for patients infected with Human Immunodeficiency Virus (HIV) have significant-ly improved. Nevertheless, as a result of not only the deleterious effects of the virus itself and pro-longed ART, but also the effects of aging, cardiovascular diseases have emerged as one of the most common causes of death among these patients. Objective: The purpose of this review is to explore the new insights on the spectrum of Cardiovascu-lar Disease (CVD) in HIV infection, with emphasis on the factors that contribute to the atherosclerot-ic process and its role in the development of acute coronary syndrome in the setting of infection. Methods: A literature search using PubMed, ScienceDirect and Web of Science was performed. Ar-ticles up to Mar, 2017, were selected for inclusion. The search was conducted using MeSH terms, with the following key terms: [human immunodeficiency virus AND (cardiovascular disease OR coronary heart disease) AND (antiretroviral therapy AND (cardiovascular disease OR coronary heart disease))]. Results: Clinical cardiovascular disease tends to appear approximately 10 years before in infected in-dividuals, when compared to the general population. The pathogenesis behind the cardiovascular, HIV-associated complications is complex and multifactorial, involving traditional CVD risk factors, as well as factors associated with the virus itself - immune activation and chronic inflammation – and the metabolic disorders related to ART regimens. Conclusion: Determining the cardiovascular risk among HIV-infected patients, as well as targeting and treating conditions that predispose to CVD, are now emerging concerns among physicians.
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Affiliation(s)
- Daniela Sofia Martins Pinto
- Department of Medicine, Faculty of Medicine, Porto University, Al. Prof. Hernâni Monteiro 4200-319, Porto, Portugal
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45
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Zanetti HR, Mendes EL, Palandri Chagas AC, Gomes Douglas MO, Paranhos Lopes LT, Roever L, Gonçalves A, Santos Resende E. Triad of the Ischemic Cardiovascular Disease in People Living with HIV? Association Between Risk Factors, HIV Infection, and Use of Antiretroviral Therapy. Curr Atheroscler Rep 2018; 20:30. [PMID: 29777448 DOI: 10.1007/s11883-018-0727-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review is focused on cardiovascular risk factors in HIV-infected people. RECENT FINDINGS Antiretroviral therapy (ART) has significantly increased the life expectancy of HIV-infected people. Thus, this population has experienced non-HIV-related diseases, mainly cardiovascular diseases. Thus, in our review, we intend to understand the cardiovascular risk factors that trigger this situation. We have demonstrated that both ART and traditional cardiovascular risk factors contribute to the development of cardiovascular disease in HIV-infected people. Thus, it becomes important to stratify the risk factors to reduce this scenario.
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Affiliation(s)
- Hugo Ribeiro Zanetti
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil. .,Master Institute of Education President Antônio Carlos, Avenida Minas Gerais, 1889 - Centro, Araguari, MG, 38.440-046, Brazil.
| | | | | | | | | | - Leonardo Roever
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Alexandre Gonçalves
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil.,Master Institute of Education President Antônio Carlos, Avenida Minas Gerais, 1889 - Centro, Araguari, MG, 38.440-046, Brazil.,Atenas Faculty, Paracatu, MG, Brazil
| | - Elmiro Santos Resende
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil
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Arafath S, Campbell T, Yusuff J, Sharma R. Prevalence of and Risk Factors for Prediabetes in Patients Infected With HIV. Diabetes Spectr 2018; 31:139-143. [PMID: 29773933 PMCID: PMC5951229 DOI: 10.2337/ds17-0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The use of highly active antiretroviral therapy (HAART) has resulted in a dramatic decrease in morbidity and mortality in HIV-infected patients. Components of HAART (e.g., protease inhibitors and nucleoside reverse transcriptase inhibitors), as well as HIV infection itself, can have significant effects on developing new-onset diabetes. The goals of this study were to determine the prevalence of prediabetes and to assess risk factors associated with prediabetes in a cohort of HIV-infected patients. METHODS This is a retrospective, cross-sectional study of 249 HIV-infected patients in an outpatient multidisciplinary HIV clinic in a university hospital. Patients with prediabetes were identified and compared with patients without prediabetes. The association between the prevalence of prediabetes and risk factors was analyzed. RESULTS Among 249 HIV-infected patients, the mean age was 46.3 years, and 54% were male. Prevalence of prediabetes was approximately 30%, and BMI ≥30 kg/m2 was found to be a significant risk factor for developing prediabetes. CONCLUSION A high prevalence of prediabetes was observed in this cohort of HIV-infected patients. Interventions targeting HIV-infected patients with increased risk of prediabetes, especially individuals with a high BMI, is needed.
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Affiliation(s)
- Syed Arafath
- NewYork-Presbyterian Weill Cornell Medical Center, New York, NY
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47
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Echecopar-Sabogal J, D'Angelo-Piaggio L, Chanamé-Baca DM, Ugarte-Gil C. Association between the use of protease inhibitors in highly active antiretroviral therapy and incidence of diabetes mellitus and/or metabolic syndrome in HIV-infected patients: A systematic review and meta-analysis. Int J STD AIDS 2018; 29:443-452. [PMID: 28956700 DOI: 10.1177/0956462417732226] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This systematic review and meta-analysis tries to determine whether there is an association between the use of protease inhibitors (PIs) and the incidence of diabetes mellitus (DM) and/or metabolic syndrome (MS) in HIV-infected patients. A systematic literature search was performed using MEDLINE/PubMed, CENTRAL, LILACS, and EMBASE. Included articles were observational studies published on or prior to November 2015 that met specific inclusion criteria. Pooled relative risks (RRs) and hazard ratios (HRs) were calculated. Nine articles met the inclusion criteria, describing 13,742 HIV patients. Use of PIs was associated with the development of MS (RR: 2.11; 95% CI 1.28-3.48; p-value 0.003). No association between the use of PIs and development of DM was found: the HR for the incidence of DM among patients using PIs was 1.23 (95% CI 0.66-2.30; p-value: 0.51) and the RR was 1.25 (95% CI 0.99-1.58; p-value 0.06). Use of PIs in HIV-infected patients is associated with an increased risk of MS. No evidence of an increased risk of DM was found. However, because MS is a precursor to DM, it is possible that studies with a longer follow-up duration are needed in order to detect an association between PI use and onset of DM.
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Affiliation(s)
| | | | - Diego M Chanamé-Baca
- 1 Escuela de Medicina, 471960 Universidad Peruana de Ciencias Aplicadas , Lima, Perú
| | - Cesar Ugarte-Gil
- 1 Escuela de Medicina, 471960 Universidad Peruana de Ciencias Aplicadas , Lima, Perú
- 2 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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48
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Prevalence and Risk Factors of Metabolic Syndrome in HIV-Infected Patients Receiving the Highly Active Antiretroviral Therapy. TOP CLIN NUTR 2018. [DOI: 10.1097/tin.0000000000000125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
Combined antiretroviral therapy (CART) has turned HIV-infection to a treatable chronic disease during which many patients survive to middle and older age. However, they prematurely develop non-AIDS comorbidities such as cardiovascular disease, metabolic syndrome, diabetes, and HIV-associated neurocognitive disorders (HAND). Microcirculatory changes and endothelial dysfunction occur early both in HIV-infected and in aging patients, in whom they usually precede cardiovascular and neurocognitive impairments. Also, mild cognitive involvement has been reported in women during the menopausal transition. Disruption of the blood-brain barrier, as well as microvascular and cerebral blood flow changes, has been reported in HIV patients with HAND, including postmenopausal women. However, most studies addressing this issue included women aged less than 50 years. Whether HIV-infected women growing older with CART would be subsequently exposed to an increased progression of cognitive impairment overtime remains unknown.
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Affiliation(s)
- Jean-Jacques Monsuez
- AP-HP, Cardiology, Hôpital René Muret, Hôpitaux universitaires de Paris Seine Saint-Denis, Avenue du docteur Schaeffner, F-93270, Sevran, France.
| | - Catherine Belin
- AP-HP, Neurology, Hôpital Avicenne, Hôpitaux universitaires de Paris Seine Saint-Denis, Bobigny, France
| | - Olivier Bouchaud
- AP-HP, Infectious diseases, Hôpital Avicenne, Hôpitaux universitaires de Paris Seine Saint-Denis, Bobigny, France
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Gruffaz M, Vasan K, Tan B, Ramos da Silva S, Gao SJ. TLR4-Mediated Inflammation Promotes KSHV-Induced Cellular Transformation and Tumorigenesis by Activating the STAT3 Pathway. Cancer Res 2017; 77:7094-7108. [PMID: 29051178 DOI: 10.1158/0008-5472.can-17-2321] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/18/2017] [Accepted: 10/16/2017] [Indexed: 12/28/2022]
Abstract
Toll-like receptors (TLR) are conserved immune sensors mediating antimicrobial and antitumoral responses, but recent evidence implicates them in promoting carcinogenesis in certain cancers. Kaposi sarcoma is caused by infection of Kaposi sarcoma-associated herpesvirus (KSHV) and is characterized by uncontrolled neoangiogenesis and inflammation. Here, we show that TLR4 is upregulated in KSHV-infected spindle tumor cells in human Kaposi sarcoma lesions. In a model of KSHV-induced cellular transformation, KSHV upregulated expression of TLR4, its adaptor MyD88, and coreceptors CD14 and MD2. KSHV induction of TLR4 was mediated by multiple viral miRNAs. Importantly, the TLR4 pathway was activated constitutively in KSHV-transformed cells, resulting in chronic induction of IL6, IL1β, and IL18. Accordingly, IL6 mediated constitutive activation of the STAT3 pathway, an essential event for uncontrolled cellular proliferation and transformation. TLR4 stimulation with lipopolysaccharides or live bacteria enhanced tumorigenesis while TLR4 antagonist CLI095 inhibited it. These results highlight an essential role of the TLR4 pathway and chronic inflammation in KSHV-induced tumorigenesis, which helps explain why HIV-infected patients, who frequently suffer from opportunistic bacterial infections and metabolic complications, frequently develop Kaposi sarcoma. Cancer Res; 77(24); 7094-108. ©2017 AACR.
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Affiliation(s)
- Marion Gruffaz
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Karthik Vasan
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brandon Tan
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Suzane Ramos da Silva
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shou-Jiang Gao
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California.
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