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Haw NJL, Lesko CR, Ng DK, Lam J, Lang R, Kitahata MM, Crane H, Eron J, Gill MJ, Horberg MA, Karris M, Loutfy M, McGinnis KA, Moore RD, Althoff K, Agwu A. Incidence of non-AIDS defining comorbidities among young adults with perinatally acquired HIV in North America. AIDS 2024; 38:1366-1374. [PMID: 38507583 PMCID: PMC11211058 DOI: 10.1097/qad.0000000000003892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The aim of this study is to describe the incidence of diabetes mellitus type 2 (T2DM), hypercholesterolemia, hypertriglyceridemia, hypertension, and chronic kidney disease (CKD) from 2000 to 2019 among North American adults with perinatally acquired HIV (PHIV) aged 18-30 years. DESIGN Description of outcomes based on electronic health records for a cohort of 375 young adults with PHIV enrolled in routine HIV care at clinics contributing data to the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). METHODS We estimated overall, sex, and race-stratified cumulative incidences using Turnbull estimation, and incidence rates using quasi-Poisson regression. T2DM was defined as glycosylated hemoglobin more than 6.5% or based on clinical diagnosis and medication use. Hypercholesterolemia was based on medication use or total cholesterol at least 200 mg/dl. Hypertriglyceridemia was based on medication use or fasting triglyceride at least 150 mg/dl or nonfasting at least 200 mg/dl. Hypertension was based on clinical diagnosis. CKD was defined as estimated glomerular filtration rates less than 90 ml/mi|1.73 m 2 for at least 3 months. RESULTS Cumulative incidence by age 30 and incidence rates from age 18 to 30 (per 100 person-years) were T2DM: 19%, 2.9; hypercholesterolemia: 40%, 4.6; hypertriglyceridemia: 50%, 5.6; hypertension: 22%, 2.0; and CKD: 25%, 3.3. Non-Black women had the highest incidence of hypercholesterolemia and hypertriglyceridemia, Black adults had the highest hypertension incidence, and Black men had the highest CKD incidence. CONCLUSION There was a high incidence of five chronic comorbidities among people with PHIV. Earlier screening at younger ages might be considered for this unique population to strengthen prevention strategies and initiate treatment in a timely way.
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Affiliation(s)
- Nel Jason L Haw
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer Lam
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Raynell Lang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mari M Kitahata
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Heidi Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Joseph Eron
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - M John Gill
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Southern Alberta Clinic, Calgary, Alberta, Canada
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Maile Karris
- Department of Medicine, University of California, San Diego, San Diego, California, USA
| | - Mona Loutfy
- Department of Medicine, University of Toronto
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | | | | | - Keri Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Agwu
- Department of Medicine
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Vance DE, Brew BJ. Plasma neurofilament light chain protein predicts greater brain-age gap, cognition, and cardiovascular risk in people with HIV. AIDS 2024; 38:1081-1083. [PMID: 38691050 DOI: 10.1097/qad.0000000000003880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bruce James Brew
- Departments of Neurology and Immunology, Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, University of New South Wales and University of Notre Dame, Sydney, New South Wales, Australia
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Fox CB, Butler K, Flynn D. Primary Prevention of Cardiovascular Disease for People Living with Human Immunodeficiency Virus. Nurs Clin North Am 2024; 59:219-233. [PMID: 38670691 DOI: 10.1016/j.cnur.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
People living with HIV (PLWH) have a risk of cardiovascular disease (CVD) that is 1.5 to 2 times higher than the general population owing to traditional risk factors, HIV-mediated factors like chronic inflammation and immune dysfunction, and exposure to antiretroviral therapy. Currently available CVD risk estimation calculators tend to underestimate risk in PLWH but can be useful when an individual's HIV history is considered. Improving modifiable risks is the primary intervention for reducing CVD risk in PLWH. Statin therapy is important for specific individuals, but attention should be given to drug interactions with antiretroviral agents used to treat HIV.
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Affiliation(s)
- Christopher B Fox
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University School of Medicine, 3270 Southwest Pavilion Loop, Mail Code: L-475, Portland, OR 97239, USA.
| | - Kristine Butler
- Division of General Cardiology, Oregon Health & Science University School of Medicine, 3270 Southwest Pavilion Loop, Mail Code: L-475, Portland, OR 97239, USA
| | - Devon Flynn
- Oregon Health & Science University, 3270 Southwest Pavilion Loop, PPV 350, Portland, OR 97239, USA
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Appleton AA, Kuniholm MH, Vásquez E, Cohen MH, Donohue J, Floris-Moore M, Friedman MR, Hanna DB, Mimiaga MJ, Moran CA, Plankey MW, Teplin LA, Shitole SG, Ware D, Jones DL, Wise J. Life course history of physical and sexual abuse is associated with cardiovascular disease risk among women living with and without HIV. AIDS 2024; 38:739-750. [PMID: 38126350 PMCID: PMC10939824 DOI: 10.1097/qad.0000000000003822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Sexual and physical abuse predict cardiovascular disease (CVD) among women in the general population. Women living with HIV (WLWH) report more abuse and have higher CVD risk compared with other women, yet associations between abuse history and CVD have not been considered among WLWH. This study fills this gap, and describes possible pathways linking abuse to CVD risk among WLWH and women living without HIV (WLWOH). METHODS Using 25 years of data from the Women's Interagency HIV Study (WIHS; n = 2734; WLWH n = 1963; WLWOH n = 771), we used longitudinal generalized estimating equations (GEE) to test associations between sexual and physical abuse with CVD risk. Framingham (FRS-H) and the American College of Cardiology/American Heart Association-Pooled Cohort Equation (ACC/AHA-PCE) scores were examined. Analyses were stratified by HIV-serostatus. RESULTS Among WLWH, childhood sexual abuse was associated with higher CVD risk ( βFRS-H = 1.25, SE = 1.08, P = 0.005; βACC/AHA-PCE = 1.14, SE = 1.07, P = 0.04) compared with no abuse. Adulthood sexual abuse was associated with higher CVD risk for WLWH ( βFRS-H = 1.39, SE = 1.08, P < 0.0001) and WLWOH ( βFRS-H = 1.58, SE = 1.14, P = 0.0006). Childhood physical abuse was not associated with CVD risk for either group. Adulthood physical abuse was associated with CVD risk for WLWH ( βFRS-H = 1.44, SE = 1.07; P < 0.0001, βACC/AHA-PCE = 1.18, SE = 1.06, P = 0.002) and WLWOH ( βFRS-H = 1.68, SE = 1.12, P < 0.0001; βACC/AHA-PCE = 1.24, SE = 1.11, P = 0.03). Several pathway factors were significant, including depression, smoking, and hepatitis C infection. CONCLUSION Life course abuse may increase CVD risk among WLWH and women at high risk of acquiring HIV. Some comorbidities help explain the associations. Assessing abuse experiences in clinical encounters may help contextualize cardiovascular risk among this vulnerable population and inform intervention.
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Affiliation(s)
- Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL
| | - Jessica Donohue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - M Reuel Friedman
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Matthew J Mimiaga
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - Caitlin A Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sanyog G Shitole
- Cardiology Section, San Francisco Veterans Affairs Healthcare System
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Deanna Ware
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Jenni Wise
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Mavarani L, Reinsch N, Albayrak-Rena S, Potthoff A, Hower M, Dolff S, Schadendorf D, Jöckel KH, Schmidt B, Esser S. The Association of HIV-Specific Risk Factors with Cardiovascular Events in Addition to Traditional Risk Factors in People Living with HIV. AIDS Res Hum Retroviruses 2024; 40:235-245. [PMID: 37675901 DOI: 10.1089/aid.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Traditional cardiovascular risk scores underestimate the incidence of cardiovascular diseases (CVD) in people living with HIV (PLH). This study compared the effect of HIV-specific cardiovascular risk factors (CRF) with traditional CRF at baseline for their association with incident CVD in PLH. The ongoing, prospective HIV HEART Aging (HIVH) study assesses CVD in PLH in the German Ruhr Area since 2004. PLH from the HIVH study with at least 5 years of follow-up were examined with the help of Cox proportional hazards models using inverse probability-of-censoring weights. The models were adjusted for age and sex. The obtained hazard ratios (HR) and 95% confidence limits (CL) assessed the strength of the associations between CRF and CVD. One thousand two hundred forty-three individuals (male 1,040, female 203; mean age of 43 ± 10 years) with 116 incident CVD events were analyzed. After adjusting for the traditional CRF, the HIV-specific CRF "a history of AIDS" and "higher age at diagnosis of HIV infection" (per 10 years) were associated with an increased CVD risk (HR 1.55, 95% CL: 1.05-2.28 and HR 1.55, 95% CL: 1.09-1.22, respectively). Higher CD4/CD8 ratio (per standard deviation), longer cumulative duration of antiretroviral therapies, and longer duration of HIV infection (per 10 years) showed indications for a decreased CVD risk (HR 0.75, 95% CL: 0.58-0.97, HR 0.71, 95% CL: 0.41-1.23, and HR 0.63, 95% CL: 0.44-0.90, respectively). Out of the traditional CRF, current smoking showed the strongest impact on CVD risk (HR 3.12, 95% CL: 2.06-4.74). In conclusion, HIV-specific factors, such as history of AIDS and CD4/CD8 ratio, were independently associated with an increased cardiovascular risk. Traditional CRF maintained a major effect on CVD. Clinical Trials Number (NCT04330287).
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Affiliation(s)
- Laven Mavarani
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nico Reinsch
- Department of Cardiology, Alfried-Krupp Hospital, Essen, Germany
- Department of Cardiology, University Witten/Hedrick, Witten, Germany
| | - Sarah Albayrak-Rena
- Department of Dermatology and Venereology, HIV Outpatient Clinic, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Anja Potthoff
- Department of Dermatology, Venereology and Allergology, Center for Sexual Health and Medicine, Interdisciplinary Immunological Outpatient Clinic, Ruhr University Bochum, Bochum, Germany
| | - Martin Hower
- Department of Pneumology, Infectious Diseases and Internal Medicine, Klinikum Dortmund, Hospital University Witten/Herdecke, Dortmund, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology and Venereology, HIV Outpatient Clinic, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stefan Esser
- Department of Dermatology and Venereology, HIV Outpatient Clinic, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Institute for Translational HIV Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Papantoniou E, Arvanitakis K, Markakis K, Papadakos SP, Tsachouridou O, Popovic DS, Germanidis G, Koufakis T, Kotsa K. Pathophysiology and Clinical Management of Dyslipidemia in People Living with HIV: Sailing through Rough Seas. Life (Basel) 2024; 14:449. [PMID: 38672720 PMCID: PMC11051320 DOI: 10.3390/life14040449] [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: 02/29/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Infections with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) represent one of the greatest health burdens worldwide. The complex pathophysiological pathways that link highly active antiretroviral therapy (HAART) and HIV infection per se with dyslipidemia make the management of lipid disorders and the subsequent increase in cardiovascular risk essential for the treatment of people living with HIV (PLHIV). Amongst HAART regimens, darunavir and atazanavir, tenofovir disoproxil fumarate, nevirapine, rilpivirine, and especially integrase inhibitors have demonstrated the most favorable lipid profile, emerging as sustainable options in HAART substitution. To this day, statins remain the cornerstone pharmacotherapy for dyslipidemia in PLHIV, although important drug-drug interactions with different HAART agents should be taken into account upon treatment initiation. For those intolerant or not meeting therapeutic goals, the addition of ezetimibe, PCSK9, bempedoic acid, fibrates, or fish oils should also be considered. This review summarizes the current literature on the multifactorial etiology and intricate pathophysiology of hyperlipidemia in PLHIV, with an emphasis on the role of different HAART agents, while also providing valuable insights into potential switching strategies and therapeutic options.
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Affiliation(s)
- Eleni Papantoniou
- First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.P.); (K.M.); (O.T.)
| | - Konstantinos Arvanitakis
- Division of Gastroenterology and Hepatology, First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.A.); (G.G.)
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Konstantinos Markakis
- First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.P.); (K.M.); (O.T.)
| | - Stavros P. Papadakos
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Olga Tsachouridou
- First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.P.); (K.M.); (O.T.)
| | - Djordje S. Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, 21137 Novi Sad, Serbia;
- Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Georgios Germanidis
- Division of Gastroenterology and Hepatology, First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.A.); (G.G.)
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Theocharis Koufakis
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 St. Kiriakidi Street, 54636 Thessaloniki, Greece
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Nazari I, Feinstein MJ. Evolving mechanisms and presentations of cardiovascular disease in people with HIV: implications for management. Clin Microbiol Rev 2024; 37:e0009822. [PMID: 38299802 PMCID: PMC10938901 DOI: 10.1128/cmr.00098-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
People with HIV (PWH) are at elevated risk for cardiovascular diseases (CVDs), including myocardial infarction, heart failure, and sudden cardiac death, among other CVD manifestations. Chronic immune dysregulation resulting in persistent inflammation is common among PWH, particularly those with sustained viremia and impaired CD4+ T cell recovery. This inflammatory milieu is a major contributor to CVDs among PWH, in concert with common comorbidities (such as dyslipidemia and smoking) and, to a lesser extent, off-target effects of antiretroviral therapy. In this review, we discuss the clinical and mechanistic evidence surrounding heightened CVD risks among PWH, implications for specific CVD manifestations, and practical guidance for management in the setting of evolving data.
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Affiliation(s)
- Ilana Nazari
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J. Feinstein
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology in the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Barr E, Marshall LJ, Collins LF, Godfrey C, St Vil N, Stockman JK, Davey DLJ, Dong K, Temkin SM, Glenshaw MT, Byrd C, Clayton JA, Goodenow MM. Centring the health of women across the HIV research continuum. Lancet HIV 2024; 11:e186-e194. [PMID: 38417977 PMCID: PMC11301651 DOI: 10.1016/s2352-3018(24)00004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 03/01/2024]
Abstract
Despite tremendous advances in HIV research, women and gender diverse people-particularly women from racial and ethnic groups under-represented in research, transgender women, and young women-remain disproportionately affected by HIV. Women and gender diverse people face unique challenges and have been under-represented in HIV research. The National Institutes of Health (NIH) is tasked to apply fundamental knowledge about the nature and behaviour of living systems to enhance health, lengthen life, and reduce disability. Rigorous exploration of-and interventions for-the individual, social, biological, structural, and environmental factors that influence HIV prevention, transmission, treatment, and cure is crucial to advance research for women, girls, and gender diverse people across the lifespan. In this Position Paper, we introduce a framework for an intersectional, equity-informed, data-driven approach to research on HIV and women and highlight selected issues for women and gender diverse people, including HIV prevention, HIV cure, ageing with HIV, substance use and misuse, violence, pregnancy, and breastfeeding or chestfeeding. This framework underlines a new HIV and Women Signature Programme from the NIH Office of AIDS Research and Office of Research on Women's Health that advances the NIH vision for women's health, in which all women receive evidence-based HIV prevention, treatment, and care across their lifespan tailored to their unique needs, circumstances, and goals. The time is now to centre the health of women, girls, and gender diverse people across the HIV research continuum.
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Affiliation(s)
- Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA.
| | - Leslie J Marshall
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, USA
| | - Lauren F Collins
- Emory University School of Medicine and the Grady Ponce de Leon Center, Atlanta, GA, USA
| | - Catherine Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington, DC, USA
| | - Noelle St Vil
- University at Buffalo School of Social Work, Buffalo, NY, USA
| | - Jamila K Stockman
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Dvora L Joseph Davey
- Division of Infectious Diseases, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Krista Dong
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA; Infectious Diseases Division, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah M Temkin
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Mary T Glenshaw
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, USA
| | - Corette Byrd
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, USA
| | - Janine A Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Maureen M Goodenow
- Office of the Director, National Institutes of Health, Bethesda, MD, USA
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Avgousti H, Feinstein MJ. Prevention and treatment of cardiovascular disease in HIV: practical insights in an evolving field. TOPICS IN ANTIVIRAL MEDICINE 2023; 31:559-565. [PMID: 38198667 PMCID: PMC10776033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
People with HIV (PWH) are at higher risk for cardiovascular disease (CVD) than people without HIV. As antiretroviral therapy (ART) and the natural history of HIV have evolved, so have the pathogenesis and manifestations of HIV-associated CVD. Epidemiologic data from several cohorts demonstrate that PWH have an approximately 50% higher risk than people without HIV for CVD, including, but not limited to, myocardial infarction and heart failure. This elevated CVD risk is not universal among PWH; for instance, the risk is higher among individuals with a history of sustained unsuppressed viremia, diminished CD4+ cell count recovery, or hepatitis C virus coinfection. Specific antiretroviral drugs may also associate differently with CVD risk. Regarding management, the recent REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) study results demonstrated a 35% relative risk reduction in atherosclerotic CVD for PWH at low to moderate predicted risk taking pitavastatin; this is a larger reduction than for comparable moderate-intensity statins in the general population. Whether these higher-than-expected reductions in CVD risk among PWH also extend to higher-intensity statins and into secondary prevention settings for people with existing CVD merits further study. Nonlipid approaches to CVD risk reduction in PWH-ranging from antithrombotic therapy to inflammation-modulating therapy-remain under active investigation. Results of these studies will provide essential information to further guide CVD management in PWH.
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Yang Y, Yao X, Liu Y, Zhao J, Sun P, Zhang Y, Li K, Chen Y, Zheng J, Deng L, Fan S, Ma X, Guo S, Shuai P, Wan Z. Global and Regional Estimate of HIV-Associated Stroke Burden: A Meta-Analysis and Population Attributable Modeling Study. Stroke 2023; 54:2390-2400. [PMID: 37477007 DOI: 10.1161/strokeaha.123.043410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND This study aimed to determine the correlation between human-immunodeficiency-virus (HIV) infection and stroke, as well as to estimate the global, regional, and national burden of HIV-associated stroke. METHODS A registered meta-analysis was performed by searching PubMed, Embase, and Web of Science for relevant literature up to October 31, 2022. The pooled relative risk of stroke in HIV-infected people was calculated using a random-effects model. HIV prevalence and disability-adjusted life years (DALYs) datasets were obtained from the Joint United Nations Program on HIV and AIDS, and the Global Health Data Exchange, respectively. The population attributable fraction was estimated and delivered to calculate the HIV-associated DALYs of stroke from 1990 to 2019, at the global, regional, and national levels. Pearson correlation analysis were conducted to assess the correlation between the age-standardized rate or estimated annual percentage changes and the sociodemographic index. RESULTS Out of 10 080 identified studies, 11 were included in this meta-analysis. Compared with individuals without HIV-infection, the pooled relative risk of stroke in HIV-infected individuals was 1.40 (95% CI, 1.18-1.65). From 1990 to 2019, the global population attributable fraction of HIV-associated stroke increased almost 3-fold, while the HIV-associated DALYs increased from 18 595 (95% CI, 7485-31 196) in 1990 to 60 684 (95% CI, 24 281-101 894) in 2019. Meanwhile, HIV-associated DALYs varied by region, with Eastern and Southern Africa having the highest value of 126 160 in 2019. Moreover, countries with middle social development index were shouldering the highest increase trend of the HIV-associated DALYs age-standardized rates. CONCLUSIONS HIV-infected individuals face a significantly higher risk of stroke, and the global burden of HIV-associated stroke has increased over the past 3 decades, showing regional variations. Eastern and Southern Africa bear the highest burden, while Eastern Europe and Central Asia have seen significant growth. Health care providers, researchers, and decision-makers should give increased attention to stroke prevention and management in HIV-endemic areas. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: CRD42022367450.
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Affiliation(s)
- Yumei Yang
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Xiaoqin Yao
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Yuping Liu
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
| | - Jianhui Zhao
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Ping Sun
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
| | - Yixuan Zhang
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Kangning Li
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Yan Chen
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- School of Public Health, Southwest Medical University, Luzhou, China (Y.C., S.F.)
| | - Jinxin Zheng
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, China (J. Zheng)
| | - Ling Deng
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China (Y.C., S.F.)
| | - Xiaoxiang Ma
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Shujin Guo
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Ping Shuai
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Zhengwei Wan
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
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11
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Urina-Jassir M, Patiño-Aldana AF, Herrera-Parra LJ, Hernández Vargas JA, Trujillo-Cáceres SJ, Valbuena-García AM, Acuña-Merchán L, Urina-Jassir D, Urina-Triana M. Factors associated with coronary artery disease among people living with human immunodeficiency virus: Results from the Colombian HIV/AIDS registry. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 18:200205. [PMID: 37664166 PMCID: PMC10469745 DOI: 10.1016/j.ijcrp.2023.200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023]
Abstract
Background People living with HIV (PLWHIV) are at a higher risk of developing coronary artery disease (CAD). We aimed to assess the factors associated with CAD among PLWHIV in Colombia. Methods We conducted a retrospective cohort study based on adults newly diagnosed with HIV, reported to the Colombian HIV/AIDS registry from 2018 to 2021. Baseline demographic and clinical characteristics were compared by age (<50 and ≥ 50 years). Our main outcome was the presence of CAD. Logistic regression models were used to assess the association between traditional and HIV-related factors with CAD. These associations were also evaluated in stratified models by age. Effect measures were odds ratios (OR) and their 95% confidence intervals. Results Among 36,483 PLWHIV, the frequency of CAD was 0.53% (n = 196). There was a high prevalence of impaired fasting glucose/diabetes mellitus (12.62%), overweight/obesity (27.79%), elevated LDL-c (86.69%), and hypertriglyceridemia (72.76%). Factors associated with CAD included male gender (OR: 2.01, 95% CI: 1.12-3.58), age ≥50 years (OR: 4.96, 95% CI: 3.29-7.45), lipoatrophy or lipodystrophy (OR 5.12, 95% CI: 1.12-23.33), AIDS-defining conditions (OR: 1.83, 95% CI: 1.07-3.12), obesity (OR: 2.95, 95% CI: 1.69-5.10), diabetes mellitus (OR: 2.50, 95% CI: 1.25-4.97), and renal impairment (OR: 3.15, 95% CI: 1.83-5.42). Conclusions Traditional CAD risk factors are common in PLWHIV. There were traditional and disease-specific factors associated with increased odds of CAD. These findings may aid clinicians and decision-makers in reducing the impact of CAD in PLWHIV.
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Affiliation(s)
- Manuel Urina-Jassir
- Departamento de Investigación Clínica, Fundación del Caribe para la Investigación Biomédica, Barranquilla, Colombia
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | | | | | | | | | - Lizbeth Acuña-Merchán
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, Colombia
| | - Daniela Urina-Jassir
- Department of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Miguel Urina-Triana
- Departamento de Investigación Clínica, Fundación del Caribe para la Investigación Biomédica, Barranquilla, Colombia
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
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12
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Collins LF, Palella FJ, Mehta CC, Holloway J, Stosor V, Lake JE, Brown TT, Topper EF, Naggie S, Anastos K, Taylor TN, Kassaye S, French AL, Adimora AA, Fischl MA, Kempf MC, Koletar SL, Tien PC, Ofotokun I, Sheth AN. Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019. JAMA Netw Open 2023; 6:e2327584. [PMID: 37548977 PMCID: PMC10407688 DOI: 10.1001/jamanetworkopen.2023.27584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Importance Despite aging-related comorbidities representing a growing threat to quality-of-life and mortality among persons with HIV (PWH), clinical guidance for comorbidity screening and prevention is lacking. Understanding comorbidity distribution and severity by sex and gender is essential to informing guidelines for promoting healthy aging in adults with HIV. Objective To assess the association of human immunodeficiency virus on the burden of aging-related comorbidities among US adults in the modern treatment era. Design, Setting, and Participants This cross-sectional analysis included data from US multisite observational cohort studies of women (Women's Interagency HIV Study) and men (Multicenter AIDS Cohort Study) with HIV and sociodemographically comparable HIV-seronegative individuals. Participants were prospectively followed from 2008 for men and 2009 for women (when more than 80% of participants with HIV reported antiretroviral therapy use) through last observation up until March 2019, at which point outcomes were assessed. Data were analyzed from July 2020 to April 2021. Exposures HIV, age, sex. Main Outcomes and Measures Comorbidity burden (the number of total comorbidities out of 10 assessed) per participant; secondary outcomes included individual comorbidity prevalence. Linear regression assessed the association of HIV status, age, and sex with comorbidity burden. Results A total of 5929 individuals were included (median [IQR] age, 54 [46-61] years; 3238 women [55%]; 2787 Black [47%], 1153 Hispanic or other [19%], 1989 White [34%]). Overall, unadjusted mean comorbidity burden was higher among women vs men (3.4 [2.1] vs 3.2 [1.8]; P = .02). Comorbidity prevalence differed by sex for hypertension (2188 of 3238 women [68%] vs 2026 of 2691 men [75%]), psychiatric illness (1771 women [55%] vs 1565 men [58%]), dyslipidemia (1312 women [41%] vs 1728 men [64%]), liver (1093 women [34%] vs 1032 men [38%]), bone disease (1364 women [42%] vs 512 men [19%]), lung disease (1245 women [38%] vs 259 men [10%]), diabetes (763 women [24%] vs 470 men [17%]), cardiovascular (493 women [15%] vs 407 men [15%]), kidney (444 women [14%] vs 404 men [15%]) disease, and cancer (219 women [7%] vs 321 men [12%]). In an unadjusted model, the estimated mean difference in comorbidity burden among women vs men was significantly greater in every age strata among PWH: age under 40 years, 0.33 (95% CI, 0.03-0.63); ages 40 to 49 years, 0.37 (95% CI, 0.12-0.61); ages 50 to 59 years, 0.38 (95% CI, 0.20-0.56); ages 60 to 69 years, 0.66 (95% CI, 0.42-0.90); ages 70 years and older, 0.62 (95% CI, 0.07-1.17). However, the difference between sexes varied by age strata among persons without HIV: age under 40 years, 0.52 (95% CI, 0.13 to 0.92); ages 40 to 49 years, -0.07 (95% CI, -0.45 to 0.31); ages 50 to 59 years, 0.88 (95% CI, 0.62 to 1.14); ages 60 to 69 years, 1.39 (95% CI, 1.06 to 1.72); ages 70 years and older, 0.33 (95% CI, -0.53 to 1.19) (P for interaction = .001). In the covariate-adjusted model, findings were slightly attenuated but retained statistical significance. Conclusions and Relevance In this cross-sectional study, the overall burden of aging-related comorbidities was higher in women vs men, particularly among PWH, and the distribution of comorbidity prevalence differed by sex. Comorbidity screening and prevention strategies tailored by HIV serostatus and sex or gender may be needed.
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Affiliation(s)
- Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - C. Christina Mehta
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - JaNae Holloway
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jordan E. Lake
- Department of Medicine, University of Texas Health Sciences Center, Houston
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth F. Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susanna Naggie
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, DC
| | - Audrey L. French
- Division of Infectious Diseases, CORE Center, Stroger Hospital of Cook County, Chicago, Illinois
| | - Adaora A. Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Margaret A. Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham
| | - Susan L. Koletar
- Division of Infectious Diseases, The Ohio State University Medical Center, Columbus
| | - Phyllis C. Tien
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco
- Medical Service, Department of Veterans Affairs, San Francisco, California
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
| | - Anandi N. Sheth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
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13
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Batterham RL, Espinosa N, Katlama C, McKellar M, Scholten S, Smith DE, Ait-Khaled M, George N, Wright J, Gordon LA, Moodley R, Wynne B, van Wyk J. Cardiometabolic Parameters 3 Years After Switch to Dolutegravir/Lamivudine vs Maintenance of Tenofovir Alafenamide-Based Regimens. Open Forum Infect Dis 2023; 10:ofad359. [PMID: 37520420 PMCID: PMC10375426 DOI: 10.1093/ofid/ofad359] [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: 03/28/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cardiometabolic outcomes were investigated 3 years after switching to the 2-drug regimen dolutegravir/lamivudine (DTG/3TC) vs continuing 3-/4-drug tenofovir alafenamide (TAF)-based regimens in a multicenter phase 3 noninferiority study based on an open-label randomized design. Method Adults with virologically suppressed HIV-1 switched to once-daily DTG/3TC (n = 369) or continued TAF-based regimens (n = 372). Cardiometabolic health parameters were assessed through week 144 via mixed-model repeated measures or logistic regression analyses, adjusting for baseline variables. Results At week 144, 13% (42/316) of the DTG/3TC group and 12% (37/303) of the TAF-based regimen group had ≥10% weight gain from baseline (adjusted odds ratio, 1.11; 95% CI, .68-1.80). Adjusted change from baseline in serum leptin, a surrogate marker of adiposity, was similar between groups (treatment ratio, 1.00; 95% CI, .89-1.13). The lipid profile generally favored DTG/3TC in the baseline boosted subgroup. Adjusted odds revealed no clinically meaningful differences between groups: homeostatic model assessment of insulin resistance ≥2 (adjusted odds ratio, 0.79; 95% CI, .50-1.26), metabolic syndrome (International Diabetes Federation criteria, 0.99; .59-1.68), hepatic fibrosis (fibrosis-4 index score ≥1.45, 1.39; .63-3.06), and coronary artery disease risk (Framingham risk score ≥10%, 0.92; .56-1.49). Baseline variables and characteristics associated with odds of each cardiometabolic parameter outcome were consistent with known risk factors, including age, sex, race, and some disease characteristics. Conclusions Cardiometabolic health 3 years after switching to DTG/3TC was comparable to that for individuals continuing TAF-based regimens, further supporting DTG/3TC as a robust switch option with a stable metabolic profile. Trial registration ClinicalTrials.gov NCT03446573.
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Affiliation(s)
- Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Nuria Espinosa
- Hospital Universitario Virgen del Rocío, Sevilla, Andalucía, Spain
| | - Christine Katlama
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, INSERM–Sorbonne Universités, Paris, France
| | - Mehri McKellar
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | - Brian Wynne
- ViiV Healthcare, Durham, North Carolina, USA
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14
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Amutuhaire W, Mulindwa F, Castelnuovo B, Brusselaers N, Schwarz JM, Edrisa M, Dujanga S, Salata RA, Yendewa GA. Prevalence of Cardiometabolic Disease Risk Factors in People With HIV Initiating Antiretroviral Therapy at a High-Volume HIV Clinic in Kampala, Uganda. Open Forum Infect Dis 2023; 10:ofad241. [PMID: 37351455 PMCID: PMC10284103 DOI: 10.1093/ofid/ofad241] [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: 01/30/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023] Open
Abstract
Background Cardiometabolic diseases are a leading cause of HIV-related morbidity and mortality, yet routine screening is not undertaken in high-burden countries. We aimed to assess the prevalence and risk factors of the metabolic syndrome (MetS) and its components in adult Ugandan people with HIV (PWH) initiating dolutegravir-based antiretroviral therapy (ART). Methods We conducted a cross-sectional study using baseline sociodemographic and clinical data of PWH aged ≥18 years enrolled in the Glucose metabolism changes in Ugandan HIV patients on Dolutegravir (GLUMED) study from January to October 2021. MetS was defined as having ≥3 of the following: abdominal obesity, hypertension (HTN), hyperglycemia, elevated triglycerides, and low high-density lipoprotein cholesterol. Multiple logistic regression was used to assess associations between potential risk factors and MetS and its components. Results Three hundred nine PWH were analyzed (100% ART-naïve, 59.2% female, median age 31 years, and median CD4 count 318 cells/mm3). The prevalence of MetS was 13.9%. The most common cardiometabolic condition was dyslipidemia (93.6%), followed by abdominal obesity (34.0%), hyperglycemia (18.4%), and HTN (8.1%). In adjusted analysis, MetS was associated with age >40 years (adjusted odds ratio [aOR], 3.33; 95% CI, 1.45-7.67) and CD4 count >200 cells/mm3 (aOR, 3.79; 95% CI, 1.23-11.63). HTN was associated with age >40 years (aOR, 2.96; 95% CI, 1.32-6.64), and dyslipidemia was associated with urban residence (aOR, 4.99; 95% CI, 1.35-18.53). Conclusions Cardiometabolic risk factors were common in this young Ugandan cohort of PWH initiating dolutegravir-based ART, underscoring the need for programmatic implementation of surveillance and management of comorbidities in Uganda and similar settings.
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Affiliation(s)
- Willington Amutuhaire
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Frank Mulindwa
- Makerere University Infectious Diseases Institute, Kampala, Uganda
- Global Health Institute, Antwerp University, Antwerp, Belgium
| | | | - Nele Brusselaers
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mutebi Edrisa
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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15
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Mouchati C, Durieux JC, Zisis SN, McComsey GA. HIV and race are independently associated with endothelial dysfunction. AIDS 2023; 37:271-277. [PMID: 36541639 PMCID: PMC9794140 DOI: 10.1097/qad.0000000000003421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/19/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Evaluating the vascular function in HIV-infected compared with HIV uninfected with assessment of body composition, inflammation, and gut integrity markers. DESIGN A noninvasive test that measures the endothelial function. METHODS We included participants at least 18 years old, with peripheral arterial tonometry testing (EndoPAT2000) between 2014 and 2022. Persons with HIV (PWH) had documented infection, a stable ART regimen, and a viral load less than 400 copies/ml. We measured the vessel's function with the reactive hyperemia index (RHI) (normal >1.67) and Augmentation Index. Lower Augmentation Index reflect better arterial elasticity. We assessed markers of systemic inflammation, immune activation, and gut integrity. We used linear mixed models to estimate endothelial dysfunction with a significant P value less than 0.05. RESULTS Overall, 511 participants (296 HIV-infected; 215 HIV-uninfected controls) were included. Estimated RHI among PWH was 13% lower (P = 0.01) compared with persons without HIV. In nonwhite race, the estimated RHI was 9% lower (P = 0.001) than white race. For every 1% increase in BMI, we would expect RHI to increase 0.17% (P = 0.01). At the time of EndoPAT, the estimated RHI was 8% lower (P = 0.04) among protease inhibitor users compared with PWH who were not taking protease inhibitors. The estimated odds of abnormal RHI ≤1.67) is 1.56 times greater [95% confidence interval (CI) 1.05-2.31] in nonwhite race compared with white race, independent of HIV status [OR = 1.4 (95% CI 0.94-2.13)]. There was not enough evidence to suggest that inflammation, gut, or monocyte markers, current or nadir CD4+ cell count, or duration of HIV were associated with endothelial dysfunction. CONCLUSION HIV, nonwhite race, and protease inhibitor use are independently associated with endothelial dysfunction.
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Affiliation(s)
- Christian Mouchati
- School of Medicine, Case Western Reserve University
- Center for Clinical Research, University Hospitals Cleveland Medical Center
| | - Jared C. Durieux
- Center for Clinical Research, University Hospitals Cleveland Medical Center
| | - Sokratis N. Zisis
- School of Medicine, Case Western Reserve University
- Center for Clinical Research, University Hospitals Cleveland Medical Center
| | - Grace A. McComsey
- School of Medicine, Case Western Reserve University
- Center for Clinical Research, University Hospitals Cleveland Medical Center
- Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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16
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Soares C, Kwok M, Boucher KA, Haji M, Echouffo-Tcheugui JB, Longenecker CT, Bloomfield GS, Ross D, Jutkowtiz E, Sullivan JL, Rudolph JL, Wu WC, Erqou S. Performance of Cardiovascular Risk Prediction Models Among People Living With HIV: A Systematic Review and Meta-analysis. JAMA Cardiol 2023; 8:139-149. [PMID: 36576812 PMCID: PMC9857084 DOI: 10.1001/jamacardio.2022.4873] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/20/2022] [Indexed: 12/29/2022]
Abstract
Importance Extant data on the performance of cardiovascular disease (CVD) risk score models in people living with HIV have not been synthesized. Objective To synthesize available data on the performance of the various CVD risk scores in people living with HIV. Data Sources PubMed and Embase were searched from inception through January 31, 2021. Study Selection Selected studies (1) were chosen based on cohort design, (2) included adults with a diagnosis of HIV, (3) assessed CVD outcomes, and (4) had available data on a minimum of 1 CVD risk score. Data Extraction and Synthesis Relevant data related to study characteristics, CVD outcome, and risk prediction models were extracted in duplicate. Measures of calibration and discrimination are presented in tables and qualitatively summarized. Additionally, where possible, estimates of discrimination and calibration measures were combined and stratified by type of risk model. Main Outcomes and Measures Measures of calibration and discrimination. Results Nine unique observational studies involving 75 304 people (weighted average age, 42 years; 59 490 male individuals [79%]) living with HIV were included. In the studies reporting these data, 86% were receiving antiretroviral therapy and had a weighted average CD4+ count of 449 cells/μL. Included in the study were current smokers (50%), patients with diabetes (5%), and patients with hypertension (25%). Ten risk prediction scores (6 in the general population and 4 in the HIV-specific population) were analyzed. Most risk scores had a moderate performance in discrimination (C statistic: 0.7-0.8), without a significant difference in performance between the risk scores of the general and HIV-specific populations. One of the HIV-specific risk models (Data Collection on Adverse Effects of Anti-HIV Drugs Cohort 2016) and 2 of the general population risk models (Framingham Risk Score [FRS] and Pooled Cohort Equation [PCE] 10 year) had the highest performance in discrimination. In general, models tended to underpredict CVD risk, except for FRS and PCE 10-year scores, which were better calibrated. There was substantial heterogeneity across the studies, with only a few studies contributing data for each risk score. Conclusions and Relevance Results of this systematic review and meta-analysis suggest that general population and HIV-specific CVD risk models had comparable, moderate discrimination ability in people living with HIV, with a general tendency to underpredict risk. These results reinforce the current recommendations provided by the American College of Cardiology/American Heart Association guidelines to consider HIV as a risk-enhancing factor when estimating CVD risk.
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Affiliation(s)
- Cullen Soares
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Michael Kwok
- Department of Medicine, Brown University, Providence, Rhode Island
| | - Kent-Andrew Boucher
- 27th Special Operations Medical Group, US Air Force, US Department of Defense, Cannon Air Force Base, Clovis, New Mexico
| | - Mohammed Haji
- Department of Medicine, Brown University, Providence, Rhode Island
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Gerald S. Bloomfield
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - David Ross
- Office of Specialty Care Service, US Department of Veterans Affairs, Washington, DC
- Infectious Disease Section, Washington DC Department of Veterans Affairs Medical Center, Washington, DC
| | - Eric Jutkowtiz
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center, Providence VA Health Care System, Providence, Rhode Island
- Brown University School of Public Health, Brown University, Providence, Rhode Island
| | - Jennifer L. Sullivan
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Brown University School of Public Health, Brown University, Providence, Rhode Island
| | - James L. Rudolph
- Department of Medicine, Brown University, Providence, Rhode Island
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center, Providence VA Health Care System, Providence, Rhode Island
- Brown University School of Public Health, Brown University, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
| | - Wen-Chih Wu
- Department of Medicine, Brown University, Providence, Rhode Island
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Brown University School of Public Health, Brown University, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
| | - Sebhat Erqou
- Department of Medicine, Brown University, Providence, Rhode Island
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center, Providence VA Health Care System, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
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17
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Morton ZP, Christina Mehta C, Wang T, Palella FJ, Naggie S, Golub ET, Anastos K, French AL, Kassaye S, Taylor TN, Fischl MA, Adimora AA, Kempf MC, Tien PC, Ofotokun I, Sheth AN, Collins LF. Cumulative Human Immunodeficiency Virus (HIV)-1 Viremia Is Associated With Increased Risk of Multimorbidity Among US Women With HIV, 1997-2019. Open Forum Infect Dis 2023; 10:ofac702. [PMID: 36751648 PMCID: PMC9897021 DOI: 10.1093/ofid/ofac702] [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: 11/09/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022] Open
Abstract
Background To evaluate the effect of cumulative human immunodeficiency virus (HIV)-1 viremia on aging-related multimorbidity among women with HIV (WWH), we analyzed data collected prospectively among women who achieved viral suppression after antiretroviral therapy (ART) initiation (1997-2019). Methods We included WWH with ≥2 plasma HIV-1 viral loads (VL) <200 copies/mL within a 2-year period (baseline) following self-reported ART use. Primary outcome was multimorbidity (≥2 nonacquired immune deficiency syndrome comorbidities [NACM] of 5 total assessed). The trapezoidal rule calculated viremia copy-years (VCY) as area-under-the-VL-curve. Cox proportional hazard models estimated the association of time-updated cumulative VCY with incident multimorbidity and with incidence of each NACM, adjusting for important covariates (eg, age, CD4 count, etc). Results Eight hundred six WWH contributed 6368 women-years, with median 12 (Q1-Q3, 7-23) VL per participant. At baseline, median age was 39 years, 56% were Black, and median CD4 was 534 cells/mm3. Median time-updated cumulative VCY was 5.4 (Q1-Q3, 4.7-6.9) log10 copy-years/mL. Of 211 (26%) WWH who developed multimorbidity, 162 (77%) had incident hypertension, 133 (63%) had dyslipidemia, 60 (28%) had diabetes, 52 (25%) had cardiovascular disease, and 32 (15%) had kidney disease. Compared with WWH who had time-updated cumulative VCY <5 log10, the adjusted hazard ratio of multimorbidity was 1.99 (95% confidence interval [CI], 1.29-3.08) and 3.78 (95% CI, 2.17-6.58) for those with VCY 5-6.9 and ≥7 log10 copy-years/mL, respectively (P < .0001). Higher time-updated cumulative VCY increased the risk of each NACM. Conclusions Among ART-treated WWH, greater cumulative viremia increased the risk of multimorbidity and of developing each NACM, and hence this may be a prognostically useful biomarker for NACM risk assessment in this population.
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Affiliation(s)
- Zoey P Morton
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - C Christina Mehta
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tingyu Wang
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Frank J Palella
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susanna Naggie
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Audrey L French
- Division of Infectious Diseases, CORE Center, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Tonya N Taylor
- SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Margaret A Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adaora A Adimora
- Gillings School of Global Public Health and the School of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Phyllis C Tien
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
- Medical Service, Department of Veterans Affairs, San Francisco, California, USA
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
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18
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High Concordance between D:A:Dr and the Framingham Risk Score in Brazilians Living with HIV. Viruses 2023; 15:v15020348. [PMID: 36851562 PMCID: PMC9960260 DOI: 10.3390/v15020348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
People living with HIV (PLHIV) have twice the risk of developing cardiovascular diseases, making it essential to identify high cardiovascular risk (CVR). However, there is no validated CVR calculator for PLHIV in Brazil. We performed a cross-sectional study with 265 individuals living with HIV, aged 40 to 74 years, to assess the agreement between three CVR scores: Framingham Risk Score (FRS), Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score, and a specific for PLHIV, Reduced Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:Dr). We assessed agreement using the weighted Kappa coefficient and the Bland-Altman plot. The median age was 52 years (47-58), 58.9% were men, 34% were hypertensive and 8.3% had a detectable viral load. There was an almost perfect agreement between D:A:Dr x FRS (k = 0.82; 95% CI 0.77-0.87; p < 0.001), and substantial agreement between FRS vs. ASCVD (k = 0.74; 95% CI 0.69-0.79; p < 0.001) and between D:A:Dr vs. ASCVD (k = 0.70; 95% CI 0.64-0.76; p < 0.001). The Bland-Altman plot revealed greater discordance between scores as the CVR increased. Our results suggest that the FRS and the D:A:Dr are adequate to classify the CVR in this population, and the D:A:Dr score can be used as an alternative to the FRS in Brazil, as other international guidelines have already advocated.
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19
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Valenzuela-Rodríguez G. [Cardiovascular compromise in the infection by the human immunodeficiency virus]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:21-29. [PMID: 37408781 PMCID: PMC10318990 DOI: 10.47487/apcyccv.v4i1.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/15/2023] [Indexed: 07/07/2023]
Abstract
Human immunodeficiency virus (HIV) infection was associated with increased morbidity and mortality, predominantly for opportunistic infections, before using antiretroviral therapy. With this, patients have experienced increased survival and cardiovascular compromise too. The etiology of these clinical conditions could be related to the infection itself, adverse events associated with antiretroviral therapy, or adverse events produced by the combination with other drugs. Some of these conditions have an acute onset, and their rapid recognition is vital for a better prognosis.
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Affiliation(s)
- Germán Valenzuela-Rodríguez
- Clínica Delgado-AUNA, Lima, Perú.Clínica Delgado-AUNALimaPerú
- Unidad de Revisiones Sistemáticas y Metaanálisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú.Universidad San Ignacio de Loyolanidad de Revisiones Sistemáticas y Metaanálisis (URSIGET)Vicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
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20
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Lang R, Humes E, Hogan B, Lee J, D'Agostino R, Massaro J, Kim A, Meigs JB, Borowsky L, He W, Lyass A, Cheng D, Kim HN, Klein MB, Cachay ER, Bosch RJ, Gill MJ, Silverberg MJ, Thorne JE, McGinnis K, Horberg MA, Sterling TR, Triant VA, Althoff KN. Evaluating the Cardiovascular Risk in an Aging Population of People With HIV: The Impact of Hepatitis C Virus Coinfection. J Am Heart Assoc 2022; 11:e026473. [PMID: 36129038 PMCID: PMC9673707 DOI: 10.1161/jaha.122.026473] [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] [Indexed: 11/16/2022]
Abstract
Background People with HIV (PWH) are at an increased risk of cardiovascular disease (CVD) with an unknown added impact of hepatitis C virus (HCV) coinfection. We aimed to identify whether HCV coinfection increases the risk of type 1 myocardial infarction (T1MI) and if the risk differs by age. Methods and Results We used data from NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) from January 1, 2000, to December 31, 2017, PWH (aged 40-79 years) who had initiated antiretroviral therapy. The primary outcome was an adjudicated T1MI event. Those who started direct-acting HCV antivirals were censored at the time of initiation. Crude incidence rates per 1000 person-years were calculated for T1MI by calendar time. Discrete time-to-event analyses with complementary log-log models were used to estimate adjusted hazard ratios and 95% CIs for T1MI among those with and without HCV. Among 23 361 PWH, 4677 (20%) had HCV. There were 89 (1.9%) T1MIs among PWH with HCV and 314 (1.7%) among PWH without HCV. HCV was not associated with increased T1MI risk in PWH (adjusted hazard ratio, 0.98 [95% CI, 0.74-1.30]). However, the risk of T1MI increased with age and was amplified in those with HCV (adjusted hazard ratio per 10-year increase in age, 1.85 [95% CI, 1.38-2.48]) compared with those without HCV (adjusted hazard ratio per 10-year increase in age,1.30 [95% CI, 1.13-1.50]; P<0.001, test of interaction). Conclusions HCV coinfection was not significantly associated with increased T1MI risk; however, the risk of T1MI with increasing age was greater in those with HCV compared with those without, and HCV status should be considered when assessing CVD risk in aging PWH.
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Affiliation(s)
- Raynell Lang
- Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Elizabeth Humes
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Brenna Hogan
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Jennifer Lee
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Ralph D'Agostino
- Department of Mathematics and StatisticsBoston UniversityBostonMA
| | - Joseph Massaro
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Arthur Kim
- Division of Infectious DiseasesMassachusetts General HospitalBostonMA
- Harvard Medical SchoolBostonMA
| | - James B. Meigs
- Harvard Medical SchoolBostonMA
- Division of General Internal MedicineMassachusetts General HospitalBostonMA
| | - Leila Borowsky
- Division of General Internal MedicineMassachusetts General HospitalBostonMA
| | - Wei He
- Division of General Internal MedicineMassachusetts General HospitalBostonMA
| | - Asya Lyass
- Department of Mathematics and StatisticsBoston UniversityBostonMA
| | - David Cheng
- Biostatistics CenterMassachusetts General HospitalBostonMA
| | | | | | - Edward R. Cachay
- Department of Medicine, Division of Infectious Diseases and Global Public HealthUniversity of CaliforniaSan DiegoCA
| | | | - M. John Gill
- Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | | | | | | | | | | | - Virginia A. Triant
- Division of Infectious DiseasesMassachusetts General HospitalBostonMA
- Division of General Internal MedicineMassachusetts General HospitalBostonMA
| | - Keri N. Althoff
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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21
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Wu KC, Woldu B, Post WS, Hays AG. Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV. Curr Opin HIV AIDS 2022; 17:261-269. [PMID: 35938459 PMCID: PMC9365326 DOI: 10.1097/coh.0000000000000753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To summarize the state-of-the-art literature on the epidemiology, disease progression, and mediators of heart failure, tachyarrhythmias, and sudden cardiac death in people living with HIV (PLWH) to inform prevention strategies. RECENT FINDINGS Recent studies corroborate the role of HIV as a risk enhancer for heart failure and arrhythmias, which persists despite adjustment for cardiovascular risk factors and unhealthy behaviors. Immune activation and inflammation contribute to the risk. Heart failure occurs more frequently at younger ages, and among women and ethnic minorities living with HIV, highlighting disparities. Prospective outcome studies remain sparse in PLWH limiting prevention approaches. However, subclinical cardiac and electrophysiologic remodeling and dysfunction detected by noninvasive testing are powerful disease surrogates that inform our mechanistic understanding of HIV-associated cardiovascular disease and offer opportunities for early diagnosis. SUMMARY Aggressive control of HIV viremia and cardiac risk factors and abstinence from unhealthy behaviors remain treatment pillars to prevent heart failure and arrhythmic complications. The excess risk among PLWH warrants heightened vigilance for heart failure and arrhythmic symptomatology and earlier testing as subclinical abnormalities are common. Future research needs include identifying novel therapeutic targets to prevent heart failure and arrhythmias and testing of interventions in diverse groups of PLWH.
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Affiliation(s)
- Katherine C. Wu
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD
| | - Bethel Woldu
- MedStar Heart and Vascular Institute, Baltimore, MD
- MedStar Georgetown University, Department of Medicine, Division of Cardiology, Washington DC
| | - Wendy S. Post
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD
| | - Allison G. Hays
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD
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22
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Moran CA, Collins LF, Beydoun N, Mehta PK, Fatade Y, Isiadinso I, Lewis TT, Weber B, Goldstein J, Ofotokun I, Quyyumi A, Choi MY, Titanji K, Lahiri CD. Cardiovascular Implications of Immune Disorders in Women. Circ Res 2022; 130:593-610. [PMID: 35175848 PMCID: PMC8869407 DOI: 10.1161/circresaha.121.319877] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immune responses differ between men and women, with women at higher risk of developing chronic autoimmune diseases and having more robust immune responses to many viruses, including HIV and hepatitis C virus. Although immune dysregulation plays a prominent role in chronic systemic inflammation, a key driver in the development of atherosclerotic cardiovascular disease (ASCVD), standard ASCVD risk prediction scores underestimate risk in populations with immune disorders, particularly women. This review focuses on the ASCVD implications of immune dysregulation due to disorders with varying global prevalence by sex: autoimmune disorders (female predominant), HIV (male-female equivalent), and hepatitis C virus (male predominant). Factors contributing to ASCVD in women with immune disorders, including traditional risk factors, dysregulated innate and adaptive immunity, sex hormones, and treatment modalities, are discussed. Finally, the need to develop new ASCVD risk stratification tools that incorporate variables specific to populations with chronic immune disorders, particularly in women, is emphasized.
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Affiliation(s)
- Caitlin A. Moran
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Lauren F. Collins
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Nour Beydoun
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Puja K. Mehta
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Yetunde Fatade
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Ijeoma Isiadinso
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Tené T Lewis
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, USA
| | - Brittany Weber
- Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jill Goldstein
- Massachusetts General Hospital, Department of Psychiatry, and Harvard Medical School, Departments of Psychiatry and Medicine, Boston, MA, USA
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Arshed Quyyumi
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - May Y. Choi
- Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Kehmia Titanji
- Emory University, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, GA, USA
| | - Cecile D. Lahiri
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
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Post WS. CARDIOVASCULAR DISEASE IN HIV. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2022; 132:126-134. [PMID: 36196186 PMCID: PMC9480569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
People living with HIV are at increased risk for cardiovascular disease. This report summarizes our work demonstrating associations between HIV and multiple subclinical markers of cardiovascular disease risk. Some of this risk appears to be related to heightened immune activation and system inflammation that is present in people living with HIV even when there is an undetectable viral load.
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24
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Salvador GLDO. Is it possible to refine cardiovascular risk scores in People living with HIV? Eur J Prev Cardiol 2021; 29:687-688. [PMID: 34927680 DOI: 10.1093/eurjpc/zwab225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Brunet L, Mallon P, Fusco JS, Wohlfeiler MB, Prajapati G, Beyer A, Fusco GP. Switch from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living with HIV: Lipid Changes and Statin Underutilization. Clin Drug Investig 2021; 41:955-965. [PMID: 34546533 PMCID: PMC8556204 DOI: 10.1007/s40261-021-01081-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Many people living with HIV (PLWH) on stable tenofovir disoproxil fumarate (TDF)-containing regimens have switched to tenofovir alafenamide (TAF), despite the potential lipid-lowering effect of TDF. We aimed to assess the impact of switching from TDF to TAF on lipids in real-world clinical practice. METHODS PLWH prescribed TDF for ≥ 4 weeks who switched to TAF were identified in the OPERA cohort. Patterns of dyslipidemia were compared before and after switch based on NCEP ATPIII guidelines. Elevated 10-year risk of atherosclerotic cardiovascular disease (ASCVD ≥ 7.5%) and statin use were assessed. RESULTS Among 6423 PLWH switched from TDF to TAF, the proportion with dyslipidemia/severe dyslipidemia observed after switch from TDF to TAF increased statistically significantly (p < 0.0001) with total cholesterol (5-10%), low-density lipoprotein cholesterol (16-23%), and triglycerides (21-27%), but decreased statistically significantly with high-density lipoprotein cholesterol (35-30%, p < 0.0001). These patterns of dyslipidemia persisted in sensitivity analyses restricted to PLWH who maintained all other antiretrovirals (N = 4328) or stratified by pharmaco-enhancer use before and after switch. An elevated ASCVD risk was detected in 29% before and 31% after switch. As many as 59% of PLWH with an elevated ASCVD risk were not prescribed a statin after switch from TDF to TAF. CONCLUSIONS In this large, diverse population of PLWH in the USA, the switch from TDF to TAF was associated with development of less favorable lipid profiles, regardless of pharmaco-enhancers or third-agent use. Statins remained underutilized after a switch from TDF to TAF.
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Affiliation(s)
- Laurence Brunet
- Epividian, Inc., 4819 Emperor Blvd., Suite 400, Durham, NC, 27703, USA.
| | - Patrick Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Jennifer S Fusco
- Epividian, Inc., 4819 Emperor Blvd., Suite 400, Durham, NC, 27703, USA
| | | | | | | | - Gregory P Fusco
- Epividian, Inc., 4819 Emperor Blvd., Suite 400, Durham, NC, 27703, USA
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