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Gill PK, Hegele RA. Low cholesterol states: clinical implications and management. Expert Rev Endocrinol Metab 2023; 18:241-253. [PMID: 37089071 DOI: 10.1080/17446651.2023.2204932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Hypocholesterolemia results from genetic - both monogenic and polygenic - and non-genetic causes and can sometimes be a source of clinical concern. We review etiologies and sequelae of hypocholesterolemia and therapeutics inspired from genetic hypocholesterolemia. AREAS COVERED Monogenic hypocholesterolemia disorders caused by the complete absence of apolipoprotein (apo) B-containing lipoproteins (abetalipoproteinemia and homozygous hypobetalipoproteinemia) or an isolated absence of apo B-48 lipoproteinemia (chylomicron retention disease) lead to clinical sequelae. These include gastrointestinal disturbances and severe vitamin deficiencies that affect multiple body systems, i.e. neurological, musculoskeletal, ophthalmological, and hematological. Monogenic hypocholesterolemia disorders with reduced but not absent levels of apo B lipoproteins have a milder clinical presentation and patients are protected against atherosclerotic cardiovascular disease. Patients with heterozygous hypobetalipoproteinemia have somewhat increased risk of hepatic disease, while patients with PCSK9 deficiency, ANGPTL3 deficiency, and polygenic hypocholesterolemia typically have anunremarkable clinical presentation. EXPERT OPINION In patients with severe monogenic hypocholesterolemia, early initiation of high-dose vitamin therapy and a low-fat diet are essential for optimal prognosis. The molecular basis of monogenic hypocholesterolemia has inspired novel therapeutics to help patients with the opposite phenotype - i.e. elevated apo B-containing lipoproteins. In particular, inhibitors of PCSK9 and ANGPTL3 show important clinical impact.
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Affiliation(s)
- Praneet K Gill
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Robert A Hegele
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Adedokun TA, Kwaghe VG, Adedokun O, Badru T, Odili AN, Alfa J, Kolade-Yunusa HO, Ojji DB. Prevalence and risk factors for subclinical atherosclerosis amongst adults living with HIV in University of Abuja Teaching Hospital, Gwagwalada. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1092211. [PMID: 36819143 PMCID: PMC9935581 DOI: 10.3389/frph.2023.1092211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
Background Subclinical atherosclerosis characterizes cardiovascular diseases (CVD), and Human Immunodeficiency Virus (HIV) infection and antiretroviral therapy (ART) are identified risk factors for atherosclerosis. Meanwhile, data on HIV and atherosclerosis in Nigeria are limited. Objectives We sought to estimate the prevalence of subclinical atherosclerosis and associated risk factors amongst adult persons living with HIV/AIDS (PLHIV) enrolled at University of Abuja Teaching Hospital, Gwagwalada, Abuja (UATH). Methods This was a cross-sectional study of 277 consecutively selected PLHIV ≥18 years enrolled for HIV care and treatment at UATH. Pretested structured questionnaire was used to collect data from consenting ART-experienced and ART-naïve patients on risk factors of atherosclerosis. Carotid intima media thickness (CIMT) ≥0.71 mm as measured by Doppler ultrasonography was used to identify patients with sub-clinical atherosclerosis. Two logistic regression models with (Model-A) and without (Model-B) traditional risk factors were fitted to identify risk factors of subclinical atherosclerosis. Results Participants' mean age was 39.44 ± 10.71 years with female preponderance (64.26%). Overall prevalence of subclinical atherosclerosis was 43.32% (62.25% in ART-experienced). Model-A identified male sex [AOR 4.33(1.74-10.76), p = 0.002], advancing age [30-39 years AOR 5.95(1.31-26.96), p = 0.021]; ≥40 years AOR 19.51(4.30-88.56), p ≤ 0.001), advancing HIV infection [≥WHO stage II AOR 4.19(1.11-15.92), p = 0.035], hypercholesterolemia [AOR 3.88(1.47-10.25), p ≤ 0.001] and ≥5 year duration on ART [AOR 9.05(3.16-25.92), p ≤ 0.001] as risk factors of subclinical atherosclerosis. In Model-B (excluding traditional risk factors) on the other hand, advancing HIV infection [≥WHO stage II AOR 3.93(1.19-13.042), p = 0.025] and duration on ART [≥5 years AOR 11.43(4.62-28.29), p = 0.001] were found as risk factors of subclinical atherosclerosis. Conclusion Subclinical atherosclerosis was higher in ART-experienced patients, and this was irrespective of presence or absence of traditional risk factors. And advancing HIV disease and duration on ART were found as significant risk factors for subclinical atherosclerosis. We therefore recommend routine CVD risk screening in PLHIV.
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Affiliation(s)
- Taiwo A. Adedokun
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, FCT, Nigeria,Correspondence: Taiwo A. Adedokun
| | - Vivian G. Kwaghe
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, FCT, Nigeria
| | - Oluwasanmi Adedokun
- Center for International Health, Education, and Biosecurity (Ciheb), Maryland Global Initiatives Corporation (MGIC) - an Affiliate of University of Maryland Baltimore, Abuja, Nigeria
| | - Titilope Badru
- Strategic Information Department, FHI360, Abuja, Nigeria
| | - Augustine N. Odili
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, FCT, Nigeria
| | - Jacob Alfa
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, FCT, Nigeria
| | - Hadijat O. Kolade-Yunusa
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, FCT, Nigeria
| | - Dike B. Ojji
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, FCT, Nigeria
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Wagle A, Goerlich E, Post WS, Woldu B, Wu KC, Hays AG. HIV and Global Cardiovascular Health. Curr Cardiol Rep 2022; 24:1149-1157. [PMID: 35802233 DOI: 10.1007/s11886-022-01741-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Because of effective combination antiretroviral therapy, people living with HIV (PLWH) are living longer but developing chronic age-related conditions including cardiovascular disease (CVD), the leading cause of death globally. This review aims to discuss the epidemiology, mechanisms, and clinical considerations of CVD in PLWH from a global perspective. RECENT FINDINGS PLWH are at greater risk for CVD at chronologically younger ages than those without HIV. Potential underlying mechanisms for CVD in PLWH include systemic inflammation, comorbidities, immune-mediated, or treatment-related mechanisms. There is also risk factor variation based on geographical location, including non-traditional CVD risk factors. CVD is prevalent in PLWH and increasing on a global scale. Further understanding the unique epidemiology, risk factors, and treatment of CVD in this population will improve the care of PLWH.
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Affiliation(s)
- Anjali Wagle
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA
| | - Erin Goerlich
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA
| | - Wendy S Post
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bethel Woldu
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA.,MedStar Heart and Vascular Institute, Baltimore, MD, USA.,Department of Medicine, Division of Cardiology, MedStar Georgetown University, Washington, DC, USA
| | - Katherine C Wu
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison G Hays
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA. .,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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4
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Effect of COVID-19 on lipid profile parameters and its correlation with acute phase reactants: A single-center retrospective analysis. Ann Med Surg (Lond) 2022; 78:103856. [PMID: 35637852 PMCID: PMC9134795 DOI: 10.1016/j.amsu.2022.103856] [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: 04/03/2022] [Revised: 05/22/2022] [Accepted: 05/22/2022] [Indexed: 01/09/2023] Open
Abstract
Background and objective The development and correlation of dyslipidemia is unknown in COVID-19. This investigation was performed to assess the pathological alterations in lipid profile and their association in COVID-19. Methods This was a retrospective study performed on real-world patients to assess serum levels of LDL-C, HDL, TG, TC on COVID-19 patients (mild: 319; moderate: 391; critical: 357). Age- and gender-matched controls who had their lipid profiles in the same period were included as the control group. Results LDL-C, HDL, TG, and TC levels were significantly lower in COVID-19 patients when compared with the control group (P < 0.001, 0.047, 0.045, <0.001, respectively). All parameters decreased gradually with COVID-19 disease severity (LDL-C: median (IQR), mild: 98 (91,134); moderate: 97 (81,113); critical: 68 (68,83); HDL: mild: 45 (37,50); moderate: 46 (41,50); critical: 40 (37,46); TG: mild: 186 (150,245); moderate: 156 (109,198); critical: 111 (98,154); TC: mild: 224 (212,238); moderate: 212 (203,213); critical: 154 (125,187)). Logistic regression demonstrated lipid profile as predictor of severity of COVID-19 disease. Conclusion Hypolipidemia develops in increasing frequency with severe COVID-19 disease. It inversely correlates with levels of acute-phase reactants, indicating SARS-COV-2 as the causative agent for alteration in lipid and thyroid levels.
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Enriquez R, Ssekubugu R, Ndyanabo A, Marrone G, Gigante B, Chang LW, Reynolds SJ, Nalugoda F, Ekstrom AM, Sewankambo NK, Serwadda DM, Nordenstedt H. Prevalence of cardiovascular risk factors by HIV status in a population-based cohort in South Central Uganda: a cross-sectional survey. J Int AIDS Soc 2022; 25:e25901. [PMID: 35419976 PMCID: PMC9008150 DOI: 10.1002/jia2.25901] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Cardiovascular disease is one of the leading causes of mortality for people living with HIV, but limited population-based data are available from sub-Saharan Africa. This study aimed to determine the prevalence of key cardiovascular disease risk factors, 10-year risk of cardiovascular disease and type 2 diabetes mellitus through risk scores by HIV status, as well as investigate factors associated with hyperglycaemia, hypertension and dyslipidaemia in South-Central Uganda. METHODS A cross-sectional study was conducted in 37 communities of the population-based Rakai Community Cohort Study from May 2016 to May 2018. In total, 990 people living with HIV and 978 HIV-negative participants aged 35-49 years were included. Prevalence estimates and 10-year cardiovascular and type 2 diabetes risk were calculated by sex and HIV serostatus. Multivariable logistic regression was used to determine associations between socio-demographic, lifestyle and body composition risk factors and hyperglycaemia, hypertension and dyslipidaemia. RESULTS Overweight (21%), obesity (9%), abdominal obesity (15%), hypertension (17%) and low high-density lipoprotein (HDL) (63%) were the most common cardiovascular risk factors found in our population. These risk factors were found to be less common in people living with HIV apart from hypertension. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low in this population with <1% categorized as high risk. In HIV-adjusted multivariable analysis, obesity was associated with a higher odds of hypertension (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.35-3.96) and high triglycerides (OR = 2.08, CI 1.25-3.47), and abdominal obesity was associated with a higher odds of high triglycerides (OR = 2.55, CI 1.55-4.18) and low HDL (OR = 1.36, CI 1.09-1.71). A positive HIV status was associated with a lower odds of low HDL (OR = 0.43, CI 0.35-0.52). CONCLUSIONS In this population-based study in Uganda, cardiovascular risk factors of obesity, abdominal obesity, hypertension and dyslipidaemia were found to be common, while hyperglycaemia was less common. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low. The majority of cardiovascular risk factors were not affected by HIV status. The high prevalence of dyslipidaemia in our study requires further research.
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Affiliation(s)
- Rocio Enriquez
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | | | | | - Gaetano Marrone
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Bruna Gigante
- Department of MedicineKarolinska InstitutetStockholmSweden
| | - Larry W. Chang
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Steven J. Reynolds
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Laboratory of ImmunoregulationDivision of Intramural ResearchNational Institute for Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | | | - Anna Mia Ekstrom
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
- Department of Infectious DiseasesSouth Central HospitalStockholmSweden
| | - Nelson K. Sewankambo
- Rakai Health Sciences ProgramKalisizoUganda
- Department of MedicineMakerere University School of MedicineKampalaUganda
| | - David M. Serwadda
- Rakai Health Sciences ProgramKalisizoUganda
- Department of Disease Control and Environmental HealthMakerere University School of Public HealthKampalaUganda
| | - Helena Nordenstedt
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
- Department of Internal Medicine and Infectious DiseasesDanderyd University HospitalStockholmSweden
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Sankaranarayanan A, Pratt R, Anoop A, Smith A, Espinoza D, Ramachandran P, Tirupati S. Serum lipids and suicidal risk among patients with schizophrenia spectrum disorders: Systematic review and meta-analysis. Acta Psychiatr Scand 2021; 144:125-152. [PMID: 33834474 DOI: 10.1111/acps.13305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A systematic review of literature was conducted to determine the association between serum lipids and suicidality in people with schizophrenia spectrum disorders. METHODS We undertook a systematic search of multiple databases for studies that ascertained an association between serum lipids and suicidality in adult patients with schizophrenia spectrum disorders (18-65 years) from database inception to 2 September 2020. Qualitative analysis was done using National Institute of Health (NIH) scales. The standard mean difference (SMD) and 95% confidence intervals (CI) were calculated for each study and standardized relative to the study. Adjusted p-value, Z-test, and heterogeneity were calculated, as well as testing for publication bias. RESULTS Of 1262 records identified, 17 studies (n = 3113) were included in our systematic review, while 11 studies were included in the meta-analysis. The majority of studies (11) rated fair on qualitative analysis. Data from seven studies (n = 1597) revealed a medium effect size for an association between low total cholesterol and suicide attempts (SMD -0.560; 95% CI: 0.949-0.170; p = 0.005). People with history of suicide attempt had a mean cholesterol value 0.56 SD lower than the mean in those without suicide attempts. There were differences in how a suicide attempt was defined and there was high heterogeneity (I2 = 83.3%). No significant association was found between any of the serum lipid parameters and suicide ideation. Funnel-plot analysis suggested small study effects with publication bias. CONCLUSIONS Suicide attempts in people with schizophrenia spectrum disorders are associated with low mean total cholesterol levels.
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Affiliation(s)
- Anoop Sankaranarayanan
- Melaleuca Unit, Blacktown Mental Health, Western Sydney LHD Mental Health Service, Sydney, NSW, Australia.,School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Robin Pratt
- Consultation-Liaison Psychiatry, Cairns Hospital, Cairns, Qld, Australia.,Faculty of Health Science and Medicine, Bond University, Robina, Qld, Australia
| | - Aparna Anoop
- Medical Student, The University of Buckingham Medical School, Buckingham, UK
| | - Angela Smith
- Research Librarian, HNE Health Libraries, Hunter New England Local Health District NSW, Waratah, NSW, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.,UWS Clinical School, Blacktown Hospital, Blacktown, NSW, Australia
| | | | - Srinivasan Tirupati
- Psychiatric Rehabilitation Service, Hunter New England LHD Mental Health Service, Blacktown, NSW, Australia.,Faculty of Medicine, University of Newcastle, Callaghan, NSW, Australia
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Kuate Defo A, Chalati MD, Labos C, Fellows LK, Mayo NE, Daskalopoulou SS. Association of HIV Infection and Antiretroviral Therapy With Arterial Stiffness: A Systematic Review and Meta-Analysis. Hypertension 2021; 78:320-332. [PMID: 34176289 DOI: 10.1161/hypertensionaha.121.17093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Alvin Kuate Defo
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre (A.K.D., S.S.D.), McGill University, Montreal, Quebec, Canada
| | - Mhd Diaa Chalati
- Faculty of Medicine and Health Sciences (M.D.C., S.S.D.), McGill University, Montreal, Quebec, Canada
| | - Christopher Labos
- Division of Cardiology, Department of Medicine, Notre-Dame Hospital, Montreal, Quebec, Canada (C.L.)
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, Montreal Neurological Institute (L.K.F.), McGill University, Montreal, Quebec, Canada
| | - Nancy E Mayo
- Centre for Outcomes Research and Evaluation, Department of Medicine, School of Physical and Occupational Therapy, Research Institute of the McGill University Health Centre (N.E.M.), McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre (A.K.D., S.S.D.), McGill University, Montreal, Quebec, Canada.,Faculty of Medicine and Health Sciences (M.D.C., S.S.D.), McGill University, Montreal, Quebec, Canada
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8
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Hu X, Chen D, Wu L, He G, Ye W. Declined serum high density lipoprotein cholesterol is associated with the severity of COVID-19 infection. Clin Chim Acta 2020; 510:105-110. [PMID: 32653486 PMCID: PMC7350883 DOI: 10.1016/j.cca.2020.07.015] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
Serum HDL-cholesterol decreased in severe COVID-19-infected patients. HDL-cholesterol is negatively correlated with C-reactive protein. HDL-cholesterol is positively correlated with lymphocyte counts. HDL-cholesterol level changes with the progression of COVID-19 infection.
Background COVID-19 infection is epidemic worldwide. We describe the serum lipid profile of the patients with COVID-19 infection. Methods In this retrospective study, we collected the first clinical laboratory data of 114 patients on admission, and 80 healthy controls. Meanwhile, we monitored the serum lipid profile, COVID-19 nucleic acid and chest CT scan of a severe patient from the early stage of infection to the recovery period for a total of 80 days. Results Compared with the healthy controls, the patients had sharply decreased concentrations of total cholesterol, HDL-cholesterol and LDL-cholesterol (P < 0.001). Among the patients, HDL-cholesterol concentration in severe groups was significantly lower than the common groups [1.01 (0.88–1.20) vs 1.21 (1.02–1.48) mmol/l, P < 0.001]. The lipid profile of a severe patient showed that serum cholesterol concentration significantly decreased in the early stage and returned to be normal in the recovery period. Moreover, the change of HDL-cholesterol in this patient was consistent with the results of nucleic acid tests and chest CT scans. In correlation analysis, HDL-cholesterol concentration was negatively correlated with C-reactive protein (CRP, r = −0.396, P < 0.001) and positively correlated with lymphocytes (r = 0.336, P < 0.001). The area under curve (AUC) in receiver operating characteristic (ROC) of HDL-cholesterol was 0.732 (P < 0.001), and, the adjusted odd ratio (OR) of HDL-cholesterol was 0.023 (95% CI 0.002–0.227). Conclusions Decreased serum HDL-cholesterol is associated with the severity of COVID-19 infection.
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Affiliation(s)
- Xingzhong Hu
- Wenzhou Central Hospital, Wenzhou, Zhejiang 32035 China
| | - Dong Chen
- Wenzhou Central Hospital, Wenzhou, Zhejiang 32035 China
| | - Lianpeng Wu
- Wenzhou Central Hospital, Wenzhou, Zhejiang 32035 China
| | - Guiqing He
- Wenzhou Central Hospital, Wenzhou, Zhejiang 32035 China
| | - Wei Ye
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
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Sridevi K, Malathi S, Kv C, G CN, Gayathri M, Chand GE, Nayyar AS. CD4 Cell Counts, Lipid Profile, and Oral Manifestations in HIV-Infected and AIDS Patients. Front Dent 2019; 16:436-449. [PMID: 33089245 PMCID: PMC7569270 DOI: 10.18502/fid.v16i6.3443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives The present study aimed to evaluate CD4 cell counts, lipid profile, and oral manifestations in human immunodeficiency virus (HIV)-infected and acquired immune deficiency syndrome (AIDS) patients and their correlation with seronegative controls. Materials and Methods In this cross-sectional, hospital-based study, there were three groups of subjects: group A consisting of 500 healthy patients (controls), group B composed of 500 HIV-infected patients, and group C comprised of 500 AIDS patients based on their CD4 cell counts. CD4 cell counts were assessed using the CyFlow counter. Lipid profile was evaluated with the Erba EM 360 analyzer. Results The results were statistically significant for CD4 cell counts (P<0.001). The levels of total cholesterol (TC) and low-density lipoproteins (LDLs) were significantly decreased while triglycerides (TGs) and very-low-density lipoproteins (VLDLs) were significantly increased in AIDS patients compared to the controls and HIV-infected patients. Various results were obtained regarding oral manifestations with different levels of significance. Conclusion CD4 cell counts, TC, LDLs, TGs, and VLDLs were significantly changed in HIV-infected and AIDS patients compared to the controls.
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Affiliation(s)
- Koduri Sridevi
- Department of Oral Medicine and Radiology, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
| | - Saka Malathi
- Department of Oral Medicine and Radiology, Army College of Dental Sciences, Secunderabad, Telangana, India
| | - Chalapathi Kv
- Department of Oral Pathology and Microbiology, Care Dental College and Hospital, Guntur, Andhra Pradesh, India
| | - Chowdary Nagarjuna G
- Department of Pedodontics and Preventive Dentistry, MNR Dental College and Hospital, Sangareddy, Telangana, India
| | - M Gayathri
- Department of Oral Medicine and Radiology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamilnadu, India
| | - G Eswar Chand
- Medical Graduate, Mamata Medical College, Khammam, Telangana, India
| | - Abhishek Singh Nayyar
- Department of Oral Medicine and Radiology, Saraswati Dhanwantari Dental College and Hospital and Post-graduate Research Institute, Parbhani, Maharashtra, India
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Pierre S, Seo G, Rivera VR, Walsh KF, Victor JJ, Charles B, Julmiste G, Dumont E, Apollon A, Cadet M, Saint‐Vil A, Marcelin A, Severe P, Lee MH, Kingery J, Koenig S, Fitzgerald D, Pape J, McNairy ML. Prevalence of hypertension and cardiovascular risk factors among long-term AIDS survivors: A report from the field. J Clin Hypertens (Greenwich) 2019; 21:1558-1566. [PMID: 31448551 PMCID: PMC6896990 DOI: 10.1111/jch.13663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/14/2019] [Accepted: 06/18/2019] [Indexed: 12/23/2022]
Abstract
HIV infection is associated with increased risk and progression of cardiovascular disease (CVD), yet little is known about the prevalence of CVD risk factors among long-term AIDS survivors in resource-limited settings. Using routinely collected data, we conducted a retrospective study to describe the prevalence of CVD risk factors among a cohort of HIV-infected patients followed for over 10 years in Port-au Prince, Haiti. This cohort includes 910 adults who initiated antiretroviral therapy (ART) between 2003 and 2004 and remained in care between 2014 and 2016 when routine screening for CVD risk factors was implemented at a large clinic in Haiti. A total of 397 remained in care ≥10 years and received screening. At ART initiation, 59% were female, median age was 38 years (IQR 33-44), and median CD4 count was 117 cells/mm3 (IQR 34-201). Median follow-up time from ART initiation was 12.1 years (IQR 11.7-12.7). At screening, median CD4 count was 574 cells/mm3 (IQR 378-771), and 84% (282 of 336 screened) had HIV-1 RNA < 1000 copies/mL. Seventy-four percent of patients had at least 1 risk factor including 58% (224/385) with hypertension, 8% (24/297) diabetes, 43% (119/275) hypercholesterolemia, 8% (20/248) active smoking, and 10% (25/245) obesity. Factors associated with hypertension were age (adjusted OR 1.06, P < .001) and weight at screening (adjusted OR 1.02, P = .019). Long-term AIDS survivors have a high prevalence of CVD risk factors, primarily hypertension. Integration of cardiovascular screening and management into routine HIV care is needed to maximize health outcomes among aging HIV patients in resource-limited settings.
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Affiliation(s)
- Samuel Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Grace Seo
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Vanessa R. Rivera
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Kathleen F. Walsh
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Jean Joscar Victor
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Benedict Charles
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Gaetane Julmiste
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Emelyne Dumont
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Molene Cadet
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Alix Saint‐Vil
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Adias Marcelin
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Myung Hee Lee
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Justin Kingery
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Serena Koenig
- Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Daniel Fitzgerald
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Jean Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Margaret L. McNairy
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
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11
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Gebhardt A, Fichtenbaum CJ. Current pharmacotherapy for the treatment of dyslipidemia associated with HIV infection. Expert Opin Pharmacother 2019; 20:1719-1729. [PMID: 31232617 PMCID: PMC6756942 DOI: 10.1080/14656566.2019.1636033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/21/2019] [Indexed: 12/18/2022]
Abstract
Introduction: Cardiovascular disease is an important cause of morbidity and mortality in persons with human immunodeficiency virus (PWH). The risk of atherosclerotic cardiovascular disease (ASCVD) is higher in PWH compared to uninfected persons. Dyslipidemia is a critical link in the pathogenesis of ASCVD in PWH. Chronic inflammation associated with HIV infection may drive both dyslipidemia and ASCVD. Areas covered: The authors review the evidence for using lipid-lowering therapy in PWH and includes an overview of the utility and complexity of using statins in PWH, in particular, drug interactions, safety, and efficacy. In addition, data covering alternate therapies like omega-3 fatty acids, fibrates, niacin, ezetimibe, and PCSK-9 inhibitors are reviewed. Expert opinion: Dyslipidemia is a common problem in PWH. The risk of ASCVD is higher in PWH. Lipid-lowering therapy reduces the risk of ASCVD, but clinical endpoint trials are lacking in PWH. Statin therapy is the mainstay of primary prevention for ASCVD. The timing of when to initiate primary prevention with statins in PWH is unclear. Beyond statins, there are limited data that other lipid-lowering agents have utility in PWH. Ongoing trials like the REPRIEVE trial will inform the community about the optimal approach to lipid-lowering therapy in PWH.
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Affiliation(s)
- Anna Gebhardt
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Carl J Fichtenbaum
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine , Cincinnati , OH , USA
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12
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Changes in Lipid Indices in HIV+ Cases on HAART. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2870647. [PMID: 30868068 PMCID: PMC6379880 DOI: 10.1155/2019/2870647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 12/31/2022]
Abstract
We assess long-term changes in lipid levels in human immunodeficiency disease- (HIV-) infected patients undergoing highly active antiretroviral treatment (HAART) and their association with diabetes mellitus (DM) and thyroid dysfunction. We observed changes in the levels of total cholesterol (TC) and total triglyceride (TG) of 63 HIV-infected patients in the 6 years from starting HAART and analyzed correlations between relevant parameters. TC levels of patients with normal baseline TC levels as well as those diagnosed with DM or impaired fasting glucose (IFG) increased significantly (P < 0.05) as did the TG levels of patients with normal baseline TG levels (P < 0.05). TC levels of patients with hypercholesterolemia in the year HAART was initiated were significantly higher than those of patients with normal baseline TC levels (P < 0.05) for all 6 years. TC levels of patients diagnosed with DM were significantly higher than those with euglycemia (P < 0.05) 2 and 4 years after HAART commencement. Levels of TC, high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) were correlated negatively with viral load, whereas levels of TC and very-low-density lipoprotein-cholesterol (VLDL-C) were correlated positively with CD4+ cell counts before HAART commencement. Linear mixed-effect model demonstrated disturbance of glucose metabolism and HAART containing nevirapine and CD4+ cell count were positively correlated with TC levels after HAART commencement. These findings suggest that there are changes in the lipid levels of patients undergoing HAART, with the potential risk of dyslipidemia.
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13
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Muswe R, Oktedalen O, Zhou DT, Zinyando E, Shawarira-Bote S, Stray-Pedersen B, Siziba A, Gomo ZAR. Inflammatory Markers and Plasma Lipids in HIV Patients: A Correlation Analysis Study. Open Biochem J 2017; 11:105-118. [PMID: 29387269 PMCID: PMC5750726 DOI: 10.2174/1874091x01711010105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/18/2017] [Accepted: 11/10/2017] [Indexed: 12/16/2022] Open
Abstract
Background Recent evidence suggests that HIV infection, even with treatment, increases the risk of coronary heart disease (CHD) and that both chronic inflammation and traditional risk factors play key roles in HIV-associated CHD. Subjects and Methods Patients (N=152), attending Harare HIV clinic, 26% of them male and 82% of them on antiretroviral therapy (ART), were studied. Inflammatory markers comprising of cytokines such as pro-inflammatory tumor necrosis factor-α, (TNF-α), anti-inflammatory interleukin 10, (IL-10) and highly sensitive C reactive protein (hsCRP) together with lipids were assayed using enzyme linked immunosorbent assay (ELISA), immuno-turbidimetric and enzymatic assays, respectively. Correlation analysis of inflammatory markers versus lipid profiles was carried out using bivariate regression analysis. Results Anti-inflammatory cytokine IL-10 and inflammatory hsCRP levels were elevated when measured in all the HIV positive patients, while TNF-α and lipid levels were within normal ranges. Pro-inflammatory TNF-α was significantly higher in ART-naive patients than ART-experienced patients, whereas the reverse was observed for anti-inflammatory IL-10 and anti-atherogenic HDL-C. Correlation analysis indicated a significant positive linear association between IL-10 and total cholesterol (TC) levels but no other correlations were found. Conclusion High cytokine ratio (TNF-α/IL-10) indicates higher CHD risk in ART-naive patients compared to the ART-exposed. The CHD risk could be further strengthened by interplay between inflammatory markers and high prevalence of low HDL-C. Lack of correlation between pro-inflammatory markers (hsCRP and TNF-α) with lipid fractions and correlation between anti-inflammatory IL-10 with artherogenic TC were unexpected findings, necessitating further studies in future.
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Affiliation(s)
- Rudo Muswe
- Department of Chemical Pathology, University of Zimbabwe, Harare, Zimbabwe
| | - Olav Oktedalen
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Danai T Zhou
- Department of Medical Laboratory Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Enita Zinyando
- Department of Chemical Pathology, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Atipa Siziba
- Controlnet Consulting - Consultants Midrand, Gauteng, South Africa
| | - Zvenyika A R Gomo
- Department of Chemical Pathology, University of Zimbabwe, Harare, Zimbabwe
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14
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Ratnam MVR, Nayyar AS, Kalivara PB, Sashikiran SVN, Upendra G, Sahu D. CD4 cell counts, complete blood picture and lipid profile in HIV infected and AIDS patients in a specific populace from South India. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2017. [DOI: 10.4103/ejim.ejim_59_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Crook MA, Mir N. Abnormal lipids and the acquired immunodeficiency syndrome: is there a problem and what should we do about it? Int J STD AIDS 2017. [DOI: 10.1177/095646249901000601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M A Crook
- Department of Chemical Pathology, Guy's and St Thomas’ Hospital and University Hospital Lewisham, London
| | - N Mir
- Department of Haematology and HIV Clinic, University Hospital Lewisham, Lewisham, London, UK
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16
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Abstract
BACKGROUND Noncommunicable diseases are common among chronically infected patients with HIV in the developed world, but little is known about these conditions in African cohorts. We assessed the epidemiology of metabolic syndrome among young South African women during the first 3 years after HIV acquisition. METHODS A total of 160 women were followed prospectively in the CAPRISA 002 Acute Infection study. Metabolic syndrome was defined as a constellation of hyperlipidemia, hypertension, hyperglycemia/diabetes, and abdominal obesity. Time trends were assessed using generalized estimation equation models. RESULTS Median age was 24 years and body mass index 27 kg/m. Prevalence of metabolic syndrome at infection was 8.7% increasing to 19.2% over 36 months (P = 0.001). The proportion of women with body mass index >30 kg/m increased from 34.4% to 47.7% (P = 0.004), those with abnormal waist circumference and elevated blood pressure increased from 33.5% to 44.3% (P = 0.060) and 23.8% to 43.9% (P < 0.001), respectively. Incidence of metabolic syndrome was 9.13/100 person-years (95% CI: 6.02 to 13.28). Predictors of metabolic syndrome were age (per year increase odds ratio (OR) = 1.12; 95% CI: 1.07 to 1.16), time postinfection (per year OR = 1.47; 95% CI: 1.12 to 1.92), family history of diabetes (OR = 3.13; 95% CI: 1.71 to 5.72), and the human leukocyte antigen (HLA)-B*81:01 allele (OR = 2.95; 95% CI: 1.21 to 7.17), whereas any HLA-B*57 or B*58:01 alleles were protective (OR = 0.34; 95% CI: 0.15 to 0.77). HIV-1 RNA (OR = 0.89; 95% CI: 0.62 to 1.27) and CD4 count (OR = 1.03; 95% CI: 0.95 to 1.11) did not predict metabolic syndrome. CONCLUSIONS The high burden of metabolic conditions in young South African HIV-infected women highlights the need to integrate noncommunicable disease and HIV care programs. Interventions to prevent cardiovascular disease must start at HIV diagnosis, rather than later during the disease course.
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17
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Lv YB, Yin ZX, Chei CL, Brasher MS, Zhang J, Kraus VB, Qian F, Shi XM, Matchar DB, Zeng Y. Serum Cholesterol Levels within the High Normal Range Are Associated with Better Cognitive Performance among Chinese Elderly. J Nutr Health Aging 2017. [PMID: 26892577 DOI: 10.1007/s12603-016-0701-6.] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The association between cognitive function and cholesterol levels is poorly understood and inconsistent results exist among the elderly. The purpose of this study is to investigate the association of cholesterol level with cognitive performance among Chinese elderly. DESIGN A cross-sectional study was implemented in 2012 and data were analyzed using generalized additive models, linear regression models and logistic regression models. SETTING Community-based setting in eight longevity areas in China. SUBJECTS A total of 2000 elderly aged 65 years and over (mean 85.8±12.0 years) participated in this study. MEASUREMENTS Total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) concentration were determined and cognitive impairment was defined as Mini-Mental State Examination (MMSE) score ≤23. RESULTS There was a significant positive linear association between TC, TG, LDL-C, HDL-C and MMSE score in linear regression models. Each 1 mmol/L increase in TC, TG, LDL-C and HDL-C corresponded to a decreased risk of cognitive impairment in logistic regression models. Compared with the lowest tertile, the highest tertile of TC, LDL-C and HDL-C had a lower risk of cognitive impairment. The adjusted odds ratios and 95% CI were 0.73(0.62-0.84) for TC, 0.81(0.70-0.94) for LDL-C and 0.81(0.70-0.94) for HDL-C. There was no gender difference in the protective effects of high TC and LDL-C levels on cognitive impairment. However, for high HDL-C levels the effect was only observed in women. High TC, LDL-C and HDL-C levels were associated with lower risk of cognitive impairment in the oldest old (aged 80 and older), but not in the younger elderly (aged 65 to 79 years). CONCLUSIONS These findings suggest that cholesterol levels within the high normal range are associated with better cognitive performance in Chinese elderly, specifically in the oldest old. With further validation, low cholesterol may serve a clinical indicator of risk for cognitive impairment in the elderly.
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Affiliation(s)
- Y-B Lv
- Dr. Xiaoming Shi, No. 7 Pan Jia Yuan Nan Li, Chaoyang District, Beijing 100021, China. Telephone: (+86) 1050930101, Fax:(+86)1050930115, E-mail:
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18
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Affiliation(s)
- R.R. Elmehdawi
- Department of Internal Medicine, Faculty of Medicine, Garyounis University, Libya
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19
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Wang Q, Ding H, Xu J, Geng W, Liu J, Guo X, Kang J, Li X, Jiang Y, Shang H. Lipids profile among ART-naïve HIV infected patients and men who have sex with men in China: a case control study. Lipids Health Dis 2016; 15:149. [PMID: 27600391 PMCID: PMC5012071 DOI: 10.1186/s12944-016-0297-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 07/27/2016] [Indexed: 12/12/2022] Open
Abstract
Background Dyslipidemia is commonly seen in human immunodeficiency virus (HIV) infected patients. Understanding the risk factors of abnormal lipid profiles is urgent for proposing targeted approaches to prevention. Our objective was to assess the incidence and associated factors of abnormal lipid profiles and atherogenic index of plasma (AIP) among antiretroviral therapy (ART) naïve men who have sex with men (MSM) acute HIV infection (AHI) and chronic HIV infection (CHI) patients in China. Methods We compared lipids parameters such as triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and AIP between MSM HIV-infected patients and MSM HIV negative controls. Multivariable linear regression was used to evaluate risk factors of higher AIP. Results We performed a case control analysis of 110 AHI, 110 CHI and 100 HIV negative MSM participants. The TC, HDL-C and LDL-C levels were decreased in the AHI and CHI groups compared to the controls (3.90 ± 0.73 mmol/L and 3.72 ± 0.74 mmol/L versus 4.49 ± 0.91 mmol/L, p < 0.001; 1.00 ± 0.25 mmol/L and 1.01 ± 0.30 mmol/L versus 1.19 ± 0.29 mmol/L, p < 0.001; 2.11 ± 0.57 mmol/L and 2.22 ± 0.58 mmol/L versus 2.75 ± 0.78 mmol/L, p < 0.001). The AIP score was higher in the AHI patients compared to the control group [0.08 (−0.05–0.20) versus−0.04 (−0.21–0.22), p = 0.039]. In total groups, AIP was associated with AHI and TG positively (β = 0.029 ± 0.012, p = 0.015;β = 0.273 ± 0.009, p < 0.001) and correlated with HDL-C inversely (β = -0.444 ± 0.023, p < 0.001). Conclusions HIV infection contributed to decreased TC, LDL-C and HDL-C. AHI contributed to higher AIP level. An urgent need exists for earlier HIV diagnosis and better prevention of dyslipidemia in China.
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Affiliation(s)
- Qi Wang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Junjie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenqing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jing Liu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaolin Guo
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jing Kang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaolin Li
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yongjun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, 110001, People's Republic of China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
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20
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Hattingh Z, Walsh C, Veldman F, Bester C. The metabolic profiles of HIV-infected and non-infected women in Mangaung, South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2009.11734213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Haser GC, Sumpio B. Systemic and cell-specific mechanisms of vasculopathy induced by human immunodeficiency virus and highly active antiretroviral therapy. J Vasc Surg 2016; 65:849-859. [PMID: 26994951 DOI: 10.1016/j.jvs.2016.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Patients infected with human immunodeficiency virus (HIV) have higher rates of dyslipidemia, atherosclerosis, and chronic inflammation that can damage the vascular system compared with the general population. This can be attributed both to HIV itself and to highly active antiretroviral therapy (HAART) they receive. This review outlines the mechanisms by which HIV and HIV medications can cause vascular complications and identifies strategic areas of research to treat these dysfunctions. REVIEW HIV and HAART affect the vascular system through several mechanisms that target systemic or metabolic systems and specific cells. HIV causes dyslipidemia and chronic immune activation, which can contribute to atherosclerosis. In addition, HIV damages macrophages, endothelial cells, smooth muscle cells, and platelets, and this damage also plays a role in the development of atherosclerosis. HAART, particularly protease inhibitors, interferes with cholesterol metabolism and can affect macrophages, endothelial cells, and smooth muscle cells. The metabolic changes and cell damage induced by HIV and HAART put HIV patients at increased risk for atherosclerosis, dyslipidemia, and serious cardiovascular events such as myocardial infarction and stroke. CONCLUSIONS HIV patients have increased risk of developing potentially life-threatening cardiovascular pathology, which cannot be explained by traditional cardiovascular risk factors alone. More research is needed into therapies to target this HIV-specific vasculopathy.
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Affiliation(s)
- Grace C Haser
- Department of Vascular Surgery, Yale School of Medicine, New Haven, Conn
| | - Bauer Sumpio
- Department of Vascular Surgery, Yale School of Medicine, New Haven, Conn.
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22
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Lv YB, Yin ZX, Chei CL, Brasher MS, Zhang J, Kraus VB, Qian F, Shi XM, Matchar DB, Zeng Y. Serum cholesterol levels within the high normal range are associated with better cognitive performance among Chinese elderly. J Nutr Health Aging 2016; 20:280-7. [PMID: 26892577 DOI: 10.1007/s12603-016-0701-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Y-B Lv
- Dr. Xiaoming Shi, No. 7 Pan Jia Yuan Nan Li, Chaoyang District, Beijing 100021, China. Telephone: (+86) 1050930101, Fax:(+86)1050930115, E-mail:
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23
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Kato H, Ohata A, Samukawa S, Ueda A, Ishigatsubo Y. Effect of adiponectin-encoding gene ADIPOQ single nucleotide polymorphisms +45 and +276 on serum lipid levels after antiretroviral therapy in Japanese patients with HIV-1-infection. J Int Med Res 2016; 44:297-306. [PMID: 26831403 PMCID: PMC5580050 DOI: 10.1177/0300060515621444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/13/2015] [Indexed: 12/28/2022] Open
Abstract
Objectives To investigate the association between single nucleotide polymorphisms (SNPs) in the adiponectin-encoding gene ADIPOQ and changes in serum lipid levels in HIV-1-infected patients after antiretroviral therapy (ART). Methods ART-naïve HIV-1-infected patients were recruited to this prospective analysis. SNP +45 and SNP +276 genotype was determined by direct sequencing. Multivariate linear regression analysis was performed to analyse the effects of genotype, and predisposing conditions on serum total cholesterol and triglyceride in the 4 months before and after ART initiation. Results The study enrolled 78 patients with HIV-1-infection (73 male, five female; age range 22–67 years). HIV-1 viral load ≥5 log10 copies/ml, baseline total cholesterol ≥160 mg/dl, and CD4+ lymphocyte count <200/µl were associated with increased serum total cholesterol levels after ART initiation. Protease inhibitor treatment and body mass index ≥25 kg/m2 were associated with increased triglyceride levels after ART initiation. There were no significant associations between SNP +45 or SNP +276 genotype and serum total cholesterol or triglyceride levels. Conclusions SNP +45 and SNP +276 genotype is not associated with changes in serum total cholesterol or triglyceride levels after ART initiation.
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Affiliation(s)
- Hideaki Kato
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan Infection Control Department, Yokohama City University Medical Centre, Minami-ku, Yokohama, Japan
| | - Aya Ohata
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Sei Samukawa
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Atsuhisa Ueda
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Yoshiaki Ishigatsubo
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
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24
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Fichtenbaum CJ. Coronary Heart Disease Risk, Dyslipidemia, and Management in HIV-Infected Persons. HIV CLINICAL TRIALS 2015; 5:416-33. [PMID: 15682355 DOI: 10.1310/p07m-hnt8-l08g-5tku] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Dyslipidemia and coronary heart disease (CHD) are of increasing concern in persons with human immunodeficiency virus (HIV) infection who are living longer because of the benefits of highly active antiretroviral therapy (HAART). All classes of drugs used in HAART have been associated with atherogenic changes in lipid profiles. The management of HIV-infected persons with dyslipidemia and/or CHD currently emphasizes the importance of monitoring and optimizing lipid levels through lifestyle changes, switching antiretrovirals (ARVs), and lipid-lowering treatments utilizing guidelines developed for persons without HIV infection. In HIV-infected persons, the use of lipid-lowering drugs may result in pharmacokinetic interactions with ARVs, complicating the management of patients. Recent advances in our understanding of the differential effects of specific ARVs on lipids is beginning to alter the clinical approach to management. In the absence of randomized clinical trials, clinicians should aggressively treat atherogenic dyslipidemia by primarily utilizing or switching to ARVs with the lowest potential to induce CHD or, when this is not possible or is ineffective, secondarily by the addition of lipid-lowering therapy. The current optimal management of HIV infection requires careful selection of ARVs with consideration given to the potential development of CHD and an understanding of how to manage dyslipidemia.
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Affiliation(s)
- Carl J Fichtenbaum
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0405, USA.
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25
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El Khoury P, Ghislain M, Villard EF, Le Goff W, Lascoux-Combe C, Yeni P, Meyer L, Vigouroux C, Goujard C, Guerin M. Plasma cholesterol efflux capacity from human THP-1 macrophages is reduced in HIV-infected patients: impact of HAART. J Lipid Res 2015; 56:692-702. [PMID: 25573889 DOI: 10.1194/jlr.m054510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The capacity of HDL to remove cholesterol from macrophages is inversely associated with the severity of angiographic coronary artery disease. The effect of human immunodeficiency virus (HIV) infection or its treatment on the ability of HDL particles to stimulate cholesterol efflux from human macrophages has never been studied. We evaluated the capacity of whole plasma and isolated HDL particles from HIV-infected subjects (n = 231) and uninfected controls (n = 200), as well as in a subset of 41 HIV subjects receiving highly active antiretroviral therapy (HAART) to mediate cholesterol efflux from human macrophages. Plasma cholesterol efflux capacity was reduced (-12%; P = 0.001) in HIV patients as compared with controls. HIV infection reduced by 27% (P < 0.05) the capacity of HDL subfractions to promote cholesterol efflux from macrophages. We observed a reduced ABCA1-dependent efflux capacity of plasma (-27%; P < 0.0001) from HIV-infected subjects as a result of a reduction in the efflux capacity of HDL3 particles. HAART administration restored the capacity of plasma from HIV patients to stimulate cholesterol efflux from human macrophages (9.4%; P = 0.04). During HIV infection, the capacity of whole plasma to remove cholesterol from macrophages is reduced, thus potentially contributing to the increased coronary heart disease in the HIV population. HAART administration restored the removal of cholesterol from macrophages by increasing HDL functionality.
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Affiliation(s)
- Petra El Khoury
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS1166, Hôpital de la Pitié, Paris, France; Sorbonne Universités, UMPC Univ Paris 6, Paris, France; Université Saint Joseph, Faculté de pharmacie, Beyrouth, Liban
| | - Mathilde Ghislain
- INSERM, UMRS 1018, CESP, Le Kremlin-Bicêtre, France; Service d'Epidémiologie et de Santé Publique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Elise F Villard
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS1166, Hôpital de la Pitié, Paris, France; Sorbonne Universités, UMPC Univ Paris 6, Paris, France
| | - Wilfried Le Goff
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS1166, Hôpital de la Pitié, Paris, France; Sorbonne Universités, UMPC Univ Paris 6, Paris, France; ICAN Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié, Paris, France
| | | | - Patrick Yeni
- Service de Maladies Infectieuses, Hôpital Bichat, AP-HP, Paris, France
| | - Laurence Meyer
- INSERM, UMRS 1018, CESP, Le Kremlin-Bicêtre, France; Service d'Epidémiologie et de Santé Publique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France; Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Corinne Vigouroux
- Sorbonne Universités, UMPC Univ Paris 6, Paris, France; ICAN Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Laboratoire de Biologie et Génétique Moléculaires, Paris, France; INSERM UMRS938, Centre de recherche Saint-Antoine, Paris, France
| | - Cécile Goujard
- INSERM, UMRS 1018, CESP, Le Kremlin-Bicêtre, France; Université Paris-Sud, Le Kremlin-Bicêtre, France; Service de Médecine Interne, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Maryse Guerin
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS1166, Hôpital de la Pitié, Paris, France; Sorbonne Universités, UMPC Univ Paris 6, Paris, France; ICAN Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié, Paris, France.
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Baril JG, Kovacs CM, Trottier S, Roederer G, Martel AY, Ackad N, Koulis T, Sampalis JS. Effectiveness and Tolerability of Oral Administration of Low-Dose Salmon Oil to HIV Patients with HAART-Associated Dyslipidemia. HIV CLINICAL TRIALS 2015; 8:400-11. [DOI: 10.1310/hct0806-400] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
During infection significant alterations in lipid metabolism and lipoprotein composition occur. Triglyceride and VLDL cholesterol levels increase, while reduced HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) levels are observed. More importantly, endotoxemia modulates HDL composition and size: phospholipids are reduced as well as apolipoprotein (apo) A-I, while serum amyloid A (SAA) and secretory phospholipase A2 (sPLA2) dramatically increase, and, although the total HDL particle number does not change, a significant decrease in the number of small- and medium-size particles is observed. Low HDL-C levels inversely correlate with the severity of septic disease and associate with an exaggerated systemic inflammatory response. HDL, as well as other plasma lipoproteins, can bind and neutralize Gram-negative bacterial lipopolysaccharide (LPS) and Gram-positive bacterial lipoteichoic acid (LTA), thus favoring the clearance of these products. HDLs are emerging also as a relevant player during parasitic infections, and a specific component of HDL, namely, apoL-1, confers innate immunity against trypanosome by favoring lysosomal swelling which kills the parasite. During virus infections, proteins associated with the modulation of cholesterol bioavailability in the lipid rafts such as ABCA1 and SR-BI have been shown to favor virus entry into the cells. Pharmacological studies support the benefit of recombinant HDL or apoA-I mimetics during bacterial infection, while apoL-1-nanobody complexes were tested for trypanosome infection. Finally, SR-BI antagonism represents a novel and forefront approach interfering with hepatitis C virus entry which is currently tested in clinical studies. From the coming years, we have to expect new and compelling observations further linking HDL to innate immunity and infections.
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da Cunha J, Ferreira Maselli LM, Treitinger A, Monteiro AM, Gidlund M, Maranhão RC, Spada C, Bydlowski SP. Serum levels of IgG antibodies against oxidized LDL and atherogenic indices in HIV-1-infected patients treated with protease inhibitors. Clin Chem Lab Med 2014; 51:371-8. [PMID: 23241595 DOI: 10.1515/cclm-2012-0225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 08/20/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Antibodies against low-density lipoproteins (LDLs) that have been oxidized are associated with development of atherosclerotic lesions. In individuals infected with human immunodeficiency virus type 1 (HIV-1) with or without therapy, dyslipidemia and increased cardiovascular risk are observed. METHODS Serum levels of IgG antibodies against oxidized LDLs (IgG anti-oxLDL Abs) were determined by assay in 151 HIV-1-infected patients. Of these, 42 patients did not receive anti-retroviral therapy (ART-naïve), whereas 109 received highly active anti-retroviral therapy (HAART) consisting of lopinavir/ritonavir (LOP/r; n=50), efavirenz (EFV; n=30) and nevirapine (NVP; n=29) associated with nucleoside reverse transcriptase inhibitors. HIV-1 seronegative individuals (n=43) participated in the study. The following parameters were quantified: total cholesterol and its fractions, atherogenic indices (AIs), apolipoproteins A1 and B100, high sensitivity C-reactive protein, CD4+ and CD8+ T cells, and HIV-1-RNA. RESULTS Levels of IgG anti-oxLDL Abs were significantly higher (p<0.05) in the LOP/r group compared with the EFV and/or NVP and the seronegative group: median 0.32 (0.15, 0.58; 95% confidence interval) vs. 0.25 (0.13, 0.53) vs. 0.18 (0.04, 0.38), respectively. HIV-1-infected ART-naïve patients (n=42) presented antibodies levels similar to those observed for the LOP/r group, 0.33 (0.13, 0.63; p>0.05). The levels of IgG anti-oxLDL Abs correlated with an increase in AIs (r=0.216; p=0.036) and triglycerides (r=0.220; p=0.044) in the LOP/r group, and AIs in the ART-naïve group (r=0.300; p=0.046). CONCLUSIONS Patients treated with LOP/r showed higher levels of IgG anti-oxLDL Abs compared with patients treated with EFV or NVP regimens, and these levels were associated with an increase in AIs.
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Affiliation(s)
- Joel da Cunha
- Laboratory of Genetics and Molecular Hematology, University of Sao Paulo Medical School (HCFMUSP), Sao Paulo, Brazil
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Ssinabulya I, Kayima J, Longenecker C, Luwedde M, Semitala F, Kambugu A, Ameda F, Bugeza S, McComsey G, Freers J, Nakanjako D. Subclinical atherosclerosis among HIV-infected adults attending HIV/AIDS care at two large ambulatory HIV clinics in Uganda. PLoS One 2014; 9:e89537. [PMID: 24586854 PMCID: PMC3938501 DOI: 10.1371/journal.pone.0089537] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/22/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The increased immune activation and inflammation of chronic HIV-infection and the characteristic dyslipidemias associated with HIV infection and antiretroviral therapy (ART) contribute to an increased risk of atherosclerotic vascular disease among HIV-infected adults. There is an emerging need to understand determinants of cardiovascular disease (CVD) among individuals aging with HIV in sub-Saharan Africa. We determined the prevalence of subclinical atherosclerosis [carotid intima media thickness (CIMT) ≥ 0.78 mm] and its correlation with traditional CVD risk factors among HIV-infected adults. METHODS In a cross-sectional study, HIV-infected adults (ART-naïve and ART-treated) were consecutively selected from patients' enrollment registers at two large HIV clinics at Mulago Hospital, Kampala, Uganda. We measured traditional CVD risk factors including age, biophysical profile, fasting blood sugar and serum lipid profile as well as biomarkers of inflammation. High resolution ultrasound was used to measure common carotid CIMT. RESULTS Of 245 patients, Median age [Interquartile range (IQR)] 37 years (31-43), 168 (69%) were females; and 100 (41%) were ART-treated for at least 7 years. Overall, 34/186 (18%) had subclinical atherosclerosis; of whom 15/108 (14%) were ART-naïve whereas 19/78 (24%) were ART-treated. Independent predictors of subclinical atherosclerosis included age [odds ratio (OR) 1.83 per 5-year increase in age; 95% confidence interval (CI) 1.24-2.69; p = 0.002], body mass index (BMI); OR 1.15; CI 1.01-1.31; p = 0.041 and high low density lipoprotein (LDL) [OR 2.99; CI 1.02-8.78, p = 0.046]. High sensitivity C-reactive protein (hsCRP) was positively correlated with traditional cardio-metabolic risk factors including waist circumference (r = 0.127, p = 0.05), triglycerides (r = 0.19, p = 0.003) and Total Cholesterol: High Density Lipoprotein ratio (TC:LDL) (r = 0.225, p<0.001). CONCLUSION The prevalence of subclinical atherosclerosis was 18% among HIV-infected adults in Uganda. Traditional CVD risk factors were associated with subclinical atherosclerosis. We recommend routine assessment of traditional CVD risk factors within HIV care and treatment programs in sub-Saharan Africa.
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Affiliation(s)
- Isaac Ssinabulya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - James Kayima
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chris Longenecker
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Mary Luwedde
- Makerere University Joint AIDS program, Kampala, Uganda
| | - Fred Semitala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS program, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Faith Ameda
- Department of Radiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sam Bugeza
- Department of Radiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace McComsey
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Juergen Freers
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Disease Institute, Makerere University, Kampala, Uganda
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Mbunkah HA, Meriki HD, Kukwah AT, Nfor O, Nkuo-Akenji T. Prevalence of metabolic syndrome in human immunodeficiency virus - infected patients from the South-West region of Cameroon, using the adult treatment panel III criteria. Diabetol Metab Syndr 2014; 6:92. [PMID: 25197324 PMCID: PMC4155121 DOI: 10.1186/1758-5996-6-92] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/21/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Several studies have reported that the metabolic syndrome (MS) is more common in subjects with HIV infection than in HIV-negative individuals. HIV infection and the use of Highly Active Antiretroviral Therapy (HAART) have been shown to predispose HIV-infected persons to MS. In this study, we report the prevalence of MS in Cameroonian HIV-infected subjects receiving different combinations of HAART as well as HIV patients who have never received antiretroviral drugs. METHODS In this cross-sectional study, 173 treated and untreated HIV-infected out-patients (aged 18-70 years) managed at the Buea and Limbe Regional Hospitals and 50 seronegative individuals (controls) were recruited after obtaining their consent. Ethical approval for this study was obtained from the National Ethics Committee of Cameroon. Metabolic syndrome prevalence was examined using the U.S. National Cholesterol Education Program Adult Treatment Panel III (ATPIII) criteria. Data was analyzed using SPSS® (Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL, USA) version 16. Statistical significance was set at p < 0.05. RESULTS AND DISCUSSION The prevalence of MS among the HIV patients was 15.6% (27/173) and 8% (4/50) among the controls and the difference was significant (p = 0.022). MS was more prevalent in HIV-infected patients on HAART than in ART-naive patients and seronegative individuals. Overall, the prevalence of MS was significantly higher (p = 0.003) in females (28/153; 18.3%) than in males (3/70; 4.3%). The patients on first-line drugs demonstrated the highest MS prevalence (15/62; 24.2%) followed by the ART-naïve group of patients (7/61; 11.5%) and the lowest prevalence was among the patients on protease inhibitors (5/50; 10%). Patients on the drug combination Lamivudine/Stavudine/Nevirapine had the highest prevalence of MS (50%). CONCLUSIONS In this study, HAART but not HIV disease plays a significant role in the development of MS. The metabolic complications as a result of treatment with HAART may predispose HIV patients to developing cardiovascular diseases and diabetes, in spite of improvements in morbidity and mortality conferred by immune reconstitution as a result of HAART treatment.
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Affiliation(s)
| | - Henry Dilonga Meriki
- />Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- />Buea Regional Hospital, Buea, Cameroon
| | - Anthony Tufon Kukwah
- />Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- />Buea Regional Hospital, Buea, Cameroon
| | - Omarine Nfor
- />Department of Medical Laboratory Science, University of Bamenda, Bamenda, Cameroon
| | - Theresa Nkuo-Akenji
- />Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- />Faculty of Science Clinical Diagnostic Laboratory, University of Buea, P.O. Box 63, Buea, Cameroon
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Tripathi A, Jerrell JM, Liese AD, Zhang J, Rizvi AA, Albrecht H, Duffus WA. Association of clinical and therapeutic factors with incident dyslipidemia in a cohort of human immunodeficiency virus-infected and non-infected adults: 1994-2011. Metab Syndr Relat Disord 2013; 11:417-26. [PMID: 23909647 DOI: 10.1089/met.2013.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the incidence rate of dyslipidemia in a retrospective cohort of human immunodeficiency virus (HIV)-infected and non-HIV-infected adults and to evaluate the association of incident dyslipidemia with exposure to combination antiretroviral therapy (cART). METHODS The study cohort included HIV-infected individuals and a matched group of non-HIV-infected individuals served through the South Carolina Medicaid database in 1994-2011. Linkage with the HIV/AIDS surveillance database provided time-varying viro-immunological status. Time-dependent proportional hazards analysis and marginal structural models were used to assess the demographic, therapeutic, and clinical factors associated with incident dyslipidemia. RESULTS Among 13,632 adults with a median age of 39 years, the overall incidence rate per 1000 person years of dyslipidemia was higher in cART-treated compared to cART-naïve and matched non-HIV groups (24.55 vs. 14.32 vs. 23.23, respectively). Multivariable results suggested a significantly higher risk of dyslipidemia in the cART-treated HIV-infected group [adjusted hazard ratio (aHR)=1.18; 95% confidence interval (CI)=1.07-1.30] and a significantly lower risk in the cART naïve HIV-infected group (aHR=0.66; CI=0.53-0.82) compared to the control non-HIV-infected group. Marginal structural modeling suggested a significant association between incident dyslipidemia and exposure to both protease inhibitor- [adjusted rate ratio (aRR)=1.27; CI=1.08-1.49] and non-nucleoside reverse transcriptase inhibitor- (aRR=1.78; CI=1.19-2.66) based cART regimens. Pre-existing hypertension, obesity, and diabetes increased the risk of dyslipidemia, whereas hepatitis C virus, lower CD4(+) T cell count, and higher HIV viral load had a protective effect. CONCLUSIONS Incident dyslipidemia is lower in the early stages of HIV infection, but may significantly increase with cumulative exposure to cART. Viro-immunological status and underlying comorbidities have a strong association with the onset of dyslipidemia.
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Affiliation(s)
- Avnish Tripathi
- 1 Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine , Jackson, Mississippi
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Nicholaou MJ, Martinson JJ, Abraham AG, Brown TT, Hussain SK, Wolinsky SM, Kingsley LA. HAART-associated dyslipidemia varies by biogeographical ancestry in the multicenter AIDS cohort study. AIDS Res Hum Retroviruses 2013; 29:871-9. [PMID: 23343448 DOI: 10.1089/aid.2012.0169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Highly active antiretroviral therapy (HAART) has been successful in delaying the progression to AIDS in HIV-1-infected individuals. Exposure to HAART can result in metabolic side effects, such as dyslipidemia, in a subset of recipients. Longitudinal data and frozen peripheral blood mononuclear cell pellets were obtained from 1,945 men enrolled in the Multicenter AIDS Cohort. Individuals were genotyped for ancestry informative markers (AIMs) and stratified by biogeographical ancestry (BGA). Then serum levels of total cholesterol (TCHOL), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TRIG) were examined controlling for a number of HIV and HAART-related covariates using multivariate mixed-effects linear regression. HIV-1 infection, in the absence of HAART, was associated with altered lipid levels for all phenotypes tested when compared to HIV-negative men. HIV-1-infected men receiving HAART also had significantly different lipid levels compared to HIV-negative men, except for LDL-C. There were statistically significant interactions between BGA and HIV/HAART status for all lipids tested. BGA remained significantly associated with lipid levels after controlling for other HIV and HAART-related covariates. There was low concordance between self-reported race (SRR) and BGA in admixed populations. BGA performed better than SRR in our statistical models. Lipid profiles in untreated HIV-1-positive men and HIV-1-positive men receiving HAART differ from HIV-negative men and this effect varies by BGA. BGA performed better in our statistical analysis as a racial classifier but SRR remains a good clinical surrogate for BGA.
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Affiliation(s)
- Matthew J. Nicholaou
- Graduate School of Public Health, Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Medical Laboratory Sciences, Weber State University, Ogden, Utah
| | - Jeremy J. Martinson
- Graduate School of Public Health, Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison G. Abraham
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Todd T. Brown
- Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Shehnaz K. Hussain
- School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California
| | - Steven M. Wolinsky
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Lawrence A. Kingsley
- Graduate School of Public Health, Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Cassol E, Misra V, Holman A, Kamat A, Morgello S, Gabuzda D. Plasma metabolomics identifies lipid abnormalities linked to markers of inflammation, microbial translocation, and hepatic function in HIV patients receiving protease inhibitors. BMC Infect Dis 2013; 13:203. [PMID: 23641933 PMCID: PMC3655873 DOI: 10.1186/1471-2334-13-203] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/25/2013] [Indexed: 02/06/2023] Open
Abstract
Background Metabolic abnormalities are common in HIV-infected individuals on antiretroviral therapy (ART), but the biochemical details and underlying mechanisms of these disorders have not been defined. Methods Untargeted metabolomic profiling of plasma was performed for 32 HIV patients with low nadir CD4 counts (<300 cells/ul) on protease inhibitor (PI)-based ART and 20 healthy controls using liquid or gas chromatography and mass spectrometry. Effects of Hepatitis C (HCV) co-infection and relationships between altered lipid metabolites and markers of inflammation, microbial translocation, and hepatic function were examined. Unsupervised hierarchical clustering, principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), Random forest, pathway mapping, and metabolite set enrichment analysis (MSEA) were performed using dChip, Metaboanalyst, and MSEA software. Results A 35-metabolite signature mapping to lipid, amino acid, and nucleotide metabolism distinguished HIV patients with advanced disease on PI-based ART from controls regardless of HCV serostatus (p<0.05, false discovery rate (FDR)<0.1). Many altered lipids, including bile acids, sulfated steroids, polyunsaturated fatty acids, and eicosanoids, were ligands of nuclear receptors that regulate metabolism and inflammation. Distinct clusters of altered lipids correlated with markers of inflammation (interferon-α and interleukin-6), microbial translocation (lipopolysaccharide (LPS) and LPS-binding protein), and hepatic function (bilirubin) (p<0.05). Lipid alterations showed substantial overlap with those reported in non-alcoholic fatty liver disease (NALFD). Increased bile acids were associated with noninvasive markers of hepatic fibrosis (FIB-4, APRI, and YKL-40) and correlated with acylcarnitines, a marker of mitochondrial dysfunction. Conclusions Lipid alterations in HIV patients receiving PI-based ART are linked to markers of inflammation, microbial translocation, and hepatic function, suggesting that therapeutic strategies attenuating dysregulated innate immune activation and hepatic dysfunction may be beneficial for prevention and treatment of metabolic disorders in HIV patients.
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Affiliation(s)
- Edana Cassol
- Department of Cancer Immunology and AIDS, Dana-Farber Cancer Institute, Boston, MA 02215, USA
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Jarrett OD, Wanke CA, Ruthazer R, Bica I, Isaac R, Knox TA. Metabolic syndrome predicts all-cause mortality in persons with human immunodeficiency virus. AIDS Patient Care STDS 2013; 27:266-71. [PMID: 23651103 DOI: 10.1089/apc.2012.0402] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We examined the association between metabolic syndrome (MS) and its individual defining criteria on all-cause mortality in human immunodeficiency virus (HIV)-infected persons. We used data from 567 HIV-infected participants of the Nutrition for Healthy Living study with study visits between 9/1/2000 and 1/31/2004 and determined mortality through 12/31/2006. MS was defined using modified National Cholesterol Education Program guidelines. Cox proportional hazards for all-cause mortality were estimated for baseline MS status and for its individual defining criteria. There were 83 deaths with median follow-up of 63 months. Baseline characteristics associated with increased risk of mortality were: older age in years (univariate hazard ratio [HR] 1.04, p<0.01), current smoking (HR 1.99, p=0.02), current heroin use (HR 1.97, p=0.02), living in poverty (HR 2.0, p<0.01), higher mean HIV viral load (HR 1.81, p<0.01), and having a BMI <18 (HR 5.84, p<0.01). For MS and its criteria, only low HDL was associated with increased risk of mortality on univariate analysis (HR 1.84, p=0.01). However, metabolic syndrome (adjusted HR 2.31, p=0.02) and high triglycerides (adjusted HR 3.97, p<0.01) were significantly associated with mortality beyond 36 months follow-up. MS, low HDL, and high triglycerides are associated with an increased risk of mortality in HIV-infected individuals.
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Affiliation(s)
- Olamide D. Jarrett
- Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois
| | - Christine A. Wanke
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Nutrition/Infection Unit, Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Robin Ruthazer
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Ioana Bica
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Rita Isaac
- RUHSA Department, Christian Medical College, Vellore, India
| | - Tamsin A. Knox
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Nutrition/Infection Unit, Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts
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Denue BA, Alkali MB, Abjah AU, Kida IM, Ajayi B, Fate BZ. Changes in Lipid Profiles and Other Biochemical Parameters in HIV-1 Infected Patients Newly Commenced on HAART Regimen. Infect Dis (Lond) 2013; 6:7-14. [PMID: 24847172 PMCID: PMC3988620 DOI: 10.4137/idrt.s10044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abnormalities of lipid metabolism are common in human immunodeficiency virus (HIV)-infected patients and tend to be accentuated in those receiving antiretroviral therapy, particularly with protease inhibitors (PIs). However, there is a dearth of information on serum lipid profiles and biochemical parameters among treatment-naive HIV-positive patients in our environment. We found that after 24 months of highly active antiretroviral therapy (HAART), there was a significant increase in serum lipids. After 24 months of HAART, renal impairment was associated with a low increase in mean HDL and a high increase in triglycerides (TG). In conclusion, abnormality of serum lipid is common and showed female preponderance among treatment-naive HIV patients in our environment. Patients with HIV infection on HAART should be screened for lipid disorders given their high prevalence as observed in this study, because of its potential for morbidity and mortality in patients on HAART.
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Affiliation(s)
- Ballah Akawu Denue
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Borno state, Nigeria
| | - Mohammed Bashir Alkali
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Borno state, Nigeria
| | - Ali Usman Abjah
- Department of Haematology, University of Maiduguri Teaching Hospital, Maiduguri, Borno state, Nigeria
| | - Ibrahim Musa Kida
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Borno state, Nigeria
| | - Babajide Ajayi
- Department of Immunology, University of Maiduguri Teaching Hospital, Maiduguri, Borno state, Nigeria
| | - Bala Zira Fate
- Department of Physiology, University of Maiduguri Teaching Hospital, Maiduguri, Borno state, Nigeria
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Impact of genetic factors on dyslipidemia in HIV-infected patients starting antiretroviral therapy. AIDS 2013; 27:529-38. [PMID: 23262498 DOI: 10.1097/qad.0b013e32835d0da1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The impact of host genetic factors on the incidence of dyslipidemia in antiretroviral-naive HIV patients starting antiretroviral therapy (ART) is not clear. We assessed the role of single nucleotide polymorphisms (SNPs) identified from previous genome-wide association studies adjusting for the contribution of nongenetic factors. METHODS We assessed 192 SNPs in an HIV cohort who started ART (1997-2008) including a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor (NNRTI). Patients had fasting plasma lipids, total cholesterol (T-Chol), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides measured prior to their ART initiation and after 1 year. A logistic regression model was constructed and multiple test was corrected using 10% false discovery rate (FDR). Haplotypes and gene interactions were analysed. RESULTS A total of 727 individuals were successfully genotyped (n = 381_PI-group; n = 346_NNRTI-group). Age and hepatitis C virus (HCV) coinfection were associated with increases and decreases in T-Chol and LDL-C (P < 0.01), respectively. Protease inhibitor containing ART showed an unfavourable association with T-Chol (P < 0.01) and triglycerides (P = 7.4E-4) and NNRTI-containing ART was favourably associated with HDL-C (P < 0.01). Moreover, SNPs in apolipoprotein B (APOB) were associated with an increase of LDL-C [rs10495712 (P = 3.18E-4); rs754524 (P = 1.26E-3)]. Six SNPs in three genes showed an association with a favourable effect on HDL-C levels when ART included NNRTI: ABCA1 (rs4149313, P = 2.97E-4), LIPC (rs1800588, P = 2.13E-3; rs473224, P = 3.06E-4; rs261336, P = 2.23E-3) and CETP (rs173539, P = 2.96E-3; rs3764261, P = 1.52E-3). After 10% FDR correction for multiple testing, one and six SNPs displayed significant associations with LDL-C and HDL-C, respectively. CONCLUSION In HIV-infected patients staring ART, one SNP in APOB was associated with an increase of LDL-C. SNPs in ABCA1/LIPC/CETP were favourably associated with HDL-C when ART included NNRTI. However, an unfavourable effect on T-Chol and triglyceride levels was observed when ART included protease inhibitor. The risk of hypercholesterolaemia increased with age and decreased with HCV coinfection. These findings might help to individualize the selection of ART.
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Daniyam C, Iroezindu M. Lipid Profile of Anti-Retroviral Treatment-Naïve HIV-Infected Patients in Jos, Nigeria. Ann Med Health Sci Res 2013; 3:26-30. [PMID: 23634325 PMCID: PMC3634219 DOI: 10.4103/2141-9248.109468] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection and its treatment are associated with lipid abnormalities. Data on lipid profile of treatment-naïve HIV-infected patients in Nigeria are limited, and available studies did not exclude the role of major host-related risk factors for dyslipidemia. AIM We assessed the lipid profile of normotensive, non-diabetic, and non-obese treatment-naïve HIV-infected patients to identify their abnormalities in comparison with age- and sex-matched HIV-negative control. SUBJECTS AND METHODS One hundred and six normotensive, non-diabetic, and non-obese HIV positive patients and 98 age-and sex-matched HIV-negative controls had lipid profile estimation in the fasting state. The CD4+ cell count of the HIV-infected patients was also quantified. RESULTS The median (IQR) triglyceride was significantly higher in HIV-positive patients than in the controls [1.75 (1.30-2.40) mmol/L vs. 1.55 (1.30-1.90) mmol/L, P = 0.01]. HIV-positive patients also had significantly lower mean total cholesterol, TC [4.18 (1.04) mmol/L vs. 4.64 (1.01) mmol/L, P = 0.001] and HDL-C [1.17 (0.35) mmol/L vs. 1.29 (0.43) mmol/L, P = 0.03]. The mean LDL-C [2.20 (0.87) mmol/L vs. 2.19 (0.75) mmol/L, P = 0.97] and TC/HDL-C ratio [3.95 (1.42) vs. 3.84 (1.14) mmol/L, P = 0.52] were similar between the HIV-positive patients and controls. The HIV-infected patients had a significantly higher proportion of subjects with low HDL-C [36.8% (39/106) vs. 23.5% (23/98), P = 0.04] and hypertriglyceridemia [31.1% (33/106) vs. 11.2% (11/98), P = 0.001] while the controls had significantly higher proportion of subjects with hypercholesterolemia [22.4% (22/98) vs. 10.4% (11/106), P = 0.02]. Lower HDL-C was associated with CD4+ cell count < 200 cells/μL (P = 0.02). CONCLUSION Lipid abnormalities are common in treatment-naïve HIV-infected patients even in the absence of major host-related risk factors for dyslipidemia. HIV-infected patients should, therefore, be routinely screened for lipid disorders before commencement of anti-retroviral therapy.
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Affiliation(s)
- Ca Daniyam
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
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Pirrone V, Libon DJ, Sell C, Lerner CA, Nonnemacher MR, Wigdahl B. Impact of age on markers of HIV-1 disease. Future Virol 2013; 8:81-101. [PMID: 23596462 PMCID: PMC3625689 DOI: 10.2217/fvl.12.127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aging is a complicated process characterized by a progressive loss of homeostasis, which results in an increased vulnerability to multiple diseases. HIV-1-infected patients demonstrate a premature aging phenotype and develop certain age-related diseases earlier in their lifespan than what is seen in the general population. Age-related comorbidities may include the development of bone disease, metabolic disorders, neurologic impairment and immunosenescence. Age also appears to have an effect on traditional markers of HIV-1 disease progression, including CD4+ T-cell count and viral load. These effects are not only a consequence of HIV-1 infection, but in many cases, are also linked to antiretroviral therapy. This review summarizes the complex interplay between HIV-1 infection and aging, and the impact that aging has on markers of HIV-1 disease.
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Affiliation(s)
- Vanessa Pirrone
- Department of Microbiology & Immunology, Drexel University College of Medicine, 245 N 15th Street, New College Building, Philadelphia, PA 19102, USA
- Drexel University College of Medicine, 245 N 15th Street, New College Building, Philadelphia, PA 19102, USA
| | - David J Libon
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Christian Sell
- Department of Pathology, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Chad A Lerner
- Department of Pathology, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Michael R Nonnemacher
- Department of Microbiology & Immunology, Drexel University College of Medicine, 245 N 15th Street, New College Building, Philadelphia, PA 19102, USA
- Drexel University College of Medicine, 245 N 15th Street, New College Building, Philadelphia, PA 19102, USA
| | - Brian Wigdahl
- Department of Microbiology & Immunology, Drexel University College of Medicine, 245 N 15th Street, New College Building, Philadelphia, PA 19102, USA
- Drexel University College of Medicine, 245 N 15th Street, New College Building, Philadelphia, PA 19102, USA
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Ekali LG, Johnstone LK, Echouffo-Tcheugui JB, Kouanfack C, Dehayem MY, Fezeu L, Nouthe B, Hayes L, Unwin NC, Sobngwi E. Fasting blood glucose and insulin sensitivity are unaffected by HAART duration in Cameroonians receiving first-line antiretroviral treatment. DIABETES & METABOLISM 2012; 39:71-7. [PMID: 23153435 DOI: 10.1016/j.diabet.2012.08.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 08/20/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
AIMS This study assessed the relationship between highly active antiretroviral therapy (HAART) duration and cardiometabolic disorders in HIV-infected Cameroonians. METHODS HIV-infected Cameroonians aged 21 years or above were cross-sectionally recruited at the Yaoundé Central Hospital, a certified HIV care centre, and their anthropometry, body composition (impedancemetry), fasting blood glucose (FBG) and lipid levels, and insulin sensitivity (IS; short insulin tolerance test) were measured. RESULTS A total of 143 participants with various durations of HAART [treatment-naïve (n=28), 1-13 months (n=44), 14-33 months (n=35) and 34-86 months (n=36)] were recruited. They were mostly women (72%), and had a mean age of 39.5 (SD: 9.8) years. Half (52%) were using a stavudine-containing regimen. There was a significant trend towards a positive change in body mass index and waist-to-hip ratio with increasing duration of HAART (all P=0.02). Systolic (P=0.04) and diastolic (P=0.03) blood pressure, total cholesterol (P=0.01), prevalence of hypertension (P=0.04) and hypercholesterolaemia (P=0.007) were also significantly increased with HAART duration, whereas triglycerides, FBG and IS were unaffected. Clustering of metabolic disorders increased (P=0.02 for ≥1 component of the metabolic syndrome and P=0.09 for ≥2 components) with HAART duration. CONCLUSION HAART duration is associated with obesity, fat distribution, blood pressure and cholesterol levels in HIV-infected Cameroonians, but does not appear to significantly affect glucose metabolism.
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Affiliation(s)
- L G Ekali
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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García-Elorriaga G, Rey-Pineda GD. Human immunodeficiency virus, atherosclerosis and Chlamydophila pneumoniae. World J Clin Infect Dis 2012; 2:54-62. [DOI: 10.5495/wjcid.v2.i4.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Chlamydophila pneumoniae (C. pneumoniae) is an obligate, intracellular bacterium associated with a wide variety of acute and chronic diseases. C. pneumoniae infection is characterized by persistence and immunopathological damage to host target tissues, including the lung. Over the past 20 years, a variety of studies have investigated a possible link between C. pneumoniae infection and atherosclerosis, because of its role in all stages of atherosclerosis, from initial inflammatory lesions to plaque rupture. In the current highly active antiretroviral therapy (HAART) era, many human immunodeficiency virus (HIV)-infected patients are experiencing health problems that accompany the aging process, mainly the risk of cardiovascular disease (CVD). There is renewed interest in a link between atherosclerotic CVD and as yet poorly defined environmental exposures, including infectious agents. On the one hand, the patient with HIV and lipodystrophy caused by HAART and exacerbated by C. pneumoniae infection could be a factor of risk for atherosclerosis. An assessment of the therapy against C. pneumoniae and HAART should always be conducted. It is advisable that HIV-acquired immune deficiency syndrome patients undergo a serological test to determine exposure to C. pneumoniae and to assess treatment options. On the other hand, in patients with a positive serology to C. pneumoniae, an increment of the body mass index has been found; therefore, it is probable that the recurrent infection may play an important role in creating adverse endothelial conditions allowing the infection by C. pneumoniae in its chronic form, to damage the endothelial surface. Vascular studies would be necessary for corroboration.
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Protease inhibitor treatment effect on aortic stiffness in normotensive patients with human immunodeficiency virus infection. ACTA ACUST UNITED AC 2012; 37:179-85. [DOI: 10.1016/j.jmv.2012.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
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Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected individuals: a randomized trial. J Am Coll Cardiol 2012; 59:979-88. [PMID: 22402068 DOI: 10.1016/j.jacc.2011.11.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 10/31/2011] [Accepted: 11/30/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the efficacy of dietary intervention on blood lipids of human immunodeficiency virus (HIV)-1-infected patients who are started on highly active antiretroviral therapy (HAART). BACKGROUND Current guidelines recommend diet as first-step intervention for HIV-1-infected individuals with HAART-related dyslipidemia, but there is no evidence from randomized trials to support this recommendation. METHODS Eighty-three HIV-1-infected patients, naive from HAART, were randomly assigned to HAART with dietary intervention (diet group, n = 43) or HAART without dietary intervention (control group, n = 40) for 12 months. Diet, according to the National Cholesterol Education Program, was given every 3 months. Before and after intervention, 24-h food records and lipid profile were obtained. Data were analyzed by intention to treat, using mixed-effects models. RESULTS Diet resulted in reduction of percentage of fat intake (from 31 ± 7% to 21 ± 3% of calories), while controls presented no change in percentage of fat intake. Plasma cholesterol (from 151 ± 29 mg/dl to 190 ± 33 mg/dl) and low-density lipoprotein cholesterol (from 85 ± 24 mg/dl to 106 ± 31 mg/dl) increased in the control group and were unchanged in the diet group. Plasma triglycerides were reduced by diet (from 135 ± 67 mg/dl to 101 ± 42 mg/dl) and increased in the control group (from 134 ± 70 mg/dl to 160 ± 76 mg/dl). After 1-year follow-up, 21% of patients who received diet had lipid profile compatible with dyslipidemia compared with 68% (p < 0.001) of controls. CONCLUSIONS Among HIV-1-positive individuals naive of previous treatment, diet prevents dyslipidemia associated with HAART. (Effect of Nutritional Intervention on the Lipid Profile of HIV-Positive Patients Who Start HAART: a Randomized Trial; NCT00429845).
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Malnutrition in a population of HIV-positive and HIV-negative drug users living in Chennai, South India. Drug Alcohol Depend 2011; 118:73-7. [PMID: 21420798 PMCID: PMC3130882 DOI: 10.1016/j.drugalcdep.2011.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 02/23/2011] [Accepted: 02/23/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Malnutrition is a strong predictor of poor outcomes in people living with HIV (PLHIV). Drug users are at increased risk of malnutrition regardless of whether or not they are infected with HIV. Little data exists on the nutritional status of drug users (with or without HIV infection) in India. METHODS We describe and compare the nutrition and metabolic status of 107 HIV-positive and 193 HIV-negative male clients of a community-based drop-in center for injection drug users in Chennai, India. Measures of nutrition and metabolic status include body composition, dietary intake, food insecurity, and serum lipid levels. RESULTS We found poor overall nutritional status in both the HIV-positive and HIV-negative clients, with HIV-positive men faring worse on some parameters. Both groups had extremely low percent body fat, but levels in HIV-positive participants were significantly lower (6.5% versus 7.9%, p=.01). HIV-positive men also had significantly lower total caloric and fat intakes compared to HIV-negative men. A considerable proportion (70%) of both HIV-positive and HIV-negative drug users were food insecure. HDL cholesterol levels were significantly lower and below normal range in the HIV-positive compared to HIV-negative men. CONCLUSIONS The high levels of food insecurity and poor nutritional status in this population, regardless of HIV status, indicates critical need for intervention. Improving nutritional status in those who are infected with HIV prior to initiation of antiretroviral treatment may help patients to reap the full benefits of therapy.
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Armstrong C, Liu E, Okuma J, Spiegelman D, Guerino C, Njelekela M, Grinspoon S, Fawzi W, Hawkins C. Dyslipidemia in an HIV-positive antiretroviral treatment-naive population in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr 2011; 57:141-5. [PMID: 21436713 PMCID: PMC3125454 DOI: 10.1097/qai.0b013e318219a3d1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Limited data are available on dyslipidemia in HIV-infected patients in resource-limited settings. We performed a cross-sectional analysis in antiretroviral therapy (ART)-naive, non-fasting HIV-infected patients in Tanzania between November 2004 to June 2008. Robust linear regression modeling was performed. Lipid parameters were assessed in 12,513 patients [65% women; median (interquartile range) age, 36 (30-42) years; CD4 count, 143 (51-290) cells/mm]. Low high-density lipoprotein was prevalent in 67% and increased triglyceride in 28%. High triglyceride and low high-density lipoprotein levels were associated with low CD4 counts (P < 0.001). In this ART-naive Tanzanian population, dyslipidemia was highly prevalent and associated with advanced disease. The impact of ART on these changes requires further exploration.
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Feeney ER, Mallon PWG. HIV and HAART-Associated Dyslipidemia. Open Cardiovasc Med J 2011; 5:49-63. [PMID: 21643501 PMCID: PMC3106351 DOI: 10.2174/1874192401105010049] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 01/01/2011] [Accepted: 01/06/2011] [Indexed: 01/09/2023] Open
Abstract
Effective highly active antiretroviral therapy (HAART) for human immunodeficiency virus-1 (HIV) infection has led to marked improvement in life-expectancy for those infected with HIV. Despite reductions in the incidence of AIDS with effective treatment, patients continue to experience considerable morbidity and mortality from non-AIDS illness such as premature cardiovascular disease, liver failure and renal failure. These morbidities, particularly premature cardiovascular disease, are thought to be related to a combination of the effects of an ageing HIV-infected population coupled with long-term effects of HIV infection and antiretroviral therapy (ART). One of the principle drivers behind the well documented increase in the risk of cardiovascular disease in HIV-infected patients is dyslipidemia. This review will focus on the clinical presentation of HIV and ART-associated dyslipidemia, what is known of its patho-physiology, including associations with use of specific antiretroviral medications, and suggest screening and management strategies.
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Affiliation(s)
- Eoin R Feeney
- HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Impact of NRTIs on lipid levels among a large HIV-infected cohort initiating antiretroviral therapy in clinical care. AIDS 2011; 25:185-95. [PMID: 21150555 DOI: 10.1097/qad.0b013e328341f925] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE to assess the associations between nucleoside reverse transcriptase inhibitors (NRTIs) and change in lipid levels among a large cohort of HIV-infected patients in routine clinical care initiating their first potent antiretroviral regimen. DESIGN longitudinal observational cohort study from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. METHODS we used generalized estimating equations to examine the association between NRTIs and lipids accounting for within-patient correlations between repeated measures and key clinical and demographic characteristics including other antiretroviral medications. RESULTS among 2267 individuals who started their first antiretroviral regimen, tenofovir with emtricitabine or lamivudine was associated with lower levels for total cholesterol, low-density lipoprotein (LDL), triglycerides, non-high-density lipoprotein (HDL), and HDL, compared with other NRTI pairs in adjusted analyses. LDL levels were highest among patients receiving didanosine/lamivudine. Triglyceride levels were highest in stavudine/lamivudine users. HDL levels were highest among patients receiving didanosine/stavudine. Hepatitis C infection and younger age were also associated with lower lipid levels. CONCLUSION we found clinically important heterogeneity within the NRTI class of antiretroviral medications regarding their effect on lipid levels over time. Although the lipid profile of tenofovir with emtricitabine or lamivudine appeared to be less pro-atherogenic in this large longitudinal study of HIV-infected patients in routine clinical care, there was no association with beneficial HDL levels. In general, the change in lipid levels associated with most antiretroviral agents, particularly those NRTI combinations currently in common use, are relatively modest. Additional studies are needed to understand the long-term implications of these findings on cardiovascular disease risk.
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Wilk A, Urbanska K, Yang S, Wang JY, Amini S, Del Valle L, Peruzzi F, Meggs L, Reiss K. Insulin-like growth factor-I-forkhead box O transcription factor 3a counteracts high glucose/tumor necrosis factor-α-mediated neuronal damage: implications for human immunodeficiency virus encephalitis. J Neurosci Res 2010; 89:183-98. [PMID: 21162126 DOI: 10.1002/jnr.22542] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/29/2010] [Accepted: 10/04/2010] [Indexed: 12/17/2022]
Abstract
In HIV patients, antiretroviral medications trigger metabolic abnormalities, including insulin resistance. In addition, the inflammatory cytokine tumor necrosis factor-α (TNFα), which is elevated in human immunodeficiency virus encephalitis (HIVE), also induces insulin resistance and inflicts neuronal damage in vitro. In differentiated PC12 cells and rat cortical neurons, high glucose (HG; 25 mM) triggers reactive oxygen species (ROS) accumulation, contributing to the retraction of neuronal processes, with only a minimal involvement of neuronal apoptosis. In the presence of TNFα, HG-treated neurons undergo massive apoptosis. Because mammalian homolog of the Forkhead family of transcription factors, Forkhead box O transcription factor 3a (FOXO3a), controls ROS metabolism, we asked whether FOXO3a could affect the fate of differentiated neurons in the paradigm of HIVE. We observed FOXO3a nuclear translocation in HG-treated neuronal cultures, accompanied by partial loss of mitochondrial potential and gradual retraction of neuronal processes. Addition of TNFα to HG-treated neurons increased expression of the FOXO-dependent proapoptotic gene Bim, which resulted in extensive apoptotic death. Insulin-like growth factor-I (IGF-I) significantly lowered intracellular ROS, which was accompanied by IGF-I-mediated FOXO3a nuclear export and decrease in its transcriptional activity. The clinical relevance of these findings is supported by detection of nuclear FOXO3a in TUNEL-positive cortical neurons from HIVE, especially in brain areas characterized by elevated TNFα.
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Affiliation(s)
- Anna Wilk
- Neurological Cancer Research, Stanley S. Scott Cancer Center, LSU Health Sciences Center, New Orleans, Louisianna 70112, USA
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Samineni D, Fichtenbaum CJ. Fenofibrate in the treatment of dyslipidemia associated with HIV infection. Expert Opin Drug Metab Toxicol 2010; 6:995-1004. [PMID: 20604734 DOI: 10.1517/17425255.2010.504715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE TO THE FIELD Dyslipidemia is common among HIV-infected patients receiving antiretroviral therapy. A higher risk of coronary heart disease (CHD) is associated with specific antiretroviral medications. The aging of HIV infected people and the intersection of other CHD risk factors have led to the need for developing effective interventions to lower the risk of CHD events. AREAS COVERED IN THIS REVIEW The authors review current literature on the use of fenofibrate and related derivatives in HIV-infected people with dyslipidemia using antiretroviral therapy. WHAT THE READER WILL GAIN Fibrates have been demonstrated to reduce the risk of CHD events in HIV seronegative individuals with mixed results on survival benefits. There are no published studies of CHD outcomes using fibrates in people with HIV infection. Several studies conducted in HIV infected people demonstrate the ability of fenofibrate to lower triglycerides and increase high-density lipoprotein cholesterol levels with few adverse events. The authors review the pharmacology and clinical efficacy/safety of the use of fenofibrate in people with HIV infection. TAKE HOME MESSAGE Fenofibrate is a generally safe and useful agent for the treatment of mixed dyslipidemia and hypertriglyceridemia in people with HIV infection though limited data are available particularly on clinical outcomes.
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Anastos K, Ndamage F, Lu D, Cohen MH, Shi Q, Lazar J, Bigirimana V, Mutimura E. Lipoprotein levels and cardiovascular risk in HIV-infected and uninfected Rwandan women. AIDS Res Ther 2010; 7:34. [PMID: 20796311 PMCID: PMC2940781 DOI: 10.1186/1742-6405-7-34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 08/26/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lipoprotein profiles in HIV-infected African women have not been well described. We assessed associations of lipoprotein levels and cardiovascular risk with HIV-infection and CD4 count in Rwandan women. METHODS Cross-sectional study of 824 (218 HIV-negative, 606 HIV+) Rwandan women. Body composition by body impedance analysis, CD4 count, and fasting serum total cholesterol (total-C), triglycerides (TG) and high-density lipoprotein (HDL) levels were measured. Low-density lipoprotein (LDL) was calculated from Friedewald equation if TG < 400 and measured directly if TG ≥ 400 mg/dl. RESULTS BMI was similar in HIV+ and -negative women, < 1% were diabetic, and HIV+ women were younger. In multivariate models LDL was not associated with HIV-serostatus. HDL was lower in HIV+ women (44 vs. 54 mg/dL, p < 0.0001) with no significant difference by CD4 count (p = 0.13). HIV serostatus (p = 0.005) and among HIV+ women lower CD4 count (p = 0.04) were associated with higher TG. BMI was independently associated with higher LDL (p = 0.01), and higher total body fat was strongly associated with higher total-C and LDL. Framingham risk scores were < 2% in both groups. CONCLUSIONS In this cohort of non-obese African women HDL and TG, but not LDL, were adversely associated with HIV infection. As HDL is a strong predictor of cardiovascular (CV) events in women, this HIV-associated difference may confer increased risk for CV disease in HIV-infected women.
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Affiliation(s)
- Kathryn Anastos
- Montefiore Medical Center, Bronx NY, USA
- Albert Einstein College of Medicine, Bronx, NY USA
| | - François Ndamage
- TRAC Plus - Center for Treatment and Research on AIDS, Malaria, Tuberculosis and other Epidemics, Kigali, Rwanda
| | | | - Mardge H Cohen
- Stroger (Cook County) Hospital and Rush University, Chicago, Illinois USA
| | - Qiuhu Shi
- New York Medical College, Valhalla, NY USA
| | - Jason Lazar
- SUNY Downstate Medical Center, Division of Cardiovascular Medicine, Brooklyn NY USA
| | | | - Eugene Mutimura
- Women's Equity in Access to Care and Treatment (WE-ACTx) and Kigali Health Institute, Kigali, Rwanda
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Abstract
Atherosclerosis is a complex inflammatory process that has been identified as an important problem in persons with HIV infection. Epidemiologic studies have linked certain antiretroviral medications (some nucleoside reverse transcriptase inhibitors and protease inhibitors) with a higher risk of coronary heart disease (CHD). Conversely, nonnucleoside reverse transcriptase inhibitors, entry inhibitors, and integrase inhibitors appear neutral. HIV infection is a chronic inflammatory process associated with endothelial dysfunction, atherogenic dyslipidemia, and a higher risk for CHD. Initiation of antiretroviral therapy in the short term appears to lower CHD risk, regardless of the specific agents used. However, adequately powered randomized trials of antiretroviral therapy with CHD as a primary end point are lacking. Thus, the evidence of whether antiretroviral therapy increases or decreases CHD risk in persons with HIV is perplexing. This article reviews the current controversy of the role of HIV and antiretroviral therapy in the development of cardiovascular disease.
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