1
|
Obeagu EI, Obeagu GU. Preventive measures against HIV among Uganda's youth: Strategies, implementation, and effectiveness. Medicine (Baltimore) 2024; 103:e40317. [PMID: 39496029 PMCID: PMC11537624 DOI: 10.1097/md.0000000000040317] [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: 11/25/2023] [Accepted: 10/11/2024] [Indexed: 11/06/2024] Open
Abstract
Preventing HIV among Uganda's youth is a critical public health priority due to the high prevalence of HIV/AIDS and the disproportionate burden of new infections among young people. This paper examines the preventive measures implemented to combat HIV/AIDS among Uganda's youth, focusing on strategies, implementation efforts, and the effectiveness of interventions. Comprehensive sexuality education programs have been implemented in schools and communities to provide young people with accurate information on HIV transmission, prevention methods, and reproductive health. Condom distribution and promotion campaigns target sexually active youth, while HIV testing and counseling services aim to reach youth in various settings, including health facilities and community outreaches. The implementation of HIV prevention strategies involves collaboration among government agencies, NGOs, healthcare providers, educators, and community leaders. Efforts are made to ensure that prevention programs are culturally appropriate, evidence-based, and responsive to the needs of young people. Despite progress in HIV prevention, challenges persist, including knowledge gaps, stigma, gender inequalities, and socio-economic factors. Continuous monitoring and evaluation are essential to assess the impact of interventions and identify areas for improvement. Recommendations include increasing funding for HIV prevention programs, strengthening policy frameworks, enhancing access to youth-friendly health services, integrating comprehensive sexuality education into school curricula, and fostering community engagement. By addressing these recommendations, Uganda can strengthen its HIV prevention efforts and reduce the incidence of HIV/AIDS among its youth population, ultimately contributing to improved health outcomes and well-being.
Collapse
|
2
|
Akpan U, Bateganya M, Toyo O, Nwanja E, Nwangeneh C, Ogheneuzuazo O, Idemudia A, James E, Ogundehin D, Adegboye A, Onyedinachi O, Eyo A. How Hypertension Rates and HIV Treatment Outcomes Compare between Older Females and Males Enrolled in an HIV Treatment Program in Southern Nigeria: A Retrospective Analysis. Trop Med Infect Dis 2023; 8:432. [PMID: 37755892 PMCID: PMC10536592 DOI: 10.3390/tropicalmed8090432] [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: 07/25/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Studies show that treatment outcomes may vary among persons living with HIV. To fast-track the attainment of epidemic control across gender and age groups, the Accelerating Control of the HIV Epidemic (ACE-5) Project implemented in Akwa Ibom and Cross Rivers States, Nigeria, examined the hypertension rates and treatment outcomes of older adults living with HIV. The demographic and treatment characteristics of males and females ≥ 50 years living with HIV, who initiated antiretroviral therapy (ART) as of September 2021, were abstracted from medical records across 154 health facilities and community sites in Akwa Ibom and Cross River states, Nigeria. We compared these characteristics by sex using the chi-square test. The log-rank test was used to compare differences in their retention (i.e., being on treatment) and viral suppression (VS) rates [<1000 copies/Ml] in September 2022. Of the 16,420 older adults living with HIV (10.8% of the treatment cohort) at the time of the study, 53.8%, and 99.5% were on a first-line ART regimen. Among the 3585 with baseline CD4 documented (21.8% of the cohort), the median [IQR] CD4 count was 496 [286-699] cells/mm3, with more males having lower baseline CD4 than females [13.4% of males vs. 10.2% of females, p-value = 0.004]. In total, 59.9% received treatment at out-of-facility locations, with more males receiving treatment in this setting than females [65.7% vs. 54.8% p-value < 0.001]. Of those in whom blood pressure was assessed (65.9% of the treatment cohort), 9.6% were hypertensive, with males being less likely to be hypertensive [8.0% vs. 11.1% p-value < 0.001] than females. Overall, retention as of September 2022 was 96.4%, while VS was 99.0% and did not differ significantly by sex [retention: p = 0.901; VS: p = 0.056]. VS was slightly but not significantly higher among females than males (98.8% versus 99.2%; Aor = 0.79, 95%CI = 0.58-1.10, p = 0.17). Although older males and females living with HIV had similar treatment outcomes, hypertension screening was suboptimal and could impact long-term morbidity and mortality. Our study emphasizes the need to integrate noncommunicable disease screening and the management of hypertension in the care of older persons living with HIV.
Collapse
Affiliation(s)
- Uduak Akpan
- Excellence Community Education Welfare Scheme (ECEWS), Uyo 520101, Nigeria
| | - Moses Bateganya
- Family Health International (FHI 360), Durham, NC 27701, USA
| | - Otoyo Toyo
- Excellence Community Education Welfare Scheme (ECEWS), Uyo 520101, Nigeria
| | - Esther Nwanja
- Excellence Community Education Welfare Scheme (ECEWS), Uyo 520101, Nigeria
| | | | - Onwah Ogheneuzuazo
- Excellence Community Education Welfare Scheme (ECEWS), Uyo 520101, Nigeria
| | | | - Ezekiel James
- US Agency for International Development, Abuja 900211, Nigeria; (E.J.)
| | - Dolapo Ogundehin
- US Agency for International Development, Abuja 900211, Nigeria; (E.J.)
| | - Adeoye Adegboye
- Excellence Community Education Welfare Scheme (ECEWS), Uyo 520101, Nigeria
| | - Okezie Onyedinachi
- Excellence Community Education Welfare Scheme (ECEWS), Uyo 520101, Nigeria
| | - Andy Eyo
- Excellence Community Education Welfare Scheme (ECEWS), Uyo 520101, Nigeria
| |
Collapse
|
3
|
Zhao Y, Li H, Guo Q, Hui H. Multiple characteristic alterations and available therapeutic strategies of cellular senescence. J Zhejiang Univ Sci B 2023; 24:101-114. [PMID: 36751697 PMCID: PMC9936135 DOI: 10.1631/jzus.b2200178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Given its state of stable proliferative inhibition, cellular senescence is primarily depicted as a critical mechanism by which organisms delay the progression of carcinogenesis. Cells undergoing senescence are often associated with the alteration of a series of specific features and functions, such as metabolic shifts, stemness induction, and microenvironment remodeling. However, recent research has revealed more complexity associated with senescence, including adverse effects on both physiological and pathological processes. How organisms evade these harmful consequences and survive has become an urgent research issue. Several therapeutic strategies targeting senescence, including senolytics, senomorphics, immunotherapy, and function restoration, have achieved initial success in certain scenarios. In this review, we describe in detail the characteristic changes associated with cellular senescence and summarize currently available countermeasures.
Collapse
Affiliation(s)
- Yunzi Zhao
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Carcinogenesis and Intervention, China Pharmaceutical University, Nanjing, 210009 China
| | - Hui Li
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Carcinogenesis and Intervention, China Pharmaceutical University, Nanjing, 210009 China
| | - Qinglong Guo
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Carcinogenesis and Intervention, China Pharmaceutical University, Nanjing, 210009 China
| | - Hui Hui
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Carcinogenesis and Intervention, China Pharmaceutical University, Nanjing 210009, China.
| |
Collapse
|
4
|
Cardiometabolic syndrome in HIV-positive and HIV-negative patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: a comparative cohort study. Cardiovasc Endocrinol Metab 2022; 12:e0273. [PMID: 36582667 PMCID: PMC9750611 DOI: 10.1097/xce.0000000000000273] [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: 09/16/2022] [Accepted: 11/10/2022] [Indexed: 12/14/2022]
Abstract
Cardiometabolic syndrome (CMetS) has recently emerged as a serious public health concern, particularly for individuals living with chronic conditions. This study aimed to determine the incidence and prevalence of CMetS, as well as the risk factors linked with it, in HIV-positive and HIV-negative adult patients. Methods A comparative cohort study was designed. The National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) tools were used to determine the outcome variables. Association studies were done using logistic regression. Result CMetS was found to have a greater point and period prevalence, and incidence estimation in HIV-negative than HIV+ patients using both the NCEP and the IDF tools. Using the NCEP tool, the risk of obesity was 44.1% [odds ratio (OR) = 0.559, 95% confidence interval (CI), (0.380-0.824); P = 0.003] lower in HIV+ than in HIV-negative participants. By contrast, no apparent difference was noted using the IDF tool. Similarly, hyperglycemia [OR = 0.651, 95% CI (0.457-0.926); P = 0.017], and hypertension [OR = 0.391, 95% CI (0.271-0.563); P < 0.001] were shown to be lower in HIV+ patients than HIV-negative patients by 34.9% and 60.9%, respectively. The study revealed significant variation in all biomarkers across the follow-up period in both HIV+ and HIV-negative participants, except for SBP. Conclusions CMetS caused more overall disruption in HIV-negative people with chronic diseases than in HIV-positive people. All of the indicators used to assess the increased risk of CMetS were equally meaningful in HIV+ and HIV-negative subjects.
Collapse
|
5
|
Emond B, Rossi C, Côté-Sergent A, Bookhart B, Anderson D, Lefebvre P, Lafeuille MH, Donga P. Body mass index increase and weight gain among people living with HIV-1 initiated on single-tablet darunavir/cobicistat/emtricitabine/tenofovir alafenamide or bictegravir/emtricitabine/tenofovir alafenamide in the United States. Curr Med Res Opin 2022; 38:287-298. [PMID: 34812097 DOI: 10.1080/03007995.2021.2007006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study evaluated body mass index (BMI) and weight changes in people living with human immunodeficiency virus (HIV-1; PLWH) initiated on single-tablet darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/c/FTC/TAF) or bictegravir/FTC/TAF (BIC/FTC/TAF). METHODS Electronic medical record (EMR) data for treatment-naïve or virologically suppressed adults with HIV-1 who initiated treatment with DRV/c/FTC/TAF or BIC/FTC/TAF (index date) were obtained from Decision Resources Group's EMRs (17 July 2017-1 March 2020). Inverse probability of treatment weighting was used to account for differences in baseline characteristics between the two cohorts. BMI and weight changes from pre-index to 3, 6, 9 and 12 months following the index date were compared using weighted mean differences (MDs). The time until an increase in BMI or weight ≥5% or ≥10% was compared using weighted hazard ratios (HRs). RESULTS The weighted DRV/c/FTC/TAF and BIC/FTC/TAF cohorts comprised 1116 and 1134 PLWH, respectively (mean age = ∼49 years, females: ∼28%). Larger increases in BMI and weight from pre-index to each post-index time point were observed in PLWH initiating BIC/FTC/TAF vs DRV/c/FTC/TAF (12 months: MD in BMI = 1.23 kg/m2, p < .001; MD in weight = 2.84 kg [6.26 lbs], p = .008). PLWH receiving BIC/FTC/TAF were significantly more likely to experience weight gain ≥5% (HR = 1.76, p = .004) and ≥10% (HR = 2.01, p = .020), and BMI increase ≥5% (HR = 1.77, p = .004) and ≥10% (HR = 1.76, p = .044) than those receiving DRV/c/FTC/TAF. CONCLUSIONS BIC/FTC/TAF was associated with greater BMI and weight increases compared to DRV/c/FTC/TAF. Weight gain and its sequelae may add to the clinical burden of PLWH and should be considered among other factors when selecting antiretroviral single-tablet regimens.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| |
Collapse
|
6
|
Dakum P, Avong YK, Okuma J, Sorungbe T, Jatau B, Nedmbi N, Odutola MK, Abimiku A, Mensah CO, Kayode GA. Prevalence and risk factors for obesity among elderly patients living with HIV/AIDS in a low-resource setting. Medicine (Baltimore) 2021; 100:e25399. [PMID: 33847636 PMCID: PMC8052014 DOI: 10.1097/md.0000000000025399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 03/14/2021] [Indexed: 01/04/2023] Open
Abstract
Obesity is associated with detrimental changes in cardiovascular and metabolic parameters, including blood pressure, dyslipidemia, markers of systemic inflammation, and insulin resistance. In the elderly living with the human immunodeficiency virus (EPLHIV), and being treated with antiretroviral medications, the obesity complications escalate and expose the elderly to the risk of noncommunicable diseases. Given that over 3 million EPLHIV in sub-Sahara Africa, we assessed the prevalence of obesity and its associated factors among EPLHIV in a low-resource setting.This was a cross sectional study of EPLHIV aged 50 years and older, being treated with antiretroviral medications from 2004 to 2018. HIV treatment data collected from multiple treatment sites were analyzed. Baseline characteristics of the participants were described, and multivariable relative risk model was applied to assess the associations between obesity (body mass index [BMI] ≥30 kg/m2) and the prespecified potential risk factors.Of the 134,652 in HIV cohort, 19,566 (14.5%) were EPLHIV: 12,967 (66.3%) were normal weight (18.5 ≤ BMI < 25), 4548 (23.2%) were overweight (25 ≤ BMI < 30), while 2,051 (10.5%) were obese (BMI ≥30). The average age the normal weight (57.1; standard deviation 6.6) and the obese (56.5; standard deviation 5.5) was similar. We observed that being an employed (relative risk [RR] 1.71; 95% confidence interval [CI] 1.48-2.00; P < .001), educated (RR 1.93; 95% CI 1.54-2.41; P < .001), and presence of hypertension (RR 1.78; 95% CI 1.44-2.20; P < .001), increased the risk of obesity. Also, being male (RR 0.38; 95% CI 0.33-0.44; P < .001), stages III/IV of the World Health Organization clinical stages of HIV (RR 0.58; 95% CI 0.50-0.68; P < .001), tenofovir-based regimen (RR 0.84; 95% CI 0.73-0.96, P < .001), and low CD4 count (RR 0.56; 95% CI 0.44-0.71; P < .001) were inversely associated with obesity.This study demonstrates that multiple factors are driving obesity prevalence in EPLHIV. The study provides vital information for policy-makers and HIV program implementers in implementing targeted-interventions to address obesity in EPLHIV. Its findings would assist in the implementation of a one-stop-shop model for the management of HIV and other comorbid medical conditions in EPLHIV.
Collapse
|
7
|
Dakum P, Avong YK, Odutola MK, Okuma J, Kayode GA, Nta IE, Ndembi N, Mensah C, Khamofu H, Okonkwo P, Okpanachi JO, Ezeanolue E. Cohort profile: the Nigerian HIV geriatric cohort study. BMC Public Health 2020; 20:1797. [PMID: 33243227 PMCID: PMC7690164 DOI: 10.1186/s12889-020-09833-9] [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: 12/03/2019] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nigerian HIV Geriatric Cohort (NHGC) is a longitudinal cohort setup to learn how elderly people living with HIV (EPLHIV) in Nigeria fare, despite not being prioritized by the national treatment program, and to deepen knowledge for their differentiated care and achieve better outcomes. In this paper, we describe data collected on sociodemographic and clinical data from EPLHIV from the inception of Nigeria's national HIV program to 2018. METHODS Patient-level data spanning the period 2004 to 2018, obtained from comprehensive HIV treatment hospitals, that are supported by four major PEPFAR-implementing partners in Nigeria were used. These 4 entities collaborated as member organizations of the Nigeria Implementation Science Alliance. We defined elderly as those aged 50 years and above. From deidentified treatment records, demographic and clinical data of EPLHIV ≥50-year-old at ART initiation during the review period was extracted, merged into a single REDcap® database, and described using STATA 13. RESULTS A total of 101,652 EPLHIV were analysed. Women accounted for 53,608 (53%), 51,037 (71%) of EPLHIV identified as married and 33,446 (51%) unemployed. Median age was 57.1 years (IQR 52-60 years) with a median duration on ART treatment of 4.1 years (IQR 1.7-7.1 years). ART profile showed that 97,586 (96%) were on 1st-line and 66,125 (65%) were on TDF-based regimens. Median body mass index (BMI) was 22.2 kg/m2 (IQR 19.5-25.4 kg/m2) with 43,012 (55%), 15,081 (19%) and 6803 (9%) showing normal (BMI 18.5 - < 25 kg/m2), overweight (BMI 25 - < 30 kg/m2) and obese (BMI ≥30 kg/m2) ranges respectively. Prevalence of hypertension (systolic-BP > 140 mmHg or diastolic-BP > 90 mmHg) was 16,201 (21%). EPLHIV median CD4 count was 381 cells/μL (IQR 212-577 cells/μL) and 26,687 (82%) had a viral load result showing < 1000copies/ml within one year of their last visit. As for outcomes at their last visit, 62,821 (62%) were on active-in-treatment, 28,463 (28%) were lost-to-follow-up, 6912 (7%) died and 2456 (3%) had stopped or transferred out. Poor population death records and aversion to autopsies makes it almost impossible to estimate AIDS-related deaths. CONCLUSIONS This cohort describes the clinical and non-clinical profile of EPLHIV in Nigeria. We are following up the cohort to design and implement intervention programs, develop prognostic models to achieve better care outcomes for EPLHIV. This cohort would provide vital information for stakeholders in HIV prevention, care and treatment to understand the characteristics of EPLHIV.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Echezona Ezeanolue
- Nigeria Implementation Science Alliance, Abuja, Nigeria.,Department of Paediatrics and Child health, University of Nigeria, Enugu, Nigeria
| |
Collapse
|
8
|
Bahemana E, Esber A, Dear N, Ganesan K, Parikh A, Reed D, Maganga L, Khamadi S, Mizinduko M, Lwilla A, Mkondoo D, Mwaisanga G, Somi N, Owouth J, Maswai J, Kiweewa F, Iroezindu M, Ake JA, Crowell TA, Valcour VG, Polyak CS. Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study. AIDS Res Ther 2020; 17:66. [PMID: 33183355 PMCID: PMC7664082 DOI: 10.1186/s12981-020-00323-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION With increased use of antiretroviral therapy (ART), HIV mortality rates are declining and people living with HIV (PLWH) are surviving longer. We characterized CD4 recovery and viral suppression among adults aged < 50 and ≥ 50 years living with HIV who initiated ART in the African Cohort Study (AFRICOS). METHODS Beginning in January 2013, PLWH at twelve clinics in Kenya, Uganda, Tanzania and Nigeria underwent medical history review, CD4 and viral load testing as part of the ongoing African Cohort Study (AFRICOS). ART-naïve PLWH who initiated ART within 30 days of enrollment and had at least one year of follow-up were included in these analyses. To compare ART response in participants < 50 years and ≥ 50 years old, changes in CD4 count and viral load suppression after ART initiation were examined at different time points using linear and binomial regression with generalized estimating equations. Variables for time since ART initiation and the interaction between age group and time on ART were included in the model to evaluate longitudinal changes in CD4 recovery and viral suppression by age. RESULTS Between January 2013 and September 2019, 2918 PLHV were enrolled in the cohort. Of these, 443 were ART naïve and initiated on ART within 30 days of enrollment, with 90% (n = 399) aged < 50 years old at ART initiation. At ART initiation, participants aged 50 and older had a higher median CD4 count compared to participants younger than 50 years of age although it did not reach statistical significance (306 cells/mm3, IQR:130-547 vs. 277cells/mm3, IQR: 132-437). In adjusted models examining CD4 recovery and viral suppression there were no significant differences by age group over time. By the end of follow-up viral suppression was high among both groups of adults (96% of adults ≥ 50 years old and 92% of adults < 50 years old). CONCLUSION This study found no difference in long-term CD4 recovery or viral suppression by age at ART initiation. We found that particularly among younger adults participants had lower median CD4 counts at ART initiation, suggesting the importance of identifying and putting this population on treatment earlier in the disease course.
Collapse
Affiliation(s)
- Emmanuel Bahemana
- HJF Medical Research International, Inc., Mbeya, Tanzania.
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kavitha Ganesan
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Ajay Parikh
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Domonique Reed
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Lucas Maganga
- National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Samoel Khamadi
- HJF Medical Research International, Inc., Mbeya, Tanzania
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Mucho Mizinduko
- Muhimbili University of Health and Allied Science-Dar-Es-Salaam, Dar-Es-Salaam, Tanzania
| | - Anange Lwilla
- HJF Medical Research International, Inc., Mbeya, Tanzania
| | - Dorothy Mkondoo
- HJF Medical Research International, Inc., Mbeya, Tanzania
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Gwamaka Mwaisanga
- HJF Medical Research International, Inc., Mbeya, Tanzania
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nancy Somi
- HJF Medical Research International, Inc., Mbeya, Tanzania
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - John Owouth
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Kisumu, Kenya
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Kericho, Kenya
| | | | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Abuja, Nigeria
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Victor G Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| |
Collapse
|
9
|
Mugisha Okello J, Nash S, Kowal P, Naidoo N, Chatterji S, Boerma T, Seeley J. Survival of people aged 50 years and older by HIV and HIV treatment status: findings from three waves of the SAGE-Wellbeing of Older People Study (SAGE-WOPS) in Uganda. AIDS Res Ther 2020; 17:17. [PMID: 32410634 PMCID: PMC7226937 DOI: 10.1186/s12981-020-00276-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
Background Data on the survival status of older adults on antiretroviral treatment (ART) are scarce in sub-Saharan Africa. The objective of this study was to determine the survival status of people aged 50 years and older who were HIV-negative, HIV-positive not on ART, and HIV-positive on ART. Methods We used three waves of data from the World Health Organisation Study on Global Ageing and adult health- Well Being of Older People Study cohort in Uganda, conducted in 2009, 2012–2013 and 2015–2016. The cohort included HIV-negative and HIV-positive persons aged 50 years and older recruited from multiple rural and peri-urban sites in Uganda. Data were collected using interviewer-administered questionnaire. Time-dependent ART data were collected from medical records using a data-abstraction form. This study was conducted before the universal test and treat policy came into effect. We fitted Cox survival models to estimate hazard ratios to compare the risk of death between groups, adjusted for age, sex, marital status and hypertension. Results Of 623 participants, 517 (82.9%) of respondents had follow-up data and were included in this analysis. We observed 1571 person-years of follow-up from 274 people who were HIV-negative, and 1252 from 243 who were HIV-positive. The estimated mortality adjusted hazard ratio (aHR) was 1.89 (95% CI 1.0–3.4; p = 0.04) among people living with HIV compared to HIV-negative people. The aHR for mortality among people receiving ART compared with HIV-negative people was 1.75 (95% CI 0.9–3.5). People who were HIV-positive and not receiving ART had the greatest risk of death (aHR = 2.09, 95% CI 1.0–4.4 compared with HIV negative participants). The aHR for HIV-positive people not receiving ART, compared to those who were on treatment, was 1.19 (95% CI 0.6–2.5). Conclusion Older adults living with HIV on ART had a risk of mortality that was nearly twice as high as HIV-negative adults. Further analyses of longitudinal data should be done to understand factors that affect the survival of older adults on ART.
Collapse
|
10
|
Al-Aufi A, Al-Wahaibi K, Stephen E, Balkhair A, Abdelhedy I, Al-Maawali H. The prevalence of and risk factors for peripheral arterial occlusive disease in human immunodeficiency virus-infected omani patients: The first study in GCC. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_91_19] [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
|
11
|
Geriatric-HIV Medicine: the geriatrician’s role. Eur Geriatr Med 2018; 10:259-265. [DOI: 10.1007/s41999-018-0144-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/24/2018] [Indexed: 12/21/2022]
|
12
|
Barré‐Sinoussi F, Abdool Karim SS, Albert J, Bekker L, Beyrer C, Cahn P, Calmy A, Grinsztejn B, Grulich A, Kamarulzaman A, Kumarasamy N, Loutfy MR, El Filali KM, Mboup S, Montaner JSG, Munderi P, Pokrovsky V, Vandamme A, Young B, Godfrey‐Faussett P. Expert consensus statement on the science of HIV in the context of criminal law. J Int AIDS Soc 2018; 21:e25161. [PMID: 30044059 PMCID: PMC6058263 DOI: 10.1002/jia2.25161] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Globally, prosecutions for non-disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. This includes instances in which no harm was intended, HIV transmission did not occur, and HIV transmission was extremely unlikely or not possible. This suggests prosecutions are not always guided by the best available scientific and medical evidence. DISCUSSION Twenty scientists from regions across the world developed this Expert Consensus Statement to address the use of HIV science by the criminal justice system. A detailed analysis of the best available scientific and medical research data on HIV transmission, treatment effectiveness and forensic phylogenetic evidence was performed and described so it may be better understood in criminal law contexts. Description of the possibility of HIV transmission was limited to acts most often at issue in criminal cases. The possibility of HIV transmission during a single, specific act was positioned along a continuum of risk, noting that the possibility of HIV transmission varies according to a range of intersecting factors including viral load, condom use, and other risk reduction practices. Current evidence suggests the possibility of HIV transmission during a single episode of sex, biting or spitting ranges from no possibility to low possibility. Further research considered the positive health impact of modern antiretroviral therapies that have improved the life expectancy of most people living with HIV to a point similar to their HIV-negative counterparts, transforming HIV infection into a chronic, manageable health condition. Lastly, consideration of the use of scientific evidence in court found that phylogenetic analysis alone cannot prove beyond reasonable doubt that one person infected another although it can be used to exonerate a defendant. CONCLUSIONS The application of up-to-date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions. The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.
Collapse
Affiliation(s)
| | - Salim S Abdool Karim
- Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
- Centre for the AIDS Program of Research in South AfricaUniversity of KwaZulu‐NatalDurbanSouth Africa
- Weill Medical CollegeCornell UniversityNew YorkNYUSA
| | - Jan Albert
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
| | - Linda‐Gail Bekker
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chris Beyrer
- Department of EpidemiologyCenter for AIDS Research and Center for Public Health and Human RightsJohn Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Pedro Cahn
- Infectious Diseases UnitJuan A. Fernandez Hospital Buenos AiresCABAArgentina
- Buenos Aires University Medical SchoolBuenos AiresArgentina
- Fundación HuéspedBuenos AiresArgentina
| | - Alexandra Calmy
- Infectious DiseasesGeneva University HospitalGenevaSwitzerland
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzFiocruz, Rio de JaneiroBrazil
| | - Andrew Grulich
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| | | | | | - Mona R Loutfy
- Women's College Research InstituteTorontoCanada
- Women's College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Kamal M El Filali
- Infectious Diseases UnitIbn Rochd Universtiy HospitalCasablancaMorocco
| | - Souleymane Mboup
- Institut de Recherche en Santéde Surveillance Epidemiologique et de FormationsDakarSenegal
| | - Julio SG Montaner
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
- BC Centre for Excellence in HIV/AIDSVancouverCanada
| | - Paula Munderi
- International Association of Providers of AIDS CareKampalaUganda
| | - Vadim Pokrovsky
- Russian Peoples’ Friendship University (RUDN‐ University)MoscowRussian Federation
- Central Research Institute of EpidemiologyFederal Service on Customers’ Rights Protection and Human Well‐being SurveillanceMoscowRussian Federation
| | - Anne‐Mieke Vandamme
- KU LeuvenDepartment of Microbiology and ImmunologyRega Institute for Medical Research, Clinical and Epidemiological VirologyLeuvenBelgium
- Center for Global Health and Tropical MedicineUnidade de MicrobiologiaInstituto de Higiene e Medicina TropicalUniversidade Nova de LisboaLisbonPortugal
| | - Benjamin Young
- International Association of Providers of AIDS CareWashingtonDCUSA
| | - Peter Godfrey‐Faussett
- UNAIDSGenevaSwitzerland
- Department of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonEngland
| |
Collapse
|
13
|
Dornelas Neto J, Nakamura AS, Cortez LER, Yamaguchi MU. [Sexually transmitted diseases among the elderly: a systematic review]. CIENCIA & SAUDE COLETIVA 2017; 20:3853-64. [PMID: 26691809 DOI: 10.1590/1413-812320152012.17602014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/29/2015] [Indexed: 01/23/2023] Open
Abstract
The prolongation of an active sexual life in addition to unsafe practices are reflected in the possibility of the occurrence of STDs among the elderly. The scope of this study is to analyze the evolving trend of STDs among the elderly in Brazil and in the world and also to identify the main issues addressed in the literature, providing data that can support public policies that address the health of the elderly. A systematic search was performed in the Lilacs, IBECS, Cochrane Library, Medline, SciELO and PubMed databases. Of a total of 979 studies found, 44 matched the inclusion criteria and comprised the sample of the review. Six main themes were identified: risk factors for infection (34 studies); the influence of Sildenafil as a possible factor (18); diagnosis of STDs in general (20); HIV treatment (24); comorbidities related to HIV (24); and the prevention of STDs (20). More than one theme can be found in each study. The conclusion drawn is that this age group remains out of the focus of public policies of health promotion in the STD context. Therefore, there is a need for awareness about the changes in behavior and the epidemiological profile of this population group.
Collapse
Affiliation(s)
- Jader Dornelas Neto
- Departamento de Medicina, Centro Universitário de Maringá, Maringá, PR, Brasil,
| | | | | | | |
Collapse
|
14
|
Abstract
OBJECTIVE The purpose of this study is to determine whether reductions in hospital utilization observed immediately after the availability of highly active antiretroviral therapy (between 1995 and 2000) have persisted into the 21st century. DATA SOURCES Data on all human immunodeficiency virus (HIV)-related hospital admissions in 5 states (California, Florida, New Jersey, New York, and South Carolina) in 2000, 2005, 2010, and 2013 were obtained from the State Inpatient Database, which is administered by the Agency for Healthcare Research and Quality. In addition, data on the number of persons living with HIV were obtained from the Centers for Disease Control and Prevention and from the California Department of Public Health. STUDY DESIGN This study compares the average number of hospitalizations per person living with HIV in each of the 5 states as well as the average cost for hospital care per person with HIV in 2000, 2005, 2010, and 2013. RESULTS The total number of hospitalizations by persons with HIV in the 5 study states fell by one third between 2000 and 2013 even though the number of persons living with HIV increased by >50%. CONCLUSIONS Persons with HIV disease were 64% less likely to be hospitalized in 2013 than they were in 2000. In addition, the probability of a person with HIV being hospitalized fell 44% between 2000 and 2010 and 29% between 2010 and 2013.
Collapse
|
15
|
Abstracts of the HIV & Hepatitis in the Americas 2017 - Congress. J Int AIDS Soc 2017; 20:21954. [PMID: 28440071 PMCID: PMC5625637 DOI: 10.7448/ias.20.3.21954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
16
|
Flint SR, Tappuni A, Leigh J, Schmidt-Westhausen AM, MacPhail L. (B3) Markers of Immunodeficiency and Mechanisms of HAART Therapy on Oral Lesions. Adv Dent Res 2016; 19:146-51. [PMID: 16672565 DOI: 10.1177/154407370601900126] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Highly active anti-retroviral therapy (HAART) has revolutionized the treatment and prognosis of HIV disease and AIDS in those who can take advantage of the treatment. There are currently 20 different anti-retroviral drugs in 4 different classes that are used in specific combinations. Suppression of HIV replication and immune reconstitution are goals of therapy. Since the prevalence of some easily detectable oral manifestations of HIV/AIDS (OMHIV/AIDS) decreases with HAART, it has been suggested that they might be clinically useful surrogate markers of HAART efficacy and immune status. This might be particularly useful if their recurrence presaged or accompanied HAART failure. To date, there has been little work in this area, but its potential value to the clinical management of HIV/AIDS is apparent, especially if frequent measures of viral load and CD4 cell counts are not readily available. However, the usefulness of OMHIV/AIDS as signals for HAART failure is complicated by three phenomena: the immune reconstitution syndrome, the similarity of some adverse reactions of HAART to OMHIV/AIDS, and the direct inhibitory effect of HAART medications on some OMHIV/AIDS ( e.g., inhibition of oral candidosis by protease inhibitors). This workshop considered the current evidence and proposed pertinent research questions.
Collapse
Affiliation(s)
- S R Flint
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Oral Pathology, Dublin Dental School and Hospital, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland.
| | | | | | | | | |
Collapse
|
17
|
Hodgson TA, Greenspan D, Greenspan JS. Oral Lesions of HIV Disease and HAART in Industrialized Countries. Adv Dent Res 2016; 19:57-62. [PMID: 16672551 DOI: 10.1177/154407370601900112] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The epidemiology of HIV-related oral disease in industrialized nations has evolved following the initial manifestations described in 1982. Studies from both the Americas and Europe report a decreased frequency of HIV-related oral manifestations of 10–50% following the introduction of HAART (highly active antiretroviral therapy). Evidence suggests that HAART plays an important role in controlling the occurrence of oral candidosis. The effect of HAART on reducing the incidence of oral lesions, other than oral candidosis, does not appear as significant, possibly as a result of low lesion prevalence in industrialized countries. In contrast to other oral manifestations of HIV, an increased prevalence of oral warts in patients on HAART has been reported from the USA and the UK. HIV-related salivary gland disease may show a trend of rising prevalence in the USA and Europe. The re-emergence of HIV-related oral disease may be indicative of failing therapy. A range of orofacial iatrogenic consequences of HAART has been reported, and it is often difficult to distinguish between true HIV-related oral disease manifestations and the adverse effects of HAART. A possible association between an increased risk of oral squamous cell carcinoma and HIV infection has been suggested by at least three epidemiological studies, with reference to the lip and tongue. These substantial and intensive research efforts directed toward enhancing knowledge regarding the orofacial consequences of HIV infection in the industrialized nations require dissemination in the wider health care environment.
Collapse
Affiliation(s)
- T A Hodgson
- Unit of Oral Medicine, UCL Eastman Dental Institute and UCLHT Eastman Dental Hospital, 256 Gray's Inn Road, London, WC1X 8LD, UK.
| | | | | |
Collapse
|
18
|
Azar A, Devlin K, Mell JC, Giovannetti T, Pirrone V, Nonnemacher MR, Passic S, Kercher K, Williams JW, Jacobson JM, Wigdahl B, Dampier W, Libon DJ, Sell C. Mitochondrial Haplogroup Influences Motor Function in Long-Term HIV-1-Infected Individuals. PLoS One 2016; 11:e0163772. [PMID: 27711166 PMCID: PMC5053473 DOI: 10.1371/journal.pone.0163772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/14/2016] [Indexed: 12/19/2022] Open
Abstract
Evolutionary divergence of the mitochondrial genome has given rise to distinct haplogroups. These haplogroups have arisen in specific geographical locations and are responsible for subtle functional changes in the mitochondria that may provide an evolutionary advantage in a given environment. Based on these functional differences, haplogroups could define disease susceptibility in chronic settings. In this study, we undertook a detailed neuropsychological analysis of a cohort of long-term HIV-1-infected individuals in conjunction with sequencing of their mitochondrial genomes. Stepwise regression analysis showed that the best model for predicting both working memory and declarative memory were age and years since diagnosis. In contrast, years since diagnosis and sub-haplogroup were significantly predictive of psychomotor speed. Consistent with this, patients with haplogroup L3e obtained better scores on psychomotor speed and dexterity tasks when compared to the remainder of the cohort, suggesting that this haplogroup provides a protective advantage when faced with the combined stress of HIV-1 infection and long-term antiretroviral therapies. Differential performance on declarative memory tasks was noted for individuals with other sub-L haplogroups, but these differences were not as robust as the association between L3e and psychomotor speed and dexterity tasks. This work provides evidence that mitochondrial haplogroup is related to neuropsychological test performance among patients in chronic disease settings such as HIV-1 infection.
Collapse
Affiliation(s)
- Ashley Azar
- Department of Pathology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Kathryn Devlin
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Joshua Chang Mell
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Genomic Sciences, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Tania Giovannetti
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Vanessa Pirrone
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Michael R. Nonnemacher
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Shendra Passic
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Katherine Kercher
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jean W. Williams
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jeffery M. Jacobson
- Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States of America
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Brian Wigdahl
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - William Dampier
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - David J. Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, New Jersey, United States of America
| | - Christian Sell
- Department of Pathology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| |
Collapse
|
19
|
Nacarelli T, Azar A, Sell C. Mitochondrial stress induces cellular senescence in an mTORC1-dependent manner. Free Radic Biol Med 2016; 95:133-54. [PMID: 27016071 DOI: 10.1016/j.freeradbiomed.2016.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 03/07/2016] [Accepted: 03/12/2016] [Indexed: 11/25/2022]
Abstract
Although mitochondrial stress is a key determinant of cellular homeostasis, the intracellular mechanisms by which this stress is communicated to the nucleus and its impact on cell fate decisions are not well defined. In this study, we report that activation of mTORC1 signaling triggered by mitochondrial-generated reactive oxygen species (ROS) results in activation of the senescence program. We show that exposure of human fibroblasts to nucleoside analogs commonly used in antiretroviral therapies, and known to induce mitochondrial dysfunction, increases mitochondrial ROS and leads to a rise in intracellular ROS concomitant with activation of mTORC1. In this setting, it appears that mTORC1 activates senescence through HDM2 phosphorylation, facilitating a p53-mediated response. Inhibition of mTORC1 by rapamycin decreases HDM2 phosphorylation and blocks activation of the senescence program in human cells. In addition, decreasing mitochondrial ROS directly blocks mTORC1 signaling and prevents the onset of senescence. Consistent with these results, both total and mitochondrial-specific ROS increased in cells undergoing replicative senescence along with ribosomal p70 phosphorylation. The results reveal a novel link between mitochondrial dysfunction, mTORC1 signaling, and the senescence program.
Collapse
Affiliation(s)
- Timothy Nacarelli
- Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA 19102, United States
| | - Ashley Azar
- Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA 19102, United States
| | - Christian Sell
- Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA 19102, United States.
| |
Collapse
|
20
|
Increase of neurofilament-H protein in sensory neurons in antiretroviral neuropathy: Evidence for a neuroprotective response mediated by the RNA-binding protein HuD. Pharmacol Res 2016; 111:23-33. [PMID: 27238228 DOI: 10.1016/j.phrs.2016.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/06/2016] [Accepted: 05/25/2016] [Indexed: 01/31/2023]
Abstract
Nucleoside reverse transcriptase inhibitors (NRTIs) are key components of HIV/AIDS treatment to reduce viral load. However, antiretroviral toxic neuropathy has become a common peripheral neuropathy among HIV/AIDS patients leading to discontinuation of antiretroviral therapy, for which the underlying pathogenesis is uncertain. This study examines the role of neurofilament (NF) proteins in the spinal dorsal horn, DRG and sciatic nerve after NRTI neurotoxicity in mice treated with zalcitabine (2',3'-dideoxycitidine; ddC). ddC administration up-regulated NF-M and pNF-H proteins with no effect on NF-L. The increase of pNF-H levels was counteracted by the silencing of HuD, an RNA binding protein involved in neuronal development and differentiation. Sciatic nerve sections of ddC exposed mice showed an increased axonal caliber, concomitantly to a pNF-H up-regulation. Both events were prevented by HuD silencing. pNF-H and HuD colocalize in DRG and spinal dorsal horn axons. However, the capability of HuD to bind NF mRNA was not demonstrated, indicating the presence of an indirect mechanism of control of NF expression by HuD. RNA immunoprecipitation experiments showed the capability of HuD to bind the BDNF mRNA and the administration of an anti-BDNF antibody prevented pNF-H increase. These data indicate the presence of a HuD - BDNF - NF-H pathway activated as a regenerative response to the axonal damage induced by ddC treatment to counteract the antiretroviral neurotoxicity. Since analgesics clinically used to treat neuropathic pain are ineffective on antiretroviral neuropathy, a neuroregenerative strategy might represent a new therapeutic opportunity to counteract neurotoxicity and avoid discontinuation or abandon of NRTI therapy.
Collapse
|
21
|
Feasibility of a Home-Based Speed of Processing Training Program in Middle-Aged and Older Adults With HIV. J Neurosci Nurs 2016; 47:247-54. [PMID: 26153789 DOI: 10.1097/jnn.0000000000000147] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There has been much optimism over the positive impact of combination antiretroviral therapy (cART) on life expectancy for people with HIV; however, those aging with HIV fear potential day-to-day challenges associated with the development of cognitive deficits. The presence of cognitive deficits has generated major safety concerns because it has been shown to impact driving, mobility, and employment. Given the efficacy of a computerized speed of processing training program administered in the laboratory to older adults and adults with HIV, this study was designed to determine the feasibility of using a home-based speed of processing training program to improve cognitive function in middle-aged and older adults with HIV. In this within-subject pre-post experimental design, 20 middle-aged and older adults (i.e., age of 40+ years) with HIV were administered a brief neuropsychological assessment to gauge their baseline cognitive function before participating in a 10-hour home-based computerized cognitive remediation training program. In addition to self-reported cognitive gains, a 6-week posttest indicated significant improvements on the Useful Field of View, a measure of speed of processing and possible transfer to the Timed Instrumental Activities of Daily Living test, a measure of everyday functioning. These findings show that speed of processing training can successfully improve cognitive function in this vulnerable population even when administered in remote settings such as the privacy of one's home.
Collapse
|
22
|
Tam WJ, Yap P. Lessons to Exchange: A Comparison of Long-Term Care Between Two Cultures: Uganda and Singapore. J Am Med Dir Assoc 2015; 16:1104.e15-9. [PMID: 26527421 DOI: 10.1016/j.jamda.2015.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
Abstract
Today, both the developed and developing world are facing fast-aging populations. Projections show that by 2050, 80% of the world's older persons will live in low and middle-income countries. As developed countries look to institutionalization as one of the means to cope with the challenges of long-term care of seniors, the developing world, with a different cultural, socioeconomic, and environmental context, may yet offer insights that instruct and inspire. By analyzing and comparing the approaches, context, and progress of Singapore and Uganda in coping with frail and dependent seniors, this article provides lessons about what the developing and developed world can offer each other, and in turn, teach us about long-term care of seniors.
Collapse
Affiliation(s)
- Wai Jia Tam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore; Geriatric Education and Research Institute (GERI), Singapore, Singapore.
| |
Collapse
|
23
|
Fazeli PL, Marquine MJ, Dufour C, Henry BL, Montoya J, Gouaux B, Moore RC, Letendre. SL, Woods SP, Grant I, Jeste DV, Moore DJ. Physical Activity is Associated with Better Neurocognitive and Everyday Functioning Among Older Adults with HIV Disease. AIDS Behav 2015; 19:1470-7. [PMID: 25731660 PMCID: PMC4527965 DOI: 10.1007/s10461-015-1024-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined the association between physical activity (PA), neurocognitive impairment (NCI), and instrumental activities of daily living (IADLs) among older HIV+ persons. One hundred older HIV+ adults completed the International Physical Activity Questionnaire, a neurocognitive battery, and IADL scale. Higher levels of moderate PA were associated with lower odds of NCI (p = 0.01), even when covariates were modeled. The association between moderate PA and NCI was driven by executive function (p = 0.04). Higher levels of moderate PA were also associated with lower odds of IADL Dependence (p = 0.03), although this fell to a trend (p = 0.08) when including covariates. Follow-up analysis showed those with both NCI and IADL Dependence had lower moderate PA than those with neither (p = 0.03). While these cross-sectional findings suggest PA is associated with better neurocognitive and everyday functioning in older HIV+ adults, longitudinal studies utilizing objective PA methods are needed to evaluate directionality and mechanisms.
Collapse
Affiliation(s)
- Pariya L. Fazeli
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Maria J. Marquine
- Department of Psychiatry, University of California San Diego, San Diego, CA
- Stein Institute for Research on Aging, University of California San Diego, San Diego, CA
| | - Catherine Dufour
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Brook L. Henry
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jessica Montoya
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Ben Gouaux
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA
- Stein Institute for Research on Aging, University of California San Diego, San Diego, CA
| | - Scott L. Letendre.
- Department of Medicine, University of California San Diego, San Diego, CA
| | | | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, San Diego, CA
- Stein Institute for Research on Aging, University of California San Diego, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA
| |
Collapse
|
24
|
|
25
|
Viswanathan S, Detels R, Mehta SH, Macatangay BJC, Kirk GD, Jacobson LP. Level of adherence and HIV RNA suppression in the current era of highly active antiretroviral therapy (HAART). AIDS Behav 2015; 19:601-11. [PMID: 25342151 DOI: 10.1007/s10461-014-0927-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The need to achieve ≥95 % adherence to HAART for treatment effectiveness may be a barrier for universal initiation at early stages of HIV. Using longitudinal data collected from 2006 to 2011 from cohort studies of MSM (MACS) and IDUs (ALIVE study), we estimated the minimum adherence needed to achieve HIV RNA suppression (<50 copies/mL), defined as the level at which at least 80 % were virally suppressed, and the odds of suppression was not significantly different than that observed with ≥95 % adherence. In the MACS, ≥80 % suppression was observed with 80-84 % adherence and the odds ratio for suppression (vs. ≥95 % adherence) was 1.43 (0.61, 3.33). In the ALIVE study where <35 % were on newer drugs, only 71.4 % were suppressed among those who reported ≥95 % adherence. Although IDUs on older HAART regimens may need to be ≥95 % adherent, concerns related to non-adherence may be less of a barrier to initiation of modern HAART regimens.
Collapse
|
26
|
The syndemic illness of HIV and trauma: implications for a trauma-informed model of care. PSYCHOSOMATICS 2014; 56:107-18. [PMID: 25597836 DOI: 10.1016/j.psym.2014.10.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND People living with HIV infection are disproportionately burdened by trauma and the resultant negative health consequences, making the combination of HIV infection and trauma a syndemic illness. Despite the high co-occurrence and negative influence on health, trauma and posttraumatic sequelae in people living with HIV infection often go unrecognized and untreated because of the current gaps in medical training and lack of practice guidelines. OBJECTIVE We set out to review the current literature on HIV infection and trauma and propose a trauma-informed model of care to target this syndemic illness. METHODS We searched PubMed, PsycINFO, and Cochrane review databases for articles that contained the following search terms: HIV AND either trauma (specifically violent trauma), PTSD, intimate partner violence (IPV), abuse, or trauma-informed care. Articles were limited to primary clinical research or metanalyses published in English. Articles were excluded if they referred to HIV-associated posttraumatic stress disorder or HIV-associated posttraumatic growth. RESULTS We confirm high, but variable, rates of trauma in people living with HIV infection demonstrated in multiple studies, ranging from 10%-90%. Trauma is associated with (1) increased HIV-risk behavior, contributing to transmission and acquisition of the virus; (2) negative internal and external mediators also associated with poor health and high-risk HIV behavior; (3) poor adherence to treatment; (4) poor HIV-related and other health outcomes; and (5) particularly vulnerable special populations. CONCLUSIONS Clinicians should consider using a model of trauma-informed care in the treatment of people living with HIV infection. Its adoption in different settings needs to be matched to available resources.
Collapse
|
27
|
Ouédraogo DD, Sawadogo LM, Sagna Y, Sawadogo AB, Diallo I, Hema A, Poda A, Drabo YJ. Risk Factors for Early Mortality on Antiretroviral Treatment of Elderly People Infected with HIV in Burkina Faso. J Int Assoc Provid AIDS Care 2014; 14:553-9. [PMID: 25294855 DOI: 10.1177/2325957414553841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Age is a key determinant of mortality due to diseases including HIV infection. METHODS A retrospective and descriptive cohort study used a computerized database to compare HIV-infected patients diagnosed in late adulthood to a group of patients diagnosed before their 49 years of age, without matching the characteristics of HIV infection. The study included patients who visited the day hospital (outpatient clinic) of the Sanou Souro Teaching Hospital of Bobo-Dioulasso, in Burkina Faso, from January 2007 to December 2011. Older adults were defined as those aged 50 years and more. RESULTS Participants in the study consisted of 2572 patients (265 older adults and 2307 young patients living with HIV. Based on Markov chain method, 32.1% of the older adults living with HIV were found to be seroconvert at 50 years or older. The median follow-up time on antiretroviral treatment (ART) was 32.7 months (range 0.03-65.4 months). Two hundred and ninety-five (11.5%) patients died, including 21.1% of older adults and 10.4% of young (P < .01). World Health Organization stage 3 or 4 and the lowest CD4 count reached <200 cells/mm(3) were the factors associated with early mortality of older adults on ART. CONCLUSION Mortality rate of older adult patients living with HIV in Burkina Faso is high. Early diagnosis, early treatment, and primary prevention of HIV infection in the older adults are the main keys that could help reduce such mortality.
Collapse
Affiliation(s)
- Dieu-Donné Ouédraogo
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Lynda Magali Sawadogo
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Yempabou Sagna
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Adrien B Sawadogo
- Infectious Department, Sanou Souro Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Ismael Diallo
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Arsène Hema
- Infectious Department, Sanou Souro Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Armel Poda
- Infectious Department, Sanou Souro Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Youssouf Joseph Drabo
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| |
Collapse
|
28
|
HIV and liver transplantation: The British Columbia experience, 2004 to 2013. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 25:159-62. [PMID: 25285113 PMCID: PMC4173979 DOI: 10.1155/2014/373898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Historically, HIV-positive individuals have not been considered to be candidates for liver transplantation due to the need for further immunosuppresion of these patients post-transplant, as well as other factors such as pharmacokinetic interactions between the necessary antiretroviral and immunosuppressant drugs. However, HIV-positive individuals with end-stage liver disease are now eligible for liver transplantation in British Columbia. The purpose of this study was to summarize the outcomes of HIV-positive individuals referred for liver transplanation in British Columbia. BACKGROUND: The demand for definitive management of end-stage organ disease in HIV-infected Canadians is growing. Until recently, despite international evidence of good clinical outcomes, HIV-infected Canadians with end-stage liver disease were ineligible for transplantation, except in British Columbia (BC), where the liver transplant program of BC Transplant has accepted these patients for referral, assessment, listing and provision of liver allograft. There is a need to evaluate the experience in BC to determine the issues surrounding liver transplantation in HIV-infected patients. METHODS: The present study was a chart review of 28 HIV-infected patients who were referred to BC Transplant for liver transplantation between 2004 and 2013. Data regarding HIV and liver disease status, initial transplant assessment and clinical outcomes were collected. RESULTS: Most patients were BC residents and were assessed by the multidisciplinary team at the BC clinic. The majority had undetectable HIV viral loads, were receiving antiretroviral treatments and were infected with hepatitis C virus (n=16). The most common comorbidities were anxiety and mood disorders (n=4), and hemophilia (n=4). Of the patients eligible for transplantation, four were transplanted for autoimmune hepatitis (5.67 years post-transplant), nonalcoholic steatohepatitis (2.33 years), hepatitis C virus (2.25 years) and hepatitis B-delta virus coinfection (recent transplant). One patient died from acute renal failure while waiting for transplantation. Ten patients died during preassessment and 10 were unsuitable transplant candidates. The most common reason for unsuitability was stable disease not requiring transplantation (n=4). CONCLUSIONS: To date, interdisciplinary care and careful selection of patients have resulted in successful outcomes including the longest living HIV-infected post-liver transplant recipient in Canada.
Collapse
|
29
|
Maldonado-Martínez G, Fernández-Santos DM, Ríos-Olivares E, Mayor AM, Hunter-Mellado RF. HIV/AIDS in the Puerto Rican elderly: immunological changes between gender and body mass index. J Health Care Poor Underserved 2014; 24:94-105. [PMID: 24241264 DOI: 10.1353/hpu.2014.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Human immunodeficiency virus (HIV) in the elderly population has serious repercussions. The elderly are underdiagnosed for HIV and the costs associated with their late-stage care represent a financial burden to the public health system. The purpose is to analyze various profiles among a cohort of elderly patients with HIV/AIDS. METHODS This is a baseline cohort 60 years or older seen in the Retrovirus Research Center between January 2000 to December 2011. We present the profiles of our cohort stratified by gender and body mass index viewed as a covariate of interest. RESULTS A total of 266 people (68% males and 32% females) seen at the Center were older than 60 years of age. Males were significantly more often overweight (p<.05). Females were significantly more underweight with chronic conditions (p<.05). Women had higher CD4 count and lower HIV viral loads (p<.05). Underweight elderly males were more heavily affected with the burden of HIV infection compared with women.
Collapse
|
30
|
Dourado I, MacCarthy S, Lima C, Veras MA, Kerr L, de Brito AM, Gruskin S. What's pregnancy got to do with it? Late presentation to HIV/AIDS services in Northeastern Brazil. AIDS Care 2014; 26:1514-20. [PMID: 25033205 DOI: 10.1080/09540121.2014.938016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite the known benefits of early treatment initiation for individual morbidity and mortality, as well as for reducing the risk of transmission, late presentation (LP) to HIV/AIDS services remains a major concern in many countries. There is little information on LP from middle- and low-income countries and studies that do evaluate LP commonly disaggregate data by sex. It is rare, however, for researchers to further disaggregate the data by pregnancy status so it remains unclear if pregnancy status modifies the effects associated with sex. The study was conducted at the only State Reference Center for HIV/AIDS in Salvador, Brazil's third largest city. LP was defined as a patient accessing services with a CD4 < 350 cells/mm(3). Data were abstracted from the electronic medical records of 1421 patients presenting between 2007 and 2009. CD4 counts and viral load (VL) information was validated with data from the National CD4/VL Database. Descriptive and bivariate statistics were conducted to inform the multivariate analysis. Adjusted prevalence ratios (APR) were estimated using generalized linear models due to the high frequency of the outcome. Half of the sample (52.5%; n = 621) was classified as LP. Compared to the prevalence among pregnant women (21.1%), the prevalence of LP was more than twice as high among non-pregnant women (56.0%) and among men (55.4%). The multivariate analysis demonstrated no statistical difference between men and nonpregnant women (APR 1.04; 95%CI 0.92-1.19), but the APR of LP for nonpregnant women was 53% less than men (APR 0.47; 95%CI 0.33-0.68). These results highlight the importance of analyzing data disaggregated not only by sex but also by pregnancy status to accurately identify the risk factors associated with LP so that programs and policies can effectively and efficiently address LP in Brazil and beyond.
Collapse
Affiliation(s)
- Inês Dourado
- a Instituto de Saúde Coletiva/Universidade Federal da Bahia , Salvador , Brazil
| | | | | | | | | | | | | |
Collapse
|
31
|
Subclinical atherosclerosis and markers of immune activation in HIV-infected children and adolescents: the CaroVIH Study. J Acquir Immune Defic Syndr 2014; 65:42-9. [PMID: 23982657 DOI: 10.1097/qai.0b013e3182a9466a] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND HIV-infected adults display increased cardiovascular disease, probably driven by inflammation and immune activation. These relationships have not been addressed in vertically HIV-infected children and adolescents, a population at very high risk for long-term non-AIDS complications. METHODS Carotid intima media thickness (IMT) was measured in a cohort of HIV-infected children and adolescents and healthy controls. C-reactive protein and markers of immune activation (CD38⁺HLA-DR⁺) and immune senescence (CD28⁻CD57⁺) were determined. RESULTS One hundred fifty HIV-infected patients and 150 controls were included, 64.8% female. IMT was thicker in HIV-infected patients (0.434 mm ± 0.025 vs. 0.424 mm ± 0.018, P < 0.001). After adjustment by age, sex, body mass index, and smoking status, HIV infection was independently associated with thicker IMT (odds ratio, 2.28; 95% confidence interval: 1.25 to 4.13; P = 0.007). Among HIV-related variables, a low CD4 nadir was related to an increased IMT. Although HIV-infected subjects presented higher frequencies of activated CD4⁺ and CD8⁺ T cells (P = 0.002 and P = 0.087, respectively), no relation was found between IMT and inflammation, immune activation, or senescence. CONCLUSIONS Structural changes of the vasculature present early in vertically HIV-infected subjects as well as immune activation and senescence. These patients should be carefully monitored for the prompt detection and early treatment of cardiovascular disease.
Collapse
|
32
|
PKC-mediated HuD–GAP43 pathway activation in a mouse model of antiretroviral painful neuropathy. Pharmacol Res 2014; 81:44-53. [DOI: 10.1016/j.phrs.2014.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 11/23/2022]
|
33
|
Kebodeaux CD, Wilson AG, Smith DL, Vouri SM. A review of cardiovascular and renal function monitoring: a consideration of older adults with HIV. HIV AIDS (Auckl) 2013; 5:263-74. [PMID: 24068878 PMCID: PMC3782510 DOI: 10.2147/hiv.s36311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The prevalence of human immunodeficiency virus (HIV) infection in older and elderly adults is significant worldwide. This population poses new challenges and opportunities in the management of HIV. In addition to the risks affecting HIV patients of all ages, including risk of opportunistic infection and medication resistance, age-related changes in physiology, higher comorbidity burdens, increased use of medications, and potential adverse drug reactions to HIV medications all factor into the care of older adults with HIV. The risk and progression of cardiovascular and renal comorbidities may be higher in the older adult HIV population and in patients taking specific HIV medications. Understanding these risks is essential when managing a new type of patient: the older adult with HIV.
Collapse
Affiliation(s)
- Clark D Kebodeaux
- St Louis College of Pharmacy, Division of Pharmacy Practice, St Louis, MO, USA
| | | | - Daron L Smith
- St Louis College of Pharmacy, Adjunct Faculty, St Louis, MO, USA
| | - Scott Martin Vouri
- St Louis College of Pharmacy, Division of Pharmacy Practice, St Louis, MO, USA
| |
Collapse
|
34
|
Abstract
The prevalence of human immunodeficiency virus (HIV) infection among people older than 50 years is increasing. Older HIV-infected patients are particularly at risk for polypharmacy because they often have multiple comorbidities that require pharmacotherapy. Overall, there is not much known with respect to both the impact of aging on medication use in HIV-infected individuals, and the potential for interactions with highly active antiretroviral therapy (HAART) and coadministered medications and its clinical consequences. In this review, we aim to provide an overview of polypharmacy with a focus on its impact on the HIV-infected older adult population and to also provide some clinical considerations in this high-risk population.
Collapse
Affiliation(s)
- Lauren J Gleason
- Division of Geriatrics and Aging, Highland Hospital, Rochester, NY 14620, USA
| | | | | |
Collapse
|
35
|
Iwuji CC, Churchill D, Gilleece Y, Weiss HA, Fisher M. Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study. BMC Public Health 2013; 13:397. [PMID: 23622568 PMCID: PMC3651303 DOI: 10.1186/1471-2458-13-397] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 04/04/2013] [Indexed: 11/19/2022] Open
Abstract
Background Initiating therapy with a low CD4 cell count is associated with a substantially greater risk of disease progression and death than earlier initiation. We examined factors associated with late presentation of HIV using the new European consensus definition (CD4 cell count <350 cells/mm3) and mortality. Methods Patients newly diagnosed with HIV infection at a UK clinic were recruited from January 1996 to May 2010. Factors associated with late presentation were assessed using logistic regression. Factors associated with mortality rates were analysed using Poisson regression. Results Of the 1536 included in the analysis, 86% were male and 10% were aged 50 years and older. Half the cohort (49%) had a CD4 cell count below 350 cells/mm3 at presentation (“late presentation”). The frequency of late presentation was highest in those aged 50 years or older and remained unchanged over time (64.3% in 1996-1998 and 65.4% in 2008-2010). In contrast, among those aged less than 50 years, the proportion with late presentation decreased over time (57.1% in 1996-1998 and 38.5% in 2008-2010). Other factors associated with late presentation were African ethnicity and being a male heterosexual. The mortality rate was 15.47/1000 person-years (pyrs) (95%-CI: 13.00-18.41). When compared with younger adults, older individuals had a higher mortality, after adjusting for confounders (rate ratio (RR) = 2.87; 95%-CI: 1.88-4.40). Conclusions Older adults were more likely to present late and had a higher mortality. Initiatives to expand HIV testing in clinical and community setting should not neglect individuals aged over 50.
Collapse
Affiliation(s)
- Collins C Iwuji
- Lawson Unit, Department of HIV/Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK.
| | | | | | | | | |
Collapse
|
36
|
Pérez-Elías MJ, Muriel A, Moreno A, Martinez-Colubi M, Iribarren JA, Masiá M, Blanco JR, Palacios R, del Romero J, Pérez DG, Hernando V. Relevant gender differences in epidemiological profile, exposure to first antiretroviral regimen and survival in the Spanish AIDS Research Network. Antivir Ther 2013; 19:375-85. [DOI: 10.3851/imp2714] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 10/25/2022]
|
37
|
Wendelken LA, Valcour V. Impact of HIV and aging on neuropsychological function. J Neurovirol 2012; 18:256-63. [PMID: 22528478 PMCID: PMC3661281 DOI: 10.1007/s13365-012-0094-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/05/2012] [Accepted: 03/13/2012] [Indexed: 11/28/2022]
Abstract
Cognitive efficiency decreases with age, and advancing age is the leading risk factor for most neurodegenerative disorders that result in dementia. In HIV infection, risk for cognitive impairment is consistently linked to advancing chronological age. As the HIV epidemic enters its fourth decade in the USA, extended life expectancy will likely result in an increased prevalence of cognitive disorders by virtue of these factors. However, it is less clear if HIV potentiates or accelerates the risk for cognitive impairment given that most reports are mixed or demonstrate only a small interaction effect. More critically, it is unclear if HIV will modulate the neuropathology associated with non-HIV cognitive disorders in a manner that will increase risk for diseases such as cerebrovascular and Alzheimer's disease. In the coming years, with increasing numbers of HIV+ patients entering their 60s and 70s, background risk for neurodegenerative disorders will be sufficiently high as to inform this issue on clinical grounds. This review summarizes knowledge of cognition in HIV as it relates to age and presents some emerging controversies.
Collapse
|
38
|
Serrano-Villar S, Estrada V, Gómez-Garre D, Ávila M, Fuentes-Ferrer M, San RJ, Soriano V, Sánchez-Parra C, Sainz T, Fernández-Cruz A. Diagnosis of subclinical atherosclerosis in HIV-infected patients: higher accuracy of the D:A:D risk equation over Framingham and SCORE algorithms. Eur J Prev Cardiol 2012; 21:739-48. [PMID: 22718798 DOI: 10.1177/2047487312452964] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS While the detection of subclinical atherosclerosis may provide an opportunity for the prevention of cardiovascular disease (CVD), which currently is a leading cause of death in HIV-infected subjects, its diagnosis is a clinical challenge. We aimed to compare the agreement and diagnostic performance of Framingham, SCORE and D:A:D equations for the recognition of subclinical atherosclerosis in HIV patients and to adjust the D:A:D equation using HIV and CVD variables. METHODS AND RESULTS Atherosclerosis was evaluated in 203 HIV-infected individuals by measuring the carotid intima-media thickness (IMT). The CVD risk was calculated using the Framingham, SCORE and D:A:D risk equations. Framingham, SCORE and D:A:D equations showed a low agreement with the IMT (Kappa: 0.219, 0.298, 0.244, respectively; p = 0.743) and a moderate predictive performance, (area under the curve [AUC] = 0.686, 0.665 and 0.716, respectively; p = 0.048), with the D:A:D equation being the most accurate. Atherosclerosis was demonstrated in a significant proportion of subjects with low predicted CVD risk by all three algorithms (16.3%, 17.2%, 17.2%, respectively; p = 0.743). In patients with an estimated low CVD risk atherosclerosis was associated with older age (p = 0.012) and low CD4 counts (p = 0.021). A model was developed to adjust the D:A:D equation; a significant increase in accuracy was obtained when CD4 counts and low-grade albuminuria were included (AUC = 0.772; p < 0.001). CONCLUSION The D:A:D equation overperforms Framingham and SCORE in HIV patients. However, all three equations underestimate the presence of subclinical atherosclerosis in this population. The accuracy of the D:A:D equation improves when CD4 counts and low-grade albuminuria are incorporated into the equation.
Collapse
Affiliation(s)
| | - Vicente Estrada
- Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Dulcenombre Gómez-Garre
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain Vascular Biology Research Laboratory, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Mario Ávila
- Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Fuentes-Ferrer
- Department of Preventive Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Román Jesús San
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
| | - Vicente Soriano
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
| | | | - Talía Sainz
- Laboratory of Immunomolecular Biology, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Arturo Fernández-Cruz
- Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
39
|
Lekalakala- Mokgele E. A literature review of the impact of HIV and AIDS on the role of the elderly in the sub-Saharan African community. Health SA 2011. [DOI: 10.4102/hsag.v16i1.564] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The status of older adults in Africa occupies a small but rapidly expanding share of the global literature on ageing. The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic has generated a new focus on the changing role of the elderly in communities that have been affected. In sub-Saharan Africa, where millions are projected to be infected with HIV and about two million deaths are recorded annually amongst the traditionally productive adults, such loss of parents and breadwinners means children and the elderly have had to take up unusual responsibilities. A literature review on the elderly and HIV and AIDS provided the data analysed for this article. Access to databases was mainly via EBSCO (www.ebsco.co), which allowed searches in major databases and search engines useful in an academic setting for finding and accessing articles in health and health-related academic journals, repositories and archived reports. Results showed that the AIDS pandemic has direct and indirect effects which have manifested in a set of interrelated social, economic and psychological dimensions that could ultimately impact on the health and well-being of the elderly. It is concluded that more needs to be done to articulate the knowledge base of the impact of HIV and AIDS in order to inform social, economic and political policies for the purpose of alleviating the problems that the pandemic is wreaking on the elderly African population.OpsommingDie status van ouer volwassenes in Afrika beklee’n klein, maar vinnig groeiende deel van die globale verouderings literatuur. Die menslike immuniteitsgebreksvirus (MIV) en verworwe immuniteitsgebreksindroom (VIGS) pandemie het ‘n nuwe fokus op die veranderende rol van bejaardes in die gemeenskap wat deur VIGS beïnvloed word, gegenereer. In sub-Sahara Afrika waar na beraming miljoene geïnfekteer word met MIV, met sowat twee miljoen sterftes jaarliks gerekordeer onder die tradisoneel produktiewe volwassenes, word daar van die kinders en bejaardes verwag om ongewone verantwoordelikhede op hulle te neem as gevolg van die verlies aan ouers of broodwinners. ‘n Literatuuroorsig wat handel oor bejaardes en MIV en VIGS het die geanaliseerde data voorsien vir hierdie artikel. Toegang tot die databasis was meestal deur EBSCO (www.ebsco.co) wat soektog toegelaat het tot groot databasisse en soekenjins wat bruikbaar in die akademiese opset is en die vind van artikels aangaande gesondheid, gesondheidverwante akademiese joernale en argief verslae. Bevindings toon dat die VIGS pandemie direkte en indirekte effekte het. Hierdie effekte manifisteer in ‘n stel sosiaal verwante, ekonomiese en psigologiese dimensies wat ten einde ‘n impak op die gesondheid en welstand van bejaardes het. Daar is tot die gevolgtrekking gekom dat meer gedoen moet word om die kennis basis van MIV en VIGS te artikuleer om die sosiale, ekonomiese en politiese beleid in kennis te stel, om sodoende die resulterende probleme van MIV en VIGS op die bejaarde Afrika populasie te verlig.
Collapse
|
40
|
Hughes AK. HIV knowledge and attitudes among providers in aging: results from a national survey. AIDS Patient Care STDS 2011; 25:539-45. [PMID: 21823908 DOI: 10.1089/apc.2011.0026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Within 5 years, half the U.S. HIV-infected population will be over age 50, and providers caring for older adults must deal with this reality. This study assessed attitudes toward people with HIV/AIDS and knowledge of HIV/AIDS among physicians with a geriatrics specialty, and nurses and social workers who specialize in gerontology. A survey mailed in 2008 to a random sample of U.S. providers yielded a 60% response rate. Main outcome measures included: Knowledge of HIV/AIDS, attitudes toward people with HIV/AIDS, and knowledge of issues related to HIV in older adults. General knowledge of HIV/AIDS was good with scores of 89%, 84%, and 81% for physicians, nurses, and social workers, respectively; groups differed significantly (F(2, 483)=18.626, p<0.0005). Attitudes were positive, with a significant main effect of profession on the attitude subscales (F(4, 952)=6.84, p<0.0005). Eighty-three percent of the sample were unaware that dementia due to HIV may be reversible; no significant differences by profession (χ(2)=4.50, p=0.105). The sample had difficulty ranking the four most common risk factors for HIV infection in older adults, with no significant differences among the professions (F(2, 483)=1.22, p=0.296). Only 6% of the sample correctly ranked all four risk factors. Estimates of the percent of U.S. AIDS cases in people over age 50 varied widely; few answered correctly, with no significant differences by professional group (F(2,319)=2.82, p=0.06). These findings highlight the need for further education among providers who specialize in aging.
Collapse
Affiliation(s)
- Anne K. Hughes
- School of Social Work, Michigan State University, East Lansing, Michigan
| |
Collapse
|
41
|
Tamí-Maury IM, Willig JH, Jolly PE, Vermund S, Aban I, Hill JD, Wilson CM, Kempf MC. Prevalence, incidence, and recurrence of oral lesions among HIV-infected patients on HAART in Alabama: a two-year longitudinal study. South Med J 2011; 104:561-6. [PMID: 21886064 DOI: 10.1097/smj.0b013e318224a15f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our aim was to quantify prevalence, incidence, and recurrence of oral lesions (OL) among a population in the Southeast. METHODS A retrospective study based on chart review was conducted among patients (n = 744) who were ≥19 years of age and initiated highly active antiretroviral therapy (HAART) between January 2000 and June 2006 at the University of Alabama at Birmingham (UAB) 1917 Clinic. Patients' laboratory data and oral conditions were recorded for 2 years after enrollment into the study. RESULTS During 2 years of follow-up, the period prevalence of individuals experienced at least one OL was 35.6% (266/744). Among all of the 374 episodes of OL, 183 were new cases, while 57 were recurrences. The OL person-visit incidence rate was 0.02 per 100 person-visits. Oropharyngeal candidiasis (OPC) was the most frequent manifestation in terms of period prevalence (74.9%) with a person-visit incident rate of 0.01 per 100 person-visits. CONCLUSIONS Patients undergoing HAART continue to be affected by HIV-related oral conditions, especially OPC. These results clearly indicate that OL during HIV infection are still highly prevalent in spite of the improvements in medical care and the availability of HAART.
Collapse
Affiliation(s)
- Irene M Tamí-Maury
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Alonso Gonzalez M, Martin L, Munoz S, Jacobson JO. Patterns, trends and sex differences in HIV/AIDS reported mortality in Latin American countries: 1996-2007. BMC Public Health 2011; 11:605. [PMID: 21801402 PMCID: PMC3173348 DOI: 10.1186/1471-2458-11-605] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 07/29/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND International cohort studies have shown that antiretroviral treatment (ART) has improved survival of HIV-infected individuals. National population based studies of HIV mortality exist in industrialized settings but few have been presented from developing countries. Our objective was to investigate on a population basis, the regional situation regarding HIV mortality and trends in Latin America (LA) in the context of adoption of public ART policies and gender differences. METHODS Cause of death data from vital statistics registries from 1996 to 2007 with "good" or "average" quality of mortality data were examined. Standardized mortality rates and Poisson regression models by country were developed and differences among countries assessed to identify patterns of HIV mortality over time occurring in Latin America. RESULTS Standardized HIV mortality following the adoption of public ART policies was highest in Panama and El Salvador and lowest in Chile. During the study period, three overall patterns were identified in HIV mortality trends- following the adoption of the free ART public policies; a remarkable decrement, a remarkable increment and a slight increment. HIV mortality was consistently higher in males compared to females. Mean age of death attributable to HIV increased in the majority of countries over the study period. CONCLUSIONS Vital statistics registries provide valuable information on HIV mortality in LA. While the introduction of national policies for free ART provision has coincided with declines in population-level HIV mortality and increasing age of death in some countries, in others HIV mortality has increased. Barriers to effective ART implementation and uptake in the context of free ART public provision policies should be further investigated.
Collapse
Affiliation(s)
| | - Luise Martin
- Pan American Health Organization. HIV/STI project Washington DC, USA
- DAAD (German Academic Exchange Service), Carlo Schmid Program, Bonn, Germany
| | - Sergio Munoz
- Facultad de Medicina, Universidad de La Frontera de Chile, Chile
| | - Jerry O Jacobson
- Pan American Health Organization. HIV/STI project. Bogota, Colombia
| |
Collapse
|
43
|
Nery F, Franca M, Almeida I, Vasconcelos C. From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients. J Clin Med Res 2011; 3:17-22. [PMID: 22043267 PMCID: PMC3194021 DOI: 10.4021/jocmr501w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2011] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system, associated with immunosuppression states. As there are only some non-published documents concerning PML in HIV infected patients in Portugal, we pretend to characterize natural history of PML infection in a population of HIV patients. METHODS We retrospectively reviewed, from 1992 to 2009, PML cases in a population of 724 HIV infected patients followed in our institution. Clinical, biological, imagery features and outcomes were characterized. RESULTS Twenty-five (3.45%) patients were identified as having PML. The mean time between HIV and PML diagnosis was 20.4 months. PML was the presentation of HIV infection in 40% of the patients, and 92% had CD4 T cell count lower than 200/mm(3). Paresis was the most common clinical presentation. No specific characteristics were found in cerebrospinal fluid and JCV DNA was positive in 3 of 7 patients. MRI revealed characteristic findings. Combined antiretroviral therapy was started or changed in 96% of the patients. Neurological condition got worse in 12 patients. From the 14 deaths, 5 were directly attributed to PML progression. Follow-up was lost in 8 patients. CONCLUSIONS PML was the presentation of HIV infection in more than 1/3 of patients, frequently associated with advanced immunocompromise. MRI sensitivity to PML is high, and JCV DNA determination in CSF was not revealed to be sensible. PML diagnosis should be taken into account in HIV patients presenting any neurological symptoms, and HIV infection should be suspected when radiological findings suggest PML lesions even in previously healthy individuals. KEYWORDS Progressive multifocal leukoencephalopathy; JC virus; Human immunodeficiency virus; Demyelinating disease.
Collapse
Affiliation(s)
- Filipe Nery
- Clinical Immunology Unit, Centro Hospitalar do Porto - Hospital Sto Antonio, Porto, Portugal
| | | | | | | |
Collapse
|
44
|
Qaqa AY, DeBari VA, Isbitan A, Mohammad N, Sison R, Slim J, Perez G, Shamoon FE. The role of postexercise measurements in the diagnosis of peripheral arterial disease in HIV-infected patients. Angiology 2011; 62:10-4. [PMID: 21134993 DOI: 10.1177/0003319710385339] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral arterial disease (PAD) is a marker of atherosclerosis, which is not well studied in the population with human immunodeficiency virus (HIV). We prospectively enrolled HIV-infected patients who had normal resting ankle-brachial index (rABI) readings. All participants performed either a treadmill walking test (TT) or pedal plantar flexion test (PFT). Patients were divided into 2 groups according to postexercise changes; PAD and No-PAD group. The 2 groups were compared with regard to established cardiovascular disease risk factors and other HIV infection parameters. Peripheral arterial disease was present in 30 (26.5%) of 113 consecutive HIV-infected patients included in the study. Mean age was 47 ± 10 years. The risk factors studied did not differ significantly among the 2 groups except for male gender, which was significantly associated with PAD (RR: 4.15; CI: 1.6 to 11.1: P < .0008). The prevalence of PAD, diagnosed by significant drop in postexercise ABI and ankle pressure in patients with HIV is high.
Collapse
Affiliation(s)
- Ashraf Y Qaqa
- Department of Cardiology, St Michaels Medical Center, Seton Hall University, Newark, NJ, USA
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Poynten IM, Templeton DJ, Grulich AE. Sexually transmissible infections in aging HIV populations. Sex Health 2011; 8:508-11. [DOI: 10.1071/sh11027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 05/16/2011] [Indexed: 12/26/2022]
Abstract
There is limited published research on sexually transmissible infections (STI) among aging HIV populations. The available literature on sexual behaviour and STI among older people with HIV is reviewed here and contrasted with data from older individuals in the general population and from older populations at high risk of HIV. A sizeable minority of older people with HIV continue to engage in higher risk sexual behaviour and thus remain at high risk of STI. There is no clear evidence of a consistent effect of older age on STI rates, clinical presentation or clinical course among HIV-infected populations, although gay men with HIV aged in their 40s or older seem to be at higher risk than younger men of acquiring several STI, including syphilis and lymphogranuloma venereum. STI risks in older people living with HIV need to be regularly assessed. Higher risk sexual behaviour and disproportionately higher rates of STI indicate that regardless of age, a thorough STI assessment should be regularly undertaken for all HIV-positive gay men as part of their routine HIV care.
Collapse
|
46
|
Kruger A, Lekalakalamokgela SE, Wentzel-Viljoen E. Rural and urban older African caregivers coping with HIV/AIDS are nutritionally compromised. J Nutr Gerontol Geriatr 2011; 30:274-290. [PMID: 21846243 DOI: 10.1080/01639366.2010.528333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article describes the nutritional status of a group of rural and urban free living African older surrogate parents caring for HIV/AIDS orphans and grandchildren. Multiple sources of data collection were used, including anthropometry, biochemical analyses, and quantitative questionnaires. The diets of these older participants were marginal. The rural to urban geographical transition in these older persons is characterized by a better micronutrient and trace element intake; however, urban dwellers also had higher fat intakes, increasing the risk for cardiovascular disease. These results suggest that to be a surrogate grandparent provides a special meaning to the life of men that needs to be better understood. However, the diets of these older people caring for HIV/AIDS-affected children were more compromised than those of non-caregivers.
Collapse
Affiliation(s)
- Annamarie Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University (Potchefstroom Campus), South Africa.
| | | | | |
Collapse
|
47
|
Pereira GS, Borges CI. Conhecimento sobre HIV/AIDS de participantes de um grupo de idosos, em Anápolis-Goiás. ESCOLA ANNA NERY 2010. [DOI: 10.1590/s1414-81452010000400010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: identificar o conhecimento sobre a infecção pelo HIV/AIDS, dos participantes do Centro de Convivência do Idoso (CCI) em Anápolis, Goiás. MÉTODO: foram entrevistados 224 idosos participantes do CCI, sendo coletados dados sociodemográficos e comportamentais, e dados referentes às formas de transmissão do HIV. RESULTADO: houve predominância do sexofeminino, de baixa escolaridade, baixa renda familiar e cor branca. Quase a metade dos idosos relatou vida sexual ativa. Desses, a maioria não faz uso de preservativo (67%). Apesar de a maioria ter conhecimento sobre as formas de transmissão, ainda acredita que picada de mosquito (79,9%), compartilhamento de sabonetes e toalhas (62,1%), talheres, copos e pratos (62,3%) podem transmitir o vírus. CONCLUSÕES: constatou-se que, apesar do bom nível de conhecimento demonstrado pelos participantes, ainda persistem dúvidas quanto às formas de transmissão, demonstrando a necessidade de investimentos públicos na educação que resulta em aumento do conhecimento e redução dos riscos.
Collapse
|
48
|
Abstract
The prevalence of HIV in patients over the age of 50 years is increasing. Although older patients may achieve equal or better virologic suppression at equal rates compared with younger patients, the immunologic benefit of highly active antiretroviral therapy (HAART) in older patients may be reduced compared with younger patients. Comorbidities are more common in older patients than younger patients and can impact management of HIV in these patients. Providers must be cognizant of drug-drug interactions and side effects of HAART regimens when selecting an antiretroviral regimen in older HIV patients. As the HIV-infected population ages, there is a growing need to better determine the ideal HAART regimen and timing of HAART initiation in older patients.
Collapse
|
49
|
Pratt G, Gascoyne K, Cunningham K, Tunbridge A. Human immunodeficiency virus (HIV) in older people. Age Ageing 2010; 39:289-94. [PMID: 20190230 DOI: 10.1093/ageing/afq009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The number of older people living with human immunodeficiency virus (HIV) in the UK is rising. Older people are at risk of acquiring HIV infection for a multitude of reasons. This, combined with effective HIV treatment which has significantly prolonged life expectancy, means that health care professionals working in the UK can expect to see increasing numbers of older people with HIV infection. In this review article, we summarise the epidemiology of HIV amongst older people, including data from our local cohort in the city of Sheffield, UK. We discuss specific and practical issues in older patients including why older people are at risk, how to make a diagnosis and the importance of doing so early, guidelines for HIV testing and an update on anti-retroviral therapy including drug interactions and side effects.
Collapse
Affiliation(s)
- Gary Pratt
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, UK.
| | | | | | | |
Collapse
|
50
|
Inpatient health services utilization among HIV-infected adult patients in care 2002-2007. J Acquir Immune Defic Syndr 2010; 53:397-404. [PMID: 19841589 DOI: 10.1097/qai.0b013e3181bcdc16] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examines the frequency of inpatient hospitalization, the number of inpatient days, and factors associated with inpatient utilization in a multistate HIV cohort between 2002 and 2007. DESIGN A prospective cohort study of HIV-infected adults in care at 11 US HIV primary and specialty care sites located in different geographic regions. METHODS Demographic, clinical, and resource utilization data were collected from medical records for the years 2002-2007. Rates of resource use were calculated for number of hospital admissions, total inpatient days, and mean length of stay per admission. RESULTS Annual inpatient hospitalization rates significantly decreased from 35 to 27 per 100 persons from 2002 to 2007. The number of inpatient days per year significantly decreased over time, whereas mean length of stay per admission was stable. Women, patients 50 years or older, blacks, injection drug users, and patients without private insurance had higher hospitalization rates than their counterparts. Admission rates were lower for patients with high CD4 counts and low HIV-1 RNA levels. CONCLUSIONS Inpatient hospitalization rates and number of inpatient days decreased for HIV patients in this multistate cohort between 2002 and 2007. Sociodemographic disparities in inpatient utilization persist.
Collapse
|