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Fernández A, Imaz A. Clinical considerations when switching antiretroviral therapy. Expert Rev Clin Pharmacol 2024; 17:565-577. [PMID: 38850057 DOI: 10.1080/17512433.2024.2365826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Antiretroviral therapy (ART) can be personalized through simple formulations with high resistance barriers, favorable safety profiles, and novel administration routes. Switching treatments has become a key clinical strategy for addressing drug toxicity and interactions and enhancing adherence and convenience. This strategy aims to improve the quality of life and long-term efficacy, even in challenging cases like people living with HIV (PLWH) with multiple comorbidities, prior virological failure, and drug resistance. AREAS COVERED The authors reviewed clinical trials and cohort studies providing evidence of benefits and risks of current antiretroviral (ARV) drugs as switching options for PLWH in various scenarios. The literature search included clinical trials, meta-analyses, observational studies, and review articles in English published after 2000, and current HIV treatment guidelines in English and Spanish as of February 2024. EXPERT OPINION New ARV drugs offer advantages in efficacy and safety over previous options but may also have adverse effects. Second-generation integrase inhibitors and tenofovir alafenamide show benefits as switching options in various scenarios, though more research is needed on potential weight gain and metabolic issues. Injectable long-acting ART is promising for switching strategies, but finding the optimal combination of new drugs remains challenging.
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Affiliation(s)
- Analuz Fernández
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arkaitz Imaz
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Mwise M, Magoma S, Meremo A. Prevalence of and factors associated with chronic kidney disease among patients infected with human immunodeficiency virus attending care and treatment centers at tertiary hospitals in dodoma, Tanzania. Heliyon 2024; 10:e32994. [PMID: 38988569 PMCID: PMC11234037 DOI: 10.1016/j.heliyon.2024.e32994] [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: 11/30/2023] [Revised: 05/01/2024] [Accepted: 06/12/2024] [Indexed: 07/12/2024] Open
Abstract
Background The burden and risk of developing chronic kidney disease (CKD) among patients with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is higher than in the general population. This study aimed to determine prevalence of and associated factors with CKD among adults infected with human immunodeficiency virus at tertiary hospitals in Dodoma, Tanzania. Method ology: A cross-sectional study was carried out between November 2022 to April 2023. Patients' demographic data, and clinical measurements were obtained on the day of the visit. Laboratory investigations were performed as standard of care. Descriptive and inferential analyses were performed, and variables associated with CKD were identified by multivariable logistic regression. Results A total of 223 patients were enrolled, with a median age of 47 (IQR 38-56) years, and 72.2 % were female. The CKD prevalence was 23.3 % whereby 18.4 % had CKD stage 3a, 4.5 % had CKD stage 3 b, and 0.4 % had CKD stage 4. CKD was observed largely among patients with obesity (34.15 %), anemia (29.41 %), hypertension (45.00 %), and diabetes mellitus (50.00 %). Variables with higher odds for CKD after adjusted analysis were hypertension (OR 3.03, 95 %% CI 1.29-7.11, P = 0.0109), diabetes mellitus (OR 4.50, 95 % CI 1.35-15.03, P = 0.0144), obesity (OR 3.07, 95 % CI 1.11-8.47, P = 0.0301), anaemia (OR 2.42, 95 % CI 1.12-5.26, P = 0.0252) and for each one-unit increase in age (years), there was statistically significant increase in the odds of having CKD by 1.084 folds (OR = 1.084, 95 % CI 1.039-1.131, p = 0.0002). Conclusion The prevalence of CKD among patients with HIV/AIDS is high. Age, obesity, anaemia, hypertension, and diabetes mellitus were strongly associated with CKD suggesting a need for integrating initiatives for non-communicable disease control in this population.
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Affiliation(s)
- Mashaka Mwise
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Internal Medicine, The Dodoma Referral Regional Hospital, Dodoma, Tanzania
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Sarah Magoma
- Department of Internal Medicine, The Dodoma Referral Regional Hospital, Dodoma, Tanzania
| | - Alfred Meremo
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Internal Medicine, The Dodoma Referral Regional Hospital, Dodoma, Tanzania
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
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Fernández-Castro I, Casar-Cocheteux C, Pernas-Pardavila H, Losada-Arias E, Antela A. Cross-sectional analysis of a cohort of people over 65 years of age living with HIV. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:317-320. [PMID: 38688820 DOI: 10.1016/j.eimce.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/16/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION This study aims to describe and analyze the characteristics of aged people who are living with HIV (APHIV) and evaluate their association on the comorbidities they currently have. METHODS Cross-sectional analysis of APHIV under active follow-up at the Infectious Diseases Unit of the University Clinical Hospital of Santiago de Compostela. Demographic and clinical data were analyzed, along with their association with the development of comorbidities in this population. A correlation and multiple linear regression analysis were performed for this purpose. RESULTS Eighty-five APHIV, 65 males and 20 females, with an average age of 69 years (IQR 8) and a duration of living with HIV of 17 years (SD 7), were studied. 41% of them had their initial diagnosis with AIDS. The most common comorbidities are hypertension and dyslipidemia in 55% and 52%, respectively. 40% of APHIV take at least 5 medications. 35% have received more than 5 lines of antiretroviral treatment. At the time of analysis, all APHIV have an undetectable viral load. No significant association was observed between the number of comorbidities and various characteristics of APHIV; however, a weak correlation was noted among age, the cumulative number of antiretroviral treatments received throughout their lives, and the number of comorbidities. CONCLUSIONS This analysis highlights the substantial burden of comorbidities and polypharmacy experienced by APHIV. Further studies are needed to better understand the characteristics and variables influencing their development.
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Affiliation(s)
- Iván Fernández-Castro
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Clara Casar-Cocheteux
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Hadrian Pernas-Pardavila
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Elena Losada-Arias
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Antonio Antela
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Cusato J, Mulasso A, Ferrara M, Manca A, Antonucci M, Accardo G, Palermiti A, Bianco G, Chiara F, Mula J, Maddalone MG, Tettoni MC, Cuomo S, Trevisan G, Bonora S, Di Perri G, Lupo C, Rainoldi A, D’Avolio A. Studying the Changes in Physical Functioning and Oxidative Stress-Related Molecules in People Living with HIV after Switching from Triple to Dual Therapy. Antioxidants (Basel) 2024; 13:518. [PMID: 38790623 PMCID: PMC11117521 DOI: 10.3390/antiox13050518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Physical activity could increase the production of oxidative stress biomarkers, affecting the metabolism and excretion of antiretroviral drugs and, consequently, the clinical outcome. Nowadays, people living with HIV (PLWH) are mostly switching from triple to dual therapy, but no data are available in terms of physical functioning and oxidative stress. The aim of this study was to evaluate if some antioxidant biomarkers and physical functioning tests could be different according to triple or dual antiretroviral therapy. METHODS PLWH were evaluated at baseline (BL), while treated with three drugs, and six months after the switch to dual therapy. Physical functioning was quantified using validated tools. Mitochondrial and cytosol antioxidant molecules were evaluated through liquid chromatography. RESULTS Twenty-five patients were analyzed. A statistically significant difference between triple and dual therapy was found for mitochondrial glutathione, but not for physical tests. Evaluating differences between physically active and inactive individuals, the following statistically significant differences were suggested, considering triple therapy (mitochondrial n-formyl-methionine p = 0.022, triglycerides p = 0.023) and double therapy (mitochondrial glycine p = 0.035, cytosol glutamic acid p = 0.007, cytosol s-adenosylmethionine p = 0.021). CONCLUSIONS For the first time, this study suggests possible differences in terms of antioxidant molecules and physical functioning in PLWH switching from triple to dual therapy.
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Affiliation(s)
- Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (J.C.); (A.P.); (G.B.); (J.M.); (M.G.M.)
| | - Anna Mulasso
- NeuroMuscolarFunction|Research Group, Department of Medical Sciences, University of Turin, 10128 Turin, Italy; (A.M.); (S.C.); (C.L.); (A.R.)
| | - Micol Ferrara
- ASL Città di Torino, Amedeo di Savoia Hospital, 10149 Turin, Italy; (M.F.); (M.A.); (M.C.T.)
| | - Alessandra Manca
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (J.C.); (A.P.); (G.B.); (J.M.); (M.G.M.)
| | - Miriam Antonucci
- ASL Città di Torino, Amedeo di Savoia Hospital, 10149 Turin, Italy; (M.F.); (M.A.); (M.C.T.)
| | - Guido Accardo
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (G.A.); (G.T.); (S.B.); (G.D.P.)
| | - Alice Palermiti
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (J.C.); (A.P.); (G.B.); (J.M.); (M.G.M.)
| | - Gianluca Bianco
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (J.C.); (A.P.); (G.B.); (J.M.); (M.G.M.)
| | - Francesco Chiara
- Laboratory of Clinical Pharmacology S. Luigi A.O.U., Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole, Orbassano, 10043 Turin, Italy;
| | - Jacopo Mula
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (J.C.); (A.P.); (G.B.); (J.M.); (M.G.M.)
| | - Maria Grazia Maddalone
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (J.C.); (A.P.); (G.B.); (J.M.); (M.G.M.)
| | - Maria Cristina Tettoni
- ASL Città di Torino, Amedeo di Savoia Hospital, 10149 Turin, Italy; (M.F.); (M.A.); (M.C.T.)
| | - Simone Cuomo
- NeuroMuscolarFunction|Research Group, Department of Medical Sciences, University of Turin, 10128 Turin, Italy; (A.M.); (S.C.); (C.L.); (A.R.)
| | - Giulia Trevisan
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (G.A.); (G.T.); (S.B.); (G.D.P.)
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (G.A.); (G.T.); (S.B.); (G.D.P.)
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (G.A.); (G.T.); (S.B.); (G.D.P.)
| | - Corrado Lupo
- NeuroMuscolarFunction|Research Group, Department of Medical Sciences, University of Turin, 10128 Turin, Italy; (A.M.); (S.C.); (C.L.); (A.R.)
| | - Alberto Rainoldi
- NeuroMuscolarFunction|Research Group, Department of Medical Sciences, University of Turin, 10128 Turin, Italy; (A.M.); (S.C.); (C.L.); (A.R.)
| | - Antonio D’Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy; (J.C.); (A.P.); (G.B.); (J.M.); (M.G.M.)
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Castro AP, Brito KB, Oliva TDR, Silva IMS, Kato BDS, Caldeira GAM, Santos FM, Libonati RMF. Fracture Risk with Modified FRAX in Men Living with HIV. J Clin Densitom 2024; 27:101460. [PMID: 38128450 DOI: 10.1016/j.jocd.2023.101460] [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: 08/13/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Aging of the HIV-infected population and prolonged use of ARTs, produced metabolic alterations, including increased fracture risk. FRAX is a validated, computer-based clinical fracture risk calculator which estimates 10-year risk of major fracture, and hip fracture. However may underestimate risk in HIV-infected individuals. Several experts recommend considering HIV a cause of secondary osteoporosis. METHODOLOGY Were included 52 men living with HIV, classified as high, moderate and low risk using ABRASSO graphic tool. RESULTS High risk prevalence found for major fracture and hip fracture were both 2 (4.2 %) using FRAX; while 10 (20.8 %) and 14 (29.2 %) using modified FRAX, respectively. Considering bone densitometry, 5 (12.8 %) were high risk for hip fracture and was noticed an increase in high risk major fracture from 4.2 % with FRAX to 5.1 % with FRAX considering bone densitometry. As for the low risk, 19 (39.6 %) for major fracture and 23 (47.9 %) for hip fracture with FRAX. While low risk modified FRAX were 0 (0 %) for major fracture and 8 (16.7 %) for hip fracture. It was also evidenced an association of high risk for major fracture and hip fracture with modified FRAX using Fisher's exact test [p=0.0273 (bilateral)]. CONCLUSION It was concluded is recommended using modified FRAX for people living with HIV for better control and therapeutic decision-making about osteometabolic alterations provocated for the virus and ARTs.
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Vemulapalli AC, Elias AA, Yerramsetti MD, Olanisa OO, Jain P, Khan QS, Butt SR. The Impact of Contemporary Antiretroviral Drugs on Atherosclerosis and Its Complications in People Living With HIV: A Systematic Review. Cureus 2023; 15:e47730. [PMID: 38021858 PMCID: PMC10676193 DOI: 10.7759/cureus.47730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
With the advent of modern antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection has been modified into a chronic manageable condition, prolonging the lifespan of people living with HIV (PLHIV). This has resulted in an increased non-AIDS-related morbidity in the HIV-infected population. Our aim is to study the role of contemporary ART in tackling the risk of atherosclerosis and cardiovascular disease (CVD) in PLHIV. We searched through the databases of PubMed, PubMed Central, and Cochrane Library for pertinent articles using the medical subject headings (MeSH) "HIV infection", "Atherosclerosis", and "Antiretroviral agents". The articles published in the past five years were retrieved, screened for relevance, and assessed for quality before being included in the review. This review was performed following the PRISMA 2020 guidelines. The results indicate that the incidence of dyslipidemia with integrase strand transfer inhibitors (INSTIs) is greater than with non-nucleoside reverse transcriptase inhibitors (NNRTIs) and lesser than with protease inhibitors (PIs). INSTIs are indispensably associated with weight gain and obesity. High triglyceride (TG) and oxidized low-density lipoproteins to low-density lipoproteins (oxLDL/LDL) ratio levels and low high-density lipoprotein (HDL) levels are seen in patients taking PIs. A higher incidence of hypertension and metabolic syndrome (MetS) was noticed with INSTIs compared to NNRTIs. PI intake for >5 years increases the risk of subclinical atherosclerosis. Increased risk of myocardial infarction with INSTIs was observed in a study, while another study reported decreased risk. HIV infection independently increases the risk for atherosclerosis and CVD. Although contemporary ART decreases this enhanced risk, it inherently increases the risk for abnormal lipid profile, MetS, weight gain, and obesity. Further research into the risk of atherosclerosis and CVD with newer ART drugs is essential for decoding the underlying mechanisms and preventing adverse cardiac outcomes in PLHIV.
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Affiliation(s)
- Abhijith C Vemulapalli
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abanob A Elias
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Monica D Yerramsetti
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Olawale O Olanisa
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Payal Jain
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Qasim S Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Samia R Butt
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Rotea-Salvo S, Giménez-Arufe V, Martínez-Pradeda A, Fernández-Oliveira C, Mena-de-Cea Á, Margusino-Framiñán L, Martín-Herranz I, Cid-Silva P. Lipid profile changes associated with antiretroviral therapies in a real-world cohort. FARMACIA HOSPITALARIA 2023; 47:T210-T217. [PMID: 37673703 DOI: 10.1016/j.farma.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To compare lipid profile changes and cardiovascular events among HIV naïve and experienced patients from a real-world cohort treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. METHOD A retrospective cohort study in HIV naïve and experienced people at a reference hospital in Spain was done. During the follow-up (March 2015-June 2019), patients were treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. Epidemiological, clinical and immunovirological variables were recorded. A statistical analysis of the lipid profile at baseline, 48 and 120 weeks after initiating the study therapy, cardiovascular events (myocardial infarction, heart failure, cerebrovascular accident, deep venous thrombosis, myocardiopathy, non-ST- segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction) and cardiovascular risks factors was performed. Data were analysed in naïve and experienced patients from each of the study treatments. The data was obtained from the medical history. The statistical analysis was performed with SPSS v.24 software. RESULTS A total of 266 and 191 patients receiving treatment with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine were included in the study, respectively. After 120 weeks of treatment, a worsening of the lipid profile was found in the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group, both in naïve and experienced patients, whereas not so conspicuously observed in the dolutegravir/abacavir/lamivudine group. Statistically significant differences between both groups were found in experienced patients favoring dolutegravir/abacavir/lamivudine; in total cholesterol (204.1 ± 38.2 vs. 187.3 ± 29.4, p < 0.001) and LDL-C (126.1 ± 31.9 vs. 113.5 ± 28.5, p = 0.001) at week 48, and in total cholesterol (201.1 ± 33.4 vs. 188.7 ± 33.9, p = 0.013) and HDL-C (54.2 ± 15.6 vs. 48.3 ± 14.3, p = 0.01) at week 120. No significant differences in cardiovascular events were found, neither in naïve nor in experienced patients. CONCLUSIONS The lipid profile among elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group worsened throughout the follow-up, both in naïve and experienced patients, not so remarkable in the dolutegravir/abacavir/lamivudine group. Both regimens were well tolerated, with similar rates of cardiovascular events.
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Affiliation(s)
- Sandra Rotea-Salvo
- Servicio de Farmacia, Hospital Universitario de A Coruña (CHUAC), A Coruña, España
| | - Víctor Giménez-Arufe
- Servicio de Farmacia, Hospital Universitario de A Coruña (CHUAC), A Coruña, España
| | | | | | - Álvaro Mena-de-Cea
- Servicio de Infecciosos, Unidad de Medicina Interna, Hospital Universitario de A Coruña (CHUAC), A Coruña, España; División de Virología Clínica, Instituto de Investigación Biomédica A Coruña (INIBIC), Hospital Universitario de A Coruña (CHUAC), Universidad de A Coruña (UDC), A Coruña, España
| | - Luis Margusino-Framiñán
- Servicio de Farmacia, Hospital Universitario de A Coruña (CHUAC), A Coruña, España; División de Virología Clínica, Instituto de Investigación Biomédica A Coruña (INIBIC), Hospital Universitario de A Coruña (CHUAC), Universidad de A Coruña (UDC), A Coruña, España
| | | | - Purificación Cid-Silva
- Servicio de Farmacia, Hospital Universitario de A Coruña (CHUAC), A Coruña, España; División de Virología Clínica, Instituto de Investigación Biomédica A Coruña (INIBIC), Hospital Universitario de A Coruña (CHUAC), Universidad de A Coruña (UDC), A Coruña, España.
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Rotea-Salvo S, Giménez-Arufe V, Martínez-Pradeda A, Fernández-Oliveira C, Mena-de-Cea Á, Margusino-Framiñán L, Martín-Herranz I, Cid-Silva P. Lipid profile changes associated with antiretroviral therapies in a real-world cohort. FARMACIA HOSPITALARIA 2023; 47:210-217. [PMID: 37349200 DOI: 10.1016/j.farma.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE To compare lipid profile changes and cardiovascular events among HIV naïve and experienced patients from a real-world cohort treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. METHOD A retrospective cohort study in HIV naïve and experienced people at a reference hospital in Spain was done. During the follow-up (March 2015-June 2019), patients were treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. Epidemiological, clinical, and immunovirological variables were recorded. A statistical analysis of the lipid profile at baseline, 48, and 120 weeks after initiating the study therapy, cardiovascular events (myocardial infarction, heart failure, cerebrovascular accident, deep venous thrombosis, myocardiopathy, non-ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction), and cardiovascular risks factors was performed. Data were analysed in naïve and experienced patients from each of the study treatments. The data were obtained from the medical history. The statistical analysis was performed with SPSS v. 24 software. RESULTS A total of 266 and 191 patients receiving treatment with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine were included in the study, respectively. After 120 weeks of treatment, a worsening of the lipid profile was found in the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group, both in naïve and experienced patients, whereas not so conspicuously observed in the dolutegravir/abacavir/lamivudine group. Statistically significant differences between both groups were found in experienced patients favouring dolutegravir/abacavir/lamivudine; in total cholesterol (204.1±38.2 vs. 187.3±29.4, P < .001) and LDL-C (126.1±31.9 vs. 113.5±28.5, P = .001) at week 48, and in total cholesterol (201.1±33.4 vs. 188.7±33.9, P = .013) and HDL-C (54.2±15.6 vs. 48.3±14.3, P = .01) at week 120. No significant differences in cardiovascular events were found, neither in naïve nor in experienced patients. CONCLUSIONS The lipid profile among elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group worsened throughout the follow-up, both in naïve and experienced patients, not so remarkable in the dolutegravir/abacavir/lamivudine group. Both regimens were well tolerated, with similar rates of cardiovascular events.
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Affiliation(s)
- Sandra Rotea-Salvo
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain
| | - Víctor Giménez-Arufe
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain
| | | | | | - Álvaro Mena-de-Cea
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain; Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC)- Universitary Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), Spain
| | - Luis Margusino-Framiñán
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain; Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC)- Universitary Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), Spain
| | - Isabel Martín-Herranz
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain
| | - Purificación Cid-Silva
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain; Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC)- Universitary Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), Spain.
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García-Peña Á, Aldana J, Botero JD, Vasquez JM, León M, Rodríguez-Lugo D, Villamil L, Barahona-Correa JE, Tamara J. Prevalence of cardiovascular risk factors in a historical cohort of people living with human immunodeficiency virus during a 10-year period. SAGE Open Med 2023; 11:20503121231166647. [PMID: 37123385 PMCID: PMC10134188 DOI: 10.1177/20503121231166647] [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: 09/27/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Objective Data on the frequency of cardiovascular disease in people living with human immunodeficiency virus from low- and middle-income countries is scarce. Methods We performed an observational study based on data from a historical cohort of people living with human immunodeficiency virus in Colombia during a 10-year follow-up to describe the prevalence of cardiovascular risk factors and their behavior according to CD4 count. Results One thousand patients were initially included, out of which 390 had a 10-year follow-up. The mean age was 34 (standard deviation 10) years, and 90% were male. We observed an increase in the prevalence of dyslipidemia (29%-52%, p < 0.001) and obesity (1.1%-3.5%, p < 0.001). Major cardiovascular events occurred in less than 1% of patients. Patients with a CD4 count <200 cells/mm3 had a higher frequency of acute myocardial infarction and obesity. Conclusion Over time, people living with human immunodeficiency virus present with an increasing prevalence of cardiovascular risk factors, particularly those with a lower CD4 count.
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Affiliation(s)
- Ángel García-Peña
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Division of Cardiology, Hospital Universitario San Ignacio, Bogotá, Colombia
- Department of Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
- Ángel García-Peña, Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Cra 7 No 40-62., Bogotá, D.C., Colombia.
| | - Jairo Aldana
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Division of Cardiology, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juan David Botero
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juan Manuel Vasquez
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Miguel León
- Department of Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diego Rodríguez-Lugo
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lina Villamil
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Jose Tamara
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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10
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de Souza RG, Lima SS, Pinto AC, Souza JS, Moura TCF, da Silva Graça Amoras E, Machado LFA, Guerreiro JF, Vallinoto ACR, Queiroz MAF, Ishak R. Change in Nutritional and Biochemical Status in People Living with HIV-1 on Antiretroviral Therapy. Viruses 2022; 14:v14112573. [PMID: 36423182 PMCID: PMC9697288 DOI: 10.3390/v14112573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Antiretroviral therapy (ART) improves the quality of life of people living with HIV-1 (PLHIV) and reduces the mortality rate, but some individuals may develop metabolic abnormalities. This study evaluated changes in the nutritional status and biochemistry of PLHIV on antiretroviral therapy in a cohort that had not previously received ART and to follow up these individuals for 24 months after starting treatment. The initial cohort consisted of 110 individuals and ended with 42 people, assessed by a physical examination. A biochemical assay was performed using the colorimetric enzyme reaction technique, the proviral load was detected by qPCR and the quantification of the CD4/CD8 T lymphocytes was conducted by flow cytometry. PLHIV had increased levels of total cholesterol, LDL, triglycerides, ALT, urea and creatinine after 24 months of ART use (p < 0.05). In the assessment of the nutritional status, PLHIV had increased measures of Triciptal Skinfold, body mass index and arm circumference after the use of ART (p < 0.05). The viral load levels decreased and the CD4 levels increased after 24 months of ART use (p < 0.05). The change in the nutritional status in PLHIV on antiretroviral therapy seems to be a slow process, occurring in the long term, therefore, there is the need for a constant evaluation of these people to identify patients who need a nutritional intervention.
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Affiliation(s)
- Ranilda Gama de Souza
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
- Graduate Program in Biology of Infectious and Parasitic Agents, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Sandra Souza Lima
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Andresa Corrêa Pinto
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Jacqueline Silva Souza
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Tuane Carolina Ferreira Moura
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Ednelza da Silva Graça Amoras
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Luiz Fernando Almeida Machado
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - João Farias Guerreiro
- Human and Medical Genetics Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Maria Alice Freitas Queiroz
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
- Correspondence:
| | - Ricardo Ishak
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
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11
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Bendala‐Estrada AD, Diaz‐Almiron M, Busca C, Mican R, Cadiñanos J, Montes ML, Martin‐Carbonero L, Valencia E, Montejano R, Delgado‐Hierro A, Bernardino JI. Change in metabolic parameters after switching from triple regimens with tenofovir alafenamide to dolutegravir‐based dual therapy. Bi‐lipid study. HIV Med 2022; 24:558-567. [PMID: 36394195 DOI: 10.1111/hiv.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The use of tenofovir alafenamide (TAF) has been associated with increased cholesterol and body weight. Real-life data on the metabolic effects of switching from a TAF-based triple regimen to a dolutegravir (DTG)-based two-drug regimen (2-DR) are scarce. METHODS A retrospective cohort study of patients who have switched from a triple TAF-based regimen to a 2-DR [DTG-lamivudine (DTG-3TC) or DTG- rilpivirine (DTG-RPV]) with at least 6 months of follow-up. The primary endpoint was the absolute change in lipid fractions at 6 months. Secondary outcomes were percentage changes in lipid fraction, effectiveness and safety at 6 and 12 months [intention to treat (ITT), missing = failures]. RESULTS A total of 118 patients (87 on DTG-3TC, 31 on DTG-RPV) were included. Median age was 51 years (interquartile range: 43-59), 86% were male, CD4 T-cell count was 692 cells/μL, and 98% viral load (VL) < 50 copies/mL. At 6 months there was a decrease in total and low-density lipoprotein cholesterol of 10.7 mg/dL [95% confidence interval (CI): 2.2-19.1; p ≤ 0.001] and 8.3 mg/dL (95% CI: 0.74-15.9; p = 0.026), respectively. There was a reduction in cardiovascular risk from 4.5% at baseline to 4% at 12 months (p = 0.040). Virological effectiveness as determined by ITT analysis was 85.6% at 6 months and 66.1% at 12 months. Seven patients (5.9%) withdrew from the 2-DR and there was no virological failure. CONCLUSIONS In real life, switching from a triple regimen with TAF to DTG-3TC or DTG-RPV dual therapy improves the lipid profile and is an effective and well-tolerated strategy.
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Affiliation(s)
| | | | - Carmen Busca
- HIV and infectious diseases Unit La Paz University Hospital, IdiPAZ, CIBER of Infectious Diseases (CIBERINFEC) Madrid Spain
| | - Rafael Mican
- HIV and infectious diseases Unit La Paz University Hospital, IdiPAZ, CIBER of Infectious Diseases (CIBERINFEC) Madrid Spain
| | - Julen Cadiñanos
- HIV and infectious diseases Unit La Paz University Hospital, IdiPAZ, CIBER of Infectious Diseases (CIBERINFEC) Madrid Spain
| | - Maria Luisa Montes
- HIV and infectious diseases Unit La Paz University Hospital, IdiPAZ, CIBER of Infectious Diseases (CIBERINFEC) Madrid Spain
| | - Luz Martin‐Carbonero
- HIV and infectious diseases Unit La Paz University Hospital, IdiPAZ, CIBER of Infectious Diseases (CIBERINFEC) Madrid Spain
| | - Eulalia Valencia
- HIV and infectious diseases Unit La Paz University Hospital, IdiPAZ, CIBER of Infectious Diseases (CIBERINFEC) Madrid Spain
| | - Rocío Montejano
- HIV and infectious diseases Unit La Paz University Hospital, IdiPAZ, CIBER of Infectious Diseases (CIBERINFEC) Madrid Spain
| | - Ana Delgado‐Hierro
- HIV and infectious diseases Unit La Paz University Hospital, IdiPAZ, CIBER of Infectious Diseases (CIBERINFEC) Madrid Spain
| | - Jose I. Bernardino
- HIV and infectious diseases Unit La Paz University Hospital, IdiPAZ, CIBER of Infectious Diseases (CIBERINFEC) Madrid Spain
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12
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Lessard D, Dubé K, Bilodeau M, Keeler P, Margolese S, Rosenes R, Sinyavskaya L, Durand M, Benko E, Kovacs C, Guerlotté C, Tharao W, Arnold K, Masching R, Taylor D, Sousa J, Ostrowski M, Taylor J, Kaytes A, Smith D, Gianella S, Chomont N, Angel JB, Routy JP, Cohen ÉA, Lebouché B, Costiniuk CT. Willingness of Older Canadians with HIV to Participate in HIV Cure Research Near and After the End of Life: A Mixed-Method Study. AIDS Res Hum Retroviruses 2022; 38:670-682. [PMID: 35778845 PMCID: PMC9483839 DOI: 10.1089/aid.2022.0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
HIV cure research requires interrogating latent HIV reservoirs in deep tissues, which necessitates autopsies to avoid risks to participants. An HIV autopsy biobank would facilitate this research, but such research raises ethical issues and requires participant engagement. This study explores the willingness to participate in HIV cure research at the end of life. Participants include Canadians with HIV [people with HIV (PWHIV)] aged 55 years or older. Following a mixed-method study design, all participants completed a phone or online survey, and a subset of participants participated in in-depth phone or videoconference interviews. We produced descriptive statistics of quantitative data and a thematic analysis of qualitative data. Barriers and facilitators were categorized under domains of the Theoretical Domains Framework. From April 2020 to August 2021, 37 participants completed the survey (mean age = 69.9 years old; mean duration of HIV infection = 28.5 years), including 15 interviewed participants. About three quarters of participants indicated being willing to participate in hypothetical medical studies toward the end of life (n = 30; 81.1%), in HIV biobanking (n = 30; 81.1%), and in a research autopsy (n = 28; 75.7%) to advance HIV cure research, mainly for altruistic benefits. The main perceived risks had to do with physical pain and confidentiality. Barriers and facilitators were distributed across five domains: social/professional role and identity, environmental context and resources, social influences, beliefs about consequences, and capabilities. Participants wanted more information about study objectives and procedures, possible accommodations with their last will, and rationale for studies or financial interests funding studies. Our results indicate that older PWHIV would be willing to participate in HIV cure research toward the end of life, HIV biobanking, and research autopsy. However, a dialogue should be initiated to inform participants thoroughly about HIV cure studies, address concerns, and accommodate their needs and preferences. Additional work is required, likely through increased community engagement, to address educational needs.
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Affiliation(s)
- David Lessard
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Karine Dubé
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Shari Margolese
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Ron Rosenes
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Liliya Sinyavskaya
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Madeleine Durand
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Charlotte Guerlotté
- COCQ-Sida, Montreal, Canada
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Wangari Tharao
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- Women's Health in Women's Hands, Canada and African and Black Diaspora Global Network on HIV and AIDS, Toronto, Canada
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Canada
| | - Keresa Arnold
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Canada
| | - Renée Masching
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- Canadian Aboriginal AIDS Network, Dartmouth, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Darien Taylor
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - José Sousa
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Mario Ostrowski
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jeff Taylor
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Andy Kaytes
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Davey Smith
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Nicolas Chomont
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Jonathan B. Angel
- Ottawa Hospital Research Institute and Division of Infectious Disease, The Ottawa Hospital, Ottawa, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
| | - Éric A. Cohen
- Institut de Recherche Clinique de Montréal, Montreal, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Cecilia T. Costiniuk
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
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13
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Camps-Vilaró A, Pérez-Fernández S, Subirana I, Teira R, Estrada V, Domingo P, Dégano IR, Marrugat J. Standardized Comparison of Cardiovascular Risk Factors Prevalence in Spanish Women and Men Living with HIV and in the General Population. J Pers Med 2021; 11:jpm11111085. [PMID: 34834438 PMCID: PMC8621654 DOI: 10.3390/jpm11111085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
People living with HIV (PLWH) have an increased risk of cardiovascular (CV) disease, likely due to a higher prevalence of CV risk factors. We compared the age-standardized prevalence and management of CV risk factors in PLWH to that of the general population in Spain. Blood pressure, lipid, glucose, and anthropometric profiles were cross-sectionally compared along with the treatment of hypertension, dyslipidemia, and diabetes in a general population cohort and a PLWH cohort. Prevalence rates were standardized by the direct method by 10-year age groups in European standard populations and stratified by gender. We included 47,593 individuals aged 35 to 74 years, 28,360 from the general population cohort and 19,233 from the PLWH cohort. Compared to the general population, PLWH had a higher concentration of triglycerides (>35 mg/dL in women and >26 mg/dL in men) and a higher prevalence of smoking (>23% and >17%) and diabetes (>9.9% and >8.5%). The prevalence of treated diabetes, hypertension, and dyslipidemia were up to three-fold lower in both women and men living with HIV. There was a significant difference in PLWH compared to the general population in the lipid, glucose, and anthropometric profile. In addition, PLWH were less often treated for diagnosed diabetes, hypertension, and dyslipidemia.
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Affiliation(s)
- Anna Camps-Vilaró
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Silvia Pérez-Fernández
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Isaac Subirana
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Ramon Teira
- Infectious Diseases Unit, Hospital Sierrallana, 39300 Torrelavega, Spain;
| | - Vicente Estrada
- Infectious Diseases Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Irene R. Dégano
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
- Correspondence: (I.R.D.); (J.M.); Tel.: +34-9-3316-0714 (I.R.D.); +34-9-3316-0733 (J.M.); Fax: +34-9-3316-0796 (I.R.D. & J.M.)
| | - Jaume Marrugat
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: (I.R.D.); (J.M.); Tel.: +34-9-3316-0714 (I.R.D.); +34-9-3316-0733 (J.M.); Fax: +34-9-3316-0796 (I.R.D. & J.M.)
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14
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Antela A, Rivero A, Llibre JM, Moreno S. Redefining therapeutic success in HIV patients: an expert view. J Antimicrob Chemother 2021; 76:2501-2518. [PMID: 34077524 PMCID: PMC8446931 DOI: 10.1093/jac/dkab168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Thanks to advances in the field over the years, HIV/AIDS has now become a manageable chronic condition. Nevertheless, a new set of HIV-associated complications has emerged, related in part to the accelerated ageing observed in people living with HIV/AIDS, the cumulative toxicities from exposure to antiretroviral drugs over decades and emerging comorbidities. As a result, HIV/AIDS can still have a negative impact on patients' quality of life (QoL). In this scenario, it is reasonable to believe that the concept of therapeutic success, traditionally associated with CD4 cell count restoration and HIV RNA plasma viral load suppression and the absence of drug resistances, needs to be redefined to include other factors that reach beyond antiretroviral efficacy. With this in mind, a group of experts initiated and coordinated the RET Project, and this group, using the available evidence and their clinical experience in the field, has proposed new criteria to redefine treatment success in HIV, arranged into five main concepts: rapid initiation, efficacy, simplicity, safety, and QoL. An extensive review of the literature was performed for each category, and results were discussed by a total of 32 clinicians with experience in HIV/AIDS (4 coordinators + 28 additional experts). This article summarizes the conclusions of these experts and presents the most updated overview on the five topics, along with a discussion of the experts' main concerns, conclusions and/or recommendations on the most controversial issues.
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Affiliation(s)
- Antonio Antela
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Rivero
- Hospital Universitario Reina Sofía, Cordoba, Spain
- Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
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15
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Ruiz-Algueró M, Hernando V, Marcos H, Gutiérrez G, Pérez-Elías MJ, López-Bernaldo de Quirós JC, Pulido F, Górgolas M, Sanz J, Suarez-García I, Fernandez MT, Losa JE, Pérez JL, Ladrero MO, Prieto MÁ, González G, Izquierdo A, Viloria LJ, López I, Martínez E, Castrillejo D, Aranguren R, Belmonte MA, Aranda-García IV, Arraiza A, Diaz A. Self-rated health among people living with HIV in Spain in 2019: a cross-sectional study. BMC Infect Dis 2021; 21:129. [PMID: 33516173 PMCID: PMC7847002 DOI: 10.1186/s12879-021-05815-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/17/2021] [Indexed: 01/29/2023] Open
Abstract
Background HIV infection has become a chronic disease and well-being of people living with HIV (PLHIV) is now of particular concern. The objectives of this paper were to describe self-rated health among PLHIV, on ART and on ART virally suppressed and to analyse its determinants. Methods Data were obtained from a second-generation surveillance system based on a cross-sectional one-day survey in public hospitals. Epidemiological and clinical data were collected among HIV-infected inpatients and outpatients receiving HIV-related care the day of the survey in 86 hospitals in 2019. Self-rated health was measured using a question included in the National Health Survey: “In the last 12 months, how would you rate your health status?” an ordinal variable with five categories (very good, good, moderate, bad and very bad). For the analysis, these responses were dichotomized into two categories: 1 = very good/good and 0 = moderate, bad or very bad health status. Factors associated with very good/good self-rated health were estimated using logistic regression. Results Of 800 PLHIV, 67.5% perceived their health as very good/good, 68.4% among PLHIV on ART and 71.7% of those virally suppressed. Having university education (adjusted odds ratio (aOR):2.1), being unemployed (aOR:0.3) or retired (aOR:0.2), ever being diagnosed of AIDS (aOR:0.6), comorbidities (aOR:0.3), less than 2 year since HIV diagnosis (aOR:0.3) and not receiving ART (aOR:0.3) were associated with good self-rated health. Moreover, among PLHIV on ART, viral load less than 200 copies (aOR:3.2) were related to better perceived health. Bad adherence was inversely associated with good self-rated health among PLHIV on ART (aOR:0.5) and of those virally suppressed (aOR:0.4). Conclusions Nearly seven in 10 PLHIV in Spain considered their health status as very good/good, being higher among virally suppressed PLHIV. Both demographic and clinical determinants affect quality of life.
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Affiliation(s)
- Marta Ruiz-Algueró
- Unidad de vigilancia de VIH, ITS y hepatitis, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, C/ Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Victoria Hernando
- Unidad de vigilancia de VIH, ITS y hepatitis, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, C/ Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Henar Marcos
- Servicio de Vigilancia Epidemiológica y Enfermedades Transmisibles, DG de Salud Pública, Consejería de Sanidad, Valladolid, Castilla y León, Spain
| | - Gonzalo Gutiérrez
- Servicio de Epidemiología, DG de Salud Pública, Consejería de Sanidad, Toledo, Castilla-La Mancha, Spain
| | | | | | - Federico Pulido
- Unidad VIH, Hospital Universitario 12 de Octubre. imas12.UCM, Madrid, Spain
| | - Miguel Górgolas
- Unidad de Enfermedades Infecciosas y VIH, Fundación Jimenez Díaz, Madrid, Spain
| | - Jesus Sanz
- Unidad de Enfermedades Infecciosas, Hospital Universitario de La Princesa, Madrid, Spain
| | - Ines Suarez-García
- Grupo de enfermedades infecciosas, Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.,FIIB HUIS HHEN, Universidad Europea, Madrid, Spain
| | | | - Juan Emilio Losa
- Unidad de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Jose Luis Pérez
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | - Maria Oliva Ladrero
- Coordinación de VIH/sida, Servicio de Promoción de la Salud y Prevención de la Enfermedad, D.G. de Salud Pública, Zaragoza, Aragón, Spain
| | - Miguel Ángel Prieto
- Servicio de Evaluación de la Salud y Programas, DG de Salud Pública, Consejería de Sanidad, Oviedo, Asturias, Spain
| | - Gustavo González
- Oficina de Coordinación VIH de Extremadura, Servicio de Participación Comunitaria en Salud, DG de Salud Pública, Servicio Extremeño de Salud, Mérida, Extremadura, Spain
| | - Ana Izquierdo
- Servicio de Epidemiología y Promoción de la Salud, DG de Salud Pública, Servicio Canario de la Salud, Santa Cruz de Tenerife, Canarias, Spain
| | - Luis Javier Viloria
- Sección de Vigilancia Epidemiológica, DG de Salud Pública, Santander, Cantabria, Spain
| | - Irene López
- Servicio de Prevención y Epidemiología del Plan sobre sida, Consejería de Sanidad y Consumo, Ceuta, Spain
| | - Eva Martínez
- Sección de Vigilancia Epidemiológica y Control de Enfermedades Transmisibles, DG de Salud Pública y Consumo, Logroño, La Rioja, Spain
| | - Daniel Castrillejo
- Servicio de Epidemiología, DG de Sanidad y Consumo, Consejería de Bienestar Social y Sanidad, Melilla, Spain
| | - Rosa Aranguren
- Coordinación Autonómica de Drogas y de la Estrategia de Sida, DG de Salut Pública i Consum, Conselleria de Salut, Família i Bienestar Social, Palma de Mallorca, Baleares, Spain
| | - Maria Antonia Belmonte
- Servicio de Promoción y Educación para la Salud, Dirección General de Salud Pública y Adicciones, Consejería de Salud, Murcia, Región de Murcia, Spain
| | - I V Aranda-García
- Servicio Promoción de la Salud y Prevención en la Etapas de la Vida, Dirección General de Salud Pública y Adicciones, Conselleria de Sanitat Universal i Salut Pública, Valencia, Comunidad Valenciana, Spain
| | - Antonio Arraiza
- Programas de Salud, Direccion General, Osakidetza, San Sebastian, País Vasco, Spain
| | - Asuncion Diaz
- Unidad de vigilancia de VIH, ITS y hepatitis, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, C/ Monforte de Lemos, 5, 28029, Madrid, Spain.
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16
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Perfil de riesgo cardiovascular e hipertensión en sujetos infectados por el VIH adscritos a un centro de salud: un toque de atención. HIPERTENSION Y RIESGO VASCULAR 2020; 37:92-94. [DOI: 10.1016/j.hipert.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 01/23/2020] [Indexed: 11/20/2022]
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17
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Vos AG, Hoeve K, Barth RE, Peper J, Moorhouse M, Crowther NJ, Venter WDF, Grobbee DE, Bots ML, Klipstein-Grobusch K. Cardiovascular disease risk in an urban African population: a cross-sectional analysis on the role of HIV and antiretroviral treatment. Retrovirology 2019; 16:37. [PMID: 31796103 PMCID: PMC6889610 DOI: 10.1186/s12977-019-0497-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/22/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Life expectancy is increasing in the HIV-positive population and age-related non-communicable diseases, such as cardiovascular disease, (CVD) are seen more frequently. This study investigated to what extent HIV and antiretroviral therapy (ART) is associated with CVD risk in an urban African population. METHODS A cross-sectional study was performed in Johannesburg, South Africa, between July 2016 and November 2017. Both HIV-positive adults (ART-naïve, or on first- or second-line ART), as well as age and sex matched HIV-negative controls who were family or friends of the HIV-positive participants were included. Data were collected on demographics, cardiovascular risk factors, HIV-related characteristics, carotid intima-media thickness (CIMT) and carotid distensibility. The association between HIV, ART and CIMT and distensibility was analysed with linear regression models, adjusting for age, gender and CVD risk factors. RESULTS The study included 548 participants, 337 (62%) females, age 38.3 ± 9.5 years of whom 104 (19.0%) were HIV-positive, ART-naïve; 94 (17.2%) were on first-line ART; 197 (35.9%) were on second-line ART; and 153 (27.9%) were HIV-negative. Participants on second-line ART had higher CIMT and lower distensibility compared to the other groups (p < 0.001). After adjustment for age, these outcomes were similar between groups. Further adjustment for CVD and HIV-related factors did not alter the findings. CONCLUSION Neither HIV nor ART was associated with CIMT or carotid distensibility in this urban African population. Longitudinal studies are needed to fully understand the relationship between HIV and CVD across different populations.
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Affiliation(s)
- Alinda G Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
- Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
- Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Klariska Hoeve
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Roos E Barth
- Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Michelle Moorhouse
- Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D F Venter
- Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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18
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Rhoades N, Mendoza N, Jankeel A, Sureshchandra S, Alvarez AD, Doratt B, Heidari O, Hagan R, Brown B, Scheibel S, Marbley T, Taylor J, Messaoudi I. Altered Immunity and Microbial Dysbiosis in Aged Individuals With Long-Term Controlled HIV Infection. Front Immunol 2019; 10:463. [PMID: 30915086 PMCID: PMC6423162 DOI: 10.3389/fimmu.2019.00463] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/20/2019] [Indexed: 01/22/2023] Open
Abstract
The introduction of highly active antiretroviral therapy (HAART) resulted in a significant increase in life expectancy for HIV patients. Indeed, in 2015, 45% of the HIV+ individuals in the United States were ≥55 years of age. Despite improvements in diagnosis and treatment of HIV infection, geriatric HIV+ patients suffer from higher incidence of comorbidities compared to age-matched HIV- individuals. Both chronic inflammation and dysbiosis of the gut microbiome are believed to be major contributors to this phenomenon, however carefully controlled studies investigating the impact of long-term (>10 years) controlled HIV (LTC-HIV) infection are lacking. To address this question, we profiled circulating immune cells, immune mediators, and the gut microbiome from elderly (≥55 years old) LTC-HIV+ and HIV- gay men living in the Palm Springs area. LTC-HIV+ individuals had lower frequency of circulating monocytes and CD4+ T-cells, and increased frequency CD8+ T-cells. Moreover, levels of systemic INFγ and several growth factors were increased while levels of IL-2 and several chemokines were reduced. Upon stimulation, immune cells from LTC-HIV+ individuals produced higher levels of pro-inflammatory cytokines. Last but not least, the gut microbiome of LTC-HIV+ individuals was enriched in bacterial taxa typically found in the oral cavity suggestive of loss of compartmentalization, while levels of beneficial butyrate producing taxa were reduced. Additionally, prevalence of Prevotella negatively correlated with CD4+ T-cells numbers in LTC-HIV+ individuals. These results indicate that despite long-term adherence and undetectable viral loads, LTC-HIV infection results in significant shifts in immune cell frequencies and gut microbial communities.
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Affiliation(s)
- Nicholas Rhoades
- Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, United States
| | - Norma Mendoza
- Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, United States
| | - Allen Jankeel
- Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, United States
| | - Suhas Sureshchandra
- Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, United States
| | - Alexander D Alvarez
- Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, United States
| | - Brianna Doratt
- Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, United States
| | - Omeid Heidari
- School of Nursing, John Hopkins University, Baltimore, MD, United States
| | - Rod Hagan
- Stonewall Medical Center, Borrego Health, Cathedral City, CA, United States
| | - Brandon Brown
- School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Steven Scheibel
- Stonewall Medical Center, Borrego Health, Cathedral City, CA, United States
| | - Theodore Marbley
- Stonewall Medical Center, Borrego Health, Cathedral City, CA, United States
| | - Jeff Taylor
- HIV+ Aging-Palm Springs, Palm Springs, CA, United States
| | - Ilhem Messaoudi
- Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, United States
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