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Lamesa TA. Biological Depiction of Lipodystrophy and Its Associated Challenges Among HIV AIDS Patients: Literature Review. HIV AIDS (Auckl) 2024; 16:123-132. [PMID: 38584795 PMCID: PMC10999207 DOI: 10.2147/hiv.s445605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Lipodystrophy syndrome is a medical condition characterized by the absence of adipose tissue without any underlying starvation or macromolecule breakdown. In HIV AIDS patients, the use of highly active antiretroviral therapy (HAART) can lead to an acquired form of lipodystrophy, with a prevalence ranging from 10% to 83% among HIV AIDS patients. It was aimed to review the current understanding of biological depiction and challenges related to lipodystrophy in AIDS patients. Relevant articles published in the English language were searched in PubMed, Google Scholar, and Google. Keywords used for the search were: lipodystrophy, lipodystrophy and HIV, ART and lipodystrophy, HIV treatment, metabolic syndrome and HIV. Articles with full abstract information were read for those that met the objective criteria of the review, then full text of the articles was accessed and used. It was revealed by the literature that patients who developed lipodystrophy are characterized by insulin abnormality, obesity, diabetes mellitus, dyslipidemia, fatty liver disease, and ovarian dysfunction. Anthropometric measurements have been known to change significantly with lipodystrophy. HIV patients suffering from hepatitis C virus, hepatitis B virus, who take a protease inhibitor, are changing treatment or duration of treatment, and are women are the common risk factors for lipodystrophy. The metabolic syndrome seen in HIV patients associated with lipodystrophy can further be complicated to different adverse health effects and can result in increased morbidity and mortality rate if not treated. Existing studies have successfully identified several challenges faced by HIV AIDS patients due to lipodystrophy, including low self-esteem, compromised quality of life, and poor treatment adherence. However, it is crucial to acknowledge that there may be numerous other challenges that have yet to be discovered, emphasizing the need for further studies. It is recommended that managing dyslipidemia, treating diabetes mellitus, modifying lifestyle, and improving the anthropometric measurements have crucial roles to halt further complications associated with lipodystrophy.
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Shimura M, Higashi-Kuwata N, Fujiwara A, Taniguchi M, Ichinose T, Hamano F, Uematsu M, Inoue T, Matsuyama S, Suzuki T, Ghosh AK, Shindou H, Shimuzu T, Mitsuya H. A lipid index for risk of hyperlipidemia caused by anti-retroviral drugs. Antiviral Res 2024; 223:105819. [PMID: 38272319 DOI: 10.1016/j.antiviral.2024.105819] [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: 11/29/2023] [Revised: 01/14/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024]
Abstract
HIV-associated lipodystrophy has been reported in people taking anti-retroviral therapy (ART). Lipodystrophy can cause cardiovascular diseases, affecting the quality of life of HIV-infected individuals. In this study, we propose a pharmacological lipid index to estimate the risk of hyperlipidemia caused by anti-retroviral drugs. Lipid droplets were stained in cells treated with anti-retroviral drugs and cyclosporin A. Signal intensities of lipid droplets were plotted against the drug concentrations to obtain an isodose of 10 μM of cyclosporin A, which we call the Pharmacological Lipid Index (PLI). The PLI was then normalized by EC50. PLI/EC50 values were low in early proteinase inhibitors and the nucleoside reverse transcriptase inhibitor, d4T, indicating high risk of hyperlipidemia, which is consistent with previous findings of hyperlipidemia. In contrast, there are few reports of hyperlipidemia for drugs with high PLI/EC50 scores. Data suggests that PLI/EC50 is a useful index for estimating the risk of hyperlipidemia.
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Affiliation(s)
- Mari Shimura
- Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan; RIKEN SPring-8 Center, Sayo, Hyogo, Japan.
| | - Nobuyo Higashi-Kuwata
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Asuka Fujiwara
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Mai Taniguchi
- Inorganic Analysis Laboratories, Toray Research Center, Inc., Otsu, Shiga, Japan
| | - Takayuki Ichinose
- Inorganic Analysis Laboratories, Toray Research Center, Inc., Otsu, Shiga, Japan
| | - Fumie Hamano
- Life Sciences Core Facility, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Lipid Signaling, Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Masaaki Uematsu
- Department of Lipid Signaling, Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Takato Inoue
- Department of Materials Physics, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8603, Japan
| | - Satoshi Matsuyama
- RIKEN SPring-8 Center, Sayo, Hyogo, Japan; Department of Materials Physics, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8603, Japan
| | - Takahiro Suzuki
- Department of Chemistry, Faculty of Science, Hokkaido University, Sapporo, Japan
| | - Arun K Ghosh
- Department of Chemistry & Department of Medicinal Chemistry, Purdue University, West Lafayette, IN, 47907, USA
| | - Hideo Shindou
- Department of Lipid Life Science, Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan; Department of Medical Lipid Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takao Shimuzu
- Department of Lipid Signaling, Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan; Institute of Microbial Chemistry, Shinagawa-ku, Tokyo, Japan
| | - Hiroaki Mitsuya
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan; Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Center Institute, National Institutes of Health, Bethesda, MD, 20893, USA.
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Sacilotto LB, Papini SJ, Mendes AL, Gatto M, Pereira PCM, Corrente JE, da Silva JDF. Relationship Between Lipodystrophy, Body Composition, Metabolic Profile, and Serum Levels of Adipocytokines. Front Nutr 2021; 8:750721. [PMID: 34957175 PMCID: PMC8698133 DOI: 10.3389/fnut.2021.750721] [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: 07/31/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the benefits in improving the clinical state of people living with HIV/aids (PLWHA), some side effects associated with the use of antiretroviral therapy (ART) are reported. Redistribution of body fat has been associated with treatment and is characterized by morphological changes, also known as lipodystrophy. The complications of metabolic and morphological changes in these individuals seem to increase the risk of cardiovascular disease. Adipocytokines are proteins that have essential functions in biological processes, in which the levels of these proteins are related to the pathogenesis of metabolic syndrome (MS) and cardiovascular disease. Recent studies have shown that such levels are generally modified in PLWHA, regardless of whether the treatment is established or not. An application of methods for body fat estimation in patients with fat redistribution, as in the case of aids, especially those that quantify body fat by segments, appears to clarify these alterations and plays an important role in the development of multiprofessional treatment. Objectives: This investigation was carried out to compare and correlate body composition, biochemical metabolic parameters, and levels of adipocytokines and cytokines of PLWHA, with and without lipodystrophy, with individuals with negative HIV serology and stratified by sex. Material and Methods: This is a cross-sectional study in which body composition, metabolic and anthropometric changes, and levels of adipocytokines of 110 individuals were assessed. These individuals were paired in sex, age, and body mass index (BMI) and subdivided into three groups: PLWHA with and without a clinical diagnosis of lipodystrophy associated with HIV, and a group control. Results: Collinearity was identified both in the general sample and for genders of the waist-to-height ratio (WHtR) with all anthropometric parameters, except for muscle mass. The results show strong association between IFN-γ and TNF-α both in the general sample and for genders and moderate correlation between leptin and fasting glucose for women; worsening of the triglyceride profile in both women with lipodystrophy compared with the control group and men without lipodystrophy compared with the control group; higher serum TNF-α values among men without lipodystrophy compared to those with HIV-associated lipodystrophy (HALS). Conclusions: The results of this study underline that, considering the manifestations of the syndrome, these patients have a high-risk endocrine metabolic profile for cardiovascular events.
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Affiliation(s)
- Lívia Bertazzo Sacilotto
- Department of Infectology, Dermatology, Diagnostic Imaging, and Radiotherapy, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Silvia Justina Papini
- Department of Nursing, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Adriana Lucia Mendes
- Internal Medicine Department, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Mariana Gatto
- Internal Medicine Department, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Paulo Câmara Marques Pereira
- Department of Infectology, Dermatology, Diagnostic Imaging, and Radiotherapy, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - José Eduardo Corrente
- Department of Biostatistics, Institute of Biosciences, São Paulo State University (UNESP), São Paulo, Brazil
| | - Julhiany de Fátima da Silva
- Department of Infectology, Dermatology, Diagnostic Imaging, and Radiotherapy, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
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Excisional lipectomy versus liposuction in HIV-associated lipodystrophy. Arch Plast Surg 2021; 48:685-690. [PMID: 34818717 PMCID: PMC8627937 DOI: 10.5999/aps.2020.02285] [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: 11/16/2020] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy. Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed. Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient’s postoperative course was complicated by seroma formation. Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.
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Consideration of Human Immunodeficiency Status in Patients Seeking Facial Feminization Surgery. J Craniofac Surg 2021; 32:2384-2387. [PMID: 34705383 DOI: 10.1097/scs.0000000000007840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Facial feminization surgery (FFS) with its proven safety and efficacy has become a mainstay surgical approach for those desiring gender-specific perceived feminine facial aesthetics. To date, specific characteristics of patients seeking FFS have been limited, with no studies investigating the role of the Human Immunodeficiency Virus (HIV) on FFS outcomes. The potential clinical implications of HIV and more specifically HIV-associated lipodystrophy, which can cause facial lipoatrophy, require further investigation. Given the importance of midface projection in feminizing the face, the authors aimed to investigate any associations HIV or Highly Active Antiretroviral Therapy may have on outcomes, including clinical consequences of facial lipoatrophy. The authors performed a retrospective chart review of all patients with a diagnosis of gender dysphoria referred to the senior author (EDR) for FFS between 2017 and 2020. Patients were grouped based on HIV status and demographics, history, and outcomes were assessed. Seventy-seven patients were included, with 28 patients (36.4%) having a diagnosis of HIV. A total of 25 (32.5%) and 23 (29.9%) patients underwent malar fat grafting and cheek implants, respectively. No significant difference was found between HIV-positive and HIV-negative patients when looking at the use of malar fat grafting, cheek implants, age, or complication rates. To the best of our knowledge, this study presents the largest cohort of HIV status assessment of FFS patients to date. Future studies, particularly on the long-term outcomes, are warranted, as is continued information sharing among providers and centers performing FFS, in order to continue advancing the literature and subsequently patient care.
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Tian X, Yao Y, He G, Jia Y, Wang K, Chen L. Systematic analysis of safety profile for darunavir and its boosted agents using data mining in the FDA Adverse Event Reporting System database. Sci Rep 2021; 11:12438. [PMID: 34127681 PMCID: PMC8203613 DOI: 10.1038/s41598-021-91549-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/24/2021] [Indexed: 11/09/2022] Open
Abstract
This current investigation was aimed to generate signals for adverse events (AEs) of darunavir-containing agents by data mining using the US Food and Drug Administration Adverse Event Reporting System (FAERS). All AE reports for darunavir, darunavir/ritonavir, or darunavir/cobicistat between July 2006 and December 2019 were identified. The reporting Odds Ratio (ROR), proportional reporting ratio (PRR), and Bayesian confidence propagation neural network (BCPNN) were used to detect the risk signals. A suspicious signal was generated only if the results of the three algorithms were all positive. A total of 10,756 reports were identified commonly observed in hepatobiliary, endocrine, cardiovascular, musculoskeletal, gastrointestinal, metabolic, and nutrition system. 40 suspicious signals were generated, and therein 20 signals were not included in the label. Severe high signals (i.e. progressive extraocular muscle paralysis, acute pancreatitis, exfoliative dermatitis, acquired lipodystrophy and mitochondrial toxicity) were identified. In pregnant women, umbilical cord abnormality, fetal growth restriction, low birth weight, stillbirth, premature rupture of membranes, premature birth and spontaneous abortion showed positive signals. Darunavir and its boosted agents induced AEs in various organs/tissues, and were shown to be possibly associated with multiple adverse pregnant conditions. This study highlighted some novel and severe AEs of darunavir which need to be monitored prospectively.
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Affiliation(s)
- Xiaojiang Tian
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, 400021, China
| | - Yao Yao
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, 400021, China
| | - Guanglin He
- Department of Anthropology and Ethnology, Institute of Anthropology, National Institute for Data Science in Health and Medicine, and School of Life Sciences, Xiamen University, Xiamen, 361005, China
| | - Yuntao Jia
- Department of Pharmacy, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Kejing Wang
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, 400021, China.
| | - Lin Chen
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, 400021, China.
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Bañó M, Morén C, Barroso S, Juárez DL, Guitart-Mampel M, González-Casacuberta I, Canto-Santos J, Lozano E, León A, Pedrol E, Miró Ò, Tobías E, Mallolas J, Rojas JF, Cardellach F, Martínez E, Garrabou G. Mitochondrial Toxicogenomics for Antiretroviral Management: HIV Post-exposure Prophylaxis in Uninfected Patients. Front Genet 2020; 11:497. [PMID: 32528527 PMCID: PMC7264262 DOI: 10.3389/fgene.2020.00497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 04/21/2020] [Indexed: 01/09/2023] Open
Abstract
Background: Mitochondrial genome has been used across multiple fields in research, diagnosis, and toxicogenomics. Several compounds damage mitochondrial DNA (mtDNA), including biological and therapeutic agents like the human immunodeficiency virus (HIV) but also its antiretroviral treatment, leading to adverse clinical manifestations. HIV-infected and treated patients may show impaired mitochondrial and metabolic profile, but specific contribution of viral or treatment toxicity remains elusive. The evaluation of HIV consequences without treatment interference has been performed in naïve (non-treated) patients, but assessment of treatment toxicity without viral interference is usually restricted to in vitro assays. Objective: The objective of the present study is to determine whether antiretroviral treatment without HIV interference can lead to mtDNA disturbances. We studied clinical, mitochondrial, and metabolic toxicity in non-infected healthy patients who received HIV post-exposure prophylaxis (PEP) to prevent further infection. We assessed two different PEP regimens according to their composition to ascertain if they were the cause of tolerability issues and derived toxicity. Methods: We analyzed reasons for PEP discontinuation and main secondary effects of treatment withdrawal, mtDNA content from peripheral blood mononuclear cells and metabolic profile, before and after 28 days of PEP, in 23 patients classified depending on PEP composition: one protease inhibitor (PI) plus Zidovudine/Lamivudine (PI plus AZT + 3TC; n = 9) or PI plus Tenofovir/Emtricitabine (PI plus TDF + FTC; n = 14). Results: Zidovudine-containing-regimens showed an increased risk for drug discontinuation (RR = 9.33; 95% CI = 1.34–65.23) due to adverse effects of medication related to gastrointestinal complications. In the absence of metabolic disturbances, 4-week PEP containing PI plus AZT + 3TC led to higher mitochondrial toxicity (−17.9 ± 25.8 decrease in mtDNA/nDNA levels) than PI plus TDF + FTC (which increased by 43.2 ± 24.3 units mtDNA/nDNA; p < 0.05 between groups). MtDNA changes showed a significant and negative correlation with baseline alanine transaminase levels (p < 0.05), suggesting that a proper hepatic function may protect from antiretroviral toxicity. Conclusions: In absence of HIV infection, preventive short antiretroviral treatment can cause secondary effects responsible for treatment discontinuation and subclinical mitochondrial damage, especially pyrimidine analogs such as AZT, which still rank as the alternative option and first choice in certain cohorts for PEP. Forthcoming efforts should be focused on launching new strategies with safer clinical and mitotoxic profile.
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Affiliation(s)
- Maria Bañó
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Constanza Morén
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Sergio Barroso
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Diana Luz Juárez
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Mariona Guitart-Mampel
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Ingrid González-Casacuberta
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Judith Canto-Santos
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Ester Lozano
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Agathe León
- Infectious Disease Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Enric Pedrol
- Internal Medicine Department, Hospital de Viladecans, Barcelona, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ester Tobías
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Josep Mallolas
- Infectious Disease Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jhon F Rojas
- Infectious Disease Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Francesc Cardellach
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
| | - Esteban Martínez
- Infectious Disease Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Gloria Garrabou
- Muscle Research and Mitochondrial Function Laboratory, Cellex-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Health Science-University of Barcelona, Internal Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.,U722 CIBERER, Barcelona, Spain
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Hoa Chung L, Qi Y. Lipodystrophy - A Rare Condition with Serious Metabolic Abnormalities. Rare Dis 2020. [DOI: 10.5772/intechopen.88667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Toribio M, Neilan TG, Awadalla M, Stone LA, Rokicki A, Rivard C, Mulligan CP, Cagliero D, Fourman LT, Stanley TL, Ho JE, Triant VA, Burdo TH, Nelson MD, Szczepaniak LS, Zanni MV. Intramyocardial Triglycerides Among Women With vs Without HIV: Hormonal Correlates and Functional Consequences. J Clin Endocrinol Metab 2019; 104:6090-6100. [PMID: 31393564 PMCID: PMC6954489 DOI: 10.1210/jc.2019-01096] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/02/2019] [Indexed: 12/31/2022]
Abstract
CONTEXT Women with HIV (WHIV) on anti-retroviral therapy (ART) are living longer but facing heightened vulnerability to heart failure. OBJECTIVE We investigated metabolic/hormonal/immune parameters relating to diastolic dysfunction-a precursor to heart failure-among WHIV without known cardiovascular disease (CVD). DESIGN AND OUTCOME MEASURES Nineteen ART-treated WHIV and 11 non-HIV-infected women without known CVD enrolled and successfully completed relevant study procedures [cardiac magnetic resonance spectroscopy (MRS) and cardiac MRI]. Groups were matched on age and body mass index. Primary outcome measures included intramyocardial triglyceride content (cardiac MRS) and diastolic function (cardiac MRI). Relationships between intramyocardial triglyceride content and clinical parameters were also assessed. RESULTS Among WHIV (vs non-HIV-infected women), intramyocardial triglyceride content was threefold higher [1.2 (0.4, 3.1) vs 0.4 (0.1, 0.5)%, P = 0.01], and diastolic function was reduced (left atrial passive ejection fraction: 27.2 ± 9.6 vs 35.9 ± 6.4%, P = 0.007). There was a strong inverse relationship between intramyocardial triglyceride content and diastolic function (ρ = -0.62, P = 0.004). Among the whole group, intramyocardial triglyceride content did not relate to chronologic age but did increase across the reproductive aging spectrum (P = 0.02). HIV status and reproductive aging status remained independent predictors of intramyocardial triglyceride content after adjusting for relevant cardiometabolic parameters (overall model R2 = 0.56, P = 0.003; HIV status P = 0.01, reproductive aging status P = 0.02). CONCLUSIONS For asymptomatic WHIV, increased intramyocardial triglyceride content is associated with diastolic dysfunction. Moreover, relationships between intramyocardial triglyceride accumulation and women's reproductive aging are noted.
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Affiliation(s)
- Mabel Toribio
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tomas G Neilan
- Cardiac MR PET, CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Magid Awadalla
- Cardiac MR PET, CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lauren A Stone
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Adam Rokicki
- Cardiac MR PET, CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Corinne Rivard
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Connor P Mulligan
- Cardiac MR PET, CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Diana Cagliero
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lindsay T Fourman
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Takara L Stanley
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer E Ho
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Virginia A Triant
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tricia H Burdo
- Department of Neuroscience, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Michael D Nelson
- Applied Physiology and Advanced Imaging Laboratory, Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | | | - Markella V Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Markella V. Zanni, MD, Metabolism Unit, Massachusetts General Hospital, 55 Fruit Street, 5 LON 207, Boston, Massachusetts 02114. E-mail:
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Abstract
Antiretroviral therapy has largely transformed HIV infection into a chronic disease condition. As such, physicians and other providers caring for individuals living with HIV infection need to be aware of the potential cardiovascular complications of HIV infection and the nuances of how HIV infection increases the risk of cardiovascular diseases, including acute myocardial infarction, stroke, peripheral artery disease, heart failure and sudden cardiac death, as well as how to select available therapies to reduce this risk. In this Review, we discuss the epidemiology and clinical features of cardiovascular disease, with a focus on coronary heart disease, in the setting of HIV infection, which includes a substantially increased risk of myocardial infarction even when the HIV infection is well controlled. We also discuss the mechanisms underlying HIV-associated atherosclerotic cardiovascular disease, such as the high rates of traditional cardiovascular risk factors in patients with HIV infection and HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection. Finally, we highlight available therapeutic strategies, as well as approaches under investigation, to reduce the risk of cardiovascular disease and lower inflammation in patients with HIV infection.
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Affiliation(s)
- Priscilla Y Hsue
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - David D Waters
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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Biological Features Implies Potential Use of Autologous Adipose-Derived Stem/Progenitor Cells in Wound Repair and Regenerations for the Patients with Lipodystrophy. Int J Mol Sci 2019; 20:ijms20215505. [PMID: 31694186 PMCID: PMC6862495 DOI: 10.3390/ijms20215505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/30/2019] [Accepted: 11/03/2019] [Indexed: 12/27/2022] Open
Abstract
A paradigm shift in plastic and reconstructive surgery is brought about the usage of cell-based therapies for wound healing and regeneration. Considering the imitations in the reconstructive surgeries in restoring tissue loss and deficiency, stem cell-based therapy, in particular, has been expected to pave the way for a new solution to the regenerative approaches. Limitations in the reconstructive surgeries in restoring tissue loss and deficiency have paved the way for new regenerative approaches. Among them, adipose-derived stem/progenitor cells (ADSCs)-based therapy could be the most promising clue, since ADSCs have pluripotent differentiation capabilities not only in adipocytes but also in a variety of cell types. Accumulating evidences have indicated that the unfavorable development of adipose-tissue damage, namely, lipodystrophy, is a systemic complication, which is closely related to metabolic abnormality. Considering ADSC-based regenerative medicine should be applied for the treatment of lipodystrophy, it is inevitable to ascertain whether the ADSCs obtained from the patients with lipodystrophy are capable of being used. It will be very promising and realistic if this concept is applied to lipoatrophy; one form of lipodystrophies that deteriorates the patients’ quality of life because of excessive loss of soft tissue in the exposed areas such as face and extremities. Since lipodystrophy is frequently observed in the human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART), the present study aims to examine the biological potentials of ADSCs isolated from the HIV-infected patients with lipodystrophy associated with the HAART treatment. Growth properties, adipogenic differentiation, and mitochondrial reactive oxygen species (ROS) production were examined in ADSCs from HIV-infected and HIV-uninfected patients. Our results clearly demonstrated that ADSCs from both patients showed indistinguishable growth properties and potentials for adipocyte differentiation in vitro. Thus, although the number of cases were limited, ADSCs isolated from the patients with lipodystrophy retain sufficient physiological and biological activity for the reconstitution of adipose-tissue, suggesting that ADSCs from the patients with lipodystrophy could be used for autologous ADSC-based regenerative therapy.
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12
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Barroso S, Morén C, González-Segura À, Riba N, Arnaiz JA, Manriquez M, Santana G, Blanco JL, Larousse M, Loncà M, de Lazzari E, Llopis J, Mallolas J, Miró O, Carné X, Gatell JM, Garrabou G, Martínez E. Metabolic, mitochondrial, renal and hepatic safety of enfuvirtide and raltegravir antiretroviral administration: Randomized crossover clinical trial in healthy volunteers. PLoS One 2019; 14:e0216712. [PMID: 31120908 PMCID: PMC6532851 DOI: 10.1371/journal.pone.0216712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/24/2019] [Indexed: 12/29/2022] Open
Abstract
CONTEXT Classical antiretroviral agents may acutely impact on metabolic, mitochondrial, renal and hepatic function in HIV-infected and uninfected persons. Fusion and integrase inhibitors are supposed to be safer, but have been scarcely investigated. To avoid any interference with HIV or other antiretrovirals, we assessed markers of these toxicities in healthy adult volunteers treated with Enfuvirtide (T20) or Raltegravir (RAL). METHODS Twenty-six healthy participants were randomized to T20/90mg vs. placebo (n = 12) or RAL/400mg vs. placebo (n = 14) every 12h in two 7-day periods separated by a 4-week washout period. Major end-points were changes in lipid profile (total cholesterol, high-density-lipoprotein (HDL)-cholesterol, low-density-lipoprotein (LDL)-cholesterol, triglycerides), insulin resistance (glucose) and mitochondrial toxicity (mitochondrial DNA content-mtDNA-in peripheral blood mononuclear cells). Renal and hepatic toxicity (creatinine, alanine transaminase (AST), alanine aminotransferase (ALT), bilirubin and total plasma proteins) and overall safety were also analysed. Effect of period, treatment, and basal measures were evaluated for each end-point. RESULTS Neither T20-administration nor RAL-administration yielded to any statistic significant change in the markers of metabolic, mitochondrial, renal or hepatic toxicity assessed. No symptoms indicative of drug toxicity were neither found in any subject. CONCLUSIONS In absence of HIV infection, or concomitant treatment, short-term exposure to T20 or RAL in healthy adult volunteers did not lead to any indicative changes in toxicity markers thus presuming the safe profile of both drugs.
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Affiliation(s)
- Sergio Barroso
- Muscle Research and Mitochondrial Function Laboratory, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Internal Medicine Department—Hospital Clínic of Barcelona (HCB), Barcelona, Spain
- Biomedical Research Networking Centres of Rare Diseases CIBERER (ISCIII), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Constanza Morén
- Muscle Research and Mitochondrial Function Laboratory, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Internal Medicine Department—Hospital Clínic of Barcelona (HCB), Barcelona, Spain
- Biomedical Research Networking Centres of Rare Diseases CIBERER (ISCIII), Barcelona, Spain
| | - Àlex González-Segura
- Muscle Research and Mitochondrial Function Laboratory, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Internal Medicine Department—Hospital Clínic of Barcelona (HCB), Barcelona, Spain
- Biomedical Research Networking Centres of Rare Diseases CIBERER (ISCIII), Barcelona, Spain
| | - Neus Riba
- Phase I Unit, Clinical Pharmacology Department, HCB, Barcelona, Spain
| | - Joan A. Arnaiz
- Phase I Unit, Clinical Pharmacology Department, HCB, Barcelona, Spain
| | - Marcela Manriquez
- Phase I Unit, Clinical Pharmacology Department, HCB, Barcelona, Spain
| | - Gemina Santana
- Phase I Unit, Clinical Pharmacology Department, HCB, Barcelona, Spain
| | | | | | - Montse Loncà
- Infectious Diseases Department, HCB, Barcelona, Spain
| | - Elisa de Lazzari
- Department of Statistics, University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Department of Statistics, University of Barcelona, Barcelona, Spain
| | | | - Oscar Miró
- Emergency Department, HCB, Barcelona, Spain
| | - Xavier Carné
- Phase I Unit, Clinical Pharmacology Department, HCB, Barcelona, Spain
| | | | - Glòria Garrabou
- Muscle Research and Mitochondrial Function Laboratory, Cellex-IDIBAPS, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Internal Medicine Department—Hospital Clínic of Barcelona (HCB), Barcelona, Spain
- Biomedical Research Networking Centres of Rare Diseases CIBERER (ISCIII), Barcelona, Spain
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13
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Bernardino JI, Mocroft A, Wallet C, de Wit S, Katlama C, Reiss P, Mallon PW, Richert L, Molina JM, Knobel H, Morlat P, Babiker A, Pozniac A, Raffi F, Arribas JR. Body composition and adipokines changes after initial treatment with darunavir-ritonavir plus either raltegravir or tenofovir disoproxil fumarate-emtricitabine: A substudy of the NEAT001/ANRS143 randomised trial. PLoS One 2019; 14:e0209911. [PMID: 30689664 PMCID: PMC6349314 DOI: 10.1371/journal.pone.0209911] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/06/2018] [Indexed: 01/03/2023] Open
Abstract
Background Comparison of changes in body composition, adipokines and inflammatory markers after initial therapy with a nucleos(t)ide reverse transcriptase inhibitor (N(t)RTI)- sparing or containing regimen are scarce. Design Randomised Clinical Trial. Methods This is the body composition substudy of NEAT 001/ANRS 143, a randomised trial comparing darunavir/ritonavir (DRV/r) plus either raltegravir (RAL) or tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in 805 ART naïve HIV-infected adults. The primary endpoint was percentage change in limb fat at week 96. Secondary endpoints were associations among these changes and metabolic markers (IL-6, insulin, leptin, adiponectin, FGF-23). Results 126 subjects (61 DRV/r + RAL and 65 DRV/r + TDF/FTC) were included. The rate of change in BMI between groups for RAL versus TDF/FTC at week 96 was 1.5% per 48-week period (p = 0.015). The rate of change in limb fat mass, trunk fat mass, total body fat and total lean mass was for RAL versus TDF/FTC at week 96 was 2.5% (p = 0.38), 7.3% ((p = 0.021), 4.9% (p = 0.061) and 1.3% (p = 0.12) respectively. Baseline insulin and leptin levels were correlated with baseline limb fat and trunk fat mass [r = 0.31 (p = 0.0043)/r = 0.28 (p = 0.0011) for limb fat, and r = 0.63 (p<0.0001)/r = 0.50(p<0.0001) for trunk fat]. After adjustment, a 10% faster increase in leptin between baseline and week 48 was associated with a more rapid increase in limb fat at week 48 (0.5% per 48 weeks, p<0.001), total body fat mass (0.6% per 48 weeks, p<0.001), and trunk fat mass (0.3% per 48 weeks, p = 0.0026). Conclusions After week 96 a N(t)RTI sparing regimen of DRV/r + RAL produced a numerically greater percentage increase in body composition variables with only change in trunk fat mass and BMI being significant.
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Affiliation(s)
- Jose I. Bernardino
- Department of Internal Medicine, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
- * E-mail:
| | | | - Cedrick Wallet
- University of Bordeaux INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Stéphane de Wit
- CHU Saint Pierre, Université Libre de Bruxeles, Brussels, Belgium
| | - Christine Katlama
- Hôpital Pitié Salpétrière, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Peter Reiss
- Department of Global Health and Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Laura Richert
- University of Bordeaux INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Jean-Michel Molina
- Hôpital Saint-Louis, University of Paris Diderot, Paris, INSERM U941, France
| | - Hernando Knobel
- Department of Infectious Diseases, Hospital del Mar, Universidad Autónoma de Barcelona, Spain
| | - Philippe Morlat
- Service de Medicine Interne et Maladies Infectieuses, CHU Bordeaux, Université de Bordeaux, Inserm U 1219, Bourdeaux, France
| | - Abdel Babiker
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Anton Pozniac
- Chelsea and Westminster hospital NHS Foundation Trust, London, United Kingdom
| | - Francois Raffi
- Department of infectious diseases, CHU de Nantes and CIC 1413, INSERM, Nantes, France
| | - Jose R. Arribas
- Department of Internal Medicine, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
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Bhagwat P, Ofotokun I, McComsey GA, Brown TT, Moser C, Sugar CA, Currier JS. Changes in Waist Circumference in HIV-Infected Individuals Initiating a Raltegravir or Protease Inhibitor Regimen: Effects of Sex and Race. Open Forum Infect Dis 2018; 5:ofy201. [PMID: 30465010 PMCID: PMC6239079 DOI: 10.1093/ofid/ofy201] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 10/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background This study investigates the association of clinical and demographic predictors with abdominal fat gain, measured using waist circumference (WC) and self-reported abdominal size. Methods We analyzed data from ACTG A5257, a clinical trial that randomized treatment-naïve HIV-infected participants to 1 of 3 antiretroviral regimens: raltegravir (RAL) or the protease inhibitors (PIs) atazanavir/ritonavir (ATV/r) or darunavir/ritonavir (DRV/r), each in combination with tenofovir disoproxil fumarate/emtricitabine. Associations of treatment and baseline/demographic characteristics with 96-week WC change were assessed using repeated-measures models. Ordinal logistic regression was used to examine the associations of predictors with week 96 self-reported abdominal changes. Results The study population (n = 1809) was 76.0% male and predominantly black non-Hispanic (41.9%) and white non-Hispanic (34.1%). Mean baseline WC was 90.6 cm, with an average 96-week increase of 3.4 cm. WC increases were higher in the RAL arm compared with DRV/r (P = .0130). Females experienced greater increases in WC on RAL vs ATV/r than males (P = .0065). Similarly, a larger difference in WC change was found for RAL vs DRV/r for black vs nonblack individuals (P = .0043). A separate multivariable model found that in addition to the treatment regimen, higher baseline viral load and lower CD4+ were also associated with WC increases. Conclusions With antiretroviral therapy initiation, higher WC increases in the RAL arm compared with PIs were more pronounced in female and black participants, and a more advanced baseline HIV disease state was a strong predictor of larger abdominal increases. Understanding factors predisposing individuals to abdominal fat gain could inform health management after therapy initiation.
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Affiliation(s)
- Priya Bhagwat
- University of California, Los Angeles, Los Angeles, California
| | - Ighovwerha Ofotokun
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | | | - Todd T Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carlee Moser
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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15
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[Survival in HIV-1 patients receiving antiretroviral therapy in Morocco]. Rev Epidemiol Sante Publique 2018; 66:311-316. [PMID: 30177238 DOI: 10.1016/j.respe.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/12/2018] [Accepted: 07/13/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The purpose was to study factors associated with the survival of HIV-1 patients receiving antiretroviral therapy in Morocco. MATERIAL AND METHOD This was a retrospective study of a cohort of 182 HIV-1 patients receiving antiretroviral therapy in the department of dermatology venereology at the Military Instruction Hospital Mohamed V in Rabat during the period from 1 January 2006 to 1 January 2017. Death of any cause during the study period was considered to be the result of HIV infection. The log-rank test was used to compare the survival curves based on determinants. The Cox regression model analyzed the determinants of survival since induction of antiretroviral therapy. RESULTS The median follow-up time was 4.7 years (IQR: 1.97-8.18). The mortality rate was 75 deaths per 1000 person-years. Advanced clinical stage CDC C (RR: 2.72; CI 95%: 1.33-5.56) and treatment with indinavir (RR: 1.41; CI 95%: 0.77-2.59) were significantly associated with death. CONCLUSION Initiation of antiretroviral therapy in the early stage of the disease and use of less toxic molecules are recommended to reduce mortality.
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16
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Silva LLG, Santos EMD, Nascimento LCPD, Cavalcanti MCDF, Arruda IKGD, Luz MCL, Cabral PC. Lipodystrophic syndrome of HIV and associated factors: a study in a university hospital. CIENCIA & SAUDE COLETIVA 2018; 25:989-998. [PMID: 32159668 DOI: 10.1590/1413-81232020253.11772018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
Abstract
The use of antiretroviral drugs has increased the survival of HIV patients, but may have side effects, such as lipodystrophic syndrome. This article aims to identify the frequency of the lipodystrophic syndrome and its associated factors in patients with HIV using antiretroviral therapy. It involved a cross-sectional study with HIV patients, monitored on an outpatient basis. The syndrome was evaluated by the association of two parameters: peripheral weight loss through the lipodystrophy severity scale and central fat accumulation, measured by the hip waist ratio. Poisson regression analysis was performed to identify the associated variables. Of the 104 patients evaluated, 27.9% presented the syndrome. After adjustment, the female sex (PRadjusted = 2.16 CI95% 1.43-3.39), being overweight (PRadjusted = 2.23 CI95% 1.35-2.65) and a longer period of use of antiretrovirals (PRadjusted = 1.64 CI95% 1.16-2.78), remained positively associated with the syndrome. On the other hand, a negative association with CD4 count £ 350 (PRadjusted = 0.39 CI95% 0.10-0.97) was observed The high prevalence of the syndrome and its association with specific groups reinforce the need for adequate follow-up and early identification to intervene in modifiable factors.
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Affiliation(s)
- Lídia Laís Gomes Silva
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Eryka Maria Dos Santos
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Luciana Caroline Paulino do Nascimento
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Mikaella Carla de França Cavalcanti
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Ilma Kruze Grande de Arruda
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Marcella Campos Lima Luz
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Poliana Coelho Cabral
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
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17
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Dos Santos AP, Navarro AM, Schwingel A, Alves TC, Abdalla PP, Venturini ACR, de Santana RC, Machado DRL. Lipodystrophy diagnosis in people living with HIV/AIDS: prediction and validation of sex-specific anthropometric models. BMC Public Health 2018; 18:806. [PMID: 29945584 PMCID: PMC6020387 DOI: 10.1186/s12889-018-5707-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/13/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Body composition alterations, or lipodystrophy, can lead to serious health problems in people living with HIV/AIDS (PLWHA). The objectives of this study are to predict and validate sex-specific anthropometric predictive models for the diagnosis of lipodystrophy in PLWHA. METHODS A cross-sectional design was employed to recruit 106 PLWHA (men = 65 and women = 41) in Brazil during 2013-2014. They were evaluated using dual-energy X-ray absorptiometry, and 19 regions of body perimeters and 6 skinfold thicknesses were taken. Sex-specific predictive models for lipodystrophy diagnosis were developed through stepwise linear regression analysis. Cross-validations using predicted residual error sum of squares was performed to validate each predictive model. RESULTS Results support the use of anthropometry for the diagnosis of lipodystrophy in men and women living with HIV/AIDS. A high power of determination with a small degree of error was observed for lipodystrophy diagnosis for men in model six (r2 = 0.77, SEE = 0.14, r2PRESS = 0.73, SEE PRESS = 0.15), that included ratio of skinfold thickness of subscapular to medial calf, skinfold thickness of thigh, body circumference of waist, formal education years, time of diagnosis to HIV months, and type of combined antiretroviral therapy (cART) (with protease inhibitor "WI/PI = 1" or without protease inhibitor "WO/PI = 0"); and model five for women (r2 = 0.78, SEE = 0.11, r2PRESS = 0.71, SEE PRESS = 0.12), that included skinfold thickness of thigh, skinfold thickness of subscapular, time of exposure to cART months, body circumference of chest, and race (Asian) ("Yes" for Asian race = 1; "No" = 0). CONCLUSIONS The proposed anthropometric models advance the field of public health by facilitating early diagnosis and better management of lipodystrophy, a serious adverse health effect experienced by PLWHA.
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Affiliation(s)
- André P Dos Santos
- Interunit Nursing Doctoral Program, College of Nursing of the University of Sao Paulo, Avenida dos Bandeirantes, Campus Universitario, 3900, Ribeirao Preto, SP, 14040-902, Brazil. .,Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL, USA.
| | - Anderson M Navarro
- Department of Clinical Medicine, Faculty of Medicine at the University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Andiara Schwingel
- Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL, USA
| | - Thiago C Alves
- Interunit Nursing Doctoral Program, College of Nursing of the University of Sao Paulo, Avenida dos Bandeirantes, Campus Universitario, 3900, Ribeirao Preto, SP, 14040-902, Brazil
| | - Pedro P Abdalla
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Ana Claudia R Venturini
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Rodrigo C de Santana
- Department of Clinical Medicine, Faculty of Medicine at the University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Dalmo R L Machado
- Interunit Nursing Doctoral Program, College of Nursing of the University of Sao Paulo, Avenida dos Bandeirantes, Campus Universitario, 3900, Ribeirao Preto, SP, 14040-902, Brazil.,School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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18
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Soriano V, Ramos JM, Barreiro P, Fernandez-Montero JV. AIDS Clinical Research in Spain-Large HIV Population, Geniality of Doctors, and Missing Opportunities. Viruses 2018; 10:v10060293. [PMID: 29848987 PMCID: PMC6024378 DOI: 10.3390/v10060293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023] Open
Abstract
The first cases of AIDS in Spain were reported in 1982. Since then over 85,000 persons with AIDS have been cumulated, with 60,000 deaths. Current estimates for people living with HIV are of 145,000, of whom 20% are unaware of it. This explains the still high rate of late HIV presenters. Although the HIV epidemic in Spain was originally driven mostly by injection drug users, since the year 2000 men having sex with men (MSM) account for most new incident HIV cases. Currently, MSM represent over 80% of new yearly HIV diagnoses. In the 80s, a subset of young doctors and nurses working at Internal Medicine hospital wards became deeply engaged in attending HIV-infected persons. Before the introduction of antiretrovirals in the earlier 1990s, diagnosis and treatment of opportunistic infections was their major task. A new wave of infectious diseases specialists was born. Following the wide introduction of triple combination therapy in the late 1990s, drug side effects and antiretroviral resistance led to built a core of highly devoted HIV specialists across the country. Since then, HIV medicine has improved and currently is largely conducted by multidisciplinary teams of health care providers working at hospital-based outclinics, where HIV-positive persons are generally seen every six months. Antiretroviral therapy is currently prescribed to roughly 75,000 persons, almost all attended at clinics belonging to the government health public system. Overall, the impact of HIV/AIDS publications by Spanish teams is the third most important in Europe. HIV research in Spain has classically been funded mostly by national and European public agencies along with pharma companies. Chronologically, some of the major contributions of Spanish HIV research are being in the field of tuberculosis, toxoplasmosis, leishmaniasis, HIV variants including HIV-2, drug resistance, pharmacology, antiretroviral drug-related toxicities, coinfection with viral hepatitis, design and participation in clinical trials with antiretrovirals, immunopathogenesis, ageing, and vaccine development.
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Affiliation(s)
- Vicente Soriano
- Infectious Diseases Unit, La Paz University Hospital, 28046 Madrid, Spain.
- UNIR Health Sciences School, 28040 Madrid, Spain.
| | - José M Ramos
- Department of Internal Medicine, General University Hospital, 03010 Alicante, Spain.
| | - Pablo Barreiro
- Infectious Diseases Unit, La Paz University Hospital, 28046 Madrid, Spain.
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19
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Ngu RC, Choukem SP, Dimala CA, Ngu JN, Monekosso GL. Prevalence and determinants of selected cardio-metabolic risk factors among people living with HIV/AIDS and receiving care in the South West Regional Hospitals of Cameroon: a cross-sectional study. BMC Res Notes 2018; 11:305. [PMID: 29769110 PMCID: PMC5956554 DOI: 10.1186/s13104-018-3444-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/11/2018] [Indexed: 12/12/2022] Open
Abstract
Objective Metabolic disorders and cardiovascular risk factors are not routinely assessed in the care of HIV patients in developing countries, known to have the highest disease burden. We described the prevalence and factors associated with major cardio-metabolic risk factors (obesity, diabetes and hypertension) in HIV/AIDS patients. Results The prevalence of diabetes, hypertension and obesity were 11.3% (95% CI 8.10–15.43), 24.8% (95% CI 20.1–30.0) and 14.5% (95% CI 11.1–19.3) respectively. Central obesity and high alcohol intake were the factors significantly associated with diabetes mellitus, while central obesity and overweight/obesity were significantly associated with having hypertension. Short duration of antiretroviral therapy was the significant predisposing factor for obesity. On multivariate analyses, the only association observed was between central obesity and diabetes (Adjusted OR 2.52, 95% CI 1.01–6.30, P = 0.048). Conclusively, DM, HTN and obesity are highly prevalent in HIV/AIDS patients in the SWR hospitals of Cameroon, with that of DM and obesity being higher than that seen in the general population while that of HTN equaling that of the general population. Awareness of these data among clinicians involved in the management of these patients should be emphasized.
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Affiliation(s)
- Roland Cheofor Ngu
- Health and Human Development (2HD) Research Network, Douala, Cameroon. .,Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon. .,Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,World Health Organization Headquarters, Geneva, Switzerland.
| | - Simeon-Pierre Choukem
- Health and Human Development (2HD) Research Network, Douala, Cameroon.,Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Diabetes and Endocrine Unit, Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Christian Akem Dimala
- Health and Human Development (2HD) Research Network, Douala, Cameroon.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Julius N Ngu
- University of Alabama at Birmingham, Birmingham, USA
| | - Gottlieb Lobe Monekosso
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Dimala CA, Ngu RC, Kadia BM, Tianyi FL, Choukem SP. Markers of adiposity in HIV/AIDS patients: Agreement between waist circumference, waist-to-hip ratio, waist-to-height ratio and body mass index. PLoS One 2018; 13:e0194653. [PMID: 29566089 PMCID: PMC5864036 DOI: 10.1371/journal.pone.0194653] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 01/29/2018] [Indexed: 11/18/2022] Open
Abstract
Background Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) are all independent predictors of cardio-metabolic risk and therefore important in HIV/AIDS patients on antiretroviral therapy at risk of increased visceral adiposity. This study aimed to assess the extent of agreement between these parameters and the body mass index (BMI), as anthropometric parameters and in classifying cardio-metabolic risk in HIV/AIDS patients. Methods A secondary analysis of data from a cross-sectional study involving 200 HIV/AIDS patients was done. Anthropometric parameters were measured from participants using standard guidelines and central obesity defined according to recommended criteria. Increased cardio-metabolic risk was defined according to the standard cut-off values for all four parameters. Data were analyzed using STATA version 14.1. Results The prevalence of WC-defined central obesity, WHR-defined central obesity and WHtR > 0.50 were 33.5%, 44.5% and 36.5%, respectively. The prevalence of BMI-defined overweight and obesity was 40.5%. After adjusting for gender and HAART status, there was a significant linear association and correlation between WC and BMI (regression equation: WC (cm) = 37.184 + 1.756 BMI (Kg/m2) + 0.825 Male + 1.002 HAART, (p < 0.001, r = 0.65)), and between WHtR and BMI (regression equation: WHtR = 0.223 + 0.011 BMI (Kg/m2)– 0.0153 Male + 0.003 HAART, (p < 0.001, r = 0.65)), but not between WHR and BMI (p = 0.097, r = 0.13). There was no agreement between the WC, WHtR and BMI, and minimal agreement between the WHR and BMI, in identifying patients with an increased cardio-metabolic risk. Conclusion Despite the observed linear association and correlation between these anthropometric parameters, the routine use of WC, WHR and WHtR as better predictors of cardio-metabolic risk should be encouraged in these patients, due to their minimal agreement with BMI in identifying HIV/AIDS patients with increased cardio-metabolic risk. HAART status does not appear to significantly affect the association between these anthropometric parameters.
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Affiliation(s)
- Christian Akem Dimala
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Orthopaedics Department, Southend University Hospital, Essex, United Kingdom
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- * E-mail:
| | - Roland Cheofor Ngu
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Medical Doctors (M.D) Research Group, Douala, Cameroon
| | - Benjamin Momo Kadia
- Foumbot District Hospital, Foumbot, Cameroon
- Grace Community Health and Development Association, Kumba, Cameroon
| | | | - Simeon Pierre Choukem
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- Diabetes and Endocrinology Unit, Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Department of Internal Medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Morieri ML, Guardigni V, Sanz JM, Dalla Nora E, Soavi C, Zuliani G, Sighinolfi L, Passaro A. Adipokines levels in HIV infected patients: lipocalin-2 and fatty acid binding protein-4 as possible markers of HIV and antiretroviral therapy-related adipose tissue inflammation. BMC Infect Dis 2018; 18:10. [PMID: 29304747 PMCID: PMC5756414 DOI: 10.1186/s12879-017-2925-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/17/2017] [Indexed: 12/31/2022] Open
Abstract
Background Metabolic and cardiovascular diseases (CVD) represent a major problem in HIV infection. The aim of this study was to evaluate the relationship of HIV infection and antiretroviral therapy (ART) with circulating levels of two adipokines (Lipocalin-2 and Fatty Acid Binding Protein-4, FABP-4), known to be associated with adipose tissue dysfunction and cardiovascular disease in the general population. Methods We enrolled 40 non-obese HIV-infected patients and 10 healthy controls of similar age and Body Mass Index (BMI). Body composition, metabolic syndrome, lipid profile, 10-years CVD risk score, and adipokines levels were compared between groups. ART-regimen status (naïve, non-nucleoside reverse transcriptase inhibitors – NNRTIs – and protease inhibitors – PIs) association with adipokines levels was tested with linear regression models. Results HIV patients showed a worse metabolic profile than controls. Lipocalin-2 levels were higher in HIV-infected subjects (+53%; p = 0.007), with a significant trend (p = 0.003) for higher levels among subjects taking NNRTIs. Association of lipocalin-2 with fat-mass and BMI was modulated by ART regimens, being positive among subjects treated with NNRTIs and negative among those treated with PIs (“ART-regimens-by-BMI” interaction p = 0.0009). FABP-4 levels were correlated with age, fat mass, BMI, lipid profile and CVD risk (all R ≥ 0.32, p < 0.05), but not influenced by HIV-status (+20%; p = 0.12) or ART-regimen (p = 0.4). Conclusions Our data confirm that HIV-infection is associated with adipose tissue inflammation, as measured by Lipocalin-2 levels, and ART does not attenuate this association. While FABP-4 is a marker of worse metabolic and CVD profile independently of HIV status or ART regimen, lipocalin-2 could represent a useful marker for HIV- and ART-related adipose tissue dysfunction. Electronic supplementary material The online version of this article (10.1186/s12879-017-2925-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mario Luca Morieri
- Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Cona, Ferrara, Italy.,Medical Science Department, University of Ferrara, Ferrara, Italy
| | - Viola Guardigni
- Unit of Infectious Diseases, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Emilia-Romagna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Juana Maria Sanz
- Medical Science Department, University of Ferrara, Ferrara, Italy
| | - Edoardo Dalla Nora
- Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Cona, Ferrara, Italy
| | - Cecilia Soavi
- Medical Science Department, University of Ferrara, Ferrara, Italy
| | - Giovanni Zuliani
- Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Cona, Ferrara, Italy.,Medical Science Department, University of Ferrara, Ferrara, Italy
| | - Laura Sighinolfi
- Unit of Infectious Diseases, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Emilia-Romagna, Italy
| | - Angelina Passaro
- Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Cona, Ferrara, Italy. .,Medical Science Department, University of Ferrara, Ferrara, Italy.
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Bedimo R, Abodunde O. Metabolic and Cardiovascular Complications in HIV/HCV-Co-infected Patients. Curr HIV/AIDS Rep 2017; 13:328-339. [PMID: 27595755 DOI: 10.1007/s11904-016-0333-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Fifteen to thirty percent of HIV-infected persons in North America and Europe are co-infected with chronic hepatitis C (HCV). The latter is associated with a significant number of extra-hepatic metabolic complications that could compound HIV-associated increased cardiovascular risk. This article reviews the basic science and epidemiologic and clinical evidence for increased cardio-metabolic risk among HIV/HCV-co-infected patients and discusses potential underlying mechanisms. We will finally review the impact of control of HCV viremia on the cardio-metabolic morbidity and mortality of HIV/HCV-co-infected patients. RECENT FINDINGS HCV infection is associated with a number of immune-related complications such as cryoglobulinemia but also metabolic complications including dyslipidemias, hepatic steatosis, insulin resistance, diabetes, and chronic kidney disease. The incidence of these complications is higher among HIV-co-infected patients and might contribute to increased mortality. The potential mechanisms of increased cardiovascular risk among HIV/HCV-co-infected subjects include endothelial dysfunction, chronic inflammation and immune activation, the cardio-metabolic effects of HCV-induced hepatic steatosis and fibrosis or insulin resistance, and chronic kidney disease. However, epidemiologic studies show discordant findings as to whether HCV co-infection further increases the risk of atherosclerotic cardiovascular diseases (acute myocardial infarctions and strokes) among HIV-infected patients. Nonetheless, successful treatment of HCV is associated with significant improvements in cardio-metabolic risk factors including diabetes mellitus. HCV co-infection is associated with a higher incidence of metabolic complications-and likely increased risk of cardiovascular events-that might contribute to increased mortality in HIV. These appear to improve with successful HCV therapy.
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Affiliation(s)
- Roger Bedimo
- Infectious Diseases Section, Medical Service, Veterans Affairs North Texas Healthcare System, Dallas, TX, USA. .,Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Oladapo Abodunde
- Infectious Diseases Section, Medical Service, Veterans Affairs North Texas Healthcare System, Dallas, TX, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Grant PM, Kitch D, McComsey GA, Collier AC, Bartali B, Koletar SL, Erlandson KM, Lake JE, Yin MT, Melbourne K, Ha B, Brown TT. Long-term body composition changes in antiretroviral-treated HIV-infected individuals. AIDS 2016; 30:2805-2813. [PMID: 27662545 PMCID: PMC5101158 DOI: 10.1097/qad.0000000000001248] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Body composition impacts physical function and mortality. We compared long-term body composition changes after antiretroviral therapy (ART) initiation in HIV-infected individuals to that in HIV-uninfected controls. DESIGN Prospective observational study. METHODS We performed dual-energy x-ray absorptiometry (DXA) approximately 7.5 years after initial DXA in available HIV-infected individuals who received DXAs during the randomized treatment trial AIDS Clinical Trials Group A5202. For controls, we used DXA results from HIV-uninfected participants in the Boston Area Community Health/Bone and Women's Interagency HIV Study cohorts. Repeated measures analyses compared adjusted body composition changes between HIV-infected and HIV-uninfected individuals. Multivariable analyses evaluated factors associated with body composition change in HIV-infected individuals. RESULTS We obtained DXA results in 97 HIV-infected and 614 HIV-uninfected participants. Compared with controls, HIV-infected individuals had greater adjusted lean mass and total, trunk, and limb fat gain during the first 96 weeks of ART. Subsequently, HIV-infected individuals lost lean mass compared with controls. Total, trunk, and limb fat gains after 96 weeks of ART slowed in HIV-infected individuals but remained greater than in controls. Lower CD4 T-cell count was associated with lean mass and fat gain during the initial 96 weeks of ART, but subsequently no HIV-related characteristic was associated with body composition change. CONCLUSION Consistent with a 'return to health effect', HIV-infected individuals, especially those with lower baseline CD4 T-cell counts, gained more lean mass and fat during the first 96 weeks of ART than HIV-uninfected individuals. Continued fat gain and lean mass loss after 96 weeks may predispose HIV-infected individuals to obesity-related diseases and physical function impairment.
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Affiliation(s)
- Philip M Grant
- aDivision of Infectious Diseases, Department of Medicine, Stanford University, Palo Alto, California bCenter for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts cDivision of Infectious Diseases, Departments of Pediatrics and Medicine, Case Western Reserve University, Cleveland, Ohio dDivision of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington eNew England Research Institute, Watertown, Massachusetts fDivision of Infectious Diseases, Department of Medicine, Ohio State University, Columbus, Ohio gDivision of Infectious Diseases, Department of Medicine, University of Colorado, Aurora, Colorado hDivision of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, California iDivision of Infectious Diseases, Department of Medicine, Columbia University, New York, New York jGilead Sciences, Foster City, California kViiv Healthcare, Research Triangle Park, Durham, North Carolina lDivision of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Boyd MA, Amin J, Mallon PWG, Kumarasamy N, Lombaard J, Wood R, Chetchotisakd P, Phanuphak P, Mohapi L, Azwa I, Belloso WH, Molina JM, Hoy J, Moore CL, Emery S, Cooper DA. Body composition and metabolic outcomes after 96 weeks of treatment with ritonavir-boosted lopinavir plus either nucleoside or nucleotide reverse transcriptase inhibitors or raltegravir in patients with HIV with virological failure of a standard first-line antiretroviral therapy regimen: a substudy of the randomised, open-label, non-inferiority SECOND-LINE study. Lancet HIV 2016; 4:e13-e20. [PMID: 27815068 DOI: 10.1016/s2352-3018(16)30189-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/15/2016] [Accepted: 08/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lipoatrophy is one of the most feared complications associated with the use of nucleoside or nucleotide reverse transcriptase inhibitors (N[t]RTIs). We aimed to assess soft-tissue changes in participants with HIV who had virological failure of a first-line antiretroviral (ART) regimen containing a non-nucleoside reverse transcriptase inhibitor plus two N(t)RTIs and were randomly assigned to receive a second-line regimen containing a boosted protease inhibitor given with either N(t)RTIs or raltegravir. METHODS Of the 37 sites that participated in the randomised, open-label, non-inferiority SECOND-LINE study, eight sites from five countries (Argentina, India, Malaysia, South Africa, and Thailand) participated in the body composition substudy. All sites had a dual energy x-ray absorptiometry (DXA) scanner and all participants enrolled in SECOND-LINE were eligible for inclusion in the substudy. Participants were randomly assigned (1:1), via a computer-generated allocation schedule, to receive either ritonavir-boosted lopinavir plus raltegravir (raltegravir group) or ritonavir-boosted lopinavir plus two or three N(t)RTIs (N[t]RTI group). Randomisation was stratified by site and screening HIV-1 RNA. Participants and investigators were not masked to group assignment, but allocation was concealed until after interventions were assigned. DXA scans were done at weeks 0, 48, and 96. The primary endpoint was mean percentage and absolute change in peripheral limb fat from baseline to week 96. We did intention-to-treat analyses of available data. This substudy is registered with ClinicalTrials.gov, number NCT01513122. FINDINGS Between Aug 1, 2010, and July 10, 2011, we recruited 211 participants into the substudy. The intention-to-treat population comprised 102 participants in the N(t)RTI group and 108 participants in the raltegravir group, of whom 91 and 105 participants, respectively, reached 96 weeks. Mean percentage change in limb fat from baseline to week 96 was 16·8% (SD 32·6) in the N(t)RTI group and 28·0% (37·6) in the raltegravir group (mean difference 10·2%, 95% CI 0·1-20·4; p=0·048). Mean absolute change was 1·04 kg (SD 2·29) in the N(t)RTI group and 1·81 kg (2·50) in the raltegravir group (mean difference 0·6, 95% CI -0·1 to 1·3; p=0·10). INTERPRETATION Our findings suggest that for people with virological failure of a first-line regimen containing efavirenz plus tenofovir and lamivudine or emtricitabine, the WHO-recommended switch to a ritonavir-boosted protease inhibitor plus zidovudine (a thymidine analogue nucleoside reverse transcriptase inhibitor) and lamivudine might come at the cost of peripheral lipoatrophy. Further study could help to define specific groups of people who might benefit from a switch to an N(t)RTI-sparing second-line ART regimen. FUNDING The Kirby Institute and the Australian National Health and Medical Research Council.
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Affiliation(s)
- Mark A Boyd
- University of Adelaide, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | | | | | - Robin Wood
- Desmond Tutu HIV Foundation, Cape Town, South Africa
| | | | - Praphan Phanuphak
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand
| | - Lerato Mohapi
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Waldo H Belloso
- Coordinación de Investigación Clínica Académica en Latinoamérica (CICAL), Buenos Aires, Argentina
| | | | - Jennifer Hoy
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Cecilia L Moore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sean Emery
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - David A Cooper
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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HIV Infection in the Elderly: Arising Challenges. J Aging Res 2016; 2016:2404857. [PMID: 27595022 PMCID: PMC4993911 DOI: 10.1155/2016/2404857] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/14/2016] [Accepted: 06/30/2016] [Indexed: 12/27/2022] Open
Abstract
Globally there is an increase in the number of people living with HIV at an advanced age (50 years and above). This is mainly due to prolonged survival following the use of highly active antiretroviral therapy. Living with HIV at an advanced age has been shown to be associated with a number of challenges, both clinical and immunological. This minireview aims at discussing the challenges encountered by elderly HIV-infected patients.
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Wu AW, Wansom T, Huang IC, CoFrancesco J, Conant MA, Sarwer DB. The Facial Appearance Inventory: Development and Preliminary Evidence for Reliability and Validity in People with HIV and Lipoatrophy. Aesthet Surg J 2016; 36:842-51. [PMID: 26931304 DOI: 10.1093/asj/sjw010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Facial lipoatrophy is common in people on antiretroviral (ARV) regimens for HIV/AIDS and can impair health-related quality of life. OBJECTIVES We developed the Facial Appearance Inventory (FAI) to measure the impact of ARV-associated facial lipoatrophy. METHODS Qualitative methods were used to identify key concerns of people with facial lipoatrophy. The major concerns were used to identify 24 items for the FAI. The FAI was administered to a cross-sectional sample of 96 people with HIV and facial lipoatrophy and compared to the established Assessment of Body Change Distress (ABCD) and MOS-HIV questionnaires. RESULTS Mean age was 48.8 years, 87.5% were men, 69.8% were Caucasian, and 60% had some college education. Mean CD4 count was 435 cells/mm(3). There were few missing data, and the summary score showed no floor or ceiling effects, with a mean (SD) of 25.6 (17.9). Cronbach's alpha for the scale was 0.98. FAI items satisfied criteria for convergent and discriminant construct validity. FAI items were more strongly correlated with mental health domains (R = 0.33) than with physical health domains (R = 0.26) on the MOS-HIV. Patients with greater severity of lipoatrophy had significantly worse scores than those with less severity (James 3-4, vs. James 0-2). There were no significant differences for FAI scores by age group, income group, CD4 cell count, or HIV viral load group. Those with less education and those with darker skin types reported less impairment (P < .05). CONCLUSIONS The 24-item FAI shows evidence for reliability, validity, and usefulness as a measure of the impact of facial lipoatrophy.
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Affiliation(s)
- Albert W Wu
- Dr Wu is a Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Dr Wansom is Clinical Research Physician, Henry M. Jackson Foundation, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand. Dr Huang is an Associate Professor, Department of Epidemiology and Cancer Control Outcomes and Policy, St. Jude Children's Research Hospital, Memphis, TN. Dr CoFrancesco is a Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Dr Conant is a Clinical Professor of Dermatology, Emeritus, University of California, San Francisco School of Medicine, San Francisco, CA. Dr Sarwer is the Associate Dean for Research and Director, Center for Obesity Research and Education College of Public Health, Temple University, Philadelphia, PA
| | - Tanyaporn Wansom
- Dr Wu is a Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Dr Wansom is Clinical Research Physician, Henry M. Jackson Foundation, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand. Dr Huang is an Associate Professor, Department of Epidemiology and Cancer Control Outcomes and Policy, St. Jude Children's Research Hospital, Memphis, TN. Dr CoFrancesco is a Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Dr Conant is a Clinical Professor of Dermatology, Emeritus, University of California, San Francisco School of Medicine, San Francisco, CA. Dr Sarwer is the Associate Dean for Research and Director, Center for Obesity Research and Education College of Public Health, Temple University, Philadelphia, PA
| | - I-Chan Huang
- Dr Wu is a Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Dr Wansom is Clinical Research Physician, Henry M. Jackson Foundation, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand. Dr Huang is an Associate Professor, Department of Epidemiology and Cancer Control Outcomes and Policy, St. Jude Children's Research Hospital, Memphis, TN. Dr CoFrancesco is a Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Dr Conant is a Clinical Professor of Dermatology, Emeritus, University of California, San Francisco School of Medicine, San Francisco, CA. Dr Sarwer is the Associate Dean for Research and Director, Center for Obesity Research and Education College of Public Health, Temple University, Philadelphia, PA
| | - Joseph CoFrancesco
- Dr Wu is a Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Dr Wansom is Clinical Research Physician, Henry M. Jackson Foundation, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand. Dr Huang is an Associate Professor, Department of Epidemiology and Cancer Control Outcomes and Policy, St. Jude Children's Research Hospital, Memphis, TN. Dr CoFrancesco is a Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Dr Conant is a Clinical Professor of Dermatology, Emeritus, University of California, San Francisco School of Medicine, San Francisco, CA. Dr Sarwer is the Associate Dean for Research and Director, Center for Obesity Research and Education College of Public Health, Temple University, Philadelphia, PA
| | - Marcus A Conant
- Dr Wu is a Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Dr Wansom is Clinical Research Physician, Henry M. Jackson Foundation, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand. Dr Huang is an Associate Professor, Department of Epidemiology and Cancer Control Outcomes and Policy, St. Jude Children's Research Hospital, Memphis, TN. Dr CoFrancesco is a Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Dr Conant is a Clinical Professor of Dermatology, Emeritus, University of California, San Francisco School of Medicine, San Francisco, CA. Dr Sarwer is the Associate Dean for Research and Director, Center for Obesity Research and Education College of Public Health, Temple University, Philadelphia, PA
| | - David B Sarwer
- Dr Wu is a Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Dr Wansom is Clinical Research Physician, Henry M. Jackson Foundation, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand. Dr Huang is an Associate Professor, Department of Epidemiology and Cancer Control Outcomes and Policy, St. Jude Children's Research Hospital, Memphis, TN. Dr CoFrancesco is a Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Dr Conant is a Clinical Professor of Dermatology, Emeritus, University of California, San Francisco School of Medicine, San Francisco, CA. Dr Sarwer is the Associate Dean for Research and Director, Center for Obesity Research and Education College of Public Health, Temple University, Philadelphia, PA
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Andrade GCD, Fujise LH, Santana Filho JED, Oliveira F, Silva RDCMAD. Non-alcoholic fatty liver disease (NAFLD) in different populations: A clinical and epidemiological study – sample of São José do Rio Preto. Rev Assoc Med Bras (1992) 2016; 62:218-26. [DOI: 10.1590/1806-9282.62.03.218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 11/03/2014] [Indexed: 01/14/2023] Open
Abstract
SUMMARY Introduction: NAFLD is an heterogeneous condition that includes steatosis and non-alcoholic steatohepatitis (NASH), in the absence of significant alcohol consumption, reaching 30% of the population. The most common risk factors are: age, gender, ethnicity, diabetes mellitus (DM), obesity, predisposition, metabolic syndrome (MS), insulin resistance (IR), drugs, and polycystic ovary syndrome. Objective: To describe the profile of patients with NAFLD seen at Hospital de Base of Rio Preto, in the state of São Paulo. Method: Patients with NAFLD were assessed, with medical and epidemiological data collected after informed consent. Results: Of the 62 patients evaluated, 76% were women, 73% Caucasians, and 71% were aged between 50 and 69 years and had no symptoms. Ultrasonography results showed steatosis in 84%. NASH was diagnosed in 61% of the sample. 21 patients underwent liver biopsy, of which 36% had cirrhosis, 1 had liver cancer, and 1 pure steatosis (5% each). Risk factors were found in 70% of patients with metabolic syndrome, 87% with increased waist circumference, 63% with dyslipidemia, 61% (n=38) with high blood pressure (HBP), 28% with DM, 52% physically inactive, and 44% with insulin resistance (IR) (HOMA> 3.5). There was an association between IR and NASH (p=0.013), IR and obesity (p=0.027), IR and MS (p=0.006), and MS and steatosis on medical ultrasound (USG) (p=0.014). Conclusion: The most frequent risk factors were MS and its variables: increased waist circumference, dyslipidemia and HBP. This underscores the importance of metabolic control in NAFLD and confirms its role as the hepatic component of metabolic syndrome.
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McComsey GA, Moser C, Currier J, Ribaudo HJ, Paczuski P, Dubé MP, Kelesidis T, Rothenberg J, Stein JH, Brown TT. Body Composition Changes After Initiation of Raltegravir or Protease Inhibitors: ACTG A5260s. Clin Infect Dis 2016; 62:853-62. [PMID: 26797215 DOI: 10.1093/cid/ciw017] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/11/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fat gain after antiretroviral therapy (ART) occurs, and its association with protease inhibitors (PIs) is unclear. METHODS Peripheral and central fat depots and lean mass were measured using standardized and centrally read abdominal CT scans and whole-body dual-energy absorptiometry scans over a 96-week period in human immunodeficiency virus (HIV)-infected treatment-naive participants. The patients were randomized to tenofovir-emtricitabine (TDF/FTC) plus atazanavir-ritonavir (ATV/r), darunavir-ritonavir (DRV/r), or raltegravir (RAL) in ACTG A5260s, a substudy of A5257. Within arm changes were assessed with signed-rank tests. The 96-week percentage changes in fat and lean mass in the 2 PI arms were not different, thus the PI arms were combined and compared to the RAL arm. Associations between baseline biomarkers and changes in body composition were assessed. All analyses used linear regression models. RESULTS 328 patients were randomized (90% male, 44% white non-Hispanic). The median age was 36 years, HIV-1 RNA 4.6 log10 copies/mL, and CD4 349 cells/μL. Overall, at week 96, increases in limb fat (13.4%), subcutaneous (19.9%) and visceral abdominal fat (25.8%), trunk fat (18%), and lean mass (1.8%) were apparent (P < .001 for changes within each arm). Changes for all fat and lean outcomes were not different between the PI arms or between the RAL and the combined PI arms. Higher baseline HIV-1 RNA levels were associated with greater gains in peripheral and central fat. CONCLUSIONS In treatment-naive participants initiating ART with TDF/FTC, no differences in lean mass and regional fat were found with RAL when compared with ATV/r or DRV/r over 96 weeks. CLINICAL TRIALS REGISTRATION NCT00811954 and NCT00851799.
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Affiliation(s)
| | - Carlee Moser
- Harvard School of Public Health, Boston, Massachusetts
| | | | | | | | - Michael P Dubé
- University of Southern California Keck School of Medicine, Los Angeles
| | | | | | - James H Stein
- University of Wisconsin School of Medicine and Public Health, Madison
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LaBounty TM, Hardy WD, Fan Z, Yumul R, Li D, Dharmakumar R, Conte AH. Carotid artery thickness is associated with chronic use of highly active antiretroviral therapy in patients infected with human immunodeficiency virus: A 3.0 Tesla magnetic resonance imaging study. HIV Med 2015; 17:516-23. [PMID: 26634886 DOI: 10.1111/hiv.12351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES While patients with HIV infection have an elevated stroke risk, ultrasound studies of carotid artery wall thickness have reported variable results. We hypothesized that subjects with HIV infection on chronic highly active antiretroviral therapy (HAART) would have increased carotid artery wall thickness by magnetic resonance imaging (MRI). METHODS This cross-sectional study compared carotid artery wall thickness between 26 individuals infected with HIV on chronic HAART and 20 controls, without HIV infection but with similar cardiovascular risk factors, using 3.0-T noncontrast MRI. Inclusion criteria included male gender, age 35-55 years, and chronic HAART (≥ 3 years) among HIV-seropositive subjects; those with known cardiovascular disease or diabetes were excluded. RESULTS Between subjects with HIV infection and controls, there were no differences in mean (±SD) age (47.8 ± 5.0 vs. 47.8 ± 4.7 years, respectively; P = 0.19) or cardiovascular risk factors (P > 0.05 for each). Mean (±SD) wall thickness was increased in those with HIV infection vs. controls for the left (0.88 ± 0.08 vs. 0.83 ± 0.08 mm, respectively; P = 0.03) and right (0.90 ± 0.10 vs. 0.85 ± 0.07 mm, respectively; P = 0.046) common carotid arteries. Among individuals with HIV infection, variables associated with increased mean carotid artery wall thickness included lipoaccumulation [+0.09 mm; 95% confidence interval (CI) 0.03-0.14 mm; P = 0.003], Framingham risk score ≥ 5% (+0.07 mm; 95% CI 0.01-0.12; P = 0.02 mm), and increased duration of protease inhibitor therapy (+0.03 mm per 5 years; 95% CI 0.01-0.06 mm; P = 0.02). CONCLUSIONS Individuals with HIV infection on chronic HAART had increased carotid artery wall thickness as compared to similar controls. In subjects with HIV infection, the presence of lipoaccumulation and longer duration of protease inhibitor therapy were associated with greater wall thickness.
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Affiliation(s)
- T M LaBounty
- Departments of Medicine and Radiology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - W D Hardy
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Z Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - R Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - D Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - R Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - A Hernandez Conte
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Kumar NS, Shashibhushan J, Malappa, Venugopal K, Vishwanatha H, Menon M. Lipodystrophy in Human Immunodeficiency Virus (HIV) Patients on Highly Active Antiretroviral Therapy (HAART). J Clin Diagn Res 2015; 9:OC05-8. [PMID: 26393154 DOI: 10.7860/jcdr/2015/12979.6183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/14/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND In recent years, abnormal lipid deposition (both lipoatrophy and fat redistribution) and its related complications have changed from an anecdotal issue into a major problem for HIV (Human Immunodeficiency Virus) infected patients on HAART (Highly Active Anti-Retroviral Therapy). Lipoatrophy and fat redistribution are potentially stigmatizing complications of HAART and leads to poor adherence among patients. Hence we conducted this study to determine the pattern and to assess various risk factors for maldeposition of lipids in HIV patients. MATERIALS AND METHODS A cross-sectional case series study was conducted in ART PLUS centre, Bellary over a period of 8 months from January to August 2014 in HIV patients on ART to determine risk factors associated with and epidemiological pattern of fat redistribution or atrophy. RESULTS A total of 50 patients with LD {lipodystrophy} (26 with fat redestribution and 24 with lipoatrophy {LA} were diagnosed in this period. Most of them belonged to younger age and was commonly seen in females (76%). Patients with LA had a significantly lower BMI (18.73 ± 7.4), {the p-value being 0.19} compared to LH group (21.54 ± 7.62). The duration of disease was comparable among both groups (6.96 years in LH and 5.79 years in LA group) {p-value is 0.29}. There was a relatively good immunity among these patients with mean CD4 count was 509.23 in LH and 545.91 in LA group {single CD4 count was taken and the p-value was 0.001}. Most of the patients were in TLN (Tenofovir, Lamivudine, Nevirapine) regimen (58%).The duration that patient was on ART before commencement of study varied from patient to patient, but the mean duration was approximately five years in fat redistribution group and 4.5 years in LA group. There were no derangements in lipid and sugar levels among them. CONCLUSION This study shows the need to identify and impact of LD with respect to treatment adherence in young patients especially female patients. Early community based screening for LD by social workers and targeted annual screening might help early detection and awareness about LD. Also adopting the least toxic regimen is one of the main aspects of LD management.
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Affiliation(s)
- N Sunil Kumar
- Post Graduate, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - J Shashibhushan
- Professor, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - Malappa
- Post Graduate, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - K Venugopal
- Post Graduate, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - Huggi Vishwanatha
- Assistant Professor, Department of General Medicine, Vijayanagara Institute of Medical Sciences , Bellary, Karanataka, India
| | - Mahesh Menon
- Post Graduate, Department of General Medicine, Vijayanagara Institute of Medical Sciences, Bellary, Karanataka, India
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Thiara DK, Liu CY, Raman F, Mangat S, Purdy JB, Duarte HA, Schmidt N, Hur J, Sibley CT, Bluemke DA, Hadigan C. Abnormal Myocardial Function Is Related to Myocardial Steatosis and Diffuse Myocardial Fibrosis in HIV-Infected Adults. J Infect Dis 2015; 212:1544-51. [PMID: 25964507 DOI: 10.1093/infdis/jiv274] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/01/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Impaired cardiac function persists in the era of effective human immunodeficiency virus (HIV) therapy, although the etiology is unclear. We used magnetic resonance imaging (MRI) to measure intramyocardial lipid levels and fibrosis as possible contributors to HIV-associated myocardial dysfunction. METHODS A cross-sectional study of 95 HIV-infected and 30 matched-healthy adults, without known cardiovascular disease (CVD) was completed. Intramyocardial lipid levels, myocardial fibrosis, and cardiac function (measured on the basis of strain) were quantified by MRI. RESULTS Systolic function was significantly decreased in HIV-infected subjects as compared to controls (mean radial strain [±SD], 21.7 ± 8.6% vs 30.5 ± 14.2%; P = .004). Intramyocardial lipid level and fibrosis index were both increased in HIV-infected subjects as compared to controls (P ≤ .04 for both) and correlated with the degree of myocardial dysfunction measured by strain parameters. Intramyocardial lipid levels correlated positively with antiretroviral therapy duration and visceral adiposity. Further, impaired myocardial function was strongly correlated with increased monocyte chemoattractant protein 1 levels (r = 0.396, P = .0002) and lipopolysaccharide binding protein levels (r = 0.25, P = .02). CONCLUSIONS HIV-infected adults have reduced myocardial function as compared to controls in the absence of known CVD. Decreased cardiac function was associated with abnormal myocardial tissue composition characterized by increased lipid levels and diffuse myocardial fibrosis. Metabolic alterations related to antiretroviral therapy and chronic inflammation may be important targets for optimizing long-term cardiovascular health in HIV-infected individuals.
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Affiliation(s)
- Diana K Thiara
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases
| | | | - Fabio Raman
- Radiology and Imaging Sciences, Clinical Center Medical Scientist Training Program, University of Alabama at Birmingham
| | - Sabrina Mangat
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases
| | - Julia B Purdy
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Horacio A Duarte
- Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine
| | - Nancyanne Schmidt
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases
| | - Jamie Hur
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases
| | | | | | - Colleen Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases
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Sánchez-Conde M, de Mendoza C, Jiménez-Nacher I, Barreiro P, Gonzalez-Lahoz J, Soriano V. Reductions in Stavudine Dose Might Ameliorate Mitochondrial-Associated Complications Without Compromising Antiviral Activity. HIV CLINICAL TRIALS 2015; 6:197-202. [PMID: 16214736 DOI: 10.1310/ed57-eu48-rk6a-e5u0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stavudine (d4T) is a nucleoside analogue approved for the treatment of HIV infection. Concern has risen due to its association with mitochondrial toxicity. Given that the toxicity might be dose-dependent, we explored prospectively whether lowering d4T doses might improve the safety profile of the drug without compromising its antiviral activity. METHOD All HIV-infected patients seen at our institution during the first semester of year 2003 who were receiving a d4T-containing regimen and had plasma HIV RNA below 50 copies/mL for the previous 3 months were invited to participate in a trial in which half of patients reduced the dose of d4T from 40 to 30 mg bid (cases) and the other half continued with the same d4T dose (controls). RESULTS A total of 92 patients were recruited in the study: 47 cases and 45 controls. A total of 9 patients experienced virological failure during the following 12 months: 4 cases and 5 controls. No significant differences between groups were recognized for mean transaminase levels, cholesterol, triglycerides, and lactate at baseline nor over the 12-month follow-up period. Lipodystrophy was recognized in 20% of patients at baseline, without significant differences between groups, and no significant improvements were recognized in the d4T 30 mg bid arm after 12 months follow-up. However, a median significant increase of 2.23-fold in the mitochondrial DNA content in peripheral blood mononuclear cells (PBMCs) was recognized in a subset of 11 patients who reduced the d4T dose, whereas it remained unchanged in 10 controls. CONCLUSION A reduction in the d4T dose from 40 to 30 mg bid may ameliorate mtDNA depletion in PBMCs without compromising the antiviral activity of the drug. However, significant improvements on surrogate laboratory markers of mitochondrial toxicity or in lipoatrophy could not be recognized over 12 months follow-up.
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Mehta N, Reilly M. Atherosclerotic Cardiovascular Disease Risk in the HAART-Treated HIV-1 Population. HIV CLINICAL TRIALS 2015; 6:5-24. [PMID: 15765307 DOI: 10.1310/ht0w-nx2n-u2bm-7luu] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Atherosclerotic cardiovascular disease (CVD), a leading cause of morbidity and mortality in the general population, is also an increasing cause for concern for HIV-infected patients. A number of risk factors for CVD are also associated with HIV disease and HIV therapy, particularly insulin resistance, metabolic dyslipidemia, and inflammation. For example, atherogenic dyslipidemia, a side effect of HIV therapy, is an established risk for CVD in the non-HIV-infected population. As our understanding of atherosclerotic disease evolves, new markers of CVD risk have been identified, including metabolic syndrome definitions and C-reactive protein, a marker of inflammation. Use of these markers, in association with established risk factor guidelines, may serve as important tools in helping HIV physicians implement drug regimens that allow optimum management of metabolic complications associated with HIV and HAART, and thereby reduce CVD risk. The objective of this article is to review the mechanisms of atherosclerotic CVD and to discuss risk factors and markers that can be applied in the evaluation and treatment of CVD in the HIV-positive population.
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Affiliation(s)
- Nehal Mehta
- Cardiovascular Division, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
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Walmsley S, Cheung AM, Fantus G, Gough K, Smaill F, Azad A, Diong C, Raboud J. A Prospective Study of Body Fat Redistribution, Lipid, and Glucose Parameters in HIV-Infected Patients Initiating Combination Antiretroviral Therapy. HIV CLINICAL TRIALS 2015; 9:314-23. [DOI: 10.1310/hct0905-314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Omar F, Dave JA, King JA, Levitt NS, Pillay TS. High Molecular Weight (HMW): total adiponectin ratio is low in hiv-infected women receiving protease inhibitors. BMC Clin Pathol 2014; 14:46. [PMID: 25580091 PMCID: PMC4289558 DOI: 10.1186/1472-6890-14-46] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/30/2014] [Indexed: 11/16/2022] Open
Abstract
Background At the time of the study, the HIV-treatment policy in South Africa included highly active antiretroviral therapy (HAART) regimens 1 (nucleotide reverse transcriptase inhibitors (NRTIs) only), and 2 (protease inhibitors (PI) and NRTIs). HAART is associated with the lipodystrophy syndrome, insulin resistance and reduced total adiponectin (TA) levels. The high molecular weight (HMW):TA ratio is a superior marker of insulin resistance. The aim of this study was to establish whether HMW:TA ratios are low in patients on PIs and whether they correlate with insulin resistance. Methods This was a cross-sectional study undertaken in an antiretroviral clinic at a tertiary hospital. The participants were 66 HIV-infected females: 22 were on regimen 2 (PI group), 22 on regimen 1 (non-PI) and 22 treatment naïve (TN), matched for BMI and age. Patients with a history of diabetes or impaired glucose tolerance were excluded. Serum adiponectin multimers were analysed using the AlpcoTM Adiponectin (Multimeric) enzyme immunoassay. Waist hip ratios (WHR), glucose and insulin levels were assessed, and HOMA-IR and QUICKI calculated. Data were analysed non-parametrically and multivariate analysis was performed. Results TA and HMW levels were lower in the treatment groups than in the TN group. HMW:TA was lower in the PI than in the non-PI and TN groups, and in the non-PI than in the TN groups. HMW:TA correlated negatively with waist, insulin and HOMA-IR, independently of BMI and duration of therapy. HOMA-IR and QUICKI did not differ among the groups. Conclusion HMW:TA is significantly decreased with HAART (particularly with PIs, but also with non-PIs) and may be a more sensitive marker of insulin resistance in these patients than conventional markers or HMW and total adiponectin individually.
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Affiliation(s)
- Fierdoz Omar
- Division of Chemical Pathology, C17 NHLS, Groote Schuur Hospital, University of Cape Town, Anzio Road Observatory, Cape Town, 7925 South Africa
| | - Joel A Dave
- Division of Diabetic Medicine and Endocrinology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Judy A King
- Division of Chemical Pathology, C17 NHLS, Groote Schuur Hospital, University of Cape Town, Anzio Road Observatory, Cape Town, 7925 South Africa
| | - Naomi S Levitt
- Division of Diabetic Medicine and Endocrinology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Tahir S Pillay
- Division of Chemical Pathology, C17 NHLS, Groote Schuur Hospital, University of Cape Town, Anzio Road Observatory, Cape Town, 7925 South Africa ; Department of Chemical Pathology, University of Pretoria and NHLS Tshwane Academic Division/Steve Biko Academic Hospital, Tshwane, South Africa
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Tsuchiya N, Pathipvanich P, Wichukchinda N, Rojanawiwat A, Auwanit W, Ariyoshi K, Sawanpanyalert P. Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: a cohort study. BMC Infect Dis 2014; 14:565. [PMID: 25361850 PMCID: PMC4226857 DOI: 10.1186/s12879-014-0565-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/16/2014] [Indexed: 01/11/2023] Open
Abstract
Background Antiretroviral therapy markedly reduced mortality in HIV-infected individuals. However, in the previous studies, up to 50% of patients are compelled to modify their regimen in middle and low-income countries where salvage drug is still limited. This cohort study aimed to investigate the incidence and predictors of regimen modification from the first-line antiretroviral regimen in northern Thailand. Methods All HIV-infected patients starting antiretroviral therapy (ART) with generic drug (GPOvir®; stavudine, lamivudine and nevirapine) at a governmental hospital in northern Thailand from 2002 to 2007 were recruited. Baseline characteristics and detailed information of regimen modification until the end of 2010 were ascertained from cohort database and medical charts. As a potential genetic predictor of regimen modification, HLA B allele was determined by bead-based array hybridization (WAKFlow® HLA typing kit). We investigated predictors of the regimen modification using Cox’s proportional hazard models. Results Of 979 patients, 914 were eligible for the analysis. The observed events of regimen modification was 377, corresponding to an incidence 13.8/100 person-year-observation (95% CI:12.5-15.3) over 2,728 person years (PY) follow up. The main reasons for regimen modification were adverse effects (73.5%), especially lipodystrophy (63.2%) followed by rash (17.7%). Sixty three patients (17.1%) changed the regimen due to treatment failure. 2% and 19% of patients had HLA-B*35:05 and B*4001, respectively. HLA-B*35:05 was independently associated with rash-related regimen modification (aHR 7.73, 95% CI:3.16-18.9) while female gender was associated with lipodystrophy (aHR 2.11, 95% CI:1.51-2.95). Female gender (aHR 0.54, 95% CI: 0.30-0.96), elder age (aHR 0.56, 95% CI: 0.32-0.99) and having HLA-B*40:01 (aHR 0.29, 95% CI: 0.10-0.82) were protective for treatment failure related modification. Conclusion HLA-B*35:05 and female gender were strong predictors of regimen modification due to rash and lipodystrophy, respectively. Female gender, elder age, and having HLA-B*40:01 had protective effects on treatment failure-related regimen modification. This study provides further information of regimen modification for future tailored ART in Asia. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0565-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naho Tsuchiya
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan. .,Global COE program, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan.
| | - Panita Pathipvanich
- Day Care Center, Lampang Hospital, 280 Paholyothin Road, Muang Lampang, Lampang, 52000, Thailand.
| | - Nuanjun Wichukchinda
- National Institute of Health, Ministry of Public Health, 88/7 Tiwanon road, Ampur Muang, Nonthaburi, 11000, Thailand.
| | - Archawin Rojanawiwat
- National Institute of Health, Ministry of Public Health, 88/7 Tiwanon road, Ampur Muang, Nonthaburi, 11000, Thailand.
| | - Wattana Auwanit
- National Institute of Health, Ministry of Public Health, 88/7 Tiwanon road, Ampur Muang, Nonthaburi, 11000, Thailand.
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan. .,Global COE program, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan.
| | - Pathom Sawanpanyalert
- Food and Drug Administration, Ministry of Public Health, 88/7 Tiwanon road, Ampur Muang, Nonthaburi, 11000, Thailand.
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Guaraldi G, Stentarelli C, Zona S, Santoro A. HIV-associated lipodystrophy: impact of antiretroviral therapy. Drugs 2014; 73:1431-50. [PMID: 24002702 DOI: 10.1007/s40265-013-0108-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the late 1990s, reports of unusual changes in body fat distribution named 'lipodystrophy' (LD) began to appear in HIV patients mitigating the enormous enthusiasm about improvement of survival and quality of life provided by the combinations of antiretroviral (ARV) drug classes, the so-called highly active antiretroviral therapy (HAART), which had just become available at that time. The objective of this paper is to critically review the literature on LD and to discuss the impact of newer ARV agents, namely atazanavir, darunavir and raltegravir, as well as strategies of the late HAART era, including single-tablet regimens and nucleoside-sparing regimens. Studies in which LD was measured by dual-energy x-ray absorptiometry or by abdominal computed tomography or magnetic resonance imaging scan only, were included. We were unable to identify studies depicting a negative impact of drugs or ARV regimens on limb fat loss. On the contrary, a few studies identified a negative impact of atazanavir/ritonavir or darunavir/ritonavir on trunk fat increase. It should be noted that this anthropometric measure is a poor instrument since it cannot distinguish between subcutaneous and visceral fat. We conclude that presumably the body fat changes currently observed in HIV-infected patients is the net result of competing phenomena: on one side the natural history of lipohypertrophy as a result of HIV and HAART impact, and on the other side the physiological body fat changes observed in the aging population.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Medical and Surgical Sciences for Children & Adults, Universisty of Modena and Reggio Emilia, Largo del Pozzo ,71, 41124, Modena, Italy,
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Shiau S, Kuhn L, Strehlau R, Martens L, McIlleron H, Meredith S, Wiesner L, Coovadia A, Abrams EJ, Arpadi SM. Sex differences in responses to antiretroviral treatment in South African HIV-infected children on ritonavir-boosted lopinavir- and nevirapine-based treatment. BMC Pediatr 2014; 14:39. [PMID: 24521425 PMCID: PMC3927631 DOI: 10.1186/1471-2431-14-39] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While studies of HIV-infected adults on antiretroviral treatment (ART) report no sex differences in immune recovery and virologic response but more ART-associated complications in women, sex differences in disease progression and response to ART among children have not been well assessed. The objective of this study was to evaluate for sex differences in response to ART in South African HIV-infected children who were randomized to continue ritonavir-boosted lopinavir (LPV/r)-based ART or switch to nevirapine-based ART. METHODS ART outcomes in HIV-infected boys and girls in Johannesburg, South Africa from 2005-2010 were compared. Children initiated ritonavir-boosted lopinavir (LPV/r)-based ART before 24 months of age and were randomized to remain on LPV/r or switch to nevirapine-based ART after achieving viral suppression. Children were followed for 76 weeks post-randomization and then long-term follow up continued for a minimum of 99 weeks and maximum of 245 weeks after randomization. Viral load, CD4 count, lipids, anthropometrics, drug concentrations, and adherence were measured at regular intervals. Outcomes were compared between sexes within treatment strata. RESULTS A total of 323 children (median age 8.8 months, IQR 5.1-13.5), including 168 boys and 155 girls, initiated LPV/r-based ART and 195 children were randomized. No sex differences in risk of virological failure (confirmed viral load >1000 copies/mL) by 156 weeks post-randomization were observed within either treatment group. Girls switched to nevirapine had more robust CD4 count improvement relative to boys in this group through 112 weeks post-randomization. In addition, girls remaining on LPV/r had higher plasma concentrations of ritonavir than boys during post-randomization visits. After a mean of 3.4 years post-randomization, girls remaining on LPV/r also had a higher total cholesterol:HDL ratio and lower mean HDL than boys on LPV/r. CONCLUSIONS Sex differences are noted in treated HIV-infected children even at a young age, and appear to depend on treatment regimen. Future studies are warranted to determine biological mechanisms and clinical significance of these differences. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00117728.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Stephen M Arpadi
- Gertrude H, Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY USA.
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Della Justina LB, Luiz MC, Maurici R, Schuelter-Trevisol F. Prevalence and factors associated with lipodystrophy in AIDS patients. Rev Soc Bras Med Trop 2014; 47:30-7. [DOI: 10.1590/0037-8682-0240-2013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/28/2014] [Indexed: 12/13/2022] Open
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Wabe NT, Dekama NH, Gemeda DH. Lipodystrophy Is Common Among Ethiopian Patients on Highly Active Antiretroviral Therapy but Is Not Associated With Quality of Life or Medication Adherence. Ther Innov Regul Sci 2013; 47:706-714. [PMID: 30235559 DOI: 10.1177/2168479013500967] [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: 11/16/2022]
Abstract
Clinical experience suggests that lipodystrophy (LD) can have a profound impact on quality of life (QOL) and medication adherence (MA). Thus, a hospital-based, cross-sectional study was conducted to determine the prevalence of LD and its association with QOL and MA. A total of 405 participants were included in the study. The majority of participants were female (64.5%), with a mean age of 35.69 years (SD = 9.63 years). The prevalence of LD was 30.9%. Multiple logistic regression analysis showed that type of regimen initially used is an independent predictor of severity of LD (adjusted odds ratio, 44.16; 95% confidence interval, 10.56-184.59; P = .001). Quality of life was assessed with the World Health Organization Quality of Life short form instrument (WHOQOL-BREF), and medication adherence was assessed by self-report. The mean WHOQOL-BREF score of the participants was 53.48; the highest mean value was in the domain of physical health (68.56) and the lowest was in the social relationships domain (47.09). The majority of the patients scored lower (ie, in the lowest 5 deciles) in the domains of psychological health, social relationships, and environment compared with physical health. No differences in the WHOQOL-BREF measurements were observed, except in the environment domain, between patients with moderate LD and severe LD ( P = .02). The LD severity was not associated with self-reported MA ( P = .42). With the exception of the psychological health domain ( P = .044), participants' WHOQOL-BREF scores were not significantly associated with MA. Lipodystrophy was not associated with QOL or MA. The prevalence of LD in the present study was within the range of previous reports; however, the mean WHOQOL-BREF score of Ethiopian patients in this study is lower compared with reports from developed countries.
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Affiliation(s)
| | - Nezif Hussien Dekama
- 2 Clinical Pharmacy Unit, Department of Pharmacy, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia
| | - Desta Hiko Gemeda
- 3 Department of Epidemiology, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia
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Rauso R, Curinga G, Rusciani A, Colella G, Amore R, Tartaro G. Safety and Efficacy of One-Step Rehabilitation of Human Immunodeficiency Virus-Related Facial Lipoatrophy Using an Injectable Calcium Hydroxylapatite Dermal Filler. Dermatol Surg 2013; 39:1887-94. [DOI: 10.1111/dsu.12358] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Martin A, Moore CL, Mallon PWG, Hoy JF, Emery S, Belloso WH, Phanuphak P, Ferret S, Cooper DA, Boyd MA. HIV lipodystrophy in participants randomised to lopinavir/ritonavir (LPV/r) +2-3 nucleoside/nucleotide reverse transcriptase inhibitors (N(t)RTI) or LPV/r + raltegravir as second-line antiretroviral therapy. PLoS One 2013; 8:e77138. [PMID: 24204757 PMCID: PMC3813715 DOI: 10.1371/journal.pone.0077138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/27/2013] [Indexed: 12/29/2022] Open
Abstract
Objective To compare changes over 48 weeks in body fat, lipids, Metabolic Syndrome and cardiovascular disease risk between patients randomised 1∶1 to lopinavir/ritonavir (r/LPV) plus raltegravir (RAL) compared to r/LPV plus 2–3 nucleoside/nucleotide reverse transcriptase inhibitors (N(t)RTIs) as second-line therapy. Methods Participants were HIV-1 positive (>16 years) failing first-line treatment (2 consecutive HIV RNA >500 copies/mL) of NNRTI +2N(t)RTI. Whole body dual energy x-ray absorptiometry was performed at baseline and week 48. Data were obtained to calculate the Metabolic Syndrome and Framingham cardiovascular disease (CVD) risk score. Linear regression was used to compare mean differences between arms. Logistic regression compared incidence of metabolic syndrome. Associations between percent limb fat changes at 48 weeks with baseline variables were assessed by backward stepwise multivariate linear regression. Analyses were adjusted for gender, body mass index and smoking status. Results 210 participants were randomised. The mean (95% CI) increase in limb fat over 48 weeks was 15.7% (5.3, 25.9) or 0.9 kg (0.2, 1.5) in the r/LPV+N(t)RTI arm and 21.1% (11.1, 31,1) or 1.3 kg (0.7, 1.9) in the r/LPV+RAL arm, with no significant difference between treatment arms (−5.4% [−0.4 kg], p>0.1). Increases in total body fat mass (kg) and trunk fat mass (kg) were also similar between groups. Total:HDL cholesterol ratio was significantly higher in the RAL arm (mean difference −0.4 (1.4); p = 0.03), there were no other differences in lipid parameters between treatment arms. There were no statistically significant differences in CVD risk or incidence of Metabolic Syndrome between the two treatment arms. The baseline predictors of increased limb fat were high viral load, high insulin and participant's not taking lipid lowering treatment. Conclusion In patients switching to second line therapy, r/LPV combined with RAL demonstrated similar improvements in limb fat as an N(t)RTI + r/LPV regimen, but a worse total:HDL cholesterol ratio over 48 weeks. Trial Registration This clinical trial is registered on Clinicaltrials.gov, registry number NCT00931463.
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Affiliation(s)
- Allison Martin
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
| | - Cecilia L. Moore
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick W. G. Mallon
- University College Dublin School of Medicine and Medical Science, Dublin, Ireland
| | - Jennifer F. Hoy
- The Alfred Hospital and Monash University, Victoria, Melbourne, Australia
| | - Sean Emery
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Waldo H. Belloso
- Coordinación de Investigación Clínica Académica en Latinoamérica, Buenos Aires, Argentina
| | | | | | - David A. Cooper
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark A. Boyd
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Pathai S, Bajillan H, Landay AL, High KP. Is HIV a model of accelerated or accentuated aging? J Gerontol A Biol Sci Med Sci 2013; 69:833-42. [PMID: 24158766 DOI: 10.1093/gerona/glt168] [Citation(s) in RCA: 288] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Antiretroviral therapy has reduced the incidence of adverse events and early mortality in HIV-infected persons. Despite these benefits, important comorbidities that increase with age (eg, diabetes, cardiovascular disease, cancer, liver disease, and neurocognitive impairment) are more prevalent in HIV-infected persons than in HIV-uninfected persons at every age, and geriatric syndromes such as falls and frailty occur earlier in HIV-infected persons. This raises a critical research question: Does HIV accelerate aging through pathways and mechanisms common to the aging process or is HIV simply an additional risk factor for a wide number of chronic conditions, thus accentuating aging? METHODS Extensive literature review. RESULTS The purpose of this review is to briefly outline the evidence that age-related clinical syndromes are exacerbated by HIV, examine the ways in which HIV is similar, and dissimilar from natural aging, and assess the validity of HIV as a model of premature aging. Specific biomarkers of aging are limited in HIV-infected hosts and impacted by antiretroviral therapy, and a high rate of modifiable life style confounders (eg, smoking, substance abuse, alcohol) and coinfections (eg, hepatitis) in HIV-infected participants. CONCLUSIONS There is a need for validated biomarkers of aging in the context of HIV. Despite these differences, welldesigned studies of HIV-infected participants are likely to provide new opportunities to better understand the mechanisms that lead to aging and age-related diseases.
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Affiliation(s)
- Sophia Pathai
- Faculty of Science, School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Hendren Bajillan
- Department of Medicine/Infectious Diseases, W.G. (Bill) Hefner VAMC, Salisbury, North Carolina
| | - Alan L Landay
- Department of Immunology/Microbiology, Rush University Medical Center, Chicago, Illinois. FC Donders Chair, Division of Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Kevin P High
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Fernández-Sender L, Alonso-Villaverde C, Rull A, Rodríguez-Gallego E, Riera-Borrull M, Hernández-Aguilera A, Camps J, Beltrán-Debón R, Aragonès G, Menendez JA, Joven J. A possible role for CCR5 in the progression of atherosclerosis in HIV-infected patients: a cross-sectional study. AIDS Res Ther 2013; 10:11. [PMID: 23659629 PMCID: PMC3663662 DOI: 10.1186/1742-6405-10-11] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/07/2013] [Indexed: 12/23/2022] Open
Abstract
Background Chemokines can block viral entry by interfering with HIV co-receptors and are recognised mediators of atherosclerosis development. A number of experimental drugs that inhibit HIV entry arrest the development of atherosclerosis in animal models. We hypothesised that the expression of chemokine receptors in circulating leukocytes is associated with the rate of atherosclerosis progression in HIV-infected patients. Methods The increase in intima-media thickness during a 2-year follow-up was used to classify HIV-infected patients (n = 178) as progressors (n = 142) or non-progressors (n = 36) with respect to atherosclerosis. Logistic regression was used to assess variables associated with atherosclerosis progression. Mutations in the CCR5Δ32, CCR2 64I, and CX3CR1 (T280M and V249I) co-receptors as well as the levels of CCR5, CXCR4, CX3CR1, and CCR2 mRNA expression in circulating leukocytes were analysed as independent variables. Results Among the baseline variables, only genetic variants explained the dichotomous outcome. The expression of CCR2 and CXCR4 did not discriminate between progressors and non-progressors. Conversely, CCR5 and CX3CR1 expression was higher in not only progressors but also patients with detectable viral load. The logistic regression, however, demonstrated a significant role for CCR5 expression as a predictor of atherosclerosis progression (B = 2.1, OR = 8.1, p = 0.04) and a negligible effect for CXC3R1 and CCR2 expression. Conclusions Available CCR5 antagonists should be investigated for their potential to delay the course of atherosclerosis in HIV-infected patients.
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Abstract
HIV-associated lipodystrophy syndrome (HALS), comprising metabolic and morphological alterations, is a known side effect of highly active antiretroviral therapy (HAART). Evidence for the role of nutrition in the management of the systemic parameters of HALS is currently limited. In the present paper we review the current knowledge base surrounding HALS, focusing particularly on the role of nutrition in mitigating the systemic parameters of the syndrome. Reported prevalence of HALS was found to vary from 9 to 83 % due to lack of a standardised definition, as well as variations in assessment methods and in the study population used. HALS is associated with both morphological (lipoatrophy, lipohypertrophy) and metabolic (dyslipidaemia, glucose intolerance, diabetes, hypertension, endothelial dysfunction and atherosclerosis) alterations, which may occur singly or in combination, and are associated with an increased risk of CVD. HAART-induced adipocyte inflammation, oxidative stress and macrophage infiltration, as well as altered adipocyte function and mitochondrial toxicity, have been shown to be central to the development of HALS. The adipocyte, therefore, represents a plausible target for treatment. Pharmacological and surgical treatment interventions have shown effect. However, their use is associated with numerous adverse effects and complications. Targeted lifestyle interventions may provide a useful alternative for managing HALS owing to their safety and tolerability. A Mediterranean-style diet has been found to be effective in improving the systemic parameters of HALS. Furthermore, the effects of n-3 PUFA supplementation are encouraging and future randomised controlled trials investigating the beneficial effects of n-3 PUFA in HALS are justified.
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Fardet L, Vigouroux C, Capeau J. [Lipodystrophies]. Rev Med Interne 2012; 34:614-22. [PMID: 23287278 DOI: 10.1016/j.revmed.2012.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/17/2012] [Accepted: 11/05/2012] [Indexed: 11/26/2022]
Abstract
Human lipodystrophies represent a group of diseases characterized by altered body fat amount and/or repartition. Most forms of lipodystrophies are associated with metabolic alterations such as insulin resistance, diabetes and dyslipemia, leading to diabetic complications, increased cardiovascular risk or liver steatosis. Lipodystrophies can be classified as genetic or acquired, generalized or partial. Genetic forms such as Berardinelli-Seip syndrome or partial familial lipodystrophies are uncommon and acquired forms are much more frequent. Beside the rare Lawrence or Barraquer-Simons syndromes, the main forms of acquired lipodystrophies are those observed in HIV-infected people treated with antiretroviral therapies or in people exposed to an endogenous or an exogenous hypercortisolism. The treatment of lipodystrophies is difficult. Lifestyle modifications (e.g., specific diet, physical training) may be helpful but are usually insufficient. Associated metabolic disorders should be treated as soon as possible with insulin sensitizers, insulin and lipid lowering drugs. New therapies such as leptin have been proven to be helpful in some genetic or acquired forms of lipodystrophy.
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Affiliation(s)
- L Fardet
- Inserm UMR S938, centre de recherche Saint-Antoine, 75012 Paris, France; UMPC, université Paris 6, 75012 Paris, France; Service de médecine interne, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Fève B, Glorian M, Hadri KE. Pathophysiology of the HIV-Associated Lipodystrophy Syndrome. Metab Syndr Relat Disord 2012; 2:274-86. [PMID: 18370696 DOI: 10.1089/met.2004.2.274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The widespread use of highly active antiretroviral therapy (HAART) has radically transformed the prognosis of HIV-infected patients in the developed countries. Unfortunately, a serious metabolic syndrome combining peripheral lipoatrohy, central adiposity, insulin resistance, and dyslipidemia has arisen in these individuals. The etiology of this heterogeneous syndrome named lipodystrophy syndrome (LDS) is multifactorial, but adipose tissue is very likely a key factor that contributes to several clinical or metabolic aspects of the syndrome. In peripheral adipose tissue, HAART may act on both preadipocytes and adipocytes to induce fat loss. Several components of the HAART regimen can inhibit preadipocyte differentiation, in particular through alterations in the expression and/or function of the transcription factor sterol responsive element binding protein-1c. In superficial mature adipocytes, HAART promotes insulin resistance and apoptosis. Insulin resistance of peripheral fat cells could be the consequence of increased lipolysis and adipocytokine dysregulation. In turn, the increased free fatty acid disposal and the disturbances in adipocytokine production may induce skeletal muscle and liver insulin resistance, dyslipidemia, and a fat redistribution toward deep depots, causing visceral lipohypertrophy. The metabolic profile observed in LDS is reminiscent of that observed in metabolic syndrome, raising potential implications for cardiovascular risk in these patients. The pathophysiological mechanisms at the basis of this syndrome represent a rational basis for the treatment or prevention of the metabolic complications.
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Affiliation(s)
- Bruno Fève
- UMR CNRS 7079-Université Paris VI, Centre de Recherches Biomédicale des Cordeliers, Paris, France
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Aberg JA, Tebas P, Overton ET, Gupta SK, Sax PE, Landay A, Falcon R, Ryan R, De La Rosa G. Metabolic effects of darunavir/ritonavir versus atazanavir/ritonavir in treatment-naive, HIV type 1-infected subjects over 48 weeks. AIDS Res Hum Retroviruses 2012; 28:1184-95. [PMID: 22352336 DOI: 10.1089/aid.2011.0327] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We assessed metabolic changes for darunavir/ritonavir (DRV/r) once daily (qd) versus atazanavir/ritonavir (ATV/r) qd with fixed-dose tenofovir/emtricitabine. This was a phase 4, multicenter, open-label, randomized exploratory study. Treatment-naive, HIV-1-infected adults received DRV/r 800/100 mg qd or ATV/r 300/100 mg qd, both with emtricitabine/tenofovir 200/300 mg qd. Primary end point: change in triglyceride levels from baseline to week 12. Secondary end points: week 12 and week 48 changes in lipid parameters, insulin sensitivity, inflammatory/coagulation/bacterial translocation biomarkers, viral load, CD4(+) cell count, and week 48 changes in adipose tissue distribution and subjects' perceptions of body changes. In the DRV/r arm, 32/34 and 29/34 subjects completed weeks 12 and 48, respectively; in the ATV/r arm, 30/31 and 25/31 subjects completed weeks 12 and 48, respectively. Small changes in lipid parameters from baseline to weeks 12 and 48 were observed in both arms. Differences were noted between arms in mean changes in total cholesterol (DRV/r, 20.3 mg/dl; ATV/r, 4.6 mg/dl) and apolipoprotein A1 (DRV/r, 10.7 mg/dl; ATV/r, -0.7 mg/dl) at week 12. At week 48, no clinically relevant differences between arms were noted for changes in any lipid parameter, fasting glucose, or insulin sensitivity. Biomarkers generally decreased and efficacy parameters improved in both arms over 48 weeks. Changes in adipose tissue were small and comparable between arms. Subjects' perceptions of body changes generally improved in both study arms. This first pilot comparison in HIV-1-infected subjects suggests that DRV/r has a metabolic profile similar to ATV/r over 48 weeks of treatment. Further randomized studies are warranted.
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Affiliation(s)
- Judith A. Aberg
- Bellevue Hospital Center at New York University School of Medicine, New York, New York
| | - Pablo Tebas
- AIDS Clinical Trials Unit, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Samir K. Gupta
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Paul E. Sax
- Division of Infectious Diseases, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Alan Landay
- Rush University Medical Center, Chicago, Illinois
| | - Ron Falcon
- Janssen Therapeutics, Titusville, New Jersey
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Tsuda LC, Silva MMD, Machado AA, Fernandes APM. Body changes: antiretroviral therapy and lipodystrophy syndrome in people living with HIV/aids. Rev Lat Am Enfermagem 2012; 20:847-53. [DOI: 10.1590/s0104-11692012000500005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 09/14/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: to identify the different types of morphological alterations from lipodystrophy syndrome (LS) in outpatients and relate them to the therapeutic regimen used. METHOD: a cross-sectional study which recruited 60 patients with HIV and LS and 79 without LS, who consented to interview and data collection from their medical notes. RESULTS: the region most affected by lipoatrophy was the face; by lipohypertrophy, the abdomen, and by the mixed form, the alterations to the abdomen, face, and upper and lower limbs. CONCLUSION: among the therapeutic regimens, that comprised of zidovudine, lamivudine and efavirenz seemed to protect against LS. Nursing can act in the early identification of the changes, as well as providing guidance and support for patients affected by the changes in their body image.
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