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Jang Y, Kim T, Choi Y, Ahn KH, Kim JH, Seong H, Kim YJ, Kim SW, Choi JY, Kim HY, Song JY, Choi HJ, Kim SI, Sohn JW, Chin B, Choi BY, Park B. Association between obesity and cancer risk in adults with HIV in Korea. AIDS 2024; 38:1386-1394. [PMID: 38597513 DOI: 10.1097/qad.0000000000003904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION This study aimed to investigate the association between obesity and cancer risk as well as site-specific cancer risks in adults with HIV using a nationwide health screening database in Korea. METHODS Of the 16,671 adults with a new diagnosis of HIV from 2004 to 2020, 456 incident cancer cases and 1814 individually matched controls by sex, year of birth, year of HIV diagnosis, and follow-up duration (1 : 4 ratio) were included in this nested case-control study. The association between obesity (BMI ≥25 kg/m 2 ) and cancer risks was estimated and presented as odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS Of the 456 cancer incident cases, there were 146 AIDS-defining cancer cases and 310 non-AIDS-defining cancer cases. Compared with nonobese adults with HIV, obese adults with HIV were at higher risk of non-AIDS-defining cancer (OR = 1.478, 95% CI = 1.118-1.955). Otherwise, the overall risk of AIDS-defining cancer (OR = 0.816, 95% CI = 0.520-1.279) and each type of AIDS-defining cancer (Kaposi sarcoma and non-Hodgkin's lymphoma) were not high in obese adults with HIV. Of the specific types of non-AIDS-defining cancers, obesity was associated with an increased risk of colorectal cancer (OR = 3.090, 95% CI = 1.110-8.604) and liver, bile duct, and pancreatic cancers (OR = 2.532, 95% CI = 1.141-5.617). CONCLUSION Obesity, which is one of the important health concerns in HIV management, was associated with an increased risk of non-AIDS-defining cancer but not AIDS-defining cancer.
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Affiliation(s)
- Yoonyoung Jang
- Department of Preventive Medicine, Hanyang University College of Medicine
- Department of Agricultural Economics and Rural Development, Seoul National University
| | - Taehwa Kim
- Department of Preventive Medicine, Hanyang University College of Medicine
- Department of Psychology, Sungkyunkwan University
| | - Yunsu Choi
- Department of Preventive Medicine, Hanyang University College of Medicine
| | - Kyoung Hwan Ahn
- Department of Preventive Medicine, Hanyang University College of Medicine
| | - Jung Ho Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Youn Jeong Kim
- Division of Infectious Disease, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine
| | - Hyo Youl Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Hee Jung Choi
- Division of Infectious Diseases, Department of Internal Medicine, Ewha Womans University College of Medicine
| | - Sang Il Kim
- Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Bo-Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine
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Raza S, Khan N. Unilateral avascular necrosis of the right hip in an HIV patient with tearing of the rectus femoris and adductor longus muscles. BMJ Case Rep 2024; 17:e258709. [PMID: 38802252 PMCID: PMC11130611 DOI: 10.1136/bcr-2023-258709] [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] [Accepted: 04/28/2024] [Indexed: 05/29/2024] Open
Abstract
A man in his 20s with a medical history of syphilis, chlamydia and HIV presented to the emergency department (ED) with 2 months of right hip pain and was found to have advanced avascular necrosis (AVN) of the right femoral head with secondary haemorrhage. The patient lacked the common risk factors of AVN in patients with HIV (PWH): ≥10 years of HIV diagnosis, extended duration on highly active antiretroviral therapy, trauma, corticosteroid use, alcohol abuse, systemic lupus erythematosus, obesity, smoking and dyslipidaemia. Given the extensive destructive changes in the hip joint and muscles, a right hip resection arthroplasty was performed, and the patient recovered well postoperatively. This case presents a learning opportunity for understanding bone pathologies in PWH and offers clinical guidance for the management of HIV-infected patients with a focus on optimising bone health.
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Affiliation(s)
- Syed Raza
- Internal Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Nazia Khan
- Internal Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
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Zhu S, Wang W, He J, Duan W, Ma X, Guan H, Wu Y, Li S, Li Y, Tian T, Kong W, Wu D, Zhang T, Huang X. Higher cardiovascular disease risks in people living with HIV: A systematic review and meta-analysis. J Glob Health 2024; 14:04078. [PMID: 38666515 PMCID: PMC11046517 DOI: 10.7189/jogh.14.04078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024] Open
Abstract
Background The prognosis of AIDS after active antiretroviral therapy (ART) and the quality of life of people living with HIV (PLWH) are both affected by non-AIDS-related diseases such as cardiovascular disease (CVD). However, the specific risk ratios between PLWH and individuals negative for HIV are poorly understood. We aimed to systematically review and investigate the CVD risk factors associated with HIV. Methods We searched PubMed, Embase, Web of Science, and Cochrane Library databases between 1 January 2015, and 12 May 2023 for articles reported the prevalence and risk factors of CVD such as hypertension, dyslipidaemia, coronary artery disease (CAD), and myocardial infarction (MI). Due to the high heterogeneity, we used a random-effects model to analyse the data. All statistical analyses were performed using Stata/MP 17.0 with 95% confidence intervals (CIs). Results We analysed 31 eligible studies including 312 913 PLWH. People living with HIV had higher risks of dyslipidaemia (hazard ratio (HR) = 1.53; 95% CI = 1.29, 1.82), CAD (HR = 1.37; 95% CI = 1.24, 1.51), and MI (HR = 1.47; 95% CI = 1.28, 1.68) compared to individuals without HIV. However, there were no significant differences in the prevalence of hypertension between groups (HR = 1.17; 95% CI = 0.97, 1.41). Subgroup analysis revealed that men with HIV, PLWH who smoked and the elderly PLWH had a high prevalence of CVD. Moreover, the disease prevalence patterns varied among regions. In the USA and Europe, for instance, some HRs for CVD were higher than in other regions. Active ART initiation after 2015 appears to have a lower risk of CVD (hypertension, hyperlipidaemia, CAD). All outcomes under analysis showed significant heterogeneity (I2>70%, P < 0.001), which the available study-level variables could only partially account for. Conclusions People living with HIV had a higher CVD risk than the general population; thus, CVD prevention in PLWH requires further attention. Rapid initiation of ART may reduce the incidence of CVD in PLWH. For timely screening of CVD high-risk individuals and thorough disease management to prevent CVD, further studies are required to evaluate the risk factors for CVD among PLWH, such as age, region, etc. Registration PROSPERO (CRD42021255508).
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Affiliation(s)
- San Zhu
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Wenjing Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Jiaze He
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Wenshan Duan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | | | - Honglin Guan
- Hematology Department, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, PR China
| | - Yaxin Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Sibo Li
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Yanbing Li
- Cardiovascular Department, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Tian Tian
- Cardiovascular Department, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Wenjun Kong
- Department of Opthalmology, Beijing Youan Hosptial, Capital Medical University, Beijing, PR China
| | - Dongxia Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
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Weatherspoon DJ, Kirk GD, Piggott DA, Thumbigere-Math V, Dye BA, Macek MD. Baltimore oral epidemiology, disease effects, and HIV evaluation study (BEEHIVE) study protocol: a prospective cohort study. BMC Oral Health 2024; 24:439. [PMID: 38600460 PMCID: PMC11008028 DOI: 10.1186/s12903-024-04200-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND As antiretroviral therapy has become widely available and highly effective, HIV has evolved to a manageable, chronic disease. Despite this health advancement, people living with HIV (PLWH) are at an increased risk for age-related non-communicable diseases (NCDs) compared to HIV-uninfected individuals. Similarly, PLWH are at an increased risk for selected oral diseases. PLWH with a history of injecting drugs experience an even greater burden of disease than their counterparts. The overall objective of the Baltimore Oral Epidemiology, Disease Effects, and HIV Evaluation (BEEHIVE) study is to determine the combined effects of HIV infection and NCDs on oral health status. The specific aims of the study are to: (1) determine to what extent HIV status influences access to and utilization of oral health care services; (2) determine to what extent HIV status affects self-reported and clinical oral health status; (3) determine to what extent HIV status influences the progression of periodontitis; and (4) determine to what extent HIV status impacts the periodontitis-associated oral microbiome signature. METHODS The BEEHIVE study uses a prospective cohort study design to collect data from participants at baseline and at a 24-month follow-up visit. Data are collected through questionnaire assessments, clinical examinations, and evaluation of oral microbiological samples to determine the drivers of oral disease among a high-risk population of PLWH with a history of injection drug use and prevalent comorbid NCDs. The established AIDS Linked to the Intravenous Experience (ALIVE) cohort serves as the source of participants for the BEEHIVE Study. DISCUSSION Upon completion of the BEEHIVE study, the knowledge gained will be important in informing future clinical and preventive interventions that can be implemented into medical and dental practice to ultimately help eliminate long-standing oral health inequities that PLWH experience.
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Affiliation(s)
- Darien J Weatherspoon
- University of Maryland School of Dentistry, 650 West Baltimore Street, Room 2209, Baltimore, MD, 21201, USA
| | - Gregory D Kirk
- Johns Hopkins Medicine, 615 North Wolfe Street, Room E6533, Baltimore, MD, 21205, USA
| | - Damani A Piggott
- Johns Hopkins Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Vivek Thumbigere-Math
- University of Maryland School of Dentistry, 650 West Baltimore Street, Room 2209, Baltimore, MD, 21201, USA
| | - Bruce A Dye
- University of Colorado School of Dental Medicine, Mail Stop F843 13065 East 17th Avenue, Room 104L, Aurora, CO, 80045, USA
| | - Mark D Macek
- University of Maryland School of Dentistry, 650 West Baltimore Street, Room 2207, Baltimore, MD, 21201, USA.
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Kaur G, Sohanur Rahman M, Shaikh S, Panda K, Chinnapaiyan S, Santiago Estevez M, Xia L, Unwalla H, Rahman I. Emerging roles of senolytics/senomorphics in HIV-related co-morbidities. Biochem Pharmacol 2024:116179. [PMID: 38556028 DOI: 10.1016/j.bcp.2024.116179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024]
Abstract
Human immunodeficiency virus (HIV) is known to cause cellular senescence and inflammation among infected individuals. While the traditional antiretroviral therapies (ART) have allowed the once fatal infection to be managed effectively, the quality of life of HIV patients on prolonged ART use is still inferior. Most of these individuals suffer from life-threatening comorbidities like chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension (PAH), and diabetes, to name a few. Interestingly, cellular senescence is known to play a critical role in the pathophysiology of these comorbidities as well. It is therefore important to understand the role of cellular senescence in the disease progression and co-morbidity development in HIV-infected individuals. In this respect, use of senolytic/senomorphic drugs as combination therapy with ART would be beneficial for HIV patients. This review provides a critical analysis of the current literature to determine the potential and efficacy of using senolytics/senotherapeutics in managing HIV infection, latency, and associated co-morbidities in humans. The various classes of senolytics have been studied in detail to focus on their potential to combat against HIV infections and associated pathologies with advancing age.
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Affiliation(s)
- Gagandeep Kaur
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Md Sohanur Rahman
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Sadiya Shaikh
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Kingshuk Panda
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Srinivasan Chinnapaiyan
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Maria Santiago Estevez
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Li Xia
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hoshang Unwalla
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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Schrock JM. Accelerated aging in people living with HIV: The neuroimmune feedback model. Brain Behav Immun Health 2024; 36:100737. [PMID: 38356933 PMCID: PMC10864877 DOI: 10.1016/j.bbih.2024.100737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/02/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024] Open
Abstract
People living with HIV (PLWH) experience earlier onset of aging-related comorbidities compared to their counterparts without HIV. This paper lays out a theoretical model to explain why PLWH experience accelerated aging. Briefly, the model is structured as follows. PLWH experience disproportionately heavy burdens of psychosocial stress across the life course. This psychosocial stress increases risks for depressive symptoms and problematic substance use. Depressive symptoms and problematic substance use interfere with long-term adherence to antiretroviral therapy (ART). Lower ART adherence, in turn, exacerbates the elevated systemic inflammation stemming from HIV infection. This inflammation increases risks for aging-related comorbidities. Systemic inflammation also reduces connectivity in the brain's central executive network (CEN), a large-scale brain network that is critical for coping with stressful circumstances. This reduced capacity for coping with stress leads to further increases in depressive symptoms and problematic substance use. Together, these changes form a neuroimmune feedback loop that amplifies the impact of psychosocial stress on aging-related comorbidities. In this paper, I review the existing evidence relevant to this model and highlight directions for future research.
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Affiliation(s)
- Joshua M. Schrock
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, United states
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Woottum M, Yan S, Sayettat S, Grinberg S, Cathelin D, Bekaddour N, Herbeuval JP, Benichou S. Macrophages: Key Cellular Players in HIV Infection and Pathogenesis. Viruses 2024; 16:288. [PMID: 38400063 PMCID: PMC10893316 DOI: 10.3390/v16020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Although cells of the myeloid lineages, including tissue macrophages and conventional dendritic cells, were rapidly recognized, in addition to CD4+ T lymphocytes, as target cells of HIV-1, their specific roles in the pathophysiology of infection were initially largely neglected. However, numerous studies performed over the past decade, both in vitro in cell culture systems and in vivo in monkey and humanized mouse animal models, led to growing evidence that macrophages play important direct and indirect roles as HIV-1 target cells and in pathogenesis. It has been recently proposed that macrophages are likely involved in all stages of HIV-1 pathogenesis, including virus transmission and dissemination, but above all, in viral persistence through the establishment, together with latently infected CD4+ T cells, of virus reservoirs in many host tissues, the major obstacle to virus eradication in people living with HIV. Infected macrophages are indeed found, very often as multinucleated giant cells expressing viral antigens, in almost all lymphoid and non-lymphoid tissues of HIV-1-infected patients, where they can probably persist for long period of time. In addition, macrophages also likely participate, directly as HIV-1 targets or indirectly as key regulators of innate immunity and inflammation, in the chronic inflammation and associated clinical disorders observed in people living with HIV, even in patients receiving effective antiretroviral therapy. The main objective of this review is therefore to summarize the recent findings, and also to revisit older data, regarding the critical functions of tissue macrophages in the pathophysiology of HIV-1 infection, both as major HIV-1-infected target cells likely found in almost all tissues, as well as regulators of innate immunity and inflammation during the different stages of HIV-1 pathogenesis.
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Affiliation(s)
- Marie Woottum
- Institut Cochin, Inserm U1016, CNRS UMR-8104, Université Paris Cité, 75014 Paris, France; (M.W.); (S.Y.); (S.S.)
| | - Sen Yan
- Institut Cochin, Inserm U1016, CNRS UMR-8104, Université Paris Cité, 75014 Paris, France; (M.W.); (S.Y.); (S.S.)
| | - Sophie Sayettat
- Institut Cochin, Inserm U1016, CNRS UMR-8104, Université Paris Cité, 75014 Paris, France; (M.W.); (S.Y.); (S.S.)
| | - Séverine Grinberg
- CNRS UMR-8601, Université Paris Cité, 75006 Paris, France; (S.G.); (D.C.); (N.B.); (J.-P.H.)
| | - Dominique Cathelin
- CNRS UMR-8601, Université Paris Cité, 75006 Paris, France; (S.G.); (D.C.); (N.B.); (J.-P.H.)
| | - Nassima Bekaddour
- CNRS UMR-8601, Université Paris Cité, 75006 Paris, France; (S.G.); (D.C.); (N.B.); (J.-P.H.)
| | - Jean-Philippe Herbeuval
- CNRS UMR-8601, Université Paris Cité, 75006 Paris, France; (S.G.); (D.C.); (N.B.); (J.-P.H.)
| | - Serge Benichou
- Institut Cochin, Inserm U1016, CNRS UMR-8104, Université Paris Cité, 75014 Paris, France; (M.W.); (S.Y.); (S.S.)
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Omar A, Marques N, Crawford N. Cancer and HIV: The Molecular Mechanisms of the Deadly Duo. Cancers (Basel) 2024; 16:546. [PMID: 38339297 PMCID: PMC10854577 DOI: 10.3390/cancers16030546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
The immune deficiency associated with human immunodeficiency virus (HIV) infection causes a distinct increased risk of developing certain cancer types. Kaposi sarcoma (KS), invasive cervical cancer and non-Hodgkin's lymphoma (NHL) are the prominent malignancies that manifest as a result of opportunistic viral infections in patients with advanced HIV infection. Despite the implementation of antiretroviral therapy (ART), the prevalence of these acquired immunodeficiency syndrome (AIDS)-defining malignancies (ADMs) remains high in developing countries. In contrast, developed countries have experienced a steady decline in the occurrence of these cancer types. However, there has been an increased mortality rate attributed to non-ADMs. Here, we provide a review of the molecular mechanisms that are responsible for the development of ADMs and non-ADMs which occur in HIV-infected individuals. It is evident that ART alone is not sufficient to fully mitigate the potential for ADMs and non-ADMs in HIV-infected individuals. To enhance the diagnosis and treatment of both HIV and malignancies, a thorough comprehension of the mechanisms driving the development of such cancers is imperative.
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Affiliation(s)
- Aadilah Omar
- Division of Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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Nicolau V, Brandão D, Rua T, Escoval A. Organisation and integrated healthcare approaches for people living with HIV, multimorbidity, or both: a systematic review. BMC Public Health 2023; 23:1579. [PMID: 37596539 PMCID: PMC10439547 DOI: 10.1186/s12889-023-16485-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Universal recommendation for antiretroviral drugs and their effectiveness has put forward the challenge of assuring a chronic and continued care approach to PLHIV (People Living with HIV), pressured by aging and multimorbidity. Integrated approaches are emerging which are more responsive to that reality. Studying those approaches, and their relation to the what of delivery arrangements and the how of implementation processes, may support future strategies to attain more effective organizational responses. METHODS We reviewed empirical studies on either HIV, multimorbidity, or both. The studies were published between 2011 and 2020, describing integrated approaches, their design, implementation, and evaluation strategy. Quantitative, qualitative, or mixed methods were included. Electronic databases reviewed cover PubMed, SCOPUS, and Web of Science. A narrative analysis was conducted on each study, and data extraction was accomplished according to the Effective Practice and Organisation of Care taxonomy of health systems interventions. RESULTS A total of 30 studies, reporting 22 different interventions, were analysed. In general, interventions were grounded and guided by models and frameworks, and focused on specific subpopulations, or priority groups at increased risk of poorer outcomes. Interventions mixed multiple integrated components. Delivery arrangements targeted more frequently clinical integration (n = 13), and care in proximity, community or online-telephone based (n = 15). Interventions reported investments in the role of users, through self-management support (n = 16), and in coordination, through multidisciplinary teams (n = 9) and continuity of care (n = 8). Implementation strategies targeted educational and training activities (n = 12), and less often, mechanisms of iterative improvement (n = 3). At the level of organizational design and governance, interventions mobilised users and communities through representation, at boards and committees, and through consultancy, along different phases of the design process (n = 11). CONCLUSION The data advance important lessons and considerations to take steps forward from disease-focused care to integrated care at two critical levels: design and implementation. Multidisciplinary work, continuity of care, and meaningful engagement of users seem crucial to attain care that is comprehensive and more proximal, within or cross organizations, or sectors. Promising practices are advanced at the level of design, implementation, and evaluation, that set integration as a continued process of improvement and value professionals and users' knowledge as assets along those phases. TRIAL REGISTRATION PROSPERO number CRD42020194117.
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Affiliation(s)
- Vanessa Nicolau
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
| | - Daniela Brandão
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | | | - Ana Escoval
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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Tice C, Zhao H, Langford D. Single nucleotide polymorphisms in aquaporin-4 associate with cognitive impairment status in people with HIV. J Neurovirol 2023; 29:258-271. [PMID: 37191905 DOI: 10.1007/s13365-023-01126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 05/17/2023]
Abstract
Neurocognitive impairments are more frequent in people with HIV (PWH) compared to their uninfected counterparts. HIV-associated neurocognitive disorder (HAND) is a spectrum disorder and up to 50% of PWH are reported to suffer from HAND. Altered waste clearance from the brain, chronic neuroinflammation and impaired metabolic processes may contribute to abnormal aging in PWH and are more common among those who suffer from HAND. Thus, it is important to identify earlier predictors for development of HAND. A key contributor to cognitive impairment in HIV and in Alzheimer's disease (AD) is formation and accumulation of aberrant proteins including hyperphosphorylated Tau (pTau). Previous data from AD and traumatic brain injury studies report that impaired waste clearance from the brain contributes in part to cognitive impairments. Evidence suggests that the aquaporin 4 (aqp4) gene may have an important role in waste clearance from the brain as single nucleotide polymorphisms (SNPs) in aqp4 have been reported to associate with changes in cognitive decline in AD patients. Given some similarities between HAND and AD, we assessed potential associations of several aqp4 SNPS with cognitive impairment in PWH. Our data show that homozygous carriers of the minor allele in SNPs rs3875089 and rs3763040 had significantly lower neuropsychological test Z-scores in multiple domains compared to the other genotypes. Interestingly, this decrease in Z-scores was only observed in PWH and not in HIV-control participants. Conversely, homozygosity of the minor allele of rs335929 associated with better executive function in PWH. Based on these data, tracking large cohorts of PWH to determine if the presence of these SNPs associate with cognitive changes during disease progression is of interest. Furthermore, screening PWH for SNPs that may be associated with cognitive impairment risk after diagnosis could be considered in alignment with traditional treatment plans to potentially work on skills in areas shown to have cognitive decline with these SNPs present.
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Affiliation(s)
- Caitlin Tice
- Lewis Katz School of Medicine, Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA
| | - Huaqing Zhao
- Lewis Katz School of Medicine, Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA
| | - Dianne Langford
- Lewis Katz School of Medicine, Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA.
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Miller MJ, Eberhart LG, Jefferson CR, Horberg MA. Beyond Antiretroviral Treatment: Patterns and Factors Associated With Composite Medication Adherence Before and During the COVID-19 Pandemic in Patients With HIV With Multiple Chronic Conditions. J Acquir Immune Defic Syndr 2023; 92:405-413. [PMID: 36728856 DOI: 10.1097/qai.0000000000003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Polypharmacy for multiple chronic conditions (MCCs) poses an increasing challenge in people with HIV (PWH). This research explores medication adherence in PWH with MCCs before and during COVID-19. SETTING Kaiser Permanente Mid-Atlantic States. METHODS Medical and pharmacy records of a continuously enrolled cohort (September 2018-September 2021) of adult PWH were used. To estimate medication adherence, monthly proportion of days covered (PDC) was measured individually for antiretrovirals (ARVs), diabetes medications (DMs), renin-angiotensin antagonists (RASMs), and statins (SMs) and combined into composite measures (CMs) with and without ARVs. Descriptive statistics, time-series models, and multivariable population-averaged panel general estimating equations were used to profile trends, effects, and factors associated with adherence. RESULTS The cohort (n = 543) was predominantly 51-64 years old (59.3%), Black (73.1%), male (69.2%), and commercially insured (65.4%). Two-thirds (63.7%) of patients were taking medications in 2 medication groups (ie, ARVs and either DMs, RASMs, or SMs), 28.9% were taking medications in 3 medication groups, and 7.4% were taking medications in all 4 medication groups. Overall, PDC for CMs without ARVs was 77.2% and 70.2% with ARVs. After March 2020, negative monthly trends in PDC were observed for CMs without ARVs (β = -0.1%, P = 0.003) and with ARVs (β = -0.3%, P = 0.001). For CMs with ARVs, Black race (aOR = 0.5; P < 0.001; ref: White) and taking medications for 3 medication groups (aOR = 0.8; P < 0.02; ref: 2) were associated with lower adherence. CONCLUSION Decreasing medication adherence trends were observed during the COVID-19 pandemic with variations among population subgroups. Opportunity exists to improve medication adherence for non-White populations and those taking medications for MCCs beyond ARVs.
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Affiliation(s)
- Michael J Miller
- Mid-Atlantic Permanente Research Institute (MAPRI), Rockville, MD
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Zabel M, Wilson TW, Sayles H, May PE, Furl R, Bares SH. The Impact of the COVID-19 Pandemic on Mental Health and Substance Use among People with and without HIV. Pathogens 2023; 12:461. [PMID: 36986383 PMCID: PMC10051668 DOI: 10.3390/pathogens12030461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
People with HIV (PWH) may be particularly vulnerable to the psychological impacts of COVID-19. To assess this, participants were recruited from two established cohorts of PWH and HIV- adults with the available pre-pandemic baseline data and completed the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Alcohol Use Identification Test (AUDIT), National Institute on Drug Abuse Quick Screen (NIDA-QS), and Pittsburgh Sleep Quality Index (PSQI) at two distinct intra-pandemic time periods. All outcomes were evaluated using generalized linear mixed models. In total, 87 participants completed all the questionnaires; 45 were PWH and 42 were HIV-. The pre-pandemic mean BDI-II, BAI, AUDIT and PSQI scores were higher in the PWH cohort. After the onset of the pandemic, the mean BDI-II, AUDIT and PSQI scores increased within the sample as a whole (p < 0.001, p = 0.029 and p = 0.046, respectively). The intra-pandemic mean BDI-II scores fell slightly for both groups and the AUDIT scores increased slightly for the PWH group and fell slightly for the HIV- group, but not significantly. The intra-pandemic PSQI scores increased sharply for both groups. The percentage of PWH and HIV- participants who moved into a more severe category of depression was identical (18%), but more PWH met the criteria for clinical evaluation. The BAI and NIDA-QS scores did not increase significantly. In conclusion, the measures of mental health symptoms and alcohol use increased in both groups after the onset of the pandemic. Although there were no significant differences in the changes between the groups, the PWH had higher baseline scores and the changes in this group had more clinical impacts.
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Affiliation(s)
- Morgan Zabel
- College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Tony W. Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Harlan Sayles
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Pamela E. May
- College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Renae Furl
- College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Sara H. Bares
- College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
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13
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Enogela EM, Jones R, Buford TW, Vance DE, Fazeli PL. Cardiometabolic Diseases and Quality-of-Life Outcomes in Adults With HIV in the Deep South: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:171-181. [PMID: 36576513 DOI: 10.1097/jnc.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/27/2022] [Indexed: 12/29/2022]
Abstract
ABSTRACT The role of cardiometabolic diseases (CMDs) on physical health-related quality of life (P-HRQoL) and quality of sleep was examined among 261 PLWH ≥40 years, recruited from a university-affiliated HIV clinic in the Deep U.S. South. Using a cross-sectional study design, participants completed the Medical Outcomes Study HIV Health Survey (MOS-HIV; P-HRQoL) and Pittsburgh Sleep Quality Index. The overall prevalence of self-reporting ≥1 CMD was 64.4%. P-HRQoL scores were lower in PLWH with ≥1 CMD compared with those with no CMDs (45.53 ± 11.54 vs. 49.67 ± 10.77, p <.01). Poor sleep quality was higher among participants with ≥1 CMD compared with those with no CMDs (9.28 ± 4.42 vs. 7.26 ± 4.17, p <.01). Each additional CMD resulted in a 1.83-point decrease in P-HRQoL and 0.74-point increase in poor sleep quality scores. Interventions that focus on targeting these quality-of-life domains in PLWH with CMDs are needed.
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Affiliation(s)
- Ene M Enogela
- Ene M. Enogela, MPH, is an Epidemiology PhD Student, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. Raymond Jones, PhD, is an Assistant Professor, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA. Thomas W. Buford, PhD, is a Professor, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA, and is also affiliated with the Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA. David E. Vance, PhD, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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14
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Tenkorang EY, Owusu AY, Zaami M, Langmagne S, Gyan S. Intimate Partner Violence and Health Outcomes Among Women Living With HIV/AIDS in Ghana: A Cross-Sectional Study. HEALTH EDUCATION & BEHAVIOR 2023; 50:347-358. [PMID: 36744741 DOI: 10.1177/10901981231152425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intimate partner violence (IPV) is known to have negative health consequences for victims. For women living with HIV/AIDS, whose health may be compromised, exposure to IPV can be devastating. Yet few (if any) studies have explored the health implications of exposure to IPV among HIV-positive women. We begin to fill this gap by examining the effects of various dimensions of IPV (physical, sexual, psychological/emotional, and economic) on the cardiovascular, psychosocial, and sexual reproductive health outcomes of HIV-positive women in Ghana. Data were collected from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern Region. We used logit models to explore relationships between IPV and health. The findings indicate high prevalence of IPV in our sample: physical violence (61%), sexual violence (50.9%), emotional/psychological violence (79.6%), and economic violence (66.8%). Generally, participants with experiences of IPV reported cardiovascular health problems, unwanted pregnancies and pregnancy loss, and poor psychosocial health. Our findings suggest the importance of screening for IPV as part of HIV care in Ghana.
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Affiliation(s)
- Eric Y Tenkorang
- Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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15
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Choudhary S, Rangasamy K, Naidu S, Sachdeva RK, Sharma A. Subtrochanteric Pathological Femur Fracture in an HIV-Positive Patient on Tenofovir-based antiretroviral therapy: A Case Report and Review of the Literature. J Orthop Case Rep 2023; 13:14-20. [PMID: 37144071 PMCID: PMC10152932 DOI: 10.13107/jocr.2023.v13.i02.3538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/20/2022] [Indexed: 05/06/2023] Open
Abstract
Introduction The population of people living with human immunodeficiency virus (HIV) and AIDS has increased and so is the incidence of fragility fractures in these patients. Multiple contributory factors are responsible for osteomalacia or osteoporosis in such patients such as a chronic inflammatory response to the HIV, highly active antiretroviral therapy (HAART) itself, and associated comorbidities. Tenofovir has also been reported to disrupt bone metabolism and causes fragility fractures. Case Report A 40-year-old HIV-positive female came to us with pain in her left hip and was unable to bear weight. She had a history of trivial fall. The patient has been taking tenofovir-associated HAART regimen for the past 6 years and has been compliant. She was diagnosed with a left-side transverse subtrochanteric closed femur fracture. Closed reduction and internal fixation was done using a proximal femur intramedullary nail (PFNA). The latest follow-up shows fracture union and good functional outcomes after treating osteomalacia, and HAART changed to a non-tenofovir regimen later. Conclusion Patients with HIV infection are prone to fragility fractures and periodic monitoring of their BMD, serum calcium, and vitamin D3 levels should be done for prevention and early diagnosis. More vigilance in patients receiving a tenofovir-associated HAART regimen is needed. Appropriate medical treatment needs to be started once any abnormality in the bone metabolic parameters is detected, and drugs like tenofovir need to be changed as it causes osteomalacia.
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Affiliation(s)
- Siddharth Choudhary
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthick Rangasamy
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Address of Correspondence: Dr. Karthick Rangasamy, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - Shankar Naidu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravinder Kaur Sachdeva
- Senior Medical Officer, ART Centre Department of Internal Medicine and ART Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine and in Charge of ART Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Yuan T, Hu Y, Zhou X, Yang L, Wang H, Li L, Wang J, Qian HZ, Clifford GM, Zou H. Incidence and mortality of non-AIDS-defining cancers among people living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101613. [PMID: 35990580 PMCID: PMC9386399 DOI: 10.1016/j.eclinm.2022.101613] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-AIDS-defining cancers (NADCs) are now becoming a rising cause of morbidity among people living with HIV (PLHIV) in the highly active antiretroviral therapy (HAART) era. We conducted a systematic review and meta-analysis to estimate the summary risk of incidence and mortality of a wide range of NADCs among PLHIV compared with the general population. Methods This systematic review and meta-analysis was registered in the PROSPERO (registration number CRD42020222020). We searched PubMed, EMBASE, Cochrane library, and Web of Science for relevant studies published before Jan 24, 2022. Cohort or registry linkage studies comparing the incidence or mortality of individual NADCs in PLHIV with that in the general population were included. Studies simply reporting outcomes of cancer precursor lesions or combined NADCs were excluded. We calculated pooled standardised incidence (SIRs) and standardised mortality ratios (SMRs) and their 95% confidence intervals (CIs) using random-effects models, and used robust variance estimation to account for non-independence in study-level effect sizes. Findings We identified 92 publications arising from 46 independent studies including 7 articles out of 7 studies from developing countries. Among the 40 types of NADCs investigated, all of the 20 infection-related NADCs, cancers related with human papillomavirus infection in particular, and half of the 20 non-infection-related NADCs occurred in excess in PLHIV compared with the general population. This risk pattern was consistent in most WHO regions and in both high-income and low-and middle-income countries. The increased SIRs for various NADCs were more evident among PLHIV with advanced immunodeficiency, and was explored by HIV transmission route, and use of HAART. PLHIV had increased mortality for anal cancer (SMR 124·07, 95% CI 27·31-563·72), Hodgkin lymphoma (41·03, 2·91-577·88), liver cancer (8·36, 3·86-18·11), lung cancer (3·95, 1·52-10·26), and skin melanoma (3·95, 1·28-12·2). Interpretation PLHIV had increased incidence and mortality for a wide spectrum of NADCs. Primary prevention and effective treatment for NADCs in this population is urgently needed. Funding Natural Science Foundation of China Excellent Young Scientists Fund, Natural Science Foundation of China International/Regional Research Collaboration Project, National Science and Technology Major Project of China, Sanming Project of Medicine in Shenzhen, High Level Project of Medicine in Longhua, Shenzhen, Shenzhen Science and Technology Innovation Commission Basic Research Program, Special Support Plan for High-Level Talents of Guangdong Province, the Guangzhou Basic Research Program on People's Livelihood Science and Technology, the National Natural Science Foundation of China.
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Affiliation(s)
- Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuqing Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xinyi Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Luoyao Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- National Clinical Research Center for Infectious Diseases, Shenzhen, China
- The Third People's Hospital of Shenzhen, Shenzhen, China
- The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou, China
- Guangzhou Medical University, Guangzhou, China
| | - Junfeng Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT USA
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, the University of New South Wales, Sydney, Australia
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17
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Khumalo GE, Lutge E, Mashamba-Thompson TP. Exploring how outreach team leaders perceive community health workers' experiences of providing HIV services in KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:239-250. [PMID: 36102053 DOI: 10.2989/16085906.2022.2060841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 06/15/2023]
Abstract
Objectives: In 2018, the KwaZulu-Natal Department of Health launched the ward-based primary health care outreach teams policy framework which sought to expand the community health worker (CHW) programme's provision of longitudinal patient support, including human immunodeficiency virus (HIV) services in communities. This study sought to explore the perceptions of outreach team leaders who supervise CHWs on their experiences of providing HIV services in the province.Study design: This was a qualitative, phenomenology study.Methods: Convenience sampling was done to select one outreach team leader from each of the 11 KwaZulu-Natal health districts to be interviewed using an interview guide. Thematic analysis, guided by the Ritchie and Spencer framework analysis, was used to analyse the data.Results: The challenges faced by CHWs in delivering HIV services were: the absence of individuals when CHWs visited their homes, self-HIV stigma, rejection of CHWs' HIV services due to traditional beliefs, CHW shortages, lack of other resources, low levels of CWH education and a lack of training. On the other hand, the provision of HIV services was fascilitated by: supportive supervision, training, having cell phones and having a positive attitude towards providing HIV services by CHWs that were HIV-positive.Conclusion: The CHWs in KwaZulu-Natal face more challenges than enablers in the provision of HIV services. The delegation of HIV services to CHWs should be aligned with their holistic empowerment by eliminating barriers to the provision of HIV services.
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Affiliation(s)
- Gugulethu E Khumalo
- Public Health Medicine, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Research & Knowledge Management Unit, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Elizabeth Lutge
- Public Health Medicine, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Research & Knowledge Management Unit, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Tivani P Mashamba-Thompson
- Public Health Medicine, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria, South Africa
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18
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Kotey M, Alhassan Y, Adomako J, Nunoo-Mensah G, Kapadia F, Sarfo B. Chronic comorbidities in persons living with HIV within three years of exposure to antiretroviral therapy at Pantang Antiretroviral Center in Ghana: a retrospective study. Pan Afr Med J 2022; 42:294. [PMID: 36415339 PMCID: PMC9643783 DOI: 10.11604/pamj.2022.42.294.35134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/10/2022] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION uptake of antiretroviral therapy (ART) and retention in care are associated with increased life expectancy but increased the risk of comorbid conditions in persons living with HIV (PLWH) and taking antiretroviral drugs. This study describes comorbid conditions among PLWH in Ghana. METHODS PLWH (n=222) out of a sample population of 900, randomly selected at Pantang ART Center participated in the study from June to July of 2020. Socio-demographic characteristics, HIV biomarkers, medication type and adherence, and diagnostic confirmed chronic conditions were extracted from medical records of PLWH. Cox proportional-hazard models and Kaplan-Meier curves graphing risk of experiencing comorbid conditions were performed. Log-rank test was performed at p<0.05. RESULTS fifty three point two percent of PLWH (222) experienced a comorbid condition including, respiratory conditions (17.6%), anaemia (12.2%), hypertension (12.2%), cardiovascular diseases (10.8%),and neurological conditions (10.8%).Factors associated with some of these conditions were medication adherence (aHR=0.43, 95% CI: 0.21-0.90) and visual changes (aHR=2.64, 95% CI: 1.08-6.45) for respiratory conditions, age (aHR=10.03, 95% CI; 1.22-82.37) for hypertension, and World Health Organization (WHO) clinical stages (stage II (aHR=13.36, 95% CI=1.54-115.63) and III (aHR=11.71, 95% CI=1.41-97.26))for peripheral neuropathy. Kaplan-Meier curves show significant risk of comorbid conditions for age, CD4 count ≤350 cells/mm2, WHO clinical stages III and IV, and ART non-adherence. CONCLUSION understanding the types of comorbidities in PLWH is integral to providing feedback to primary care providers to monitor.
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Affiliation(s)
- Martha Kotey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Yakubu Alhassan
- Department of Health Policy, Planning and Management, School of Public Health, University of Legon, Accra, Ghana
| | - James Adomako
- Department of Plant and Environmental Biology, University of Ghana, Legon, Accra, Ghana
| | | | - Farzana Kapadia
- Department of Epidemiology, School of Global Public Health, New York University, New York, USA
| | - Bismark Sarfo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Identifying subtypes of HIV/AIDS-related symptoms in China using latent profile analysis and symptom networks. Sci Rep 2022; 12:13271. [PMID: 35918513 PMCID: PMC9345945 DOI: 10.1038/s41598-022-17720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 07/29/2022] [Indexed: 11/09/2022] Open
Abstract
The identification of subgroups of people living with HIV in China based on the severity of symptom clusters and individual symptoms is crucial to determine group-specific symptom management strategies. Participants reported 27 highly prevalent HIV/AIDS-related symptoms. Latent profile analysis based on symptom severity was used to identify person-centered subtypes of HIV/AIDS-related symptoms. Symptom networks were compared among subgroups identified by latent profile analysis. A total of 2927 eligible people living with HIV (PWH) were included in the analysis. Five profiles were identified: "Profile 1: all low symptom severity" (n2 = 2094, 71.54%), "Profile 2: medium symptom severity with syndemic conditions" (n3 = 109, 3.72%), "Profile 3: medium symptom severity with low functional status" (n1 = 165, 5.64%), "Profile 4: medium symptom severity in transitional period" (n4 = 448, 15.31%), and "Profile 5: all high symptom severity" (n5 = 111, 3.79%). Except for Profile 1 and Profile 5, the symptom severity was similar among the other three profiles. Profiles 1 (2.09 ± 0.52) and 4 (2.44 ± 0.66) had the smallest ∑s values, and Profiles 2 (4.38 ± 1.40) and 5 (4.39 ± 1.22) had the largest ∑s values. Our study demonstrates the need for health care professionals to provide PWH with group-specific symptom management interventions based on five profiles to improve their physical and psychological well-being. Future studies should be conducted in different contexts using different symptom checklists to further validate our results.
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Emanuel KM, Runner K, Brodnik ZD, Morsey BM, Lamberty BG, Johnson HS, Acharya A, Byrareddy SN, España RA, Fox HS, Gaskill PJ. Deprenyl reduces inflammation during acute SIV infection. iScience 2022; 25:104207. [PMID: 35494221 PMCID: PMC9046124 DOI: 10.1016/j.isci.2022.104207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/28/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
In the era of antiretroviral therapy, inflammation is a central factor in numerous HIV-associated comorbidities, such as cardiovascular disease, cognitive impairment, and neuropsychiatric disorders. This highlights the value of developing therapeutics that both reduce HIV-associated inflammation and treat associated comorbidities. Previous research on monoamine oxidase inhibitors (MAOIs) suggests this class of drugs has anti-inflammatory properties in addition to neuropsychiatric effects. Therefore, we examined the impact of deprenyl, an MAOI, on SIV-associated inflammation during acute SIV infection using the rhesus macaque model of HIV infection. Our results show deprenyl decreased both peripheral and CNS inflammation but had no effect on viral load in either the periphery or CNS. These data show that the MAOI deprenyl may have broad anti-inflammatory effects when given during the acute stage of SIV infection, suggesting more research into the anti-inflammatory effects of this drug could result in a beneficial adjuvant for antiretroviral therapy.
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Affiliation(s)
- K M Emanuel
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - K Runner
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19102, USA
| | - Z D Brodnik
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
- Center on Compulsive Behaviors, NIH Intramural Research Program, Baltimore, MD 21224, USA
- Integrative Neuroscience Research Branch, Neuronal Networks Section, Baltimore, MD 21224, USA
| | - B M Morsey
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - B G Lamberty
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - H S Johnson
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19102, USA
| | - A Acharya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - S N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - R A España
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - H S Fox
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - P J Gaskill
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19102, USA
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Sosnowski DW, Feder KA, Astemborski J, Genberg BL, Letourneau EJ, Musci RJ, Mojtabai R, McCall L, Hollander E, Loving L, Maher BS, Kirk GD, Mehta SH, Sun J. Adverse childhood experiences and comorbidity in a cohort of people who have injected drugs. BMC Public Health 2022; 22:986. [PMID: 35578217 PMCID: PMC9109307 DOI: 10.1186/s12889-022-13369-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood adversity is associated with the onset of harmful adult substance use and related health problems, but most research on adversity has been conducted in general population samples. This study describes the prevalence of adverse childhood experiences in a cohort of people who have injected drugs and examines the association of these adverse experiences with medical comorbidities in adulthood. METHODS Six hundred fifty three adults were recruited from a 30-year cohort study on the health of people who have injected drugs living in and around Baltimore, Maryland (Median age = 47.5, Interquartile Range = 42.3-52.3 years; 67.3% male, 81.1% Black). Adverse childhood experiences were assessed retrospectively in 2018 via self-report interview. Lifetime medical comorbidities were ascertained via self-report of a provider diagnosis. Multinomial logistic regression with generalized estimating equations was used to examine the association between adversity and comorbid conditions, controlling for potential confounders. RESULTS Two hundred twelve participants (32.9%) reported 0-1 adverse childhood experiences, 215 (33.3%) reported 2-4, 145 (22.5%) reported 5-9, and 72 (11.1%) reported ≥10. Neighborhood violence was the most commonly reported adversity (48.5%). Individuals with ≥10 adverse childhood experiences had higher odds for reporting ≥3 comorbidities (Adjusted Odds Ratio = 2.9, 95% CI = 1.2 - 6.8, p = .01). CONCLUSIONS Among people who have injected drugs, adverse childhood experiences were common and associated with increased occurrence of self-reported medical comorbidities. Findings highlight the persistent importance of adversity for physical health even in a population where all members have used drugs and there is a high burden of comorbidity.
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Affiliation(s)
- David W Sosnowski
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth A Feder
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth J Letourneau
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rashelle J Musci
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa McCall
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eileen Hollander
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lynnet Loving
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Brion S Maher
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jing Sun
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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22
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Koroukian SM, Zhou G, Navale SM, Schiltz NK, Kim U, Rose J, Cooper GS, Moore SE, Mintz LJ, Avery AK, Mukherjee S, Markt SC. Excess cancer prevalence in men with HIV: A nationwide analysis of Medicaid data. Cancer 2022; 128:1987-1995. [PMID: 35285515 DOI: 10.1002/cncr.34166] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cancer is one of the most common comorbidities in men living with HIV (MLWH). However, little is known about the MLWH subgroups with the highest cancer burden to which cancer prevention efforts should be targeted. Because Medicaid is the most important source of insurance for MLWH, we evaluated the excess cancer prevalence in MLWH on Medicaid relative to their non-HIV counterparts. METHODS In this cross-sectional study using 2012 Medicaid Analytic eXtract data nationwide, we flagged the presence of HIV, 13 types of cancer, symptomatic HIV, and viral coinfections using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. The study population included individuals administratively noted to be of male sex (men), aged 18 to 64 years, with (n = 82,495) or without (n = 7,302,523) HIV. We developed log-binomial models with cancer as the outcome stratified by symptomatic status, age, and race/ethnicity. RESULTS Cancer prevalence was higher in MLWH than in men without HIV (adjusted prevalence ratio [APR], 1.84; 95% confidence interval [CI], 1.78-1.90) and was higher among those with symptomatic HIV (APR, 2.74; 95% CI, 2.52-2.97) than among those with asymptomatic HIV (APR, 1.73; 95% CI, 1.67-1.79). The highest APRs were observed for anal cancer in younger men, both in the symptomatic and asymptomatic groups: APR, 312.97; 95% CI, 210.27-465.84, and APR, 482.26; 95% CI, 390.67-595.32, respectively. In race/ethnicity strata, the highest APRs were among Hispanic men for anal cancer (APR, 198.53; 95% CI, 144.54-272.68) and for lymphoma (APR, 9.10; 95% CI, 7.80-10.63). CONCLUSIONS Given the Medicaid program's role in insuring MLWH, the current findings highlight the importance of the program's efforts to promote healthy behaviors and vaccination against human papillomavirus in all children and adolescents and to provide individualized cancer screening for MLWH.
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Affiliation(s)
- Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Guangjin Zhou
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Nicholas K Schiltz
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Uriel Kim
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Cleveland, Ohio.,Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Johnie Rose
- Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Cleveland, Ohio.,Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Clinical Translational Science Doctoral Program, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Gregory S Cooper
- Department of Internal Medicine, University Hospital Cleveland Medical Center, Cleveland, Ohio.,Cancer Prevention and Control Program, Case Comprehensive Cancer Center, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Laura J Mintz
- School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Department of Internal Medicine Pediatrics, MetroHealth Medical Center, Cleveland, Ohio
| | - Ann K Avery
- School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Division of Infectious Diseases, MetroHealth Medical Center, Cleveland, Ohio
| | - Sudipto Mukherjee
- Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio.,Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Sarah C Markt
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Cleveland, Ohio
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23
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Sehl ME, Breen EC, Shih R, Chen L, Wang R, Horvath S, Bream JH, Duggal P, Martinson J, Wolinsky SM, Martinez-Maza O, Ramirez CM, Jamieson BD. Increased Rate of Epigenetic Aging in Men Living With HIV Prior to Treatment. Front Genet 2022; 12:796547. [PMID: 35295196 PMCID: PMC8919029 DOI: 10.3389/fgene.2021.796547] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/06/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Epigenetic aging is accelerated in tissues of persons living with HIV (PLWH) and may underlie the early onset of age-related illnesses. This study examines the rate-of-change in epigenetic age in PLWH following HIV infection but before HAART, using archived longitudinal samples from the Multicenter AIDS Cohort Study. Methods: DNA was isolated from cryopreserved peripheral blood mononuclear cells from 101 men living with HIV, with baseline visit <2.5 years after HIV seroconversion (Visit 1) and follow-up visit <1.5 years before the initiation of HAART (Visit 2), and 100 HIV-uninfected men matched on age and visits with comparable time intervals. DNA methylation (DNAm) age was estimated for five clocks (Pan-tissue, Extrinsic, Phenotypic, Grim, and Skin & Blood age), and a DNAm-based estimate of telomere length (DNAmTL). Multivariate linear regression models were used to examine baseline factors associated with rate-of-aging, defined as (DNAm age visit 2-DNAm age visit 1)/(age visit 2-age visit 1). Results: Epigenetic age increased approximately twice as fast in PLWH as uninfected controls (Pan-tissue, Extrinsic, and Phenotypic clocks). Shortening of DNAmTL was nearly 3-fold faster in PLWH than controls. Faster rate-of-aging was associated with HIV status (Pan-Tissue, Extrinsic, Phenotypic, and DNAmTL), white race (Extrinsic, DNAmTL), higher cumulative HIV viral load (Grim), and lower baseline DNAm age (Phenotypic, Skin & Blood). Conclusion: Epigenetic rates-of-aging were significantly faster for untreated PLWH. Our findings expand on the important impact of HIV infection on biologic aging, both in elevating epigenetic age and increasing the rate-of-aging in the years following infection.
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Affiliation(s)
- Mary E. Sehl
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Crabb Breen
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roger Shih
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Larry Chen
- UCLA Computational and Systems Biology Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ruibin Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jay H. Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Immunology Training Program, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Priya Duggal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven M. Wolinsky
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Otoniel Martinez-Maza
- Departments of Obstetrics and Gynecology and Microbiology, Immunology and Molecular Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Christina M. Ramirez
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Beth D. Jamieson
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
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24
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Ahmed S, Algarin AB, Thadar H, Zhou Z, Taskin T, Vaddiparti K, Villalba K, Wang Y, Ennis N, Morano JP, Somboonwit C, Cook RL, Ibañez GE. Comorbidities among persons living with HIV (PLWH) in Florida: a network analysis. AIDS Care 2022; 35:1055-1063. [PMID: 35172664 PMCID: PMC9378751 DOI: 10.1080/09540121.2022.2038363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ABSTRACTPeople living with HIV (PLWH) experience a higher rate of age-related comorbidities at younger ages. Understanding common comorbidities among PLWH and their relationship to one another could be significant in improving aging for PLWH. The goal of the present study is to identify the most common comorbidities among PLWH and the relationship between them using network analysis. We used abstracted electronic medical record (EMR) data of PLWH from the Florida Cohort study, a prospective cohort study conducted in eight cities in Florida, USA. We used International Classification of Diseases (10th revision, ICD-10) code to classify comorbidities and organ systems. Network analysis was conducted to determine the degree and betweenness centrality among comorbidities. We included 756 PLWH with an average age of 46.4 years (SD 11.3) in the analysis. Infectious diseases (A00-B99, 50.8%), mental and behavioural (F01-F99, 47.0%), endocrine, nutritional and metabolic (E00-E88, 45.2%), and circulatory (I00-I99, 39%) disorders were the most prevalent system comorbidities among PLWH. Hypertensive disorder (I10-I1635.8%), dyslipidaemia (E78, 25.7%) and major depressive disorder (F32-F33, 23.9%) were the most common non-infectious conditions affecting PLWH. Viral hepatitis (B15-B19, 17.1%) and syphilis (A15-A53, 12%) were the most common coinfections among PLWH. Hypertension, dyslipidaemia and major depressive disorder were the most central of the comorbidities among PLWH. Comorbidities among PLWH were most prevalent for chronic disease and mental illness. Targeting shared disease risk factors in addition to monitoring known pathological pathways may prevent comorbidities among PLWH.
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Affiliation(s)
- Shyfuddin Ahmed
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Hsu Thadar
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Tanjila Taskin
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Krishna Vaddiparti
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Karina Villalba
- Department of Population Health, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Yan Wang
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Jamie P Morano
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
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25
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Ramírez-Suárez AC, Paneque-Guerrero T, Casillas-Casanova D, Cosme K, Bacardí D, Duarte CA, Ancízar J, Brown E, Castro J, Suárez-Alba J, Garay H, Pereira K, Fernández-Ortega C. Preliminary safety assessment of CIGB-210, an investigational peptide for HIV infection. Hum Exp Toxicol 2022; 41:9603271211073708. [PMID: 35112887 DOI: 10.1177/09603271211073708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current human immunodeficiency virus treatments need to be periodically administered lifelong. In this study we assess the effect of repeated doses of an anti-HIV peptide drug candidate in C57BL6 strain. Two schemes of up to 15 administrations and one of 30, daily dosing for 5 days per week, all by the subcutaneous route were evaluated. Different dose concentrations of the peptide were assayed. CIGB-210 treated animals showed no symptoms or abnormal behavior as compared with placebo. All the animals gained weight during the study. Macroscopic evaluation showed no alterations in any of the organs studied. Microscopic analysis of the tissues did not show morphological changes in thymus, stomach, small and large intestines, kidney, brain, or cerebellum. The proliferative response of splenocytes and their capacity to secrete gamma interferon were not compromised by the repeated administration of CIGB-210. There were not statistically significant differences for any of the parameters evaluated during the study among treated and non-treated groups. We can conclude that CIGB-210 is well tolerated in C57BL6 mice in the dose concentration range explored and merits subsequent toxicological studies.
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Affiliation(s)
- Anna C Ramírez-Suárez
- Pharmaceutical Department, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | - Taimi Paneque-Guerrero
- Pharmaceutical Department, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | | | - Karelia Cosme
- Preclinical Research Direction, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | - Dania Bacardí
- Preclinical Research Direction, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | - Carlos A Duarte
- Pharmaceutical Department, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | - Julio Ancízar
- Preclinical Research Direction, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | - Emma Brown
- Preclinical Research Direction, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | - Jorge Castro
- Preclinical Research Direction, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | - José Suárez-Alba
- Preclinical Research Direction, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | - Hilda Garay
- Chemical and Physical Department, 113016Center for Genetic Engineering and Biotechnology (CIGB), Havana, Cuba
| | - Karla Pereira
- Pharmaceutical Department, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
| | - Celia Fernández-Ortega
- Pharmaceutical Department, 113016Center for Genetic Engineering and Biotechnology, Habana, Cuba
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26
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Paula AAD, Chequer P, Pires DRF, Lemos KRVD, Barone LG, Veloso VG, Pacheco AG. Assessing the underreporting of deaths among people living with HIV in Rio de Janeiro, Brazil, from 2014 to 2019. CAD SAUDE PUBLICA 2022; 38:e00081821. [PMID: 35107508 DOI: 10.1590/0102-311x00081821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
We assessed the proportions and causes of the underreporting of deaths among people living with HIV (PLHIV) in Rio de Janeiro, Brazil, from 2014 to 2019. Demographic variables, mention of tuberculosis (TB), and CD4 cell counts closest to death were used to compare those who had HIV/AIDS mentioned on their death certificate (HMDC) to those who did not. Out of 10,698 deaths, 2,863 (26.8%) had no HMDC, from which 412 (14.4%) had external underlying cause. After excluding deaths from external causes, we found that 24% still had no HMDC. Age ≥ 40 years (OR = 1.75; 95%CI: 1.52-2.01), non-white race/ethnicity (OR = 1.16; 95%CI: 1.02-1.31), the male gender (OR = 1.25; 95%CI: 1.11-1.42), higher CD4 cell counts closest to death (OR = 1.14; 95%CI: 1.12-1.16), absence of TB (OR = 4.86; 95%CI: 3.76-6.29) and not dying within a hospital (OR = 2.61; 95%CI: 2.31-2.95) were associated with increased probabilities of not having HMDC. The proportion of deaths with no HMDC increased from 18.7% to 35.1% between 2014 and 2019. The high proportion of underreported deaths in Rio de Janeiro indicates that HIV/AIDS mortality coefficients in the state may be underestimated. With the changing patterns of mortality of PLHIV, physicians are advised to consider the broader clinical spectrum of HIV infection, and surveillance officers should improve death monitoring.
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Affiliation(s)
- Adelzon Assis de Paula
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | - Luciana Garritano Barone
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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27
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Nanditha NGA, Dong X, McLinden T, Sereda P, Kopec J, Hogg RS, Montaner JSG, Lima VD. The impact of lookback windows on the prevalence and incidence of chronic diseases among people living with HIV: an exploration in administrative health data in Canada. BMC Med Res Methodol 2022; 22:1. [PMID: 34991473 PMCID: PMC8734246 DOI: 10.1186/s12874-021-01448-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We described the impact of different lengths of lookback window (LW), a retrospective time period to observe diagnoses in administrative data, on the prevalence and incidence of eight chronic diseases. METHODS Our study populations included people living with HIV (N = 5151) and 1:5 age-sex-matched HIV-negative individuals (N = 25,755) in British Columbia, Canada, with complete follow-up between 1996 and 2012. We measured period prevalence and incidence of diseases in 2012 using LWs ranging from 1 to 16 years. Cases were deemed prevalent if identified in 2012 or within a defined LW, and incident if newly identified in 2012 with no previous cases detected within a defined LW. Chronic disease cases were ascertained using published case-finding algorithms applied to population-based provincial administrative health datasets. RESULTS Overall, using cases identified by the full 16-year LW as the reference, LWs ≥8 years and ≥ 4 years reduced the proportion of misclassified prevalent and incidence cases of most diseases to < 20%, respectively. The impact of LWs varied across diseases and populations. CONCLUSIONS This study underscored the importance of carefully choosing LWs and demonstrated data-driven approaches that may inform these choices. To improve comparability of prevalence and incidence estimates across different settings, we recommend transparent reporting of the rationale and limitations of chosen LWs.
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Affiliation(s)
- Ni Gusti Ayu Nanditha
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Xinzhe Dong
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jacek Kopec
- Arthritis Research Canada, Richmond, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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28
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Kouhpayeh H, Ansari H. HIV infection and increased risk of COVID-19 mortality: A Meta-Analysis. Eur J Transl Myol 2021; 31. [PMID: 34962366 PMCID: PMC8758963 DOI: 10.4081/ejtm.2021.10107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
There are some concerns on the effect of infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) on the outcome and mortality of COVID- 19. In this meta-analysis, we aimed to address this issue and assess the risk of mortality in COVID-19 patients who are co-infected with HIV. Two International electronic databases (PubMed, Scopus) were searched from the first time available to 12 August 2021. The targeted outcome was the pooled odds ratio to examine the effect of HIV infection on COVID-19 mortality. The crude odds ratio (OR) for all studies and the pooled OR were calculated with 95% confidence interval. The forest plot was used to graphically represent the result of conducted meta-analysis and calculated OR for individual studies. The I2 statistic was used to examine the Heterogeneity in the included studies. Eleven studies were included in our study consisting of 19,642,775 COVID-19 infected cases, 59,980 HIV-positive, and 4,373 deaths due to COVID-19 in HIV positive patients. The overall pooled odds ratio was 1.21 (CI: 1.02; 1.43) and P-value < 0.0277. The I^2 value was 89% (P-value < 0.0001), which shows that included studies are heterogeneous. In this study, the funnel plot analysis showed symmetry among the included studies. HIV-positive patients are 21% more likely to die because of COVID-19 infection than people without HIV. Special attention should be considered for the prevention and treatment of COVID-19 and consistent treatment for HIV infection, in HIV-positive patients.
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Affiliation(s)
- Hamidreza Kouhpayeh
- Tropical and Infectious Diseases Department, Zahedan University of Medical Sciences, Zahedan, Iran; Zahedan University of Medical Sciences Research Center, Emam Ali Hospital, Zahedan.
| | - Hossein Ansari
- Health Promotion Research Center, Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan.
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29
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Marino A, Zafarana G, Ceccarelli M, Cosentino F, Moscatt V, Bruno G, Bruno R, Benanti F, Cacopardo B, Celesia BM. Immunological and Clinical Impact of DAA-Mediated HCV Eradication in a Cohort of HIV/HCV Coinfected Patients: Monocentric Italian Experience. Diagnostics (Basel) 2021; 11:2336. [PMID: 34943573 PMCID: PMC8700507 DOI: 10.3390/diagnostics11122336] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022] Open
Abstract
HCV treatment became available for all infected patients regardless of their comorbidities, especially for HIV coinfected subjects, leading to an improvement in both clinical and immunological conditions. We retrospectively analyzed a cohort of HIV/HCV coinfected patients treated with DAA therapies; data regarding epidemiological, viral-immunological, and hepatic parameters before and after DAA administration have been collected. Drug-drug interactions between DAA and both antiretroviral therapy and non-ART-drugs were also evaluated; the study showed the efficacy of DAA schedules in HCV eradication also for HIV/HCV patients with multiple comorbidities and assuming many different drugs. Principal issues are still represented by drug interactions, pill burden, and patients' compliance. These concerns have to be taken into account, especially in HIV patients for whom the immunological state and ART interactions should always be considered.
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Affiliation(s)
- Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Gabriella Zafarana
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
| | - Federica Cosentino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Vittoria Moscatt
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Gabriele Bruno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
| | - Roberto Bruno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
| | - Francesco Benanti
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
| | - Benedetto Maurizio Celesia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.Z.); (M.C.); (F.C.); (V.M.); (G.B.); (R.B.); (F.B.); (B.C.)
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Robinson NM, Gu A, Kaar SG, Corey RM, Bovonratwet P, Sculco PK, Kim C. Rotator cuff repair in HIV-positive patients ages 65 and older: only slight increase in risk of general postoperative surgical complications. Knee Surg Sports Traumatol Arthrosc 2021; 29:3971-3980. [PMID: 34347141 DOI: 10.1007/s00167-021-06685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine postoperative complications associated with rotator cuff repair (RCR) in HIV-positive patients ages 65 and older. METHODS Data were collected from the Medicare Standardized Analytic Files between 2005 and 2015 using the PearlDiver Patient Records Database. Subjects were selected using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Demographics including age, sex, medical comorbidities, and smoking status were collected. Complications were examined at 7-day, 30-day, and 90-day postoperative time points. Data were examined with univariate and multivariate analyses. RESULTS The study included 152,114 patients who underwent RCR, with 24,486 (16.1%) patients who were HIV-positive. Following univariate analysis, patients with HIV were observed to be more likely to develop 7-day, 30-day, and 90-day postoperative complications. However, the absolute risk of each complication was quite low for HIV-positive patients. Univariate and multivariate analysis showed that within 7 days following surgery, patients with HIV were more likely to develop myocardial infarction (OR 2.5, AR 0.1%) and sepsis (OR 2.5, AR 0.04%). Within 30 days, HIV-positive patients were at increased risk for postoperative anemia (OR 2.8, AR 0.1%), blood transfusion (OR 3.3, AR 0.1%), heart failure (OR 2.3, AR 0.8%), and sepsis (OR 2.7, AR 0.1%). Within 90 days, mechanical complications (OR 2.1, AR 0.1%) were increased in the HIV-positive group. CONCLUSION Postoperative complications of RCR occurred at increased rates in the HIV-positive group compared to the HIV-negative group in patients ages 65 and older. In particular, increased risk for myocardial infarction, sepsis, heart failure, anemia, and mechanical complications was noted in HIV-positive patients. However, the actual percentage of patients who experienced each complication was low, indicating RCR is likely safe to perform even in older HIV-positive patients. As more older adults living with HIV present for elective orthopedic procedures, the results of the present study may reassure physicians who are considering RCR as an option for patients in this particular population, while also informing providers about potential complications. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Neil M Robinson
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA
| | - Alex Gu
- George Washington University School of Medicine and Health Sciences, 2300 Eye St NW, Washington, DC, 20037, USA.,Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Scott G Kaar
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA.
| | - Robert M Corey
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA
| | - Patawut Bovonratwet
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Christopher Kim
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA
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Diaz-Martinez J, Tamargo JA, Delgado-Enciso I, Liu Q, Acuña L, Laverde E, Barbieri MA, Trepka MJ, Campa A, Siminski S, Gorbach PM, Baum MK. Resilience, Anxiety, Stress, and Substance Use Patterns During COVID-19 Pandemic in the Miami Adult Studies on HIV (MASH) Cohort. AIDS Behav 2021; 25:3658-3668. [PMID: 34009479 PMCID: PMC8132028 DOI: 10.1007/s10461-021-03292-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 01/11/2023]
Abstract
We evaluated mental health and substance use during the COVID-19 pandemic in 196 participants from the Miami Adult Studies on HIV (MASH) Cohort. A survey was administered between July-August of 2020, including validated measures of resilience and anxiety, a scale to measure COVID-19-related worry, and self-reported substance use. Compared to HIV-uninfected participants (n = 80), those living with HIV (n = 116) reported fewer anxiety symptoms, less COVID-19-related worry, and higher resilience. Those with more anxiety symptoms and lower resilience engaged in more frequent alcohol consumption, binge drinking, and cocaine use. Alcohol misuse was more common among HIV-uninfected participants. Cocaine use was reported by 21% fewer participants during the pandemic compared with 7.3 ± 1.5 months earlier. Possibly due to their experiences with HIV, PLWH responded with higher resilience and reduced worry and anxiety to the adversities brought by the COVID-19 pandemic.
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Affiliation(s)
- Janet Diaz-Martinez
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Javier A Tamargo
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | | | - Qingyun Liu
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Leonardo Acuña
- College of Arts, Sciences & Education, Florida International University, Miami, FL, USA
| | - Eduardo Laverde
- College of Arts, Sciences & Education, Florida International University, Miami, FL, USA
| | - Manuel A Barbieri
- College of Arts, Sciences & Education, Florida International University, Miami, FL, USA
| | - Mary Jo Trepka
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Adriana Campa
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | | | - Pamina M Gorbach
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Marianna K Baum
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
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Stage II and stage III periodontitis clinical burdens of HIV-1 undergoing antiretroviral therapy. Clin Oral Investig 2021; 26:2187-2195. [PMID: 34601633 PMCID: PMC8487450 DOI: 10.1007/s00784-021-04201-2] [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: 05/14/2021] [Accepted: 09/22/2021] [Indexed: 12/01/2022]
Abstract
Objectives The aim of this retrospective cross-sectional study was to estimate the association of HIV-1 infection under highly active antiretroviral treatment (HAART) on the clinical parameters of periodontitis. Materials and methods A total of 205 patients were divided in two groups: 74 HIV + and 131 HIV − . Periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and visible supragingival biofilm (VSB) were recorded. The association of HIV-1 infection with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm in non-adjacent teeth was estimated using binary logistic regression models. Results The variables HIV-1 infection (OR = 5.53, p < 0.0001, 95% CI: 2.45–13.64), age [range 35–50 years old (OR = 5.73, p < 0.0001, 95% CI: 2.49–13.20); > 50 years old (OR = 6.29, p = 0.002, 95% CI: 1.94–20.42)], and VSB (OR = 23.68, p < 0.0001, 95% CI: 8.07–69.53) showed a significant direct association with BOP outcome. Conclusions HIV-1 infection under HAART did not have association with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm. However, HIV patients on HAART had direct association of HIV-1 infection with BOP and an inverse association with PPD. Clinical relevance These results support that monitoring gingival bleeding associated with oral prophylaxis would be beneficial in the prevention and management of periodontitis in HIV-1 patients on HAART.
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33
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Antela A, Rivero A, Llibre JM, Moreno S. Redefining therapeutic success in HIV patients: an expert view. J Antimicrob Chemother 2021; 76:2501-2518. [PMID: 34077524 PMCID: PMC8446931 DOI: 10.1093/jac/dkab168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Thanks to advances in the field over the years, HIV/AIDS has now become a manageable chronic condition. Nevertheless, a new set of HIV-associated complications has emerged, related in part to the accelerated ageing observed in people living with HIV/AIDS, the cumulative toxicities from exposure to antiretroviral drugs over decades and emerging comorbidities. As a result, HIV/AIDS can still have a negative impact on patients' quality of life (QoL). In this scenario, it is reasonable to believe that the concept of therapeutic success, traditionally associated with CD4 cell count restoration and HIV RNA plasma viral load suppression and the absence of drug resistances, needs to be redefined to include other factors that reach beyond antiretroviral efficacy. With this in mind, a group of experts initiated and coordinated the RET Project, and this group, using the available evidence and their clinical experience in the field, has proposed new criteria to redefine treatment success in HIV, arranged into five main concepts: rapid initiation, efficacy, simplicity, safety, and QoL. An extensive review of the literature was performed for each category, and results were discussed by a total of 32 clinicians with experience in HIV/AIDS (4 coordinators + 28 additional experts). This article summarizes the conclusions of these experts and presents the most updated overview on the five topics, along with a discussion of the experts' main concerns, conclusions and/or recommendations on the most controversial issues.
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Affiliation(s)
- Antonio Antela
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Rivero
- Hospital Universitario Reina Sofía, Cordoba, Spain
- Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
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34
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Yang Z, Zhu Z, Lizarondo L, Xing W, Han S, Hu H, Hu Y, Wu B. Experience of chronic noncommunicable disease in people living with HIV: a systematic review and meta-aggregation of qualitative studies. BMC Public Health 2021; 21:1651. [PMID: 34507576 PMCID: PMC8431942 DOI: 10.1186/s12889-021-11698-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/29/2021] [Indexed: 12/17/2022] Open
Abstract
Background An increasing number of people living with HIV (PLWH) have had chronic noncommunicable diseases (NCDs) over the last 5 years. However, robust evidence regarding the perception and challenges of having NCDs among PLWH is limited. Therefore, this study aimed to synthesize qualitative evidence regarding the experiences of PLWH with NCDs. Methods We used a meta-aggregation approach to synthesize qualitative studies. Peer-reviewed and gray literature published in English and Chinese from 1996 to November 2020 was searched using electronic databases. Two reviewers independently appraised the methodological quality and extracted data from the included studies. The Joanna Briggs Institute (JBI) meta-aggregation approach was used to synthesize the findings. Results In total, 10,594 studies were identified in the initial database search. Fourteen eligible studies were included in the meta-synthesis. Among these studies, nine synthesized findings regarding the following topics were identified: fragmented healthcare systems, care continuity, manifestations of multiple conditions, financial hardship, stigma and discrimination, polypharmacy burden and adherence, reciprocal relationships between HIV and NCDs, and coping strategies. Conclusions In recent years, attempts have been made to institutionalize NCD preventive and control services in HIV long-term care. However, considering the growing problem of HIV and NCD comorbidity globally, integrated primary health care systems are needed to address the problems of PLWH with NCDs. Healthcare professionals should help PLWH develop strategies to better monitor their polypharmacy burden and adherence, stigma and discrimination, financial hardship, and manifestations of multiple conditions to achieve high levels of care continuity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11698-5.
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Affiliation(s)
- Zhongfang Yang
- Fudan University School of Nursing, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Zheng Zhu
- Fudan University School of Nursing, Shanghai, China. .,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
| | - Lucylynn Lizarondo
- Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Weijie Xing
- Fudan University School of Nursing, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Shuyu Han
- Fudan University School of Nursing, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Hui Hu
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yan Hu
- Fudan University School of Nursing, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York City, New York, USA
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Time to hypertension development among people living with HIV in South Africa: A longitudinal analysis of the National Income Dynamics Survey (NIDS). Heliyon 2021; 7:e07750. [PMID: 34430739 PMCID: PMC8365442 DOI: 10.1016/j.heliyon.2021.e07750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/07/2021] [Accepted: 08/06/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction There is an increased risk of hypertension among people living with HIV (PLWH). Older age has been associated with a higher risk of chronic conditions. In this study, we assess the time taken before adults living with HIV develop hypertension and explore the factors associated with hypertension diagnosis among PLWH. Methods Retrospective analysis on (n = 95 701) HIV positive adults from the longitudinal survey data from the National Income Dynamics Survey (NIDS) in South Africa was performed. The adults (18–75 years) were followed in order to determine the age of hypertension risk. Kaplan Meier survival estimates were used to show time to diagnosis. Multivariate cox regression model was used to determine the factors associated with hypertension diagnosis. Results 10.5% had HIV and hypertension at the start of the NID survey (wave 1:2008). Of the remaining (n = 85 569), over 75% aged 30–46 were at risk of developing hypertension. Thereafter the risk of hypertension comorbidity begins to decrease after the age of 45. In other words, the risk of hypertension began to reduce once the adults living with HIV turned 45 years old. There was no significant association between the development of hypertension comorbidity and the other demographic, socio-economic and health characteristics assessed. Conclusion Young adults living with HIV are also at risk of hypertension. HIV infected persons need to routinely screen for chronic diseases and started on treatment timeously.
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Tighe RM, Patel SM. HIV, Smoking, and COPD: A Case of T Cells Stuck in the Wrong Place? Am J Respir Cell Mol Biol 2021; 65:464-465. [PMID: 34370962 PMCID: PMC8641845 DOI: 10.1165/rcmb.2021-0295ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Robert M Tighe
- Duke Medicine, 213850, Medicine, Durham, North Carolina, United States;
| | - Sweta M Patel
- Duke Medicine, 213850, Medicine, Durham, North Carolina, United States
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Wang S, Liu Y, Lam J, Gao Z. Chronic Illness, Subjective Wellbeing, and Health Services Availability: A Study of Older Adults in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157718. [PMID: 34360012 PMCID: PMC8345639 DOI: 10.3390/ijerph18157718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/09/2021] [Accepted: 07/17/2021] [Indexed: 11/25/2022]
Abstract
Chronic illness is prevalent in older adults. While current scholarship has examined how various factors may be associated with the onset of chronic illnesses, fewer scholars have examined the role of health services availability. Drawing on a sample of older adults aged 50 and above from wave 16 of the Household, Income, and Labour Dynamics in Australia survey and geo-coded information of general practitioners (GPs) from the Australian Medical Directory, 2016, we investigated whether living in areas with a greater number of GPs is related to reports of living with a chronic illness. Contrary to our hypothesis, we did not find an association between the availability of health services and reports of chronic illnesses, though factors such as better socioeconomic status and better subjective wellbeing are related to lower likelihoods of reporting a chronic illness. We concluded that, while easy access to local health services may be important for the diagnosis and treatment of chronic illnesses, it is less persuasive to attribute the availability of health services to the likelihood of older adults reporting chronic illnesses without knowing how much or how often they use the services.
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Affiliation(s)
- Siqin Wang
- School of Earth and Environmental Sciences, The University of Queensland, St Lucia 4067, Australia; (S.W.); (Y.L.)
| | - Yan Liu
- School of Earth and Environmental Sciences, The University of Queensland, St Lucia 4067, Australia; (S.W.); (Y.L.)
| | - Jack Lam
- Institute for Social Science Research, The University of Queensland, Indooroopilly 4068, Australia;
| | - Zhe Gao
- Hubei Provincial Key Laboratory for Geographical Process Analysis and Simulation, Central China Normal University, Wuhan 430079, China
- Correspondence:
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38
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Okoli C, Schwenk A, Radford M, Myland M, Taylor S, Barnes J, Fox A, Darley A, Grimson F, Reeves I, Munshi S, Croucher A, Boxall N, Paice A, van Wyk J, Benn P. Using Climate-HIV to describe real-world clinical outcomes for people living with HIV taking dolutegravir-based regimens. Int J STD AIDS 2021; 32:1165-1173. [PMID: 34156330 PMCID: PMC8593281 DOI: 10.1177/09564624211027099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives: The objective of this study was to describe the real-world use and effectiveness of dolutegravir-based regimens (DBRs) in routine clinical practice in the United Kingdom. Methods: Retrospective analysis was conducted using data from four National Health Service trusts using Climate-HIV, an electronic case record system. Eligible patients were aged ≥18 years with HIV-1 infection who were prescribed a DBR from December 2012 to March 2018. Outcome measurements were accessed at DBR initiation and at weeks 24, 48 and 96 and the last recorded visit up to the extraction date (last measurement). The primary endpoint was the proportion of patients with HIV-1 RNA <50 copies/mL at Week 48. Results: The study cohort included 934 patients; 337 (36%) were female, 414 (47%) were white and 717 (77%) were treatment experienced (TE). The Kaplan–Meier estimated probability of achieving HIV-1 RNA <50 copies/mL at 48 weeks was 96% for treatment-naive (TN) patients and 86% for TE patients. Median times to viral suppression (<50 copies/mL) were 49 and 57 days for TN and TE patients with detectable baseline viral load, respectively, according to Kaplan–Meier analysis. Median follow-up time was 377 days (interquartile range: 131–683). At last measurement, 87% (809/934) of patients remained on a DBR; among those patients, 681 (84%) had HIV-1 RNA <50 copies/mL. Conclusions: High levels of virologic suppression and low rates of discontinuation of DBRs were seen in a large, diverse, UK-based population with HIV-1 infection. These findings are broadly consistent with efficacy data from phase III studies.
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Affiliation(s)
| | - Achim Schwenk
- North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - Stephen Taylor
- Birmingham Heartlands HIV Service, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Justine Barnes
- Birmingham Heartlands HIV Service, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ashini Fox
- 9820Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alison Darley
- 9820Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Iain Reeves
- 4721Homerton University Hospital NHS Foundation Trust, London, UK
| | - Sajid Munshi
- 4721Homerton University Hospital NHS Foundation Trust, London, UK
| | - Adam Croucher
- 4721Homerton University Hospital NHS Foundation Trust, London, UK
| | - Naomi Boxall
- IQVIA Real World Insights, UK & Ireland, London, UK
| | | | | | - Paul Benn
- 252349ViiV Healthcare, Brentford, UK
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Okere NE, Censi V, Machibya C, Costigan K, Katambi P, Martelli G, de Klerk J, Hermans S, Gomez GB, Pozniak A, de Wit TR, Naniche D. Beyond viral suppression: Quality of life among stable ART clients in a differentiated service delivery intervention in Tanzania. Qual Life Res 2021; 31:159-170. [PMID: 34052956 PMCID: PMC8800900 DOI: 10.1007/s11136-021-02889-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND With antiretroviral therapy, more people living with HIV (PLHIV) in resource-limited settings are virally suppressed and living longer. WHO recommends differentiated service delivery (DSD) as an alternative, less resource-demanding way of expanding HIV services access. Monitoring client's health-related quality of life (HRQoL) is necessary to understand patients' perceptions of treatment and services but is understudied in sub-Saharan Africa. We assessed HRQoL among ART clients in Tanzania accessing two service models. METHODS Cross-sectional survey from May-August 2019 among stable ART clients randomly sampled from clinics and clubs in the Shinyanga region providing DSD and clinic-based care. HRQoL data were collected using a validated HIV-specific instrument-Functional Assessment of HIV infection (FAHI), in addition to socio-demographic, HIV care, and service accessibility data. Descriptive analysis of HRQoL, logistic regression and a stepwise multiple linear regression were performed to examine HRQoL determinants. RESULTS 629 participants were enrolled, of which 40% accessed DSD. Similar HRQoL scores [mean (SD), p-value]; FAHI total [152.2 (22.2) vs 153.8 (20.6), p 0.687] were observed among DSD and clinic-based care participants. Accessibility factors contributed more to emotional wellbeing among DSD participants compared to the clinic-based care participants (53.4% vs 18.5%, p = < 0.001). Satisfactory (> 80% of maximum score) HRQoL scoring was associated with (OR [95% CI], p-value) being male (2.59 [1.36-4.92], p 0.004) among clinic participants and with urban residence (4.72 [1.70-13.1], p 0.001) among DSD participants. CONCLUSIONS Similar HRQoL was observed in DSD and clinic-based care. Our research highlights focus areas to identify supporting interventions, ultimately optimizing HRQoL among PLHIV.
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Affiliation(s)
- Nwanneka Ebelechukwu Okere
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Veronica Censi
- Doctors with Africa (CUAMM), Test & Treat Project Shinyanga, Shinyanga, Tanzania
| | | | - Kathleen Costigan
- Bugisi Health Centre, Catholic Diocese of Shinyanga, Shinyanga, Tanzania
| | - P Katambi
- Ngokolo Health Centre, Catholic Diocese of Shinyanga, Shinyanga, Tanzania
| | - Giulia Martelli
- Doctors with Africa (CUAMM), Test & Treat Project Shinyanga, Shinyanga, Tanzania
| | - Josien de Klerk
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sabine Hermans
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gabriela B Gomez
- Department of Global Health and Development London School of Health and Tropical Medicine United Kingdom, London, UK
| | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Tobias Rinke de Wit
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Denise Naniche
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain
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Tamargo JA, Hernandez-Boyer J, Teeman C, Martin HR, Huang Y, Johnson A, Campa A, Martinez SS, Li T, Rouster SD, Meeds HL, Sherman KE, Baum MK. Immune activation: A link between food insecurity and chronic disease in people living with HIV. J Infect Dis 2021; 224:2043-2052. [PMID: 33993311 DOI: 10.1093/infdis/jiab257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 11/14/2022] Open
Abstract
Persistent immune activation is a hallmark of HIV infection and thought to play a role on chronic diseases in people with HIV (PWH). Food insecurity is disproportionately prevalent in PWH and is associated with adverse health outcomes. We determined whether food insecurity was associated with increased plasma levels of sCD14, sCD27, and sCD163 in 323 antiretroviral -treated PWH from the Miami Adult Studies on HIV (MASH) Cohort. Nearly half (42.7%) of participants were food insecure and 85.5% were virally suppressed (<200 copies/mL). Food insecurity was independently associated with higher levels of sCD14 and sCD27. Very low food security was associated with increased sCD163 levels among those with lower CD4+ cell counts. Food insecurity may promote immune activation in PWH, suggesting a biological link between food insecurity and chronic disease among PWH. Improving financial security and access to high-quality diets could reduce the burden of disease in this highly vulnerable population.
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Affiliation(s)
- Javier A Tamargo
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | | | - Colby Teeman
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Haley R Martin
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Yongjun Huang
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Angelique Johnson
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Adriana Campa
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Sabrina S Martinez
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Susan D Rouster
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heidi L Meeds
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Marianna K Baum
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
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41
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Davis K, Perez-Guzman P, Hoyer A, Brinks R, Gregg E, Althoff KN, Justice AC, Reiss P, Gregson S, Smit M. Association between HIV infection and hypertension: a global systematic review and meta-analysis of cross-sectional studies. BMC Med 2021; 19:105. [PMID: 33980222 PMCID: PMC8117497 DOI: 10.1186/s12916-021-01978-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Improved access to effective antiretroviral therapy has meant that people living with HIV (PLHIV) are surviving to older ages. However, PLHIV may be ageing differently to HIV-negative individuals, with dissimilar burdens of non-communicable diseases, such as hypertension. While some observational studies have reported a higher risk of prevalent hypertension among PLHIV compared to HIV-negative individuals, others have found a reduced burden. To clarify the relationship between HIV and hypertension, we identified observational studies and pooled their results to assess whether there is a difference in hypertension risk by HIV status. METHODS We performed a global systematic review and meta-analysis of published cross-sectional studies that examined hypertension risk by HIV status among adults aged > 15 (PROSPERO: CRD42019151359). We searched MEDLINE, EMBASE, Global Health and Cochrane CENTRAL to August 23, 2020, and checked reference lists of included articles. Our main outcome was the risk ratio for prevalent hypertension in PLHIV compared to HIV-negative individuals. Summary estimates were pooled with a random effects model and meta-regression explored whether any difference was associated with study-level factors. RESULTS Of 21,527 identified studies, 59 were eligible (11,101,581 participants). Crude global hypertension risk was lower among PLHIV than HIV-negative individuals (risk ratio 0.90, 95% CI 0.85-0.96), although heterogeneity between studies was high (I2 = 97%, p < 0.0001). The relationship varied by continent, with risk higher among PLHIV in North America (1.12, 1.02-1.23) and lower among PLHIV in Africa (0.75, 0.68-0.83) and Asia (0.77, 0.63-0.95). Meta-regression revealed strong evidence of a difference in risk ratios when comparing North American and European studies to African ones (North America 1.45, 1.21-1.74; Europe 1.20, 1.03-1.40). CONCLUSIONS Our findings suggest that the relationship between HIV status and prevalent hypertension differs by region. The results highlight the need to tailor hypertension prevention and care to local contexts and underscore the importance of rapidly optimising integration of services for HIV and hypertension in the worst affected regions. The role of different risk factors for hypertension in driving context-specific trends remains unclear, so development of further cohorts of PLHIV and HIV-negative controls focused on this would also be valuable.
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Affiliation(s)
- Katherine Davis
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK.
| | - Pablo Perez-Guzman
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK
| | - Annika Hoyer
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ralph Brinks
- Hiller Research Unit of Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Edward Gregg
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Amy C Justice
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Peter Reiss
- Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.,HIV Monitoring Foundation, Amsterdam, Netherlands
| | - Simon Gregson
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mikaela Smit
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK
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42
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Taylor HE, Calantone N, Lichon D, Hudson H, Clerc I, Campbell EM, D'Aquila RT. mTOR Overcomes Multiple Metabolic Restrictions to Enable HIV-1 Reverse Transcription and Intracellular Transport. Cell Rep 2021; 31:107810. [PMID: 32579936 DOI: 10.1016/j.celrep.2020.107810] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/28/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
Cellular metabolism governs the susceptibility of CD4 T cells to HIV-1 infection. Multiple early post-fusion steps of HIV-1 replication are restricted in resting peripheral blood CD4 T cells; however, molecular mechanisms that underlie metabolic control of these steps remain undefined. Here, we show that mTOR activity following T cell stimulatory signals overcomes metabolic restrictions in these cells by enabling the expansion of dNTPs to fuel HIV-1 reverse transcription (RT), as well as increasing acetyl-CoA to stabilize microtubules that transport RT products. We find that catalytic mTOR inhibition diminishes the expansion of pools of both of these metabolites by limiting glucose and glutamine utilization in several pathways, thereby suppressing HIV-1 infection. We demonstrate how mTOR-coordinated biosyntheses enable the early steps of HIV-1 replication, add metabolic mechanisms by which mTOR inhibitors block HIV-1, and identify some metabolic modules downstream of mTOR as druggable targets for HIV-1 inhibition.
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Affiliation(s)
- Harry E Taylor
- Department of Microbiology and Immunology, State University of New York (SUNY) Upstate Medical University, Syracuse, NY 13210, USA.
| | - Nina Calantone
- Division of Infectious Diseases and HIV Translational Research Center, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Drew Lichon
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Hannah Hudson
- Division of Infectious Diseases and HIV Translational Research Center, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Isabelle Clerc
- Division of Infectious Diseases and HIV Translational Research Center, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Edward M Campbell
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Richard T D'Aquila
- Division of Infectious Diseases and HIV Translational Research Center, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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43
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Cavalcante MG, Parente MDSR, Gomes PEADC, Meneses GC, Silva Júnior GBD, Pires Neto RDJ, Daher EDF. Death-related factors in HIV/AIDS patients undergoing hemodialysis in an intensive care unit. Rev Inst Med Trop Sao Paulo 2021; 63:e33. [PMID: 33909847 PMCID: PMC8075620 DOI: 10.1590/s1678-9946202163033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/19/2021] [Indexed: 12/25/2022] Open
Abstract
HIV-infected patients are at high risk for developing critical diseases,
including opportunistic infections (OI), with consequent admission in intensive
care units (ICU). Renal disfunctions are risk factors for death in HIV/AIDS
patients, and survival rates in patients undergoing hemodialysis are smaller
than the ones observed in the general population. In this context, this study
aimed to investigate death-related factors in HIV/AIDS patients in an intensive
care setting. This is a retrospective cross-sectional study performed through
the analysis of medical records from 271 HIV/AIDS-diagnosed patients
hospitalized in an intensive care unit of an infectious disease hospital, in
Fortaleza, Ceara State, Brazil. Patients were divided into two groups: those who
underwent dialysis during hospitalization and those who did not. Clinical and
demographic parameters that could be associated with death were evaluated.
Results indicated a prevalence of death of 19.1% (CI 95%: 14.8-24.3). The median
age of patients was 47 years, with a male predominance (71.3%). The main causes
of admission were pulmonary tuberculosis (16.9%), followed by neurotoxoplasmosis
(14.9%). In the bivariate analysis, for those that did not undergo dialysis,
age, fever, dyspnea, oliguria, disorientation, kidney injury, use of lamivudine
and efavirenz, length of hospitalization, CD4 count, WBC count, platelet count,
urea, sodium and LDH levels were the associated variables. In those who needed
dialysis, the use of stavudine, abacavir and ritonavir, and the length of
hospitalization were associated factors. Renal toxicity by the antiretroviral
agents and length of hospitalization increased the risk of death among HIV
patients under dialysis.
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Affiliation(s)
| | | | | | | | - Geraldo Bezerra da Silva Júnior
- Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, Ceará, Brazil.,Universidade de Fortaleza, Curso de Medicina, Fortaleza, Ceará, Brazil
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44
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Rees-Spear C, McCoy LE. Vaccine responses in ageing and chronic viral infection. OXFORD OPEN IMMUNOLOGY 2021; 2:iqab007. [PMID: 36845567 PMCID: PMC9914503 DOI: 10.1093/oxfimm/iqab007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Over the last few decades, changing population demographics have shown that there are a growing number of individuals living past the age of 60. With this expanding older population comes an increase in individuals that are more susceptible to chronic illness and disease. An important part of maintaining health in this population is through prophylactic vaccination, however, there is growing evidence that vaccines may be less effective in the elderly. Furthermore, with the success of anti-viral therapies, chronic infections such as HIV are becoming increasingly prevalent in older populations and present a relatively unstudied population with respect to the efficacy of vaccination. Here we will examine the evidence for age-associated reduction in antibody and cellular responsiveness to a variety of common vaccines and investigate the underlying causes attributed to this phenomenon, such as inflammation and senescence. We will also discuss the impact of chronic viral infections on immune responses in both young and elderly patients, particularly those living with HIV, and how this affects vaccinations in these populations.
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Affiliation(s)
- Chloe Rees-Spear
- Division of Infection and Immunity, University College London, London, UK
| | - Laura E McCoy
- Division of Infection and Immunity, University College London, London, UK,Correspondence address. Division of Infection and Immunity, University College London, London, UK. E-mail:
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45
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Nath A, Johnson TP. Mechanisms of viral persistence in the brain and therapeutic approaches. FEBS J 2021; 289:2145-2161. [PMID: 33844441 DOI: 10.1111/febs.15871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022]
Abstract
There is growing recognition of the diversity of viruses that can infect the cells of the central nervous system (CNS). While the majority of CNS infections are successfully cleared by the immune response, some viral infections persist in the CNS. As opposed to resolved infections, persistent viruses can contribute to ongoing tissue damage and neuroinflammatory processes. In this manuscript, we provide an overview of the current understanding of factors that lead to viral persistence in the CNS including how viruses enter the brain, how these pathogens evade antiviral immune system responses, and how viruses survive and transmit within the CNS. Further, as the CNS may serve as a unique viral reservoir, we examine the ways in which persistent viruses in the CNS are being targeted therapeutically.
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Affiliation(s)
- Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Tory P Johnson
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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46
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Turner CT, Brown J, Shaw E, Uddin I, Tsaliki E, Roe JK, Pollara G, Sun Y, Heather JM, Lipman M, Chain B, Noursadeghi M. Persistent T Cell Repertoire Perturbation and T Cell Activation in HIV After Long Term Treatment. Front Immunol 2021; 12:634489. [PMID: 33732256 PMCID: PMC7959740 DOI: 10.3389/fimmu.2021.634489] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
Objective In people living with HIV (PLHIV), we sought to test the hypothesis that long term anti-retroviral therapy restores the normal T cell repertoire, and investigate the functional relationship of residual repertoire abnormalities to persistent immune system dysregulation. Methods We conducted a case-control study in PLHIV and HIV-negative volunteers, of circulating T cell receptor repertoires and whole blood transcriptomes by RNA sequencing, complemented by metadata from routinely collected health care records. Results T cell receptor sequencing revealed persistent abnormalities in the clonal T cell repertoire of PLHIV, characterized by reduced repertoire diversity and oligoclonal T cell expansion correlated with elevated CD8 T cell counts. We found no evidence that these expansions were driven by cytomegalovirus or another common antigen. Increased frequency of long CDR3 sequences and reduced frequency of public sequences among the expanded clones implicated abnormal thymic selection as a contributing factor. These abnormalities in the repertoire correlated with systems level evidence of persistent T cell activation in genome-wide blood transcriptomes. Conclusions The diversity of T cell receptor repertoires in PLHIV on long term anti-retroviral therapy remains significantly depleted, and skewed by idiosyncratic clones, partly attributable to altered thymic output and associated with T cell mediated chronic immune activation. Further investigation of thymic function and the antigenic drivers of T cell clonal selection in PLHIV are critical to efforts to fully re-establish normal immune function.
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Affiliation(s)
- Carolin T. Turner
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - James Brown
- Departments of HIV and Respiratory Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Emily Shaw
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Imran Uddin
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Evdokia Tsaliki
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Jennifer K. Roe
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Gabriele Pollara
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Yuxin Sun
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - James M. Heather
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Marc Lipman
- Departments of HIV and Respiratory Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Benny Chain
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
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47
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New-Aaron M, Ganesan M, Dagur RS, Kharbanda KK, Poluektova LY, Osna NA. Pancreatogenic Diabetes: Triggering Effects of Alcohol and HIV. BIOLOGY 2021; 10:108. [PMID: 33546230 PMCID: PMC7913335 DOI: 10.3390/biology10020108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
Multiorgan failure may not be completely resolved among people living with HIV despite HAART use. Although the chances of organ dysfunction may be relatively low, alcohol may potentiate HIV-induced toxic effects in the organs of alcohol-abusing, HIV-infected individuals. The pancreas is one of the most implicated organs, which is manifested as diabetes mellitus or pancreatic cancer. Both alcohol and HIV may trigger pancreatitis, but the combined effects have not been explored. The aim of this review is to explore the literature for understanding the mechanisms of HIV and alcohol-induced pancreatotoxicity. We found that while premature alcohol-inducing zymogen activation is a known trigger of alcoholic pancreatitis, HIV entry through C-C chemokine receptor type 5(CCR5)into pancreatic acinar cells may also contribute to pancreatitis in people living with HIV (PLWH). HIV proteins induce oxidative and ER stresses, causing necrosis. Furthermore, infiltrative immune cells induce necrosis on HIV-containing acinar cells. When necrotic products interact with pancreatic stellate cells, they become activated, leading to the release of both inflammatory and profibrotic cytokines and resulting in pancreatitis. Effective therapeutic strategies should block CCR5 and ameliorate alcohol's effects on acinar cells.
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Affiliation(s)
- Moses New-Aaron
- Department of Environmental Health, Occupational Health and Toxicology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
| | - Murali Ganesan
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Raghubendra Singh Dagur
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kusum K. Kharbanda
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Larisa Y. Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Natalia A. Osna
- Department of Environmental Health, Occupational Health and Toxicology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA;
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48
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Laher AE, Venter WDF, Richards GA, Paruk F. Profile of presentation of HIV-positive patients to an emergency department in Johannesburg, South Africa. South Afr J HIV Med 2021; 22:1177. [PMID: 33604064 PMCID: PMC7876985 DOI: 10.4102/sajhivmed.v22i1.1177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/15/2020] [Indexed: 12/17/2022] Open
Abstract
Background Despite improved availability and better access to antiretroviral therapy (ART), approximately 36% of human immunodeficiency virus (HIV)-positive South Africans are still not virally suppressed. Objective The aim of this study was to describe the patterns of presentation of HIV-positive patients to a major central hospital emergency department (ED). Methods In this prospectively designed study, consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) adult ED were enrolled between 07 July 2017 and 18 October 2018. Results A total of 1224 participants were enrolled. Human immunodeficiency virus was newly diagnosed in 212 (17.3%) patients, 761 (75.2%) were on ART, 245 (32.2%) reported ART non-adherence, 276 (22.5%) had bacterial pneumonia, 244 (19.9%) had tuberculosis (TB), 86 (7.0%) had gastroenteritis, 205 (16.7%) required intensive care unit admission, 381 (31.1%) were admitted for ≥ 7 days and 166 (13.6%) died. With regard to laboratory parameters, CD4 cell count was < 100 cell/mm3 in 527 (47.6%) patients, the viral load (VL) was > 1000 copies/mL in 619 (59.0%), haemoglobin was < 11 g/dL in 636 (56.3%), creatinine was > 120 µmol/L in 294 (29.3%), lactate was > 2 mmol/L in 470 (42.0%) and albumin was < 35 g/L in 633 (60.8%). Conclusion Human immunodeficiency virus-positive patients presenting to the CMJAH ED demonstrated a high prevalence of opportunistic infections, required a prolonged hospital stay and had high mortality rates. There is a need to improve the quality of ART services and accessibility to care.
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Affiliation(s)
- Abdullah E Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fathima Paruk
- Department of Critical Care, University of Pretoria, Pretoria, South Africa
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49
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Tamargo JA, Sherman KE, Campa A, Martinez SS, Li T, Hernandez J, Teeman C, Mandler RN, Chen J, Ehman RL, Baum MK. Food insecurity is associated with magnetic resonance-determined nonalcoholic fatty liver and liver fibrosis in low-income, middle-aged adults with and without HIV. Am J Clin Nutr 2021; 113:593-601. [PMID: 33515016 PMCID: PMC7948863 DOI: 10.1093/ajcn/nqaa362] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the United States. Food-insecure individuals often depend on low-cost, energy-dense but nutritionally poor foods, resulting in obesity and chronic diseases related to NAFLD. OBJECTIVES To determine whether food insecurity is associated with NAFLD in a cohort of HIV and hepatitis C virus (HCV) infected and uninfected adults. METHODS We conducted a cross-sectional analysis of low-income, middle-aged adults from the Miami Adult Studies on HIV (MASH) cohort without a history of excessive alcohol consumption. Food security was assessed with the USDA's Household Food Security Survey. MRIs were used to assess liver steatosis and fibrosis. Metabolic parameters were assessed from fasting blood, anthropometrics, and vitals. RESULTS Of the total 603 participants, 32.0% reported food insecurity. The prevalences of NAFLD, fibrosis, and advanced fibrosis were 16.1%, 15.1%, and 4.6%, respectively. For every 5 kg/m2 increase in BMI, the odds of NAFLD increased by a factor of 3.83 (95% CI, 2.37-6.19) in food-insecure participants compared to 1.32 (95% CI, 1.04-1.67) in food-secure participants. Food insecurity was associated with increased odds for any liver fibrosis (OR, 1.65; 95% CI, 1.01-2.72) and advanced liver fibrosis (OR, 2.82; 95% CI, 1.22-6.54), adjusted for confounders. HIV and HCV infections were associated with increased risks for fibrosis, but the relationship between food insecurity and liver fibrosis did not differ between infected and uninfected participants. CONCLUSIONS Among low-income, middle-aged adults, food insecurity exacerbated the risk for NAFLD associated with a higher BMI and independently increased the risk for advanced liver fibrosis. People who experience food insecurity, particularly those vulnerable to chronic diseases and viral infections, may be at increased risk for liver-related morbidity and mortality. Improving access to adequate nutrition and preventing obesity among low-income groups may lessen the growing burden of NAFLD and other chronic diseases.
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Affiliation(s)
| | | | | | | | - Tan Li
- Florida International University, Miami, FL, USA
| | | | - Colby Teeman
- Florida International University, Miami, FL, USA
| | | | - Jun Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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50
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McArthur JC, Johnson TP. Chronic inflammation mediates brain injury in HIV infection: relevance for cure strategies. Curr Opin Neurol 2021; 33:397-404. [PMID: 32209807 DOI: 10.1097/wco.0000000000000807] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Chronic inflammation is a major component of HIV infection, the effects of which can be devastating in the central nervous system (CNS). Protecting the brain is, therefore, critical as efforts proceed to cure HIV infection by reactivating latent viral reservoirs and driving immune responses. We review the clinical presentation and pathology findings of inflammatory processes in the CNS in patients managed with ART and the drivers of these processes. RECENT FINDINGS Chronic inflammation is associated with increased mortality and morbidity and HIV infection increases the risk for chronic diseases, especially cognitive impairment. Latent viral reservoirs, including microglia and tissue macrophages, contribute to inflammation in the CNS. Inflammation is generated and maintained through residual viral replication, dysregulation of infected cells, continuously produced viral proteins and positive feedback loops of chronic inflammation. Novel therapeutics and lifestyle changes may help to protect the CNS from immune-mediated damage. SUMMARY As therapies are developed to cure HIV, it is important to protect the CNS from additional immune-mediated damage. Adjunctive therapies to restore glial function, reduce neuroinflammation and systemic inflammation, and inhibit expression of viral proteins are needed.
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Affiliation(s)
- Justin C McArthur
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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