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Muccini C, Bottanelli M, Castagna A, Spagnuolo V. Cardiometabolic complications in children and adolescents with HIV on antiretroviral therapy. Expert Opin Drug Metab Toxicol 2024:1-13. [PMID: 39210779 DOI: 10.1080/17425255.2024.2395562] [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: 02/07/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The course of HIV infection has changed radically with the introduction of antiretroviral therapy (ART), which has significantly reduced mortality and improved quality of life. However, antiretroviral drugs can cause adverse effects, including cardiometabolic complications and diseases, which are among the most common. Compared to the adult population, there are fewer studies in the pediatric population on treatment-related complications. The purpose of this review is to provide an update on the literature regarding cardiometabolic complications and diseases in children and adolescents with HIV. AREAS COVERED A comprehensive literature review was conducted using PubMed and related bibliographies to provide an overview of the current knowledge of metabolic complications (dyslipidemia, insulin resistance, lipodystrophy, weight gain and liver complications) and diseases (prediabetes/diabetes and cardiovascular diseases) associated with ART in children and adolescents with HIV. EXPERT OPINION Metabolic complications are conditions that need to be closely monitored in children and adolescents with HIV, as they increase the risk of early development of non-communicable diseases, such as cardiovascular disease. Key areas for improvement include ensuring access to treatment, reducing side effects and improving diagnostic capabilities. Overcoming existing challenges will require collaborative efforts across disciplines, advances in technology, and targeted interventions to address socioeconomic disparities.
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Affiliation(s)
- Camilla Muccini
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Antonella Castagna
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Vincenzo Spagnuolo
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Reimer Jensen AM, Frikke-Schmidt R, Gelpi M, Knudsen AD, Benfield T, Nordestgaard BG, Afzal S, Biering-Sørensen T, Nielsen SD. Elevated plasma apolipoprotein E levels in people living with HIV: Associations with biomarkers and HIV-specific risk factors. Atherosclerosis 2024; 390:117457. [PMID: 38301603 DOI: 10.1016/j.atherosclerosis.2024.117457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND AIMS Apolipoprotein E (apoE) plays a crucial role in cholesterol metabolism, and high levels of apoE in plasma are associated with cardiovascular disease and all-cause mortality. We aimed to assess if HIV is independently associated with high plasma apoE and to determine HIV-related risk factors for high plasma apoE. METHODS We included 661 people with HIV (PWH) from the Copenhagen Comorbidity in HIV (COCOMO) study with available measurement of plasma apoE. COCOMO participants were frequency matched 1:1 on age and sex with controls from the Copenhagen General Population Study. High plasma apoE was defined as levels above the 90th percentile (66.2 mg/L). The association between HIV and high plasma apoE was assessed using logistic regression models. Among PWH, both linear and logistic regression models were used to determine HIV-specific risk factors for high plasma apoE. RESULTS Mean age was 52 years and 89 % were male. Median plasma apoE was 49.0 mg/L in PWH and 43.3 mg/L in controls, p < 0.001. HIV was associated with higher plasma apoE after adjusting for potential confounders, including triglycerides (odds ratio 2.14 [95 % CI: 1.39-3.29], p < 0.001). In PWH, higher plasma apoE was associated with a previous AIDS-defining condition in linear models before adjustment for triglycerides and integrase strand transfer inhibitor use in fully adjusted linear models. CONCLUSIONS PWH had higher plasma apoE than controls even after adjusting for triglycerides. Further studies are needed to elucidate the clinical impact of high plasma apoE in PWH.
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Affiliation(s)
- Anne Marie Reimer Jensen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Marco Gelpi
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas D Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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Dirajlal-Fargo S, McComsey GA. Cardiometabolic Complications in Youth With Perinatally Acquired HIV in the Era of Antiretroviral Therapy. Curr HIV/AIDS Rep 2021; 18:424-435. [PMID: 34652624 DOI: 10.1007/s11904-021-00574-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Antiretroviral therapy (ART) scale-up has dramatically reduced rates of pediatric HIV mortality and morbidity. Children living with perinatally acquired HIV (PHIV) are now expected to live through adolescence and well into adulthood, such that adolescents now represent the largest growing population living with HIV. This review aims to discuss the prevalence and mechanisms for cardiometabolic comorbidities in the setting of newer ART regimens and the research gaps that remain. RECENT FINDINGS Data highlight the continued risks of subclinical cardiometabolic complications in PHIV in the setting of newer ART. Novel techniques in imaging and omics may help identify early cardiometabolic abnormalities in this young population and potentially identify early changes in the mechanistic pathways related to these changes. Further studies to determine risk and management strategies of the cardiometabolic effects in PHIV adolescents, beyond ART, are warranted. Focus should be on prevention of these complications in youth to avoid new epidemic of diabetes and cardiovascular disease when these youths become aging adults.
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Affiliation(s)
- Sahera Dirajlal-Fargo
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA. .,University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA. .,Case Western Reserve University, Cleveland, OH, USA. .,University Hospitals Cleveland Medical Center, Case School of Medicine, Cleveland, OH, 44106, USA.
| | - Grace A McComsey
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.,Case Western Reserve University, Cleveland, OH, USA
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Dirajlal-Fargo S, Sattar A, Yu J, Albar Z, Chaves FC, Riedl K, Kityo C, Bowman E, McComsey GA, Funderburg N. Lipidome association with vascular disease and inflammation in HIV+ Ugandan children. AIDS 2021; 35:1615-1623. [PMID: 33878042 PMCID: PMC8286331 DOI: 10.1097/qad.0000000000002923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE HIV infection and antiretroviral therapy (ART) have both been linked to dyslipidemia and increased cardiovascular disease (CVD). The relationships among the lipidome, immune activation, and subclinical vascular disease in children with perinatally acquired HIV (PHIV) have not been investigated. METHODS Serum lipid composition, including 13 lipid classes constituting 850 different lipid species were measured by direct infusion-tandem mass spectrometry in samples from 20 ART-treated PHIV and 20 age-matched and sex-matched HIV- Ugandan children. All participants were between 10 and 18 years of age with no other known active infections. PHIVs had HIV-1 RNA level 50 copies/ml or less. In addition, common carotid artery intima--media thickness (IMT), as well as plasma marker of systemic inflammation (hsCRP, IL6, sTNFRa I), monocyte activation (soluble CD14 and CD163), and T-cell activation (expression of CD38 and HLA-DR on CD4+ and CD8+) were evaluated. RESULTS Median age (Q1, Q3) of study participants was 13 years (11, 15), 37% were boys, 75% were on an NNRTI-based ART regimen. The concentrations of cholesterol ester, LCER, phosphatidylcholines, and sphingomyelin lipid classes were significantly increased in serum of PHIV compared with HIV (P≤0.04). Biomarkers associated with CVD risk including hsCRP, sCD163, and T-cell activation were directly correlated with lipid species in PHIV (P ≤ 0.04). Contents of free fatty acids including palmitic (16 : 0), stearic (18 : 0), and arachidic acid (20 : 0) were positively correlated with IMT in PHIV. CONCLUSION Serum lipidome is altered in young virally suppressed PHIV on ART. A direct association between inflammation and lipid species known to be associated with CVD was observed.
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Affiliation(s)
- Sahera Dirajlal-Fargo
- University Hospitals Cleveland Medical Center
- Rainbow Babies and Children's Hospital
- Case Western Reserve University, Cleveland
| | | | - Jiao Yu
- Case Western Reserve University, Cleveland
| | | | - Fabio C Chaves
- Department of Food Science and Technology, and the OSU Comprehensive Cancer Center, The Ohio State University, OH, USA
| | - Ken Riedl
- Department of Food Science and Technology, and the OSU Comprehensive Cancer Center, The Ohio State University, OH, USA
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Emily Bowman
- Ohio State University School of Health and Rehabilitation Sciences, Columbus, OH, USA
| | - Grace A McComsey
- University Hospitals Cleveland Medical Center
- Rainbow Babies and Children's Hospital
- Case Western Reserve University, Cleveland
| | - Nicholas Funderburg
- Ohio State University School of Health and Rehabilitation Sciences, Columbus, OH, USA
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Hudson P, Woudberg NJ, Kamau F, Strijdom H, Frias MA, Lecour S. HIV-related cardiovascular disease: any role for high-density lipoproteins? Am J Physiol Heart Circ Physiol 2020; 319:H1221-H1226. [PMID: 33006917 DOI: 10.1152/ajpheart.00445.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The introduction of antiretroviral therapy (ART) has improved the life expectancy of patients infected with human immunodeficiency virus (HIV). However, this population is at an increased risk for noncommunicable diseases, including atherosclerotic cardiovascular disease (CVD). Both ART and viral infection may be potential contributors to the pathophysiology of HIV-related CVD. The mechanisms behind this remain unclear, but it is critical to delineate early biomarkers of cardiovascular risk in the HIV population. In this review, we postulate that potential biomarkers could include alterations to high-density lipoprotein (HDL). Indeed, recent data suggest that HIV and ART may induce structural changes of HDL, thus resulting in shifts in HDL subclass distribution and HDL functionality.
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Affiliation(s)
- Peter Hudson
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Nicholas J Woudberg
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Festus Kamau
- Faculty of Medicine and Health Sciences, Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Stellenbosch University, Stellenbosch, South Africa
| | - Hans Strijdom
- Faculty of Medicine and Health Sciences, Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Stellenbosch University, Stellenbosch, South Africa
| | - Miguel A Frias
- Department of Diagnostics, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sandrine Lecour
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
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Bowman E, Funderburg NT. Lipidome Abnormalities and Cardiovascular Disease Risk in HIV Infection. Curr HIV/AIDS Rep 2020; 16:214-223. [PMID: 30993515 DOI: 10.1007/s11904-019-00442-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Human immunodeficiency virus (HIV) infection and its treatment with antiretroviral therapy (ART) are associated with lipid abnormalities that may enhance cardiovascular disease risk (CVD). RECENT FINDINGS Chronic inflammation persists in HIV+ individuals, and complex relationships exist among lipids and inflammation, as immune activation may be both a cause and a consequence of lipid abnormalities in HIV infection. Advances in mass spectrometry-based techniques now allow for detailed measurements of individual lipid species; improved lipid measurement might better evaluate CVD risk compared with the prognostic value of traditional assessments. Lipidomic analyses have begun to characterize dynamic changes in lipid composition during HIV infection and following treatment with ART, and further investigation may identify novel lipid biomarkers predictive of adverse outcomes. Developing strategies to improve management of comorbidities in the HIV+ population is important, and statin therapy and lifestyle modifications, including diet and exercise, may help to improve lipid levels and mitigate CVD risk.
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Affiliation(s)
- Emily Bowman
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University College of Medicine, 453 W. 10th Ave. 535A Atwell Hall, Columbus, OH, 43210, USA
| | - Nicholas T Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University College of Medicine, 453 W. 10th Ave. 535A Atwell Hall, Columbus, OH, 43210, USA.
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Quiros-Roldan E, Castelli F, Bonito A, Vezzoli M, Calza S, Biasiotto G, Zanella I. The impact of integrase inhibitor-based regimens on markers of inflammation among HIV naïve patients. Cytokine 2019; 126:154884. [PMID: 31670006 DOI: 10.1016/j.cyto.2019.154884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 12/15/2022]
Abstract
The use of combination anti-retroviral therapy (cART) correlates with longer and healthier life and with nearly normal life expectancy in people living with HIV. However, cART does not completely restore health. Chronic immune activation and inflammation persist in treated patients and have been described as predictors for clinical events and mortality in HIV-infected patients. Limited information is available on the impact of the various cART regimens on inflammation/immunoactivation. The aim of this work was to explore the impact of elvitegravir, dolutegravir, raltegravir (integrase strand transfer inhibitors, INSTIs) and atazanavir (protease inhibitor, PI) on several soluble markers of immune activation and inflammation during the first year of effective combination anti-retroviral therapy (cART). We conducted an observational retrospective cohort study in HIV-infected cART-naïve patients who initiated an INSTI or atazanavir regimen between March 2015 and February 2016 and a serum sample was available at baseline, 6 and 12 months after initiation. We compared the trend of D-Dimer, TNF- α, IL-2, IL-6, IL-7, IL-10, CCL4/MIP1-β, CCL5/RANTES, s-CD14, s-CD163, hs-CRP levels among the 4 arms of treatment. Percentage of variation from baseline was also measured for all markers. A total of 36 patients were included. We observed heterogeneous modifications in inflammation markers among arms. In particular, we noted that EVG have significant negative effect on s-CD14, hs-CRP, IL-6 and D-Dimer in respect to other INSTIs and this different effect occurs mainly during the first 6 months of cART. IL-7 values increased in the three arms with INSTIs (significantly only in EGV, 159.8%, p = 0.0003) and decreased significantly in patients on PI (-48.96%; p = 0.04) over the period. In conclusion, our results provide further data on changes of inflammatory marker levels, especially for the new INSTIs. Our data show that among INSTIs, EVG seems to have a worse impact on inflammation.
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Affiliation(s)
- Eugenia Quiros-Roldan
- University Department of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili di Brescia, Italy.
| | - Andrea Bonito
- University Department of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - Marika Vezzoli
- Department of Molecular and Translational Medicine, University of Brescia, Italy.
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Italy.
| | - Giorgio Biasiotto
- Department of Molecular and Translational Medicine, University of Brescia, Italy.
| | - Isabella Zanella
- Department of Molecular and Translational Medicine, University of Brescia, Italy; Clinical Chemistry Laboratory, Diagnostic Department, ASST Spedali Civili di Brescia, Italy.
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Waters DD, Hsue PY. Lipid Abnormalities in Persons Living With HIV Infection. Can J Cardiol 2018; 35:249-259. [PMID: 30704819 DOI: 10.1016/j.cjca.2018.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/16/2023] Open
Abstract
Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug-drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.
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Affiliation(s)
- David D Waters
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA
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Rodríguez-Gallego E, Gómez J, Domingo P, Ferrando-Martínez S, Peraire J, Viladés C, Veloso S, López-Dupla M, Beltrán-Debón R, Alba V, Vargas M, Castellano AJ, Leal M, Pacheco YM, Ruiz-Mateos E, Gutiérrez F, Vidal F, Rull A. Circulating metabolomic profile can predict dyslipidemia in HIV patients undergoing antiretroviral therapy. Atherosclerosis 2018; 273:28-36. [PMID: 29677628 DOI: 10.1016/j.atherosclerosis.2018.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/28/2018] [Accepted: 04/06/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Dyslipidemia in HIV-infected patients is unique and pathophysiologically associated with host factors, HIV itself and the use of antiretroviral therapy (ART). The use of nuclear magnetic resonance spectroscopy (NMR) provides additional data to conventional lipid measurements concerning the number of lipoprotein subclasses and particle sizes. METHODS To investigate the ability of lipoprotein profile, we used a circulating metabolomic approach in a cohort of 103 ART-naive HIV-infected patients, who were initiating non-nucleoside analogue transcriptase inhibitor (NNRTI)-based ART, and we subsequently followed up these patients for 36 months. Univariate and multivariate analyses were performed to evaluate the predictive power of NMR spectroscopy. RESULTS VLDL-metabolism (including VLDL lipid concentrations, sizes, and particle numbers), total triglycerides and lactate levels resulted in good classifiers of dyslipidemia (AUC 0.903). Total particles/HDL-P ratio was significantly higher in ART-associated dyslipidemia compared to ART-normolipidemia (p = 0.001). Large VLDL-Ps were positively associated with both LDL-triglycerides (ρ 0.682, p < 0.001) and lactate concentrations (ρ 0.416, p < 0.001), the last one a marker of mitochondrial low oxidative capacity. CONCLUSIONS Our data suggest that circulating metabolites have better predictive values for HIV/ART-related dyslipidemia onset than do the biochemical markers associated with conventional lipid measurements. NMR identifies changes in VLDL-P, lactate and LDL-TG as potential clinical markers of baseline HIV-dyslipidemia predisposition. Differences in circulating metabolomics, especially differences in particle size, are indicators of important derangements of mitochondrial function that are linked to ART-related dyslipidemia.
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Affiliation(s)
| | - Josep Gómez
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain; Metabolomics Platform, Department of Electronic Engineering, Universitat Rovira i Virgili, IISPV, Tarragona, Spain
| | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Joaquim Peraire
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Consuelo Viladés
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Sergi Veloso
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Miguel López-Dupla
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Raúl Beltrán-Debón
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Verónica Alba
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Montserrat Vargas
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Alfonso J Castellano
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Manuel Leal
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Yolanda María Pacheco
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Ezequiel Ruiz-Mateos
- Laboratory of Immunovirology, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Hospital General de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Francesc Vidal
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain.
| | - Anna Rull
- Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain.
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10
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Zanetti HR, Roever L, Gonçalves A, Resende ES. Human Immunodeficiency Virus Infection, Antiretroviral Therapy, and Statin: a Clinical Update. Curr Atheroscler Rep 2018; 20:9. [PMID: 29423787 DOI: 10.1007/s11883-018-0708-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This clinical update is intended to focus in relationship between HIV infection and use of antiretroviral therapy (ART) and statin. RECENT FINDINGS Though ART significantly changed the course of HIV infection, it is related to numerous side effects principally to the lipid profile. In this way, statins became one of the most used lipid-lowering therapies in this population. In our clinical update, we evaluated studies that demonstrate the relationship and molecular mechanisms that HIV infection and ART use trigger dyslipidemia and also the use of statin to reduce this condition. We have demonstrated that use of statin can be used in dyslipidemic HIV-infected people as long as there is no drug interaction with ART. Recently, studies using rosuvastatin have shown greater effects when compared to the other statins.
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Affiliation(s)
- Hugo Ribeiro Zanetti
- Master Institute of Education President Antônio Carlos, Avenida Minas Gerais, 1889 - Centro, Araguari, MG, 38.440-046, Brazil. .,Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil.
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Alexandre Gonçalves
- Master Institute of Education President Antônio Carlos, Avenida Minas Gerais, 1889 - Centro, Araguari, MG, 38.440-046, Brazil.,Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil.,Paulista University, Brasília, DF, Brazil.,Atenas College, Paracatu, MG, Brazil
| | - Elmiro Santos Resende
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil
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11
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Pedro MN, Rocha GZ, Guadagnini D, Santos A, Magro DO, Assalin HB, Oliveira AG, Pedro RDJ, Saad MJA. Insulin Resistance in HIV-Patients: Causes and Consequences. Front Endocrinol (Lausanne) 2018; 9:514. [PMID: 30233499 PMCID: PMC6133958 DOI: 10.3389/fendo.2018.00514] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022] Open
Abstract
Here we review how immune activation and insulin resistance contribute to the metabolic alterations observed in HIV-infected patients, and how these alterations increase the risk of developing CVD. The introduction and evolution of antiretroviral drugs over the past 25 years has completely changed the clinical prognosis of HIV-infected patients. The deaths of these individuals are now related to atherosclerotic CVDs, rather than from the viral infection itself. However, HIV infection, cART, and intestinal microbiota are associated with immune activation and insulin resistance, which can lead to the development of a variety of diseases and disorders, especially with regards to CVDs. The increase in LPS and proinflammatory cytokines circulating levels and intracellular mechanisms activate serine kinases, resulting in insulin receptor substrate-1 (IRS-1) serine phosphorylation and consequently a down regulation in insulin signaling. While lifestyle modifications and pharmaceutical interventions can be employed to treat these altered metabolic functions, the mechanisms involved in the development of these chronic complications remain largely unresolved. The elucidation and understanding of these mechanisms will give rise to new classes of drugs that will further improve the quality of life of HIV-infected patients, over the age of 50.
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Affiliation(s)
- Marcelo N. Pedro
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Guilherme Z. Rocha
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Dioze Guadagnini
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Andrey Santos
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Daniela O. Magro
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Heloisa B. Assalin
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Alexandre G. Oliveira
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
- Biosciences Institute, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Rogerio de Jesus Pedro
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Mario J. A. Saad
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
- *Correspondence: Mario J. A. Saad
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Abstract
Infection with the human immunodeficiency virus (HIV), and subsequent treatment with antiretroviral therapy (ART), is often associated with perturbations in lipid profiles. Furthermore, persistent inflammation, in spite of suppression of viral replication by ART, likely contributes to modifications in lipid composition and function, exacerbating risk for development of cardiovascular disease (CVD). Increased levels of several pro-inflammatory lipid species, including oxidized low-density lipoprotein (LDL) and high-density lipoprotein (HDL), have been measured in HIV-infected persons and are associated with markers of immune activation. The mechanisms linked to this bidirectional relationship in which inflammation increases lipid levels and promotes their modification, and these modified lipid species perpetuate inflammatory processes, require further investigation. Treatment with statins and other lifestyle modifications, including improvement in dietary intake and exercise, are critical to reducing CVD risk. Well-designed clinical trials that take into account the complex relationships among lipids and inflammation within persons infected with HIV need to be considered.
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Affiliation(s)
- Nicholas T Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, 453 W. 10th Ave., 535A Atwell Hall, Columbus, OH, 43210, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, Bethesda, MD, 20892, USA.
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13
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Belury MA, Bowman E, Gabriel J, Snyder B, Kulkarni M, Palettas M, Mo X, Lake JE, Zidar D, Sieg SF, Rodriguez B, Playford MP, Andrade A, Kuritzkes DR, Mehta NN, Lederman MM, Funderburg NT. Prospective Analysis of Lipid Composition Changes with Antiretroviral Therapy and Immune Activation in Persons Living with HIV. Pathog Immun 2017; 2:376-403. [PMID: 29098203 PMCID: PMC5663243 DOI: 10.20411/pai.v2i3.218] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Lipid profiles are altered by HIV infection and antiretroviral therapy (ART). Among HIV-uninfected (HIV-) populations the concentrations of various lipid classes (ie, lyso-phosphatidylcholine, LPC) and their saturated (SaFA), mono-unsaturated (MUFA), and polyunsaturated fatty acid (PUFA) composition are related to cardiometabolic disease risk. Associations between changes in the lipidome and immune activation in HIV-infected (HIV+) individuals beginning ART have not been described. Methods Plasma lipid concentrations and their fatty acid composition were measured by differential mobility spectroscopy in samples from 35 treatment-naive HIV+ participants beginning raltegravir (RAL)-based ART and from HIV- individuals (n = 13) matched for age and sex. Results The levels of SaFA, including palmitic (16:0) and stearic (18:0) acid were enriched in HIV+ participants (pre- and post-ART), and SaFA levels were often positively correlated with levels of immune activation (ie, IL-6, sCD14, and TNFR1) at baseline and week 48. Levels of PUFAs (including 18:3, 20:4, and 20:5) were lower in HIV+ participants at baseline compared to levels in HIV- participants (P < 0.01), and levels of these PUFAs were increased following 48 weeks of ART. Levels of PUFAs were often inversely related to immune activation. Levels of LPC were increased in HIV+ participants, both pre- and post-ART vs HIV- participants, and the composition of LPC was enriched for SaFAs among HIV+ individuals. At week 48, several LPC molecules containing SaFAs were positively correlated with levels of sCD14, D-dimer, and TNFR1 (P < 0.01), and levels of PUFA-containing LPC (18:3, 20:5, 22:5, 22:6) were positively correlated with CD4+ T cell counts and inversely correlated with sCD14 and IL-6 (P < 0.01). Conclusions The composition of the lipidome is altered in HIV infection and changes when ART is administered. Alterations in SaFAs were generally associated with inflammatory markers and may contribute to comorbid disease pathogenesis.
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Affiliation(s)
- Martha A Belury
- Department of Human Sciences, Ohio State University, Columbus, Ohio
| | - Emily Bowman
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
| | - Janelle Gabriel
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
| | - Brandon Snyder
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
| | - Manjusha Kulkarni
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
| | - Marilly Palettas
- Center for Biostatistics, Department of Biomedical Informatics, Ohio State University, Columbus, Ohio
| | - Xiaokui Mo
- Center for Biostatistics, Department of Biomedical Informatics, Ohio State University, Columbus, Ohio
| | - Jordan E Lake
- University of Texas Health Science Center, Houston, Texas
| | - David Zidar
- Case Western Reserve University, Cleveland Ohio
| | | | | | | | | | - Daniel R Kuritzkes
- Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Nehal N Mehta
- National Heart Lung and Blood Institute, Bethesda, Maryland
| | | | - Nicholas T Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
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Non LR, Escota GV, Powderly WG. HIV and its relationship to insulin resistance and lipid abnormalities. Transl Res 2017; 183:41-56. [PMID: 28068521 DOI: 10.1016/j.trsl.2016.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/18/2016] [Accepted: 12/15/2016] [Indexed: 12/19/2022]
Abstract
Antiretroviral therapy has revolutionized the care of people with human immunodeficiency virus (HIV) by reducing morbidity and mortality from acquired immunodeficiency syndrome-related conditions. Despite longer life expectancy, however, HIV-infected individuals continue to have a higher risk of death compared with the general population. This has been attributed to the increasing incidence of noncommunicable diseases, in particular, atherosclerotic cardiovascular diseases. This is driven, in part, by the emergence of metabolic disorders, particularly dyslipidemia, insulin resistance, and lipodystrophy, in those on antiretroviral therapy. The pathogenesis of these metabolic derangements is complex and multifactorial, and could be a consequence of an interplay between traditional age-related risk factors, HIV infection, antiretroviral therapy effects, and the inflammatory state and immune activation in this population. Understanding the contributions of each of these factors could not just impact the current management of these individuals and help mitigate the risk for premature cardiovascular disease, but also shape the future direction of research in HIV.
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Affiliation(s)
- Lemuel R Non
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Mo.
| | - Gerome V Escota
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Mo
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15
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Kulkarni M, Bowman E, Gabriel J, Amburgy T, Mayne E, Zidar DA, Maierhofer C, Turner AN, Bazan JA, Koletar SL, Lederman MM, Sieg SF, Funderburg NT. Altered Monocyte and Endothelial Cell Adhesion Molecule Expression Is Linked to Vascular Inflammation in Human Immunodeficiency Virus Infection. Open Forum Infect Dis 2016; 3:ofw224. [PMID: 28066794 PMCID: PMC5198584 DOI: 10.1093/ofid/ofw224] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected individuals have increased risk for vascular thrombosis, potentially driven by interactions between activated leukocytes and the endothelium. METHODS Monocyte subsets (CD14+CD16-, CD14+CD16+, CD14DimCD16+) from HIV negative (HIV-) and antiretroviral therapy-treated HIV positive (HIV+) participants (N = 19 and 49) were analyzed by flow cytometry for adhesion molecule expression (lymphocyte function-associated antigen 1 [LFA-1], macrophage-1 antigen [Mac-1], CD11c/CD18, very late antigen [VLA]-4) and the fractalkine receptor (CX3CR1); these receptors recognize ligands (intercellular adhesion molecules [ICAMs], vascular cell adhesion molecule [VCAM]-1, fractalkine) on activated endothelial cells (ECs) and promote vascular migration. Plasma markers of monocyte (soluble [s]CD14, sCD163) and EC (VCAM-1, ICAM-1,2, fractalkine) activation and systemic (tumor necrosis factor receptor [TNFR-I], TNFR-II) and vascular (lipoprotein-associated phospholipase A2 [Lp-PLA2]) inflammation were measured by enzyme-linked immunosorbent assay. RESULTS Proportions of CD16+ monocyte subsets were increased in HIV+ participants. Among all monocyte subsets, levels of LFA-1 were increased and CX3CR1 levels were decreased in HIV+ participants (P < .01). Levels of sCD163, sCD14, fractalkine, ICAM-1, VCAM-1, TNFR-II, and Lp-PLA2 were also increased in HIV+ participants (P < .05), and levels of sCD14, TNFR-I, and TNFR-II were directly related to ICAM-1 and VCAM-1 levels in HIV+ participants. Expression of CX3CR1 on monocyte subsets was inversely related to plasma Lp-PLA2 (P < .05 for all). CONCLUSIONS Increased proportions of CD16+ monocytes, cells with altered adhesion molecule expression, combined with elevated levels of their ligands, may promote vascular inflammation in HIV infection.
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Affiliation(s)
- Manjusha Kulkarni
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University , Columbus
| | - Emily Bowman
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University , Columbus
| | - Janelle Gabriel
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University , Columbus
| | - Taylor Amburgy
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University , Columbus
| | - Elizabeth Mayne
- National Health Laboratory Service and Faculty of Health Sciences, University of Witwatersrand , Johannesburg
| | - David A Zidar
- Harrington Heart & Vascular Institute, University Hospitals Case Medical Center , Cleveland, Ohio
| | - Courtney Maierhofer
- Department of Medicine, Division of Infectious Diseases, Ohio State University , Columbus
| | - Abigail Norris Turner
- Department of Medicine, Division of Infectious Diseases, Ohio State University , Columbus
| | - Jose A Bazan
- Department of Medicine, Division of Infectious Diseases, Ohio State University , Columbus
| | - Susan L Koletar
- Department of Medicine, Division of Infectious Diseases, Ohio State University , Columbus
| | - Michael M Lederman
- Department of Internal Medicine, Division of Infectious Diseases, Case Western Reserve University/University Hospitals of Cleveland , Ohio
| | - Scott F Sieg
- Department of Internal Medicine, Division of Infectious Diseases, Case Western Reserve University/University Hospitals of Cleveland , Ohio
| | - Nicholas T Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University , Columbus
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Funderburg NT, Xu D, Playford MP, Joshi AA, Andrade A, Kuritzkes DR, Lederman MM, Mehta NN. Treatment of HIV infection with a raltegravir-based regimen increases LDL levels, but improves HDL cholesterol efflux capacity. Antivir Ther 2016; 22:71-75. [PMID: 27740536 DOI: 10.3851/imp3091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Persons infected with HIV often have altered lipid profiles that may be affected by antiretroviral therapies (ART). Traditional lipid measurements may be insufficient to assess cardiovascular disease (CVD) risk in this population. METHODS We report results from 39 ART-naive participants in a substudy of A5248, a single-arm study of raltegravir, emtricitabine/tenofovir administration. Samples were collected at baseline, 12, 24 and 48 weeks after ART initiation. We performed advanced lipid phenotyping using nuclear magnetic resonance spectroscopy (Liposcience, Raleigh, NC, USA) for lipid particle size and number, and examined high-density lipoprotein (HDL) function measuring reverse cholesterol transport using J774 macrophages. RESULTS We report significant increases in total cholesterol (13 mg/dl; P<0.001) and low-density lipoprotein (LDL; 8 mg/dl; P=0.03), with no change in triglycerides and without an increase in LDL particle number (P>0.1 all time points). HDL levels were increased over baseline levels at all time points (P<0.003), but reached a peak at week 12 and subsequently declined. HDL particle numbers also increased from baseline (P<0.002) and HDL function improved at week 48 (7% increase in efflux capacity; P<0.001). Oxidized LDL (oxLDL) levels decreased by week 12, but rose subsequently, and were not different from baseline at later time points. CONCLUSIONS HDL increases were associated with increases in beneficial HDL particles and HDL cholesterol efflux capacity, which may reduce future CVD events. Persistent inflammation in these HIV+ participants, may be a cause or consequence of oxLDL levels, and may contribute to declining levels of HDL over time. Clinicaltrials.gov NCT00660972.
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Affiliation(s)
- Nicholas T Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, OH, USA
| | - Dihua Xu
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | | | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Adriana Andrade
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | | | - Michael M Lederman
- Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
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Funderburg NT, McComsey GA, Kulkarni M, Bannerman T, Mantini J, Thornton B, Liu HC, Zhang Y, Song Q, Fang L, Dinoso J, Cheng A, McCallister S, Fordyce MW, Das M. Equivalent Decline in Inflammation Markers with Tenofovir Disoproxil Fumarate vs. Tenofovir Alafenamide. EBioMedicine 2016; 13:321-327. [PMID: 27742226 PMCID: PMC5264242 DOI: 10.1016/j.ebiom.2016.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 01/22/2023] Open
Abstract
Background Initiation of antiretroviral therapy (ART) and subsequent virologic suppression reduces immune activation and systemic inflammation. Methods We examined longitudinal changes in biomarkers of monocyte activation (sCD14, sCD163), and systemic (IL-6, hsCRP, sTNFR-I and D-dimer) and vascular (Lp-PLA2) inflammation in a subgroup (N = 100 per arm) of participants enrolled in a randomized, placebo-controlled trial comparing elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF; TAF) to E/C/F/tenofovir disoproxil fumarate (E/C/F/TDF; TDF) in treatment-naïve adults. Results For 194 participants (TAF, 98; TDF, 96), baseline levels of biomarkers did not differ by treatment arm; there were no differences in biomarker values between groups at weeks 12, 24, or 48 (p > 0.05), except IL-6 at week 12 (p = 0.012). Among all participants (combining groups), there were statistically significant declines from baseline observed for D-dimer, sCD163, and sTNFR-1 by week 12 and IL-6 by week 24. The proportion of participants with Lp-LA2 levels < 200 ng per mL (p = 0.250) or hsCRP levels < 3000 mg per L (p = 0.586) was unchanged through week 48. Conclusions We observed equivalent declines in biomarkers of monocyte activation and systemic inflammation in treatment-naïve adults treated with TAF or TDF for 48 weeks, suggesting that TAF and TDF have equivalent impact on immune activation and inflammation. Persons infected with HIV continue have residual immune activation and inflammation despite virologic suppression. Several markers of immune activation and inflammation are associated with mortality and cardiovascular disease (CVD). Decline in these markers is equivalent with tenofovir alafenamide and tenofovir disoproxil fumarate.
Biomarkers of immune activation and inflammation are associated with non AIDS–associated comorbidities and all-cause mortality. TDF decreased inflammatory markers associated with cardiovascular risk in treatment-naïve individuals. Studies have demonstrated that TAF is as efficacious at virologic suppression as TDF, and safer regarding renal and bone toxicity, but treatment differences in decline of immune activation and inflammation have not been explored. Results of our study suggest that TAF is equivalent to TDF in reducing markers of immune activation and inflammation associated with all-cause mortality, while providing an improved renal and bone safety profile compared with TDF.
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Affiliation(s)
- Nicholas T Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, OH 43210, USA.
| | - Grace A McComsey
- Case Western Reserve University, Cleveland, OH 44106, USA; Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Manjusha Kulkarni
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, OH 43210, USA
| | - Tammy Bannerman
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, OH 43210, USA
| | - Jessica Mantini
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, OH 43210, USA
| | - Bernadette Thornton
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, OH 43210, USA
| | - Hui C Liu
- Gilead Sciences Inc., Foster City, CA 94404, USA
| | - Yafeng Zhang
- Gilead Sciences Inc., Foster City, CA 94404, USA
| | - Qinghua Song
- Gilead Sciences Inc., Foster City, CA 94404, USA
| | - Liang Fang
- Gilead Sciences Inc., Foster City, CA 94404, USA
| | - Jason Dinoso
- Gilead Sciences Inc., Foster City, CA 94404, USA
| | - Andrew Cheng
- Gilead Sciences Inc., Foster City, CA 94404, USA
| | | | | | - Moupali Das
- Gilead Sciences Inc., Foster City, CA 94404, USA
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Identification of Immune Activation Profiles That May Predict Morbidity During Antiretroviral Therapy Treated HIV Infection. EBioMedicine 2016; 8:16-17. [PMID: 27428408 PMCID: PMC4919721 DOI: 10.1016/j.ebiom.2016.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/24/2022] Open
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Zanetti HR, Cruz LGD, Lourenço CLM, Neves FDF, Silva-Vergara ML, Mendes EL. Non-linear resistance training reduces inflammatory biomarkers in persons living with HIV: A randomized controlled trial. Eur J Sport Sci 2016; 16:1232-9. [PMID: 27027897 DOI: 10.1080/17461391.2016.1167962] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study is to analyse the effect of 12 weeks of non-linear resistance training (NLRT) on anthropometry, muscle strength and inflammatory biomarkers in persons infected with human immunodeficiency virus (PIHIV). Thirty previously sedentary PIHIVs were randomized into the NLRT (n = 15) and control (CON, n = 15) groups. NLRT group were submitted to 12 weeks of training, whereas the CON group maintained their daily habits. At baseline and after 12 weeks, both groups underwent anthropometric evaluations and blood sampling for the analysis of inflammatory biomarkers. Analysis of covariance using preintervention values as covariate was performed to determine the effects of exercise on anthropometry, muscle strength, cytokines levels and T cells. Significance was set at p < 0.05. After 12 weeks of intervention, there was a decrease in subcutaneous body fat (p < .0001), neck, abdomen and waist circumferences (p < .05), waist-to-hip ratio (p = .009), blood levels of interleukin (IL)-1β (p = .029), IL-6 (p = .005), IL-8 (p = .010), and tumour necrosis factor (TNF)-α (p = .001) and an increase in muscle strength (p < .0001), IL-10 levels (p = .030) and CD4(+) (p = .004) and CD8(+) (p < .0001) counts in the NLRT compared to CON group. Twelve weeks of NLRT promoted positive changes in the body fat, body circumferences, muscular strength and inflammatory profile in PIHIV.
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Affiliation(s)
- Hugo Ribeiro Zanetti
- a Postgraduate Program in Physical Education , Federal University of Triângulo Mineiro , Uberaba , MG , Brazil
| | - Lucas Gonçalves da Cruz
- a Postgraduate Program in Physical Education , Federal University of Triângulo Mineiro , Uberaba , MG , Brazil
| | | | - Fernando de Freitas Neves
- b Postgraduate Program in Infectious Diseases and Tropical Medicine , Federal University of Triângulo Mineiro , Uberaba , MG , Brazil
| | - Mário Leon Silva-Vergara
- b Postgraduate Program in Infectious Diseases and Tropical Medicine , Federal University of Triângulo Mineiro , Uberaba , MG , Brazil
| | - Edmar Lacerda Mendes
- a Postgraduate Program in Physical Education , Federal University of Triângulo Mineiro , Uberaba , MG , Brazil.,c Department of Sport Sciences , Federal University of Triângulo Mineiro , Uberaba , MG , Brazil
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20
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Zimmerman DD. HIV: A Chronic Condition. J Insur Med 2015; 45:136-141. [PMID: 27584920 DOI: 10.17849/0743-6661-45.3.136] [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: 06/06/2023]
Abstract
By virtue of the success of anti-retroviral therapy (ART), human immunodeficiency virus (HIV) infection has evolved into a chronic disease in which the typical complications of acquired immune deficiency syndrome (AIDS) are no longer the dominant problem. Rather than dealing with acute and potentially life-threatening complications, clinicians are now confronted with managing a chronic disease that, in the absence of a cure, will persist for many decades. (1) This review will focus on the longer term sequelae and consequences of chronic HIV infection.
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