Metabolic abnormalities and coronary heart disease risk in human immunodeficiency virus-infected adults

General Factors That Reduce Cardiovascular Risk in People With Schizophrenia: A Systematic Review

BACKGROUND

The life expectancy of individuals with schizophrenia in the United States is 20% shorter than that of the general population owing to cardiovascular disease (CVD). It is crucial to identify the factors that reduce CVD risk in these individuals.

OBJECTIVE

In this systematic review, we examined the factors associated with CVD in people with schizophrenia.

METHODS

We searched 3 electronic databases for English articles published before April 2023. Investigators assessed the factors associated with 2 cardiovascular health outcomes among people with schizophrenia: the 10-year coronary heart disease (CHD)/CVD risk and peak oxygen uptake (VO2Peak/max).

RESULTS

We retrieved 17 studies from the search. Investigators examined factors affecting 10-year CHD/CVD risk in 11 studies and VO2Peak/max in 6 studies among people with schizophrenia. We found that individuals who had low metabolic symptoms (ie, hypertension and hyperglycemia), did not smoke, engaged in continuous CVD risk assessments, had a shorter duration of the diagnosis and hospitalization, and were of normal weight had a lower 10-year CHD/CVD risk. Furthermore, individuals who engaged in specific physical activity had a higher VO2Peak/max. Finally, those taking antipsychotic medications had a higher 10-year CHD/CVD risk and a lower VO2Peak/max.

CONCLUSIONS

The CVD risk factors observed in the general population are common among people with schizophrenia. When these risk factors are controlled, the 10-year CHD/CVD risk and VO2Peak/max of these individuals may be improved. Given the elevated CVD risk associated with antipsychotic medications, future researchers should examine modifying CVD risk factors to mitigate the additional risks associated with medication use in this population.

The metabolic effects of APOL1 in humans

Harboring apolipoprotein L1 (APOL1) variants coded by the G1 or G2 alleles of the APOL1 gene increases the risk for collapsing glomerulopathy, focal segmental glomerulosclerosis, albuminuria, chronic kidney disease, and accelerated kidney function decline towards end-stage kidney disease. However, most subjects carrying APOL1 variants do not develop the kidney phenotype unless a second clinical condition adds to the genotype, indicating that modifying factors modulate the genotype-phenotype correlation. Subjects with an APOL1 high-risk genotype are more likely to develop essential hypertension or obesity, suggesting that carriers of APOL1 risk variants experience more pronounced insulin resistance compared to noncarriers. Likewise, arterionephrosclerosis (the pathological correlate of hypertension-associated nephropathy) and glomerulomegaly take place among carriers of APOL1 risk variants, and these pathological changes are also present in conditions associated with insulin resistance, such as essential hypertension, aging, and diabetes. Insulin resistance may contribute to the clinical features associated with the APOL1 high-risk genotype. Unlike carriers of wild-type APOL1, bearers of APOL1 variants show impaired formation of lipid droplets, which may contribute to inducing insulin resistance. Nascent lipid droplets normally detach from the endoplasmic reticulum into the cytoplasm, although the proteins that enable this process remain to be fully defined. Wild-type APOL1 is located in the lipid droplet, whereas mutated APOL1 remains sited at the endoplasmic reticulum, suggesting that normal APOL1 may participate in lipid droplet biogenesis. The defective formation of lipid droplets is associated with insulin resistance, which in turn may modulate the clinical phenotype present in carriers of APOL1 risk variants.

Histological Manifestations of Diabetic Kidney Disease and its Relationship with Insulin Resistance

Histological manifestations of diabetic kidney disease (DKD) include mesangiolysis, mesangial matrix expansion, mesangial cell proliferation, thickening of the glomerular basement membrane, podocyte loss, foot process effacement, and hyalinosis of the glomerular arterioles, interstitial fibrosis, and tubular atrophy. Glomerulomegaly is a typical finding. Histological features of DKD may occur in the absence of clinical manifestations, having been documented in patients with normal urinary albumin excretion and normal glomerular filtration rate. Furthermore, the histological picture progresses over time, while clinical data may remain normal. Conversely, histological lesions of DKD improve with metabolic normalization following effective pancreas transplantation. Insulin resistance has been associated with the clinical manifestations of DKD (nephromegaly, glomerular hyperfiltration, albuminuria, and kidney failure). Likewise, insulin resistance may underlie the histological manifestations of DKD. Morphological changes of DKD are absent in newly diagnosed type 1 diabetes patients (with no insulin resistance) but appear afterward when insulin resistance develops. In contrast, structural lesions of DKD are typically present before the clinical diagnosis of type 2 diabetes. Several heterogeneous conditions that share the occurrence of insulin resistance, such as aging, obesity, acromegaly, lipodystrophy, cystic fibrosis, insulin receptor dysfunction, and Alström syndrome, also share both clinical and structural manifestations of kidney disease, including glomerulomegaly and other features of DKD, focal segmental glomerulosclerosis, and C3 glomerulopathy, which might be ascribed to the reduction in the synthesis of factor H binding sites (such as heparan sulfate) that leads to uncontrolled complement activation. Alström syndrome patients show systemic interstitial fibrosis markedly similar to that present in diabetes.

Impact of obstructive sleep apnea on cardiometabolic health in a random sample of older adults in rural South Africa: building the case for the treatment of sleep disorders in underresourced settings

STUDY OBJECTIVES

The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa.

METHODS

Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV status were determined. A continuous CMR score was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis.

RESULTS

In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses.

CONCLUSIONS

In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR. We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women.

Relationship between sleep disorders, HIV status and cardiovascular risk: cross-sectional study of long-haul truck drivers from Southern Africa

OBJECTIVES

Long-haul truck drivers (TDs) may have lifestyles that promote cardiovascular disease (CVD), including diet, sleep and activity issues. Most studies conducted among truckers investigated the relationship between poor sleep and cardiometabolic health, but none assessed whether suspected obstructive sleep apnoea (OSA) and shortened sleep were associated with markers of cardiometabolic risk. We determined whether sleep disorders and circadian misalignment were associated with chronic inflammation and CVD risk in TDs from Southern Africa.

METHODS

Participants were recruited at roadside wellness centres in Gauteng and Free State Provinces, South Africa. OSA risk was assessed using the Berlin Questionnaire, while sleep duration and sleep quality were assessed using items from the Pittsburgh Sleep Quality Index. Clinical information, neck circumference (NC), metabolic profile, elevated BP, HIV status and C-reactive protein (CRP) were collected. CVD risk was assessed using the Framingham Risk Score (FRS).

RESULTS

Out of 575 participants aged on average 37.7 years, 17.2% were at OSA risk, 72.0% had elevated BP, 9.4% had HIV and 28.0% were obese. Mean sleep duration was 7.4±1.8 hours, and 49.6% reported working night shift at least once a week. Shortened sleep, OSA risk, age, body mass index, NC and years as full-time TD were associated with greater FRS independently of HIV status and night shift. Working night shift was associated with higher CRP levels in HIV+ compared with HIV- participants.

CONCLUSIONS

Circadian misalignment in HIV, and OSA and short sleep duration in all truckers were associated with increased CVD risk. Truckers should be given careful attention in terms of health management and sleep education.

Sleep disruption and duration are associated with variants in genes involved in energy homeostasis in adults with HIV/AIDS

OBJECTIVE

To determine whether selected genes and plasma markers involved in energy homeostasis are associated with sleep disruption or duration in adults with HIV/AIDS.

METHODS

A sample of 289 adults with HIV/AIDS wore a wrist actigraph for 72 h to estimate total sleep time (TST) and wake after sleep onset (WASO). Twenty-three single nucleotide polymorphisms (SNP) spanning 5 energy homeostasis genes (adiponectin [ADIPOQ], ghrelin [GHRL], leptin [LEP], peroxisome proliferator-activated receptor-alpha [PPARA], and -gamma [PPARG]) were genotyped using a custom array. Plasma markers of energy homeostasis (adiponectin, ghrelin, leptin) were measured by commercial multiplex assay.

RESULTS

After adjusting for demographic and clinical characteristics (race/ethnicity, gender, CD4 cell count, waist circumference, medications), both WASO and TST were associated with SNPs in ADIPOQ (rs182052), LEP (rs10244329, rs3828942), PPARA (rs135551, rs4253655), and PPARG (rs709151). Additional SNPs in ADIPOQ were associated with WASO (rs1501299, rs3821799, rs6773957) and TST (rs2241766). TST was also associated with SNPs in GHRL (rs26802), LEP (rs11760956), PPARA (rs135547, rs8138102, rs4253776), and PPARG (rs12490265, rs796313). Many covariate-adjusted associations involved a significant interaction with markers of HIV (viral load, years since diagnosis). Among plasma markers, higher adiponectin was associated with less WASO, higher ghrelin and glucose levels with shorter TST, and higher leptin with longer TST.

CONCLUSIONS

Replication of SNPs in all five genes and three plasma markers of energy homeostasis were associated with objective sleep measures. HIV disease influenced many of the associations. Findings strengthen evidence for associations between energy homeostasis genetics and poor sleep, and provide direction for pharmacological intervention research.

HIV and metabolic syndrome in an Ethiopian population

BACKGROUND

The global prevalence of metabolic syndrome (MS) is increasing due to lifestyle changes. Studies have found that MS is associated with human immunodeficiency virus (HIV) and antiretroviral treatment (ART), but controversies still exist on associations between HIV and MS.

AIMS

To assess associations between HIV and MS among ART-naïve HIV positive individuals compared to HIV negative individuals.

SUBJECTS AND METHODS

A cross-sectional study among ART-naïve HIV positive and HIV negative individuals recruited from HIV treatment and testing facilities in Ethiopia. Information was collected on components of MS: waist circumference, triglycerides, high-density lipoprotein cholesterol (HDL-C), blood pressure and fasting plasma glucose (FPG). Data were analysed using logistic and linear regression stratified by sex and adjusted for age, wealth and education.

RESULTS

Data from 329 HIV positive and 100 HIV negative individuals were included. HIV positive status was associated with higher odds of MS in women (OR: 3.56, 95%CI: 1.25; 10.15) (n = 292), but not in men (OR: 0.98, 95%CI: 0.22; 4.30) (n = 137), interaction: p= .11. Associations between HIV and components of MS were strongest for HDL-C among women and for FPG among men. The most prevalent components of MS in HIV positive individuals were elevated triglycerides, reduced HDL-C and elevated FPG.

CONCLUSIONS

HIV was associated with MS among ART-naïve women, suggesting that MS should be evaluated before initiating ART and monitored during treatment to identify those at risk of developing diabetes and cardiovascular disease (CVD).

Prevalence and Associated Risk Factors of Hyperglycemia and Diabetes Mellitus Among HIV Positive Patients in Tehran, Iran

BACKGROUND

The introduction of Antiretroviral Therapy (ART) has resulted in the emergence of some metabolic complications including hyperglycemia and diabetes mellitus among HIV positive patients. The aim of this study was to investigate the prevalence of hyperglycemia, diabetes mellitus and their associated risk factors in HIV positive patients.

METHODS

This cross-sectional study was conducted on HIV positive patients who visited Voluntary Counseling and Testing (VCT) center of Imam Khomeini Hospital, Tehran, Iran (2004-2013). Medical records of patients were reviewed retrospectively. A logistic regression model was applied for analysis of the association between glycemic status and relevant risk factors.

RESULTS

Out of 480 patients who were included in this study, 267 (55.6%) had hyperglycemia, including 28 (5.8%) with diabetes mellitus and 239 (49.8%) with pre-diabetes. The higher frequency of hyperglycemia, was found to be significantly associated with older age (OR for patients ˃40 years old, 2.260; 95% CI, 1.491, 3.247), male gender (OR, 1.555; 95% CI, 1.047, 2.311), higher Body Mass Index (OR for patients with BMI˃25 Kg/m², 1.706; 95% CI, 1.149, 2.531) and prolonged duration of HIV infection (OR for patients with duration of HIV infection ≥60 months, 2.027; 95% CI, 1.372, 2.992).

CONCLUSION

Hyperglycemia, especially pre-diabetes, is highly frequent among Iranian people living with HIV. Male gender, older age, prolonged duration of HIV infection, and higher BMI were associated with a higher prevalence of hyperglycemia. Hence, it is important to screen all HIV infected patients at the time of diagnosis and then periodically for hyperglycemia.

A Wake-up Call for Human Immunodeficiency Virus (HIV) Providers: Obstructive Sleep Apnea in People Living With HIV

Obstructive sleep apnea (OSA) is defined by repetitive collapse of the upper airway during sleep leading to transient hypoxemia and arousals from sleep. Surges in sympathetic activity, repeated oxygen desaturation, and sleep fragmentation can lead to cardiovascular (eg, myocardial infarction) and neurocognitive (eg, excessive daytime sleepiness) consequences. Emerging data suggest that OSA is common in people living with human immunodeficiency virus (PLWH) and that traditional risk factors for OSA, such as obesity, are not highly predictive of OSA in PLWH. Untreated OSA is associated with increased fatigue and levels of inflammation. Despite these data, most PLWH with OSA remain undiagnosed and untreated. Improved awareness of OSA among healthcare providers and greater use of OSA diagnostic approaches have the potential to substantially improve quality of life and outcomes in PLWH.

Association of HIV-infection, antiretroviral treatment and metabolic syndrome with large artery stiffness: a cross-sectional study

Background

Effective combined antiretroviral therapy (cART) has improved life expectancy among people living with HIV-1 infection. Treated HIV-1infection increases the prevalence of metabolic syndrome (MS). Despite sub-Saharan Africa having among the highest rates of HIV-1 infection, the effects of MS in HIV-1-infected individuals on cardiovascular risk is poorly explored. The aim of the study was to assess whether MS and/or HIV-1 treatment correlates with large elastic artery stiffness in HIV-1-infected patients treated with first-line cART.

Methods

The study sample comprised of 102 subjects free of cardiovascular disease and major risk factors divided into two groups based on HIV-1 infection, treatment, and MS status: HIV-1⁺/cART⁺/MS⁺ (n = 12); HIV-1⁺/cART⁻/MS⁺ (n = 16); HIV-1⁻/ MS⁺ (n = 10); HIV-1⁺/cART⁺/MS⁻ (n = 42); HIV-1⁺/cART⁻/MS⁻ (n = 32); HIV-1⁻/ MS⁻ (n = 39). MS was established according the International Diabetes Federation definition. Large artery stiffness was measured using applanation tonometry to assess aortic pulse wave velocity (aPWV) and aortic augmentation index at heart rate of 75 bpm (AIx@HR75). cART included lamivudine/zidovudine and nevirapine or efavirenz.

Results

The prevalence of MS in the HIV-1-infected patients was 28%. There were no significant differences in aPWV in the non-MS groups. However, in subjects with MS, aPWV was significantly higher in the HIV-1 cART patients (9.0 ± 1.9 m/s) compared with both controls (7.5 ± 1.8 m/s; P = 0.018) and untreated HIV-1 patients (7.7 ± 1.3 m/s; P = 0.023), and these differences remained after adjustment for blood pressure and sex. Aortic PWV was significantly elevated (P = 0.009) in HIV-1 cART patients with MS compared to their counterparts without MS. Untreated HIV-1 patients with MS also demonstrated increased aPWV compared to their counterparts without MS (P = 0.05). Aortic AIx@HR75 was, on average, ~ 5% higher in HIV-1 cART patients with MS (28.3 ± 62% compared with untreated HIV-1 patients with MS (23.5 ± 9%; P = 0.075). Sub-group multivariate analysis identified MS as an independent predictor of increased aPWV in HIV-1 cART patients.

Conclusions

Our study established that presence of MS in HIV-1 patients on treatment was associated with increased aPWV and hence increased arterial stiffness in sub-Saharan African HIV-1 patients on first-line cART.

Association of physical inactivity with hypertension and low educational level in people living with HIV / AIDS

The aim of this study was to determine the prevalence of physical inactivity and whether it is associated with sociodemographic, lifestyle, clinical, anthropometric, and body composition variables in people living with HIV/AIDS (PLWHA). This study makes use of data from a cohort of 288 adults aged ≥19 years, conducted between October 2009 and July 2011. The variables studied were sex, age, education, income, skin color, tobacco use, alcohol intake, body mass index, body fat percentage, waist circumference, and waist-hip ratio, length of HIV/AIDS diagnosis, use of antiretroviral therapy and length of its use, CD4, hypertension (HT) and diabetes mellitus. Physical inactivity was defined as a score below 600 metabolic equivalent minutes/week according to the International Physical Activity Questionnaire - Short Version. Poisson multiple regression was applied in the multivariate analysis with a significance level of 5%. The prevalence of physical inactivity was 44.1%. Education of ≤4 years of study (prevalence ratio [PR]: 1.71) and HT (PR: 1.49) were associated with physical inactivity. Physical inactivity was highly prevalent in PLWHA and associated with low educational level and HT. We highlight the simultaneous association between two cardiometabolic risk factors, HT and physical inactivity.

A Meta-Analysis of the Metabolic Syndrome Prevalence in the Global HIV-Infected Population

BACKGROUND

Cardio-metabolic risk factors are of increasing concern in HIV-infected individuals, particularly with the advent of antiretroviral therapy (ART) and the subsequent rise in longevity. However, the prevalence of cardio-metabolic abnormalities in this population and the differential contribution, if any, of HIV specific factors to their distribution, are poorly understood. Therefore, we conducted a systematic review and meta-analysis to estimate the global prevalence of metabolic syndrome (MS) in HIV-infected populations, its variation by the different diagnostic criteria, severity of HIV infection, ART used and other major predictive characteristics.

METHODS

We performed a comprehensive search on major databases for original research articles published between 1998 and 2015. The pooled overall prevalence as well as by specific groups and subgroups were computed using random effects models.

RESULTS

A total of 65 studies across five continents comprising 55094 HIV-infected participants aged 17-73 years (median age 41 years) were included in the final meta-analysis. The overall prevalence of MS according to the following criteria were: ATPIII-2001:16.7% (95%CI: 14.6-18.8), IDF-2005: 18% (95%CI: 14.0-22.4), ATPIII-2004-2005: 24.6% (95%CI: 20.6-28.8), Modified ATPIII-2005: 27.9% (95%CI: 6.7-56.5), JIS-2009: 29.6% (95%CI: 22.9-36.8), and EGIR: 31.3% (95%CI: 26.8-36.0). By some MS criteria, the prevalence was significantly higher in women than in men (IDF-2005: 23.2% vs. 13.4, p = 0.030), in ART compared to non-ART users (ATPIII-2001: 18.4% vs. 11.8%, p = 0.001), and varied significantly by participant age, duration of HIV diagnosis, severity of infection, non-nucleoside reverse transcriptase inhibitors (NNRTIs) use and date of study publication. Across criteria, there were significant differences in MS prevalence by sub-groups such as in men, the Americas, older publications, regional studies, younger adults, smokers, ART-naïve participants, NNRTIs users, participants with shorter duration of diagnosed infection and across the spectrum of HIV severity. Substantial heterogeneities across and within criteria were not fully explained by major study characteristics, while evidence of publication bias was marginal.

CONCLUSIONS

The similar range of MS prevalence in the HIV-infected and general populations highlights the common drivers of this condition. Thus, cardio-metabolic assessments need to be routinely included in the holistic management of the HIV-infected individual. Management strategies recommended for MS in the general population will likely provide similar benefits in the HIV-infected.

Higher levels of circulating monocyte-platelet aggregates are correlated with viremia and increased sCD163 levels in HIV-1 infection

Increased levels of monocyte-platelet aggregates (MPAs) are reported to be highly correlated with cardiovascular events. In this study, the MPA levels in different monocyte subsets and the associations between MPA levels, HIV-1 viremia and monocyte activation were evaluated during HIV-1 infection. The results showed that the percentages of MPAs in all three monocyte subsets were higher in HIV-1-infected subjects than in healthy controls, and were associated with the plasma viral load in the non-classical and intermediate monocyte subsets. The plasma levels of sCD14 and sCD163 were upregulated in HIV-1 infection and were positively associated with viral loads and negatively associated with CD4 counts. P-selectin glycoprotein ligand-1 (PSGL-1) was shown to be expressed at significantly lower levels on all three monocyte subsets and was negatively correlated with the sCD163 level. The MPA level was correlated with the levels of plasma sCD163 but negatively correlated with CD163 and PSGL-1 on all three monocyte subsets. An elevated immune activation status was correlated with increased MPA formation, underlying the potential interaction between monocyte activation and MPA formation. This interaction may be related to a higher thromboembolic risk in patients infected with HIV-1.Cellular & Molecular Immunology advance online publication, 11 August 2014; doi:10.1038/cmi.2014.66.

[Metabolic syndrome and cardiovascular risk patients under antiretrovirals in a day hospital at Bobo-Dioulasso (Burkina Faso)]

Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality of HIV but has led to an increasing metabolic cardiovascular risk. A cross-sectional study was conducted from May to September 2011 in Day Care Hospital for HIV-Patients of Bobo-Dioulasso. We included in this study 400 patients infected by HIVon antiretroviral therapy ≥ 6 months selected by a random draw. Metabolic syndrome was assessed according to the definitions of the IDF and ATP-III. The high risk of cardiovascular disease in 10 years was defined by a Framingham score ≥ 20%. The average age of our patients was 41.4 years [20-76]. 17% received an IP. The average duration of PI exposure was 35.5 months and 50.1 months for NNRTI. The prevalence of diabetes was 1.3% (95% CI: 0.5-3) and that of hypertension of 12.0 % (95% CI: 9.3-16). The prevalence of metabolic syndrome according to IDF was 10% (95% CI: 7.3-13.5) and the metabolic syndrome according to ATP-III 12.3% (95% CI: 9.3-16). The body mass index was higher (BMI 25.2 vs. 22.5 kg/m(2), p <10(-3) with ATPIII and BMI 26.6 vs. 22.4 kg/m(2), p <10(-3) with IDF), and duration exposure to ARVs longer in patients with metabolic syndrome regardless of the definition used (58.6 months vs 27.9 months). High cardiovascular risk was present in 1.8% (95% CI: 0.8 to 3.7) of our patients, all male more than half (n=4/7) of them were smoking. The choice of antiretroviral therapy must take into account its potential long-term toxicity. It should also strengthen supervision.

Cardiovascular risk assessment: a comparison of the Framingham, PROCAM, and DAD equations in HIV-infected persons

This study aims to estimate the risk of cardiovascular disease (CVD) and to assess the agreement between the Framingham, Framingham with aggravating factors, PROCAM, and DAD equations in HIV-infected patients. A cross-sectional study was conducted in an outpatient centre in Brazil. 294 patients older than 19 years were enrolled. Estimates of 10-year cardiovascular risk were calculated. The agreement between the CVD risk equations was assessed using Cohen's kappa coefficient. The participants' mean age was 36.8 years (SD = 10.3), 76.9% were men, and 66.3% were on antiretroviral therapy. 47.8% of the participants had abdominal obesity, 23.1% were current smokers, 20.0% had hypertension, and 2.0% had diabetes. At least one lipid abnormality was detected in 72.8%, and a low HDL-C level was the most common. The majority were classified as having low risk for CV events. The percentage of patients at high risk ranged from 0.4 to 5.7. The PROCAM score placed the lowest proportion of the patients into a high-risk group, and the Framingham equation with aggravating factors placed the highest proportion of patients into the high-risk group. Data concerning the comparability of different tools are informative for estimating the risk of CVD, but accuracy of the outcome predictions should also be considered.

Association of clinical and therapeutic factors with incident dyslipidemia in a cohort of human immunodeficiency virus-infected and non-infected adults: 1994-2011

OBJECTIVE

The aim of this study was to determine the incidence rate of dyslipidemia in a retrospective cohort of human immunodeficiency virus (HIV)-infected and non-HIV-infected adults and to evaluate the association of incident dyslipidemia with exposure to combination antiretroviral therapy (cART).

METHODS

The study cohort included HIV-infected individuals and a matched group of non-HIV-infected individuals served through the South Carolina Medicaid database in 1994-2011. Linkage with the HIV/AIDS surveillance database provided time-varying viro-immunological status. Time-dependent proportional hazards analysis and marginal structural models were used to assess the demographic, therapeutic, and clinical factors associated with incident dyslipidemia.

RESULTS

Among 13,632 adults with a median age of 39 years, the overall incidence rate per 1000 person years of dyslipidemia was higher in cART-treated compared to cART-naïve and matched non-HIV groups (24.55 vs. 14.32 vs. 23.23, respectively). Multivariable results suggested a significantly higher risk of dyslipidemia in the cART-treated HIV-infected group [adjusted hazard ratio (aHR)=1.18; 95% confidence interval (CI)=1.07-1.30] and a significantly lower risk in the cART naïve HIV-infected group (aHR=0.66; CI=0.53-0.82) compared to the control non-HIV-infected group. Marginal structural modeling suggested a significant association between incident dyslipidemia and exposure to both protease inhibitor- [adjusted rate ratio (aRR)=1.27; CI=1.08-1.49] and non-nucleoside reverse transcriptase inhibitor- (aRR=1.78; CI=1.19-2.66) based cART regimens. Pre-existing hypertension, obesity, and diabetes increased the risk of dyslipidemia, whereas hepatitis C virus, lower CD4(+) T cell count, and higher HIV viral load had a protective effect.

CONCLUSIONS

Incident dyslipidemia is lower in the early stages of HIV infection, but may significantly increase with cumulative exposure to cART. Viro-immunological status and underlying comorbidities have a strong association with the onset of dyslipidemia.

Reduced levels of serum FGF19 and impaired expression of receptors for endocrine FGFs in adipose tissue from HIV-infected patients

BACKGROUND

To determine the role of fibroblast growth factor (FGF)-19 and FGF21 and the endocrine FGFs receptor system in the metabolic alterations that manifest in HIV-1-infected patients undergoing highly active antiretroviral treatment (HAART).

METHODS

Serum FGF19 and FGF21 levels were determined in 4 groups of individuals as follows: (1) HIV-1-infected HAART patients with lipodystrophy (n = 38); or (2) without lipodystrophy (n = 34); (3) untreated (naive) HIV-1-infected patients (n = 34); and (4) healthy controls (n = 31). Serum FGF19 levels were correlated with anthropometric, metabolic, HIV-1 infection-related, and HAART-related parameters and with FGF21 levels. The gene expression of FGF receptor 1 and the coreceptor β-Klotho was analyzed in adipose tissue from 10 individuals from each group.

RESULTS

Serum FGF19 levels were significantly reduced in all groups of HIV-1-infected patients, whereas FGF21 levels were increased. FGF19 levels were negatively correlated with insulin resistance and insulin levels and positively correlated with high-density lipoprotein cholesterol. FGF19 was inversely correlated with cumulative exposure to nucleoside reverse transcriptase inhibitor and nonnucleoside reverse transcriptase inhibitor drugs. The expression of FGF receptor 1 and coreceptor β-Klotho was reduced in adipose tissue from all groups of HIV-infected patients.

CONCLUSIONS

FGF19 levels are reduced in HIV-1-infected patients, in contrast with FGF21 levels. Impaired expression of the corresponding receptor and coreceptor, which mediate the actions of endocrine FGFs in adipose tissue, suggests a resistance to the metabolic effects of FGF19 and FGF21 in HIV-1-infected patients. Considering the beneficial effects of endocrine FGFs on metabolism, the observed reduction in FGF19 levels and decreased sensitivity to endocrine FGFs in adipose tissue may contribute to metabolic alterations in HIV-1-infected patients.

Independent predictors of metabolic syndrome in HIV-infected patients

Metabolic syndrome (MetS) is associated with development of type 2 diabetes mellitus and increased risk for cardiovascular disease. However, a few studies have assessed its prevalence and risk factors among HIV patients from developing countries. The aim of this study was to identify independent risk factors for metabolic syndrome by the criteria of the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) among HIV-infected men and women. A cross-sectional study enrolled patients, aged 18 years or older, who sought to confirm the diagnosis or sought treatment in the outpatient service of a public health care center in southern Brazil. From June 2006 to December 2008, certified research assistants conducted interviews using standardized questionnaires and anthropometric measurements. Fasting blood sample was collected, use of highly active antiretroviral therapy (HAART) was ascertained, and MetS was characterized by AHA/NHLBI criteria. In the total, 1240 of 1295 HIV-infected patients were included. MetS prevalence was 24.7% and was similar among men and women. Among men, age, education, physical activity, body mass index (BMI), and HAART use were independently associated with MetS, while among women, there were associations with age, BMI, and use of protease inhibitors. In conclusion, high prevalence of MetS was detected in HIV-infected men and women. In both genders, age and BMI were directly and independently associated with MetS. The association between the use of HAART and MetS was confirmed among men but not among women.

Approach to dyslipidemia, lipodystrophy, and cardiovascular risk in patients with HIV infection

There is a significant prevalence (20%–80% depending on the population and the study) of lipid disorders and other cardiovascular risk factors in people living with HIV infection. This review focuses on HIV and HIV treatment–associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascular risk and other problems associated with these syndromes are discussed. Screening for cardiovascular risk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed.