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Gillespie A, Song R, Barile JP, Okada L, Brown S, Traub K, Trout J, Simoncini GM, Hall CDX, Tan Y, Gadegbeku CA, Ma GX, Wong FY. Discrimination and hypertension among a diverse sample of racial and sexual minority men living with HIV: baseline findings of a longitudinal cohort study. J Hum Hypertens 2024; 38:603-610. [PMID: 38926521 PMCID: PMC11329369 DOI: 10.1038/s41371-024-00919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Racial and sexual orientation discrimination may exacerbate the double epidemic of hypertension (HTN) and HIV that affects men of color who have sex with men (MSM). This was a cross-sectional analysis of African American, Asian American, Native Hawaiian, or Pacific Islander (NHPI) MSM living with HIV (PLWH) cohort in Honolulu and Philadelphia. Racial and sexual orientation discrimination, stress, anxiety, and depression were measured with computer-assisted self-interview questionnaires (CASI). We examined the associations between racial and sexual orientation discrimination with hypertension measured both in the office and by 24-h ambulatory blood pressure monitoring (ABPM) using multivariable logistic regression. Sixty participants (60% African American, 18% Asian, and 22% NHPI) completed CASIs and 24-h ABPM. African American participants (80%) reported a higher rate of daily racial discrimination than Asian American (36%) and NHPI participants (17%, p < 0.001). Many participants (51%) reported daily sexual orientation discrimination. Sixty-six percent of participants had HTN by office measurement and 59% had HTN by 24-h ABPM measurement. Participants who experienced racial discrimination had greater odds of having office-measured HTN than those who did not, even after adjustment (Odds Ratio 5.0 (95% Confidence Interval [1.2-20.8], p = 0.03)). This association was not seen with 24-h ABPM. Hypertension was not associated with sexual orientation discrimination. In this cohort, MSM of color PLWH experience significant amounts of discrimination and HTN. Those who experienced racial discrimination had higher in-office blood pressure. This difference was not observed in 24-h APBM and future research is necessary to examine the long-term cardiovascular effects.
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Affiliation(s)
- Avrum Gillespie
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
| | - Rui Song
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - John P Barile
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Lorie Okada
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Shari Brown
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Kerry Traub
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julia Trout
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Gina M Simoncini
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Absolute Care, Philadelphia, PA, USA
| | - Casey D Xavier Hall
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Crystal A Gadegbeku
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Frank Y Wong
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
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2
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Freitas M, Neves C, Sarmento H, Cunha P, Cotter J. Assessment of Cardiovascular Risk and Arterial Stiffness in Patients With Human Immunodeficiency Virus. Cureus 2023; 15:e41784. [PMID: 37575811 PMCID: PMC10420332 DOI: 10.7759/cureus.41784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Several studies suggest that patients infected with the human immunodeficiency virus (HIV) under highly active antiretroviral therapy (HAART) have a higher cardiovascular risk than the general population. Arterial stiffness is an independent predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (PWV). The objectives of this study were to characterize a sample of HIV-infected patients under HAART regarding cardiovascular risk, compare PWV values of this group with those of uninfected controls, and investigate predictors of PWV in the HIV-infected group. METHODS PWV was measured, and data was collected from a sample of 125 HIV-infected patients under HAART. PWV measurements in the study group were compared with those in a control group of 250 subjects similar in sex, age, prevalence of hypertension, and type 2 diabetes mellitus (DM). A linear regression model was constructed to identify predictors of PWV in the HIV-infected group. RESULTS In the HIV-infected group, composed mostly of men, the mean age and respective standard deviation were 48.6 ± 11.6 years. In this group, 112 individuals (89.6%) presented moderate to very high cardiovascular risk. Significant differences were found in median PWV between HIV-infected and control groups (8.56 vs. 8.00 m/s, p = .002). Age, peripheral systolic blood pressure, presence of DM, amount of alcohol consumed, and current CD4+ T cell count were independent predictors of PWV in the HIV-infected group. Conclusions: The HIV-infected group showed higher cardiovascular risk and arterial stiffness measurements than the general population. PWV may be an important predictor of subclinical cardiovascular disease in HIV-infected patients.
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Affiliation(s)
- Mariana Freitas
- Nephrology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT
- School of Medicine, University of Minho, Braga, PRT
| | - Clarisse Neves
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Helena Sarmento
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Pedro Cunha
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Jorge Cotter
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
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Trifirò S, Cavallin F, Mangi S, Mhaluka L, Maffoni S, Taddei S, Putoto G, Torelli GF. Hypertension in people living with HIV on combined antiretroviral therapy in rural Tanzania. Afr Health Sci 2023; 23:129-136. [PMID: 37545920 PMCID: PMC10398461 DOI: 10.4314/ahs.v23i1.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Exposure to anti-retroviral therapy in HIV infection has been associated with hypertension, but whether and to what extent HIV-related factors and anti-retroviral treatment contribute to hypertension is not well defined; in addition, data are particularly scarce in Sub-Saharan Africa. Aim of the study was to investigate prevalence and awareness of hypertension in a cohort of people living with HIV (PLWHIV) on anti-retroviral therapy in rural Tanzania, and to identify possible predictors of hypertension. A cross-sectional study on hypertension in PLWHIV was conducted at Tosamaganga District Hospital, Iringa Region, Tanzania. Subjects on anti-retroviral therapy, age 26-80 years and with monthly attendance to the HIV clinic, were considered eligible. A total number of 242 patients were included in the analysis. Sixty-two subjects (26%) had hypertension, the majority (77%) of them not aware of the condition and/or not on treatment. Older age, higher BMI and lower baseline T-CD4 count were predictors of hypertension at multivariate analysis. The results of the study suggest that hypertension screening should become part of ordinary care of PLWHIV in Tanzania, particularly in subjects with more severe immunosuppression. Leveraging already existing HIV services could be an option to prevent the burden of non-AIDS complication and related deaths.
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Affiliation(s)
- Silvia Trifirò
- Doctors with Africa CUAMM, Iringa, Tanzania
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Sabina Mangi
- Tosamaganga Council Designated Hospital, Iringa, Tanzania
| | | | - Silvia Maffoni
- Doctors with Africa CUAMM, Iringa, Tanzania
- University of Pavia, Italy
| | | | | | - Giovanni F Torelli
- Doctors with Africa CUAMM, Dar Es Salaam, Tanzania
- Policlinico Umberto I, Rome, Italy
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Rivera AS, Rusie L, Plank M, Siddique J, Beach LB, Lloyd-Jones D, Feinstein MJ. Association of Cumulative Viral Load With the Incidence of Hypertension and Diabetes in People With HIV. Hypertension 2022; 79:e135-e142. [PMID: 36378919 PMCID: PMC9673163 DOI: 10.1161/hypertensionaha.122.19302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND HIV induces several metabolic derangements that contribute to cardiovascular disease, but it is unclear if HIV increases diabetes or hypertension risk. Refining longitudinal relationships between HIV-specific factors and cardiovascular disease risk factors across different care settings may help inform cardiovascular disease prevention among people with HIV (PWH). METHODS We tested the hypothesis that long-term higher cumulative viral load (viremia-copy-year) is associated with higher risk of diabetes and hypertension by analyzing electronic records of PWH from 2 distinct health systems in Chicago (Northwestern Medicine and Howard Brown Health Care) receiving care in 2004 to 2019. We used joint longitudinal-survival models to assess multivariable-adjusted associations. Subgroup analyses per site were also conducted. RESULTS We observed 230 (3.0%) incident diabetes cases in 7628 PWH without baseline diabetes and 496 (6.7%) hypertension cases in 7450 PWH without baseline hypertension. Pooled analysis showed a direct association of viremia-copy-year with incident hypertension (hazards ratio, 1.20 [95% CI, 1.14-1.26]) but not with diabetes (hazards ratio, 1.03 [95% CI, 0.96-1.10]). However, site-specific differences existed whereby the Northwestern-only analysis demonstrated a significant association of viremia-copy-year with hypertension (hazards ratio, 1.29 [95% CI, 1.08-1.32]). Additionally, higher social deprivation index (both sites) and diagnosis of mental health disorder (Howard Brown Health only) was associated with higher diabetes and hypertension risk. CONCLUSIONS Cumulative viral load may be associated with incident hypertension among PWH. Associations of HIV control with cardiovascular disease risk factors among PWH may differ by health care system context.
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Affiliation(s)
- Adovich S. Rivera
- Institute for Public Health and Management, Feinberg School
of Medicine, Northwestern University
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
| | | | | | - Juned Siddique
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
| | - Lauren B. Beach
- Institute for Sexual and Gender Minority Health, Feinberg
School of Medicine, Northwestern University
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
- Department of Medicine, Feinberg School of Medicine,
Northwestern University
| | - Matthew J. Feinstein
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
- Institute for Sexual and Gender Minority Health, Feinberg
School of Medicine, Northwestern University
- Department of Pathology, Feinberg School of Medicine,
Northwestern University
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5
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Valderrama-Beltrán S, Martínez-Vernaza S, Figueredo M, Martínez E, Blair KJ, Cuervo-Rojas J, Arévalo L, De La Hoz A, Quiroga C, Mueses H, Sussmann O, Mantilla M, Ramírez C, Gonzalez C, Montero-Riascos L, Botero M, Alzate-Ángel J, García-Garzón M, Franco J, Lenis W, Galindo-Orrego X, Stand J, Fonseca N, Alzamora D, Ramos O, Tobon W, Ruiz J, León S, Rojas-Rojas M, Urrego-Reyes J, Beltrán-Rodríguez C, Rosselli D, Rodriguez-Lugo DA, Villamil-Castañeda LP, Álvarez-Moreno C. Cardiovascular risk factors and comorbidities in people living with HIV: A cross-sectional multicenter study from Colombia comorbidities in a Colombian PLWHIV population. Int J STD AIDS 2022; 33:641-651. [PMID: 35502981 DOI: 10.1177/09564624221089456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. METHODS This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. RESULTS A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively. CONCLUSIONS In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.
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Affiliation(s)
- Sandra Valderrama-Beltrán
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Samuel Martínez-Vernaza
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - María Figueredo
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ernesto Martínez
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, 28006Universidad Del Valle, Cali, Colombia
| | - Kevin J Blair
- Department of Surgery, David Geffen School of Medicine, 12222University of California, Los Angeles, CA, USA.,Division of Infectious Diseases, Department of Medicine, South American Program in HIV Prevention Research (SAPHIR), UCLA, Los Angeles, CA, USA
| | - Juliana Cuervo-Rojas
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Arévalo
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia
| | - Alejandro De La Hoz
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Camilo Quiroga
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Héctor Mueses
- HIV Clinic, 456131Corporación de Lucha Contra El Sida, Cali, Colombia
| | - Otto Sussmann
- HIV Clinic, Infectoclínicos, Bogotá, Colombia.,HIV Clinic, Asistencia Científica de Alta Complejidad, Bogotá, Colombia
| | - Mónica Mantilla
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia.,HIV Clinic, SANAS IPS, Bogotá, Colombia
| | | | | | - Leonardo Montero-Riascos
- Division of Infectious Diseases, School of Medicine, 67637Universidad Libre, Cali, Colombia.,HIV Clinic, Todomed Cali, Cali, Colombia
| | | | | | | | | | | | | | - Javier Stand
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia
| | - Norberto Fonseca
- HIV Clinic, Asistencia Científica de Alta Complejidad, Bogotá, Colombia
| | | | - Olga Ramos
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia
| | - Wilmar Tobon
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia
| | - Jaime Ruiz
- Research Department, MSD Colombia, Bogotá, Colombia
| | | | | | | | | | - Diego Rosselli
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diego-Andres Rodriguez-Lugo
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lina Paola Villamil-Castañeda
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Álvarez-Moreno
- Vicepresidente Científico, Clínica Colsanitas, Bogotá, Colombia.,Division of Infectious Diseases, Facultad de Medicina, 28021Universidad Nacional de Colombia, Bogotá, Colombia
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O'Neil PJ, Stafford KA, Ryscavage PA. Assessing risk factors for hypertension in young adults with perinatally acquired HIV infection: A case-control study. HIV Med 2021; 23:457-464. [PMID: 34725913 DOI: 10.1111/hiv.13199] [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: 09/15/2020] [Revised: 04/28/2021] [Accepted: 10/10/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although the risk of AIDS-associated diseases has declined dramatically with combination antiretroviral therapy (cART), the incidence rates of chronic non-AIDS-associated diseases in perinatally HIV-infected adults have risen and have not been well characterized. Both traditional and HIV-associated risk factors have been found to contribute to hypertension in non-perinatally HIV-infected adults; whether these same factors contribute to hypertension in perinatally infected adults is not known. The purpose of this study was to determine the socio-demographic, clinical, virological and immunological factors associated with systemic hypertension among a cohort of perinatally HIV-infected adolescents and young adults. METHODS We conducted a case-control study among a population of adults aged 18-35 years with perinatally acquired HIV infection receiving care at the University of Maryland Medical Center. Covariates assessed included traditional risk factors such as age, family history of hypertension, and smoking, as well as numerous HIV- and antiretroviral-associated covariates, including CD4 nadir. RESULTS Approximately 31% of the cohort met criteria for hypertension. There were no significant differences in the odds of most traditional or HIV-associated risk factors among perinatally HIV-infected adults with hypertension compared with those with no diagnosis of hypertension. Exposure to lopinavir/ritonavir was associated with greater odds of not having hypertension, while a concurrent diagnosis of chronic kidney disease (CKD) was associated with greater odds of having hypertension. CONCLUSIONS The results of this study suggest that most traditional and HIV-related risk factors do not appear to increase the odds of having hypertension in this cohort of individuals. The aetiology of hypertension in this population remains to be elucidated.
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Affiliation(s)
- Patrick J O'Neil
- Greater Lawrence Family Health Center, Lawrence, Massachusetts, USA
| | - Kristen A Stafford
- Institute of Human Virology, University of Maryland Medical School, Baltimore, Maryland, USA
| | - Patrick A Ryscavage
- Institute of Human Virology, University of Maryland Medical School, Baltimore, Maryland, USA
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Taramasso L, Bonfanti P, Ricci E, Maggi P, Orofino G, Squillace N, Menzaghi B, Madeddu G, Molteni C, Vichi F, Riguccini E, Saracino A, Santoro C, Guastavigna M, Francisci D, Di Biagio A, De Socio GV. Metabolic syndrome and body weight in people living with HIV infection: analysis of differences observed in three different cohort studies over a decade. HIV Med 2021; 23:70-79. [PMID: 34473897 DOI: 10.1111/hiv.13165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/25/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to assess the incidence of being overweight and metabolic syndrome (MS) among people living with HIV (PHIV) in three different cross-sectional studies conducted over three different periods: 2005, 2011 and 2015. METHODS This was a multi-centre, nationwide study. Data were collected in three studies from the CISAI group - SIMOne, HIV-HY and STOPSHIV - and included a total of 3014 PHIV. Logistic regression [odds ratio (OR), 95% confidence interval (CI)] was used to account for age and gender difference among three groups when comparing MS prevalence and being overweight; potential confounders were accounted for by including them in the regression equation. RESULTS Overall, the mean age was 46.9 ± 10.2 years, and men comprised 73.3% of participants. Comparing 2005, 2011 and 2015, MS was present in 34.5%, 33.0% and 29.3% of PHIV, respectively. Adjusted OR for MS was 0.64 (95% CI: 0.52-0.78) in 2011 and 0.56 (95% CI: 0.46-0.69) in 2015 compared with 2005, while BMI (kg/m2 ) increased from 23.6 in 2005, 24.5 in 2011 and 24.5 in 2015, with a concomitant increase of being overweight from 29.4% to 39.5% to 39.6% (p < 0.0001). CONCLUSIONS In recent years, PHIV have had a significantly improved metabolic profile compared with previously, despite increasing weight and BMI.
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Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Clinic, Policlinico San Martino Hospital-IRCCS, Genoa, Italy
| | - Paolo Bonfanti
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A", Amedeo di Savoia Hospital, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Chiara Molteni
- Infectious Diseases Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Italy
| | - Erika Riguccini
- Clinica di Malattie Infettive, Ospedale "Santa Maria della Misericordia" e Università di Perugia, Perugia, Italy
| | | | - Carmen Santoro
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Marta Guastavigna
- Unit of Infectious Diseases, "Divisione A", Amedeo di Savoia Hospital, Torino, Italy
| | - Daniela Francisci
- Clinica di Malattie Infettive, Ospedale "Santa Maria della Misericordia" e Università di Perugia, Perugia, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Giuseppe Vittorio De Socio
- Clinica di Malattie Infettive, Ospedale "Santa Maria della Misericordia" e Università di Perugia, Perugia, Italy
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8
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Gómez-Berrocal A, De Los Santos-Gil I, Abad-Pérez D, Gutiérrez-Liarte Á, Ibáñez-Sanz P, Sanz-Sanz J, Suárez C. Ambulatory Blood Pressure Monitoring in HIV-Infected Patients: Usefulness for Cardiovascular Risk Assessment. J Int Assoc Provid AIDS Care 2021; 19:2325958220935693. [PMID: 32812480 PMCID: PMC7444154 DOI: 10.1177/2325958220935693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: There is a lack of consensus regarding the risk of hypertension in HIV-infected patients compared to the general population. Ambulatory blood pressure monitoring (ABPM) is the most accurate method for the hypertension diagnosis. Nevertheless, it is rarely used in HIV clinical care. Materials and Methods: All HIV-infected patients who underwent 24 hours ABPM were included. The agreement between office blood pressure (BP) readings and ABPM was analyzed. The rate of patients with masked hypertension (MH), isolated clinical hypertension, and nocturnal hypertension was obtained. Furthermore, it was analyzed if the differences between both methods may affect the cardiovascular risk (CVR) assessment. Results: A total of 116 patients were included. The κ coefficient between office BP and ABPM was 0.248. Over a quarter of the cohort was diagnosed with MH—25.8% (CI 95% 17.7%-34.0%), and 12% (CI 95%: 6.1%-16.1%) was diagnosed with ICH. Moreover, 19% of patients had hypertension exclusively during the night. The patients classified as low risk according to the CVR scores had a different diagnosis with ABPM than with office BP (P < .001). Conclusions: The agreement between office BP and ABPM was low in HIV-infected patients. Ambulatory BP monitoring is useful in HIV-infected patients as a hypertension diagnosis method, especially among patients classified as low risk.
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Affiliation(s)
- Ana Gómez-Berrocal
- 16517Hospital Universitario de La Princesa, Madrid, Spain.,16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Ignacio De Los Santos-Gil
- 16517Hospital Universitario de La Princesa, Madrid, Spain.,16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Patricia Ibáñez-Sanz
- 16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Jesús Sanz-Sanz
- 16517Hospital Universitario de La Princesa, Madrid, Spain.,16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Suárez
- 16517Hospital Universitario de La Princesa, Madrid, Spain.,16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
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9
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Jackson IL, Ukwe CV. Clinical outcomes of pharmaceutical care intervention in HIV positive patients with hypertension: A randomized controlled study. J Clin Pharm Ther 2021; 46:1083-1094. [PMID: 33666264 DOI: 10.1111/jcpt.13400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Pharmaceutical care (PC) has been shown to improve clinical outcomes in hypertensive patients as well as in people living with HIV (PLWHV). The objective of this study was to evaluate the impact of PC on blood pressure (BP) control, viral load and adherence to medications in hypertensive PLWHV. METHODS This was a prospective, randomized controlled study conducted in the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria. Eligible ambulatory patients were randomized equally to two study arms. The control arm (CA) received the traditional care offered at the HIV clinic; the intervention arm (IA) received the traditional care in addition to PC by the research pharmacist, which included structured education/counselling. BP and self-reported medication adherence were measured at baseline, 6 months and 12 months. Viral load was obtained at baseline and after 12 months. Data were analysed with spss, version 25.0. RESULTS AND DISCUSSION Of the 206 participants initially randomized, 182 (91 in each study arm) completed the 12-month follow-up. No significant differences existed in both arms concerning socio-demographic/clinical characteristics of participants at baseline (p > 0.05). After 12 months, BP control was significantly higher in the IA (53.4% vs. 25.2%; p < 0.001, adjusted odds ratio, aOR = 3.20 (95% CI 1.59-6.44). Systolic BP reduced by 0.9 mmHg from baseline in the CA (p = 0.668) and by 16.67 mmHg from baseline value in the IA (p < 0.001). Diastolic BP increased by 1.9 mmHg in the CA (p = 0.444), but reduced by 7.0 mmHg in the IA (p < 0.001). No significant differences were observed in the change from baseline in the proportion with undetectable plasma viral load (UPVL) in both groups (p > 0.05). PC led to an increase in mean adherence to antiretroviral drugs (Δ = 0.55; p = 0.015), and an increase in mean adherence to antihypertensive drugs (Δ = 2.32; p < 0.001) in the IA. WHAT IS NEW AND CONCLUSION To our knowledge, this is the first prospective randomized controlled study evaluating the impacts of PC on clinical outcomes in hypertensive PLWHV with a 12-month follow-up. Our results show that PC significantly improved BP control and adherence to antiretroviral and antihypertensive medications, but had no significant effect on viral load in HIV positive patients with hypertension. Providers of care for PLWHV should leverage the established HIV treatment successes for promoting adherence to treatment for common comorbidities like hypertension in PLWHV in order to improve clinical outcomes.
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Affiliation(s)
- Idongesit L Jackson
- Department of Clinical Pharmacy and Biopharmacy, University of Uyo, Uyo, Nigeria
| | - Chinwe V Ukwe
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Nigeria
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10
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Is It Feasible to Impact on Smoking Habits in HIV-Infected Patients? Mission Impossible From the STOPSHIV Project Cohort. J Acquir Immune Defic Syndr 2020; 83:496-503. [PMID: 31914000 DOI: 10.1097/qai.0000000000002284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Assessment of the feasibility and effectiveness of a brief intervention for smoking cessation in people living with HIV (PLWH). SETTING Multicenter cohort prospective study involving PLWH from 10 Italian infectious disease centers. METHODS During routine HIV care, clinicians delivered the 5As brief intervention (Ask, Advise, Assess, Assist, Arrange) to each patient who enrolled in the study, following the European AIDS Clinical Society guidelines. At study end, participating clinicians evaluated their own adherence to intervention: "standard" if counseling was delivered in at least half of the follow-up visits, "soft" if less. The main outcome measure was smoking abstinence ≥6 months. Abstinence predictors were evaluated using a Cox-proportional hazard regression model. RESULTS One thousand eighty-seven PLWH-patients (age 47.9 ± 10.8, male 73.5%) were followed for a median of 23 months (interquartile range 21-25). At baseline, current smokers were 561 (51.6%). Standard intervention was performed in 4 of 10 centers and included 343 smokers; soft intervention was performed in 6 centers (218 smokers). At last visit, 35 patients in standard (10.8%) and 6 in soft intervention (2.8%) achieved self-reported tobacco abstinence ≥6 months (P = 0.0009). Overall, the 5As intervention led to 7.3% 6-month interruptions. In the multivariable analysis, significant predictors for 6-month smoking cessation were: lower Fagerström score, stage of change (preparation/contemplation vs. precontemplation), and standard intervention. CONCLUSION Adherence to the 5As brief intervention emerged as a critical factor for success. In fact, compared with soft intervention, the standard intervention significantly increased abstinence, highlighting that clinicians need more time and supporting tools to encourage PLWH to quit smoking.
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11
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Vargas-Pacherrez D, Brites C, Cotrim HP, Daltro C. High Prevalence of AH in HIV Patients on ART, in Bahia, Brazil. Curr HIV Res 2020; 18:324-331. [PMID: 32586252 DOI: 10.2174/1570162x18666200620212547] [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: 02/27/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The prevalence of arterial hypertension (AH) in HIV-patients is highly variable and its association with antiretroviral therapy (ART) is controversial. OBJECTIVE To estimate the prevalence of AH and associated factors in HIV-patients on ART. METHODS This cross-sectional study was conducted in HIV-patients attended in a referral center in Salvador, Brazil. We evaluated clinical, socio-demographic and anthropometric data. Student's ttests or Mann-Whitney's and Pearson's chi-square tests were used to compare the groups. Values of p <0.05 were considered significant. The variables that presented a value of p <0.20 were included in a logistic regression model. RESULTS We evaluated 196 patients (60.7% male) with a mean age of 46.8 ± 11.7 years and a mean body mass index of 24.9 ± 5.3 kg / m2. The median elapsed time since HIV diagnosis and ART use was 11.8 (4.4 - 18.1) and 7.2 (2.7 - 15.3) years, respectively. The prevalence of AH was 41.8%. For individuals > 50 years old, there was a significant association between the increased abdominal circumference and AH and patients ≤ 50 years old presented significant association between AH and overweight, increased abdominal circumference and number of previous ART regimens. After multivariate analysis, age [OR:1.085; 95% CI 1,039 - 1,133], overweight [OR: 4.205; 95% CI 1,841 - 9,606], family history of AH [OR: 2.938; 95% CI 1,253 - 6.885], increased abdominal circumference [OR: 2.774; 95% CI 1.116 - 6.897] and life-time number of ART regimens used [OR: 3.842; 95% CI 1.307 - 11.299] remained associated with AH. CONCLUSION AH was highly prevalent and was associated not only with classical risk factors for arterial hypertension, but also with specific ART regimens.
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Affiliation(s)
- Daniel Vargas-Pacherrez
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Bahia, Brazil,Unit of Communicable Diseases and Environmental – Pan American Health Organization Office Altamira - Caracas 1060, Venezuela
| | - Carlos Brites
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Bahia, Brazil
| | - Helma P Cotrim
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Bahia, Brazil
| | - Carla Daltro
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Bahia, Brazil,Escola de Nutrição - Universidade Federal da Bahia (UFBA), Bahia, Brazil
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12
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Masenga SK, Elijovich F, Koethe JR, Hamooya BM, Heimburger DC, Munsaka SM, Laffer CL, Kirabo A. Hypertension and Metabolic Syndrome in Persons with HIV. Curr Hypertens Rep 2020; 22:78. [PMID: 32880756 PMCID: PMC7467859 DOI: 10.1007/s11906-020-01089-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW With the advent of highly active antiretroviral therapy (ART), the life span of persons with HIV (PWH) has been nearly normalized. With aging, prevalence of the metabolic syndrome (MetS), including hypertension, has increased in the HIV population and exceeds that in the general population in some studies. This is due to a combination of traditional risk factors in addition to the effects attributable to the virus and ART. We review recent findings on the mechanisms contributing to MetS and hypertension in PWH, particularly those specific to the viral infection and to ART. RECENT FINDINGS Activation of the renin-angiotensin-aldosterone system (RAAS) and chronic immune activation contribute to the development of MetS and hypertension in PWH. HIV proteins and some ART agents alter adipocyte health contributing to dyslipidemias, weight gain, and insulin resistance. HIV infection also contributes to hypertension by direct effects on the RAAS that intertwine with inflammation by the RAAS also contributing to T cell activation. Recent data suggest that in addition to current ART, therapeutic targeting of the MetS and hypertension in PWH, by interfering with the RAAS, treating insulin resistance directly or by use of immunomodulators that dampen inflammation, may be critical for preventing or treating these risk factors and to improve overall cardiovascular complications in the HIV-infected aging population.
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Affiliation(s)
- Sepiso K Masenga
- HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Fernando Elijovich
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benson M Hamooya
- HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Douglas C Heimburger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Sody M Munsaka
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Cheryl L Laffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Room 536 Robinson Research Building, Nashville, TN, 37232-6602, USA.
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13
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Xu Y, Chen X, Zhou Z, Morano J, Cook RL. The interaction between detectable plasma viral load and increased body mass index on hypertension among persons living with HIV. AIDS Care 2020; 32:890-895. [PMID: 31530006 PMCID: PMC7874985 DOI: 10.1080/09540121.2019.1668521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
Increased body mass index (BMI) and HIV are each associated with hypertension. This study tested interactions between BMI and detectable plasma viral load (pVL) on hypertension among 659 persons living with HIV (PLWH). All participants were categorized into four subgroups based on BMI (<25 and ≥25 kg/m2) and pVL (<200 and ≥200 copies/ml). Multiplicative interaction was assessed using logistic regression; addictive interaction was assessed using three measures: Relative Excess Risk due to Interaction (RERI), Attributable Proportion (AP), and Synergy index (S). Compared to the participants with normal BMI and undetectable pVL, those who had increased BMI with an undetectable pVL had an elevated risk of hypertension with OR [95%CI] = 1.80 [1.02, 3.20]; the risk was further increased for those who had increased BMI with detectable pVL with OR [95%CI] = 3.54 [1.71, 7.31]. The multiplicative interaction was significant (p = 0.01). Results from additive interaction indicated RERI [95%CI] =1.89 [0.76, 4.79] and AP [95%CI] = 0.64 [0.32, 0. 95]. The interaction effects of increased BMI and detectable pVL on hypertension on both multiplicative and additive scales suggested that PLWH with increased BMI and detectable pVL should be intensively managed and monitored for hypertension prevention and treatment.
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Affiliation(s)
- Yunan Xu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Xinguang Chen
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jamie Morano
- Division of Infectious Diseases and International Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
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14
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De Socio GV, Pasqualini M, Ricci E, Maggi P, Orofino G, Squillace N, Menzaghi B, Madeddu G, Taramasso L, Francisci D, Bonfanti P, Vichi F, dell'Omo M, Pieroni L. Smoking habits in HIV-infected people compared with the general population in Italy: a cross-sectional study. BMC Public Health 2020; 20:734. [PMID: 32434482 PMCID: PMC7238525 DOI: 10.1186/s12889-020-08862-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Tobacco use is a leading cause of preventable diseases and death for all individuals, even more so for people living with HIV (PLWH), due to their status of chronic inflammation. To date, in Italy no study was performed to compare smoking habits in PLWH and the general population. We aimed to investigate smoking habits in PLWH, as compared to the general population. Methods Multi-center cross-sectional study. Smoking habits were compared between PLWH and the general population. PLWH were enrolled in the STOPSHIV Study. The comparison group from the general population was derived from a survey performed by the National Statistics Institute (ISTAT), with a stratified random sampling procedure matching 2:1 general population subjects with PLWH by age class, sex, and macro-area of residence. Results The total sample consisted of 1087 PLWH (age 47.9 ± 10.8 years, male 73.5%) and 2218 comparable subjects from the general population. Prevalence of current smokers was 51.6% vs 25.9% (p < 0.001); quitting smoking rate was 27.1% vs. 50.1% (p < 0.001) and the mean number of cigarettes smoked per day was 15.8 vs. 11.9 (p < 0.001), respectively for PLWH and the general population. Smoking and heavy smoking rates amongst PLWH were significantly higher even in subjects who reported diabetes, hypertension and extreme obesity (p < 0.001). Logistic regressions showed that PLWH were more likely current smokers (adjusted Odds Ratio, aOR = 3.11; 95% Confidence Interval (CI) =2.62–3.71; p < 0.001) and heavy smokers (> 20 cigarettes per day) (aOR = 4.84; 95% CI = 3.74–6.27; p < 0.001). PLWH were less likely to have quitted smoking (aOR = 0.36; 95% CI = 0.29–0.46; p < 0.001). Conclusion HIV-infected patients showed a higher rate of current smokers, a larger number of cigarettes smoked and a lower quitting rate than the general population. Our findings emphasize the need for smoking cessation strategies targeting HIV persons.
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Affiliation(s)
- Giuseppe Vittorio De Socio
- Department of Medicine 2, Infectious Diseases Unit, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy. .,Current Address: Azienda Ospedaliera di Perugia, Piazzale Menghini 1, 06129, Perugia, Italy.
| | - Marta Pasqualini
- Department of Political Science, University of Perugia, Perugia, Italy
| | - Elena Ricci
- Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Maggi
- Infectious Diseases Clinic, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giancarlo Orofino
- Division I Infectious and Tropical Diseases, ASL Città di Torino, Turin, Italy
| | - Nicola Squillace
- Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Infectious Diseases Unit, ASST della Valle Olona - Busto Arsizio (VA), Busto Arsizio, Italy
| | - Giordano Madeddu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Lucia Taramasso
- Department of Health Science (DISSAL), Infectious Disease Clinic, University of Genova, Genoa, Italy.,Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Francisci
- Department of Medicine 2, Infectious Diseases Unit, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, A. Manzoni Hospital, Lecco, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, USL Centro, Florence, Italy
| | - Marco dell'Omo
- Department of Medicine, Perugia University, Perugia, Italy
| | - Luca Pieroni
- Current Address: Azienda Ospedaliera di Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
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15
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Dominick L, Midgley N, Swart LM, Sprake D, Deshpande G, Laher I, Joseph D, Teer E, Essop MF. HIV-related cardiovascular diseases: the search for a unifying hypothesis. Am J Physiol Heart Circ Physiol 2020; 318:H731-H746. [PMID: 32083970 DOI: 10.1152/ajpheart.00549.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although the extensive rollout of antiretroviral (ARV) therapy resulted in a longer life expectancy for people living with human immunodeficiency virus (PLHIV), such individuals display a relatively increased occurrence of cardiovascular diseases (CVD). This health challenge stimulated significant research interests in the field, leading to an improved understanding of both lifestyle-related risk factors and the underlying mechanisms of CVD onset in PLHIV. However, despite such progress, the precise role of various risk factors and mechanisms underlying the development of HIV-mediated CVD still remains relatively poorly understood. Therefore, we review CVD onset in PLHIV and focus on 1) the spectrum of cardiovascular complications that typically manifest in such persons and 2) underlying mechanisms that are implicated in this process. Here, the contributions of such factors and modulators and underlying mechanisms are considered in a holistic and integrative manner to generate a unifying hypothesis that includes identification of the core pathways mediating CVD onset. The review focuses on the sub-Saharan African context, as there are relatively high numbers of PLHIV residing within this region, indicating that the greater CVD risk will increasingly threaten the well-being and health of its citizens. It is our opinion that such an approach helps point the way for future research efforts to improve treatment strategies and/or lifestyle-related modifications for PLHIV.
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Affiliation(s)
- Leanne Dominick
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Natasha Midgley
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lisa-Mari Swart
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Devon Sprake
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Gaurang Deshpande
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ismail Laher
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa.,Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danzil Joseph
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eman Teer
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - M Faadiel Essop
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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16
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Ballegaard V, Pedersen KK, Brændstrup P, Kirkby N, Stryhn A, Ryder LP, Gerstoft J, Nielsen SD. Cytomegalovirus-specific CD8+ T-cell responses are associated with arterial blood pressure in people living with HIV. PLoS One 2020; 15:e0226182. [PMID: 31929537 PMCID: PMC6957152 DOI: 10.1371/journal.pone.0226182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
People living with HIV (PLHIV) are at increased risk for cardiovascular disease (CVD), and immunity against cytomegalovirus (CMV) may be a contributing factor. We hypothesized that enhanced T-cell responses against CMV and CMV-IgG antibody-levels are associated with higher arterial blood pressure in PLHIV. We assessed serum CMV-IgG, systolic- (SBP) and diastolic- (DBP) blood pressure, pulse pressure (PP), traditional risk factors, activated CD8+ T-cells (CD38+HLA-DR+), senescent CD8+ T-cells (CD28-CD57+) and interleukin-6 (IL-6) in 60 PLHIV and 31 HIV-uninfected controls matched on age, gender, education and comorbidity. In PLHIV, expression of interleukin-2, tumor necrosis factor-α and interferon-γ was measured by intracellular-cytokine-staining after stimulation of T-cells with CMV-pp65 and CMV-gB. Associations between CMV-specific immune responses and hypertension, SBP, DBP or PP were assessed by multivariate logistic and linear regression models adjusted for appropriate confounders. The median age of PLHIV was 47 years and 90% were male. Prevalence of hypertension in PLHIV was 37% compared to 55% of HIV-uninfected controls. CMV-specific CD8+ T-cell responses were independently associated with higher PP (CMV-pp65; β = 2.29, p = 0.001, CMV-gB; β = 2.42, p = 0.001) in PLHIV. No significant differences were found with regard to individual measures of SBP and DBP. A possible weak association was found between CMV-IgG and hypertension (β = 1.33, p = 0.049) after adjustment for age, smoking and LDL-cholesterol. HIV-related factors, IL-6, CD8+ T-cell activation or CD8+ T-cell senescence did not mediate the associations, and no associations were found between CMV-specific CD4+ T-cell responses and blood pressure in PLHIV. In conclusion, increased arterial blood pressure in PLHIV may be affected by heightened CMV-specific CD8+ T-cell responses.
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Affiliation(s)
- Vibe Ballegaard
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Karin Kaereby Pedersen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Peter Brændstrup
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Herlev University Hospital, Herlev, Denmark
| | - Nikolai Kirkby
- Department of Medical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anette Stryhn
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Lars P Ryder
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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17
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De Socio GV, Maggi P, Ricci E, Orofino G, Squillace N, Menzaghi B, Madeddu G, Di Biagio A, Francisci D, Bonfanti P, Vichi F, Schiaroli E, Santoro C, Guastavigna M, dell'Omo M. Smoking Habits in Human Immunodeficiency Virus-Infected People from Italy: A Cross-Sectional Analysis of the STOPSHIV Cohort. AIDS Res Hum Retroviruses 2020; 36:19-26. [PMID: 31502468 DOI: 10.1089/aid.2019.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In a nationwide Italian sample of people living with HIV (PLWH), the prevalence of smoking, nicotine dependence, propensity to stop smoking, and cardiovascular profile were investigated. The nicotine dependence by Fagerström test and the propensity to stop according to the stages of change were evaluated. Associations between smoking habits and patients' characteristics were analyzed using an unconditional logistic regression model. Among 1,087 PLWH (age 47.9 ± 10.8 years, men 73.5%), the prevalence of current smokers was 51.6%. The median of Fagerström test was 4 (interquartile range 2-6); 60.1% of the smokers were in precontemplation, 17.6% in contemplation, 18.7% in preparation, and 3.6% in action. In a logistic multivariate model, current smoking was associated with male sex, being divorced/widowed, Caucasian ethnicity, dyslipidemia, atherosclerotic cardiovascular disease risk, psychiatric comorbidity, hepatitis C virus infection, and alcohol abuse. Low high-density lipoprotein cholesterol level was associated with high nicotine dependence. More than 50% of PLWH were current smokers, one-third of them showed a high or very high degree of dependence. Our findings draw attention to the need of smoking cessation strategies for PLWH.
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Affiliation(s)
- Giuseppe Vittorio De Socio
- Department of Medicine 2, Infectious Diseases Clinic, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Paolo Maggi
- Infectious Diseases Clinic, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elena Ricci
- Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona-Busto Arsizio, Busto Arsizio, Italy
| | - Giordano Madeddu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Antonio Di Biagio
- Infectious Diseases, San Martino Policlinico Hospital Genoa, Genoa, Italy
| | - Daniela Francisci
- Department of Medicine 2, Infectious Diseases Clinic, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Paolo Bonfanti
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, USL Centro, Florence, Italy
| | - Elisabetta Schiaroli
- Department of Medicine 2, Infectious Diseases Clinic, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Carmen Santoro
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Marta Guastavigna
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, Italy
| | - Marco dell'Omo
- Department of Medicine, Perugia University, Perugia, Italy
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Muiruri C, Sico IP, Schexnayder J, Webel AR, Okeke NL, Longenecker CT, Gonzalez JM, Jones KA, Gonzales SE, Bosworth HB. Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry. Patient Prefer Adherence 2020; 14:985-994. [PMID: 32669837 PMCID: PMC7337208 DOI: 10.2147/ppa.s254882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND After achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression. METHODS Qualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory. RESULTS Fifty-one individuals who had achieved viral suppression (<200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers' recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors. CONCLUSION Findings suggest that future research should focus on developing interventions to enhance patient-provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.
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Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Correspondence: Charles Muiruri Email
| | - Isabelle P Sico
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie Schexnayder
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah E Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Ryscavage P, Still W, Nyemba V, Stafford K. Prevalence of Systemic Hypertension Among HIV-Infected and HIV-Uninfected Young Adults in Baltimore, Maryland. South Med J 2019; 112:387-391. [PMID: 31282968 DOI: 10.14423/smj.0000000000001001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Adults with perinatally acquired human immunodeficiency virus (PHIV) infection may be at increased risk for nonacquired immunodeficiency syndrome (AIDS) diseases, including systemic hypertension (HTN). The purpose of this study was to examine the prevalence of HTN among young adults with PHIV compared with recently infected and uninfected young adults. METHODS We conducted a cross-sectional study of young adults with PHIV, frequency matched on race and sex to a stratified random sample of young adults with nonperinatally acquired HIV (NPHIV) and HIV-uninfected young adults. All of the subjects were aged 18 to 29 years. HTN was defined as two systolic blood pressure measurements ≥140 mm Hg or diastolic ≥90 mm Hg at least 3 months apart and/or prescription for an antihypertensive medication. Logistic regression was used to estimate adjusted prevalence odds ratios and 95% confidence intervals (CIs) for the association between HIV infection and HTN. RESULTS A total of 324 patients were included-108 per exposure group. The prevalence of HTN was 23% among individuals with PHIV, 10% among individuals with NPHIV, and 8% among HIV-uninfected patients. PHIV patients had 3.4 (95% CI 1.48-7.66) times the base odds of having HTN compared with HIV-uninfected patients, and 2.7 (95% CI 1.23-5.71) times the odds compared with NPHIV patients. By multivariable analysis, PHIV patients had 4.7 and 2.9 times the odds of having HTN compared with HIV-uninfected patients and NPHIV patients, respectively, after controlling for sex, race, and family history of hypertension. CONCLUSIONS Our findings suggest that HTN prevalence among PHIV young adults is significantly higher than sex- and race-matched NPHIV and HIV-uninfected patients of similar age.
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Affiliation(s)
- Patrick Ryscavage
- From the Institute of Human Virology, and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - William Still
- From the Institute of Human Virology, and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Vimbai Nyemba
- From the Institute of Human Virology, and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Kristen Stafford
- From the Institute of Human Virology, and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
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Pierre S, Seo G, Rivera VR, Walsh KF, Victor JJ, Charles B, Julmiste G, Dumont E, Apollon A, Cadet M, Saint‐Vil A, Marcelin A, Severe P, Lee MH, Kingery J, Koenig S, Fitzgerald D, Pape J, McNairy ML. Prevalence of hypertension and cardiovascular risk factors among long-term AIDS survivors: A report from the field. J Clin Hypertens (Greenwich) 2019; 21:1558-1566. [PMID: 31448551 PMCID: PMC6896990 DOI: 10.1111/jch.13663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/14/2019] [Accepted: 06/18/2019] [Indexed: 12/23/2022]
Abstract
HIV infection is associated with increased risk and progression of cardiovascular disease (CVD), yet little is known about the prevalence of CVD risk factors among long-term AIDS survivors in resource-limited settings. Using routinely collected data, we conducted a retrospective study to describe the prevalence of CVD risk factors among a cohort of HIV-infected patients followed for over 10 years in Port-au Prince, Haiti. This cohort includes 910 adults who initiated antiretroviral therapy (ART) between 2003 and 2004 and remained in care between 2014 and 2016 when routine screening for CVD risk factors was implemented at a large clinic in Haiti. A total of 397 remained in care ≥10 years and received screening. At ART initiation, 59% were female, median age was 38 years (IQR 33-44), and median CD4 count was 117 cells/mm3 (IQR 34-201). Median follow-up time from ART initiation was 12.1 years (IQR 11.7-12.7). At screening, median CD4 count was 574 cells/mm3 (IQR 378-771), and 84% (282 of 336 screened) had HIV-1 RNA < 1000 copies/mL. Seventy-four percent of patients had at least 1 risk factor including 58% (224/385) with hypertension, 8% (24/297) diabetes, 43% (119/275) hypercholesterolemia, 8% (20/248) active smoking, and 10% (25/245) obesity. Factors associated with hypertension were age (adjusted OR 1.06, P < .001) and weight at screening (adjusted OR 1.02, P = .019). Long-term AIDS survivors have a high prevalence of CVD risk factors, primarily hypertension. Integration of cardiovascular screening and management into routine HIV care is needed to maximize health outcomes among aging HIV patients in resource-limited settings.
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Affiliation(s)
- Samuel Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Grace Seo
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Vanessa R. Rivera
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Kathleen F. Walsh
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Jean Joscar Victor
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Benedict Charles
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Gaetane Julmiste
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Emelyne Dumont
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Molene Cadet
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Alix Saint‐Vil
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Adias Marcelin
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Myung Hee Lee
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Justin Kingery
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Serena Koenig
- Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Daniel Fitzgerald
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Jean Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Margaret L. McNairy
- Department of Medicine, Center for Global HealthWeill Cornell MedicineNew YorkNYUSA
- Division of General Internal MedicineWeill Cornell MedicineNew YorkNYUSA
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Maggi P, Santoro CR, Nofri M, Ricci E, De Gennaro N, Bellacosa C, Schiaroli E, Orofino G, Menzaghi B, Di Biagio A, Squillace N, Francisci D, Vichi F, Molteni C, Bonfanti P, Gaeta GB, De Socio GV. Clusterization of co-morbidities and multi-morbidities among persons living with HIV: a cross-sectional study. BMC Infect Dis 2019; 19:555. [PMID: 31238916 PMCID: PMC6593514 DOI: 10.1186/s12879-019-4184-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/12/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Among people living with HIV (PLWH), the prevalence of non-HIV related co-morbidities is increasing. Aim of the present study is to describe co-morbidity and multi-morbidity, their clustering mode and the potential disease-disease interactions in a cohort of Italian HIV patients. METHODS Cross-sectional analysis conducted by the Coordinamento Italiano per lo Studio di Allergia e Infezioni da HIV (CISAI) on adult subjects attending HIV-outpatient facilities. Non-HIV co-morbidities included: cardiovascular disease, diabetes mellitus, hypertension, oncologic diseases, osteoporosis, probable case of chronic obstructive pulmonary disease (COPD), hepatitis C virus (HCV) infection, psychiatric illness, kidney disease. Multi-morbidity was defined as the presence of two or more co-morbidities. RESULTS One thousand and eighty-seven patients were enrolled in the study (mean age 47.9 ± 10.8). One hundred-ninety patients (17.5%) had no co-morbidity, whereas 285 (26.2%) had one condition and 612 (56.3%) were multi-morbid. The most recurrent associations were: 1) dyslipidemia + hypertension (237, 21.8%); 2) dyslipidemia + COPD (188, 17.3%); 3) COPD + HCV-Ab+ (141, 12.9%). Multi-morbidity was associated with older age, higher body mass index, current and former smoking, CDC stage C and longer ART duration. CONCLUSIONS More than 50% of PLHW were multi-morbid and about 30% had three or more concurrent comorbidities. The identification of common patterns of comorbidities address the combined risks of multiple drug and disease-disease interactions.
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Affiliation(s)
- Paolo Maggi
- Infectious Diseases Clinic University of Campania "Luigi Vanvitelli", Neaples, Italy
| | | | - Marco Nofri
- Infectious Diseases Clinic, Department of Medicine 2, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Elena Ricci
- Department of Women, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | | | | | - Elisabetta Schiaroli
- Infectious Diseases Clinic, Department of Medicine 2, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio, VA, Italy
| | | | - Nicola Squillace
- Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Department of Medicine 2, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy.,Infectious Diseases Clinic, "Santa Maria" Hospital, University of Perugia, Terni, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, Usl centro, Florence, Italy
| | - Chiara Molteni
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Paolo Bonfanti
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | | | - Giuseppe Vittorio De Socio
- Infectious Diseases Clinic, Department of Medicine 2, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
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Hatleberg CI, Ryom DRL, Monforte AD, Fontas E, Reiss P, Kirk O, Sadr WE, Phillips A, de Wit S, Dabis F, Weber R, Law M, Lundgren JD, Sabin C. Association between exposure to antiretroviral drugs and the incidence of hypertension in HIV-positive persons: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. HIV Med 2018; 19:605-618. [PMID: 30019813 PMCID: PMC6169998 DOI: 10.1111/hiv.12639] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Previous studies have suggested that hypertension in HIV-positive individuals is associated primarily with traditional risk factors such as older age, diabetes and dyslipidaemia. However, controversy remains as to whether exposure to antiretroviral (ARV) drugs poses additional risk, and we investigated this question in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort. METHODS The incidence of hypertension [systolic blood pressure (BP) > 140 and/or diastolic BP > 90 mmHg and/or initiation of antihypertensive treatment] was determined overall and in strata defined by demographic, metabolic and HIV-related factors, including cumulative exposure to each individual ARV drug. Predictors of hypertension were identified using uni- and multivariable Poisson regression models. RESULTS Of 33 278 included persons, 7636 (22.9%) developed hypertension over 223 149 person-years (PY) [incidence rate: 3.42 (95% confidence interval (CI) 3.35-3.50) per 100 PY]. In univariable analyses, cumulative exposure to most ARV drugs was associated with an increased risk of hypertension. After adjustment for demographic, metabolic and HIV-related factors, only associations for nevirapine [rate ratio 1.07 (95% CI: 1.04-1.13) per 5 years] and indinavir/ritonavir [rate ratio 1.12 (95% CI: 1.04-1.20) per 5 years] remained statistically significant, although effects were small. The strongest independent predictors of hypertension were male gender, older age, black African ethnicity, diabetes, dyslipidaemia, use of lipid-lowering drugs, high body mass index (BMI), renal impairment and a low CD4 count. CONCLUSIONS We did not find evidence for any strong independent association between exposure to any of the individual ARV drugs and the risk of hypertension. Findings provide reassurance that screening policies and preventative measures for hypertension in HIV-positive persons should follow algorithms used for the general population.
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Affiliation(s)
- Camilla Ingrid Hatleberg
- CHIP, Dept. of Infectious Diseases Section 2100, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - DR Lene Ryom
- CHIP, Dept. of Infectious Diseases Section 2100, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Antonella d’Arminio Monforte
- Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy
| | - Eric Fontas
- Dept. of Public Health, Nice University Hospital, Nice, France
| | - Peter Reiss
- Academic Medical Center, Dept. of Global Health and Div. of Infectious Diseases, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Ole Kirk
- CHIP, Dept. of Infectious Diseases Section 2100, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wafaa El- Sadr
- ICAP-Columbia University and Harlem Hospital, New York, USA
| | - Andrew Phillips
- Research Dept. of Infection and Population Health, UCL, London, United Kingdom
| | - Stephane de Wit
- Div. of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Francois Dabis
- CHU de Bordeaux and INSERM U897, Université de Bordeaux, Talence, France
| | - Rainer Weber
- Division of infectious diseases and hospital epidemiology, University hospital Zurich, University of Zurich, Switzerland
| | - Matthew Law
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Jens Dilling Lundgren
- CHIP, Dept. of Infectious Diseases Section 2100, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Sabin
- Research Dept. of Infection and Population Health, UCL, London, United Kingdom
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Abstract
PURPOSE OF REVIEW This review describes what is known concerning the burden of hypertension among people living with HIV (PLHIV), and also addresses relevant topics with respect to its risk factors and clinical management. RECENT FINDINGS Hypertension is highly prevalent in HIV-positive populations, and may be more common than in HIV-negative populations. Risk factors contributing to the development of hypertension in PLHIV include demographic factors, genetic predisposition, lifestyle, comorbidities such as obesity, antiretroviral therapy-related changes in body composition, and potentially also immunodeficiency, immune activation and inflammation, as well as effects from antiretroviral therapy itself. Clinical management of hypertension in PLHIV requires awareness for drug-drug interactions between antiretroviral drugs and antihypertensive drugs. Awareness, treatment, and control of hypertension in PLHIV is currently suboptimal and should be improved. SUMMARY The burden of hypertension among PLHIV is high and its pathophysiology most likely multifactorial. Elucidating the exact pathophysiology of hypertension in PLHIV is vital as this may provide new targets to impact and improve clinical management. In the meantime, efforts should be made to improve hypertension management as per existing clinical guidelines in order to safeguard cardiovascular health and quality of life in PLHIV.
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Burkholder GA, Tamhane AR, Safford MM, Muntner PM, Willig AL, Willig JH, Raper JL, Saag MS, Mugavero MJ. Racial disparities in the prevalence and control of hypertension among a cohort of HIV-infected patients in the southeastern United States. PLoS One 2018; 13:e0194940. [PMID: 29596462 PMCID: PMC5875791 DOI: 10.1371/journal.pone.0194940] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 03/13/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND African Americans are disproportionately affected by both HIV and hypertension. Failure to modify risk factors for cardiovascular disease and chronic kidney disease such as hypertension among HIV-infected patients may attenuate the benefits conferred by combination antiretroviral therapy. In the general population, African Americans with hypertension are less likely to have controlled blood pressure than whites. However, racial differences in blood pressure control among HIV-infected patients are not well studied. METHODS We conducted a cross-sectional study evaluating racial differences in hypertension prevalence, treatment, and control among 1,664 patients attending the University of Alabama at Birmingham HIV Clinic in 2013. Multivariable analyses were performed to calculate prevalence ratios (PR) with 95% confidence intervals (CI) as the measure of association between race and hypertension prevalence and control while adjusting for other covariates. RESULTS The mean age of patients was 47 years, 77% were male and 54% African-American. The prevalence of hypertension was higher among African Americans compared with whites (49% vs. 43%; p = 0.02). Among those with hypertension, 91% of African Americans and 93% of whites were treated (p = 0.43). Among those treated, 50% of African Americans versus 60% of whites had controlled blood pressure (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg) (p = 0.007). After multivariable adjustment for potential confounders, prevalence of hypertension was higher among African Americans compared to whites (PR 1.25; 95% CI 1.12-1.39) and prevalence of BP control was lower (PR 0.80; 95% CI 0.69-0.93). CONCLUSIONS Despite comparable levels of hypertension treatment, African Americans in our HIV cohort were less likely to achieve blood pressure control. This may place them at increased risk for adverse outcomes that disproportionately impact HIV-infected patients, such as cardiovascular disease and chronic kidney disease, and thus attenuate the benefits conferred by combination antiretroviral therapy.
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Affiliation(s)
- Greer A. Burkholder
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ashutosh R. Tamhane
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Paul M. Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amanda L. Willig
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - James H. Willig
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - James L. Raper
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michael S. Saag
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michael J. Mugavero
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Association between CD4 Cell Count and Blood Pressure and Its Variation with Body Mass Index Categories in HIV-Infected Patients. Int J Hypertens 2018; 2018:1691474. [PMID: 29610680 PMCID: PMC5828536 DOI: 10.1155/2018/1691474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 11/01/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to establish whether an independent relationship exists between CD4 count and hypertension and if this relationship is modified or confounded by the body mass index (BMI). Methods. A secondary data analysis of a cross-sectional study on 200 HIV/AIDS patients at a referral hospital in Cameroon was conducted. Linear and logistic regression models were used as appropriate to explore the association between the variables of interest. Results. There was no linear association between log CD4 count and both systolic (p = 0.200; r = 0.12) and diastolic blood pressures (p = 0.123; r = 0.14), respectively. After adjusting for BMI, patients with CD4 count ≥ 350 cells/μl were more likely to have hypertension than those with CD4 count < 350 cells/μl (AOR: 2.50, 95% CI: 1.05–5.93, and p = 0.032). There was no effect modification from BMI (test of homogeneity, p = 0.721). There was no independent relationship between CD4 count and hypertension after controlling for age, sex, family history of hypertension, BMI-defined overweight, HAART use, and duration of HIV infection (AOR: 1.66, 95% CI: 0.48–5.71, and p = 0.419). Conclusion. This study did not identify any independent relationship between CD4 count and hypertension. Large prospective studies are recommended to better explore this relationship between hypertension and CD4 count.
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Ding Y, Lin H, Liu X, Zhang Y, Wong FY, Sun YV, Marconi VC, He N. Hypertension in HIV-Infected Adults Compared with Similar but Uninfected Adults in China: Body Mass Index-Dependent Effects of Nadir CD4 Count. AIDS Res Hum Retroviruses 2017; 33:1117-1125. [PMID: 28562067 DOI: 10.1089/aid.2017.0008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Hypertension is a growing problem in the HIV population. The relationship between low nadir CD4 count and hypertension in the HIV-infected population has been reported. However, the effect of nadir CD4 on hypertension due to a different body mass index (BMI) is yet to be fully elucidated. In this cross-sectional study, 345 HIV-infected participants aged ≥40 years were recruited. They were frequency matched and compared with age, sex, and education with HIV-uninfected adults (n = 345). Hypertension prevalence was lower in HIV-infected than in HIV-uninfected participants (23.8% vs. 31.9%; p = .011), but this association was not significant after adjusting for potential confounders. Among HIV-infected individuals, older age, overweight, with a family history of cardiovascular diseases, and nadir CD4 count <50 cells/μl were independently associated with hypertension. Stratifying individuals with BMI category revealed that nadir CD4 count-regardless if it was operationalized as a dichotomous variable (<50 cells/μl) or continuous variable-was found to be associated with hypertension among individuals who were underweight and obese, but not among those who were normal weight and overweight. Among HIV-uninfected individuals, older age and having a waist circumference above cutoff were significantly associated with hypertension. This is one of the first studies to demonstrate that the association of nadir CD4 and hypertension is observed in underweight and obese HIV-infected patients. While these results suggest that the relationship between nadir CD4 count and hypertension might be mediated by body weight, future longitudinal studies will be needed to validate the findings, including its causal pathways.
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Affiliation(s)
- Yingying Ding
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Haijiang Lin
- Department of AIDS/STD Control and Prevention, Taizhou City Center for Disease Control and Prevention, Taizhou City, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yucheng Zhang
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Frank Y. Wong
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, Hawaii
| | - Yan V. Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vincent C. Marconi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
| | - Na He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
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Time trend in hypertension prevalence, awareness, treatment, and control in a contemporary cohort of HIV-infected patients: the HIV and Hypertension Study. J Hypertens 2017; 35:409-416. [PMID: 28005710 DOI: 10.1097/hjh.0000000000001150] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hypertension control is often inadequate in HIV patients. In a contemporary, nationwide cohort of Italian HIV-infected adults, we assessed time trends in hypertension prevalence, awareness, treatment, and control. We also evaluated predictors of cardiovascular events and of new-onset hypertension. METHODS Multicenter prospective cohort study, sampling 961 consecutive HIV patients (71% men, mean age 46 ± 9 years, 30% hypertensive) examined in 2010-2014 and after a median follow-up of 3.4 years. RESULTS Among hypertensive patients, hypertension awareness (63% at baseline and 92% at follow-up), treatment (54 vs. 79%), and control (35 vs. 59%) all improved during follow-up. The incidence of new-onset hypertension was 50.1/1000 person-years (95% confidence interval, 41.2-60.3). Multivariable-adjusted predictors of hypertension were age, BMI, estimated cardiovascular risk, blood pressure, and advanced HIV clinical stage.In total, 35 new cardiovascular events were reported during follow-up (11.1/1000 person-years). In a multivariate model, baseline cardiovascular risk and hypertensive status predicted incident cardiovascular events, whereas a higher CD4 cell count had a protective role. In treated hypertensive patients, the use of integrase strand transfer inhibitors at follow-up was associated with a lower SBP (average yearly change, -3.8 ± 1.6 vs. -0.9 ± 0.5 mmHg in integrase strand transfer inhibitor users vs. nonusers, respectively, P = 0.02). CONCLUSION Hypertension awareness, treatment, and control rates all improved in adult Italian HIV patients over the last few years, although hypertension remains highly prevalent (41%) in middle-aged HIV patients, and significantly impacts cardiovascular morbidity. Traditional risk factors and advanced HIV disease predict new-onset hypertension, whereas CD4 cell count favorably affects future cardiovascular events.
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Aortic stiffness aging is influenced by past profound immunodeficiency in HIV-infected individuals: results from the EVAS-HIV (EValuation of Aortic Stiffness in HIV-infected individuals). J Hypertens 2017; 34:1338-46. [PMID: 27137177 DOI: 10.1097/hjh.0000000000000957] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We compared aortic stiffness between HIV-infected and HIV-uninfected individuals and examined the determinants of vascular aging during HIV infection. METHODS Aortic stiffness using carotid-femoral pulse wave velocity (cf-PWV) was evaluated cross-sectionally between HIV-infected individuals and uninfected controls frequency-matched for age and sex, and longitudinally in a subgroup of HIV-infected individuals. Determinants of elevated cf-PWV levels were assessed using logistic regression. Changes in cf-PWV levels during follow-up (mixed-effect linear regression) and risk factors for achieving cf-PWV below (Group 1) or above the median (Group 2) at last follow-up visit were evaluated only in HIV-infected individuals. RESULTS A total of 133 HIV-infected and 135 HIV-uninfected individuals (mean age: 47.7 ± 8.9 years, 91% men) were enrolled. Median cf-PWV at baseline was similar between HIV-infected individuals and controls [7.5 m/s (interquartile range = 6.7-8.4) vs. 7.5 m/s (interquartile range = 6.6-8.4), respectively; P = 0.64]. In multivariable analysis, only mean arterial pressure showed significant association with elevated cf-PWV in the overall population (P = 0.036). In HIV-infected individuals, elevated cf-PWV was associated with current smoking (P = 0.042), and nadir CD4 T-cell count less than 200 cells/μl (P = 0.048). Ninety-one HIV-infected individuals were followed for a mean 7.6 ± 2.0 years. cf-PWV progression was associated with age (P = 0.018), mean arterial pressure (P = 0.020), and nadir CD4 T-cell count (P = 0.005). Patients from Group 2 had higher baseline waist circumference, pulse pressure, and nadir CD4 T-cell count less than 200 cells/μl. CONCLUSION We observed no difference in aortic stiffness between HIV-infected and controls. Moreover, aortic stiffness aging was independently associated with past severe immunodeficiency, along with other traditional risk factors. Our results call for early antiretroviral initiation.
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Edmonds A, Ludema C, Eron JJ, Cole SR, Adedimeji AA, Cohen MH, Cooper HL, Fischl M, Johnson MO, Krause DD, Merenstein D, Milam J, Wilson TE, Adimora AA. Effects of Health Insurance Interruption on Loss of Hypertension Control in Women With and Women Without HIV. J Womens Health (Larchmt) 2017; 26:1292-1301. [PMID: 28682658 DOI: 10.1089/jwh.2016.6308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Among low-income women with and without HIV, it is a priority to reduce age-related comorbidities, including hypertension and its sequelae. Because consistent health insurance access has been identified as an important factor in controlling many chronic diseases, we estimated the effects of coverage interruption on loss of hypertension control in a cohort of women in the United States. METHODS We analyzed prospective, longitudinal data from the Women's Interagency HIV Study. HIV-infected and HIV-uninfected women were included between 2005 and 2014 when they reported health insurance at consecutive biannual visits and had controlled hypertension, and were followed for any insurance break and loss of hypertension control. We estimated hazard ratios (HRs) by Cox proportional hazards regression with inverse-probability-of-treatment-and censoring weights (marginal structural models), and plotted the cumulative incidence of hypertension control loss. RESULTS Among 890 HIV-infected women, the weighted HR for hypertension control loss comparing health insurance interruption to uninterrupted coverage was 1.37 (95% confidence interval [CI], 0.99-1.91). Inclusion of AIDS Drug Assistance Program (ADAP) participation with health insurance modestly increased the HR (1.47; 95% CI, 1.04-2.07). Analysis of 272 HIV-uninfected women yielded a similar HR (1.39; 95% CI, 0.88-2.21). Additionally, there were indications of uninterrupted coverage having a protective effect on hypertension when compared with the natural course in HIV-infected (HR, 0.82; 95% CI, 0.61-1.11) and HIV-uninfected (HR, 0.78; 95% CI, 0.52-1.19) women. CONCLUSIONS This study provides evidence that health insurance continuity promotes hypertension control in key populations. Interventions that ensure coverage stability and ADAP access should be a policy priority.
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Affiliation(s)
- Andrew Edmonds
- 1 Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Christina Ludema
- 2 Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Joseph J Eron
- 2 Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Stephen R Cole
- 1 Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Adebola A Adedimeji
- 3 Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, New York
| | - Mardge H Cohen
- 4 Department of Medicine, Cook County Health and Hospital System and Rush University , Chicago, Illinois
| | - Hannah L Cooper
- 5 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Margaret Fischl
- 6 Division of Infectious Diseases, Department of Medicine, University of Miami School of Medicine , Miami, Florida
| | - Mallory O Johnson
- 7 Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Denise D Krause
- 8 Department of Biomedical Materials Science, School of Dentistry, University of Mississippi Medical Center , Jackson, Mississippi
| | - Dan Merenstein
- 9 Department of Family Medicine, Georgetown University Medical Center , Washington, District of Columbia
| | - Joel Milam
- 10 Department of Preventive Medicine, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Tracey E Wilson
- 11 Department of Community Health Sciences, School of Public Health, State University of New York (SUNY) Downstate Medical Center , Brooklyn, New York
| | - Adaora A Adimora
- 1 Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
- 2 Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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Magande PN, Chirundu D, Gombe NT, Mungati M, Tshimanga M. Determinants of uncontrolled hypertension among clients on anti-retroviral therapy in Kadoma City, Zimbabwe, 2016. Clin Hypertens 2017; 23:14. [PMID: 28690867 PMCID: PMC5496338 DOI: 10.1186/s40885-017-0070-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/28/2017] [Indexed: 12/12/2022] Open
Abstract
Background Clients on anti-retroviral therapy (ART) are living longer and have risk of hypertension. Side effects of medicines and aging increase this risk. Hypertension prevalence among clients on ART in Kadoma City was estimated to be 30% in 2015. Of these, 61% had uncontrolled hypertension. This was high compared to 46% of hypertensives in the general population who had uncontrolled hypertension. We determined factors associated with uncontrolled hypertension among clients on ART. Methods A 1.1 unmatched case control study was conducted. Interviews, anthropometric measurements and record reviews were to collect data on demography and medical history. Epi Info 7 was used for univariate, bivariate analysis and logistic regression. Results One hundred and fifty-two cases and 152 controls were recruited into the study. Adding salt to dishes regularly aOR = 5.69 (3.19–10.16), body mass index (BMI) above 25 kg/m2 aOR = 2.81 (1.60–4.91) and history of elevated blood pressure in previous year aOR = 2.34 (1.33–4.13) were independent risk factors. Independent protective factors were duration more than 2 years since HIV diagnosis aOR = 0.58 (0.35–0.95), duration less than 5 years since hypertension diagnosis aOR = 0.50 (0.30–0.83) and walking or cycling as a means of transport aOR = 0.27 (0.16–0.48). Conclusion Adding salt to dishes regularly, BMI above 25 kg/m2, history of elevated blood pressure in the previous year, duration more than 2 years since HIV diagnosis, duration less than 5 years since hypertension diagnosis and walking or cycling as a means of transport were independently associated with uncontrolled hypertension. Health education on lifestyle changes like walking and cycling as transport and dietary modification such as salt intake reduction were recommended.
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Affiliation(s)
| | | | | | - More Mungati
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Mufuta Tshimanga
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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Manner IW, Waldum-Grevbo B, Witczak BN, Bækken M, Øktedalen O, Os I, Schwartz T, Sjaastad I. Immune markers, diurnal blood pressure profile and cardiac function in virologically suppressed HIV-infected patients. Blood Press 2017; 26:332-340. [PMID: 28675304 DOI: 10.1080/08037051.2017.1346459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Non-dipping nocturnal blood pressure (BP) pattern has been reported prevalent among HIV-infected patients and is associated with adverse cardiovascular outcomes. The aims of this observational study were to identify predictors of nocturnal BP decline, and to explore whether diurnal BP profile is associated with alterations in cardiac structure and function. MATERIALS AND METHODS A total of 108 treated HIV-infected patients with suppressed viremia underwent ambulatory BP measurement, 51 of these patients also underwent echocardiography. RESULTS Non-dipping nocturnal BP pattern was present in 51% of the patients. Decreased nocturnal decline in systolic BP (SBP) correlated with lower CD4 count (rsp = 0.21, p = 0.032) and lower CD4/CD8 ratio (rsp = 0.26, p = 0.008). In multivariate linear regression analyses, lower BMI (p = 0.015) and CD4/CD8 ratio <0.4 (p = 0.010) remained independent predictors of nocturnal decline in SBP. Nocturnal decline in SBP correlated with impaired diastolic function, e' (r = 0.28, p = 0.049) as did nadir CD4 count (rsp = 0.38, p = 0.006). In multivariate linear regression analyses, nadir CD4 count <100 cells/μL (p = 0.037) and age (p < 0.001) remained independent predictors of e'. CONCLUSIONS Compromised immune status may contribute to attenuated diurnal BP profile as well as impaired diastolic function in well-treated HIV infection.
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Affiliation(s)
- Ingjerd W Manner
- a Department of Nephrology , Oslo University Hospital , Oslo , Norway
| | | | - Birgit Nomeland Witczak
- b Institute for Experimental Medical Research , Oslo University Hospital and University of Oslo , Oslo , Norway
| | - Morten Bækken
- a Department of Nephrology , Oslo University Hospital , Oslo , Norway
| | - Olav Øktedalen
- c Department of Infectious Diseases , Oslo University Hospital , Oslo , Norway
| | - Ingrid Os
- a Department of Nephrology , Oslo University Hospital , Oslo , Norway.,d Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Thomas Schwartz
- b Institute for Experimental Medical Research , Oslo University Hospital and University of Oslo , Oslo , Norway.,c Department of Infectious Diseases , Oslo University Hospital , Oslo , Norway
| | - Ivar Sjaastad
- b Institute for Experimental Medical Research , Oslo University Hospital and University of Oslo , Oslo , Norway.,e Department of Cardiology , Oslo University Hospital , Oslo , Norway
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Illness Perceptions, Medication Beliefs, and Adherence to Antiretrovirals and Medications for Comorbidities in Adults With HIV Infection and Hypertension or Chronic Kidney Disease. J Acquir Immune Defic Syndr 2017; 73:403-410. [PMID: 27171742 DOI: 10.1097/qai.0000000000001075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mortality in patients with HIV infection is increasingly due to comorbid medical conditions. Research on how adherence to medications for comorbidities relates to antiretroviral (ARV) medication adherence and how interrelations between illness perceptions and medication beliefs about HIV and comorbidities affect medication adherence is needed to inform adherence interventions. METHODS HIV-infected adults with hypertension (HTN) (n = 151) or chronic kidney disease (CKD; n = 41) were recruited from ambulatory practices at an academic medical center. Illness perceptions and medication beliefs about HIV and HTN or CKD were assessed and adherence to one ARV medication and one medication for either HTN or CKD was electronically monitored for 10 weeks. RESULTS Rates of taking, dosing, and timing adherence to ARV medication did not differ from adherence to medication for HTN or CKD, with the exception that patients were more adherent to the timing of their ARV (78%) than to the timing of their antihypertensive (68%; P = 0.01). Patients viewed HIV as better understood, more chronic, having more negative consequences, and eliciting more emotions, compared with HTN. Patients viewed ARVs as more necessary than medication for HTN or CKD. Having a realistic view of the efficacy of ARVs (r = -0.20; P < 0.05) and a high level of perceived HIV understanding (r = 0.21; P < 0.05) correlated with better ARV adherence. CONCLUSIONS Patients with HIV showed similar rates of adherence to ARVs as to medications for comorbidities, despite perceiving HIV as more threatening and ARVs as more important. This can be used in adapting existing interventions for ARV adherence to encompass adherence to medications for comorbid conditions.
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Abstract
: Populations living with HIV who access effective antiretroviral therapies are ageing and thus facing chronic disease-related comorbidities. Cardiovascular disease is now a leading cause of morbidity and mortality in the HIV population as in the general population. The increased incidence of cardiovascular complications experienced by the HIV population is due to physiological aging and consequently the increased risk of hypertension, diabetes, and renal failure. Whether HIV itself is an additive and independent risk factor for cardiovascular disease (CVD) remains a central question. If and how HIV impacts the ageing process is an important and related question. The purpose of the present review is to highlight the risk of CVD in the ageing HIV population, particularly concerning atherosclerotic CVD (ASCVD) and heart failure, and to address effective CVD prevention in an aging HIV population at risk of poly-pharmacy.
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Guo F, Hsieh E, Lv W, Han Y, Xie J, Li Y, Song X, Li T. Cardiovascular disease risk among Chinese antiretroviral-naïve adults with advanced HIV disease. BMC Infect Dis 2017; 17:287. [PMID: 28427339 PMCID: PMC5397830 DOI: 10.1186/s12879-017-2358-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/28/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is an important cause of mortality among HIV-infected patients, however little is known about the burden of CVD among this population in Asia. We sought to quantify prevalence of CVD risk factors, 10-year CVD risk, and patterns of CVD risk factor treatment in a group of individuals with HIV in China. METHODS We retrospectively analyzed baseline data from treatment-naïve HIV-infected adults enrolled in two multicenter clinical trials in China. Data regarding CVD risk factors such as smoking, hypertension, diabetes, dyslipidemia and obesity were assessed. The Framingham Risk Score (FRS) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk scores were calculated to estimate 10-year CVD risk. The American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score was used to identify individuals meeting criteria for lipid-lowering therapy. RESULTS In total, 973 patients were included in the analysis. Mean age was 36.0 ± 10.2 years and 74.2% were men. The most common CVD risk factors were dyslipidemia (51.7%) and smoking (23.7%). Prevalence of hypertension, diabetes and obesity were 8.4%, 4.6% and 1.0%, respectively. Over 65% of patients had at least one CVD risk factor. The prevalence of 10-year risk of CVD ≥10% was 4.5% based upon FRS and was 3.3% based upon D:A:D risk score. Few patients with dyslipidemia, hypertension or diabetes were on treatment. CONCLUSIONS CVD risk factors are common but under-treated among Chinese treatment-naïve individuals with HIV. Future interventions should focus on training HIV providers to appropriately recognize and manage CVD risk factors during routine clinical assessments.
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Affiliation(s)
- Fuping Guo
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Evelyn Hsieh
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Wei Lv
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Han
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Xie
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanling Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojing Song
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Volpe M, Uglietti A, Castagna A, Mussini C, Marchetti G, Bellagamba R, Bini T, Mancusi D, Termini R. Cardiovascular disease in women with HIV-1 infection. Int J Cardiol 2017; 241:50-56. [PMID: 28285796 DOI: 10.1016/j.ijcard.2017.02.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/30/2017] [Accepted: 02/24/2017] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease is a leading cause of death in women, nevertheless it is often underestimated in female patients without overt risk factors. The chronic infection by Human Immunodeficiency Virus (HIV) is clearly associated, along with the use of certain antiretroviral drugs and traditional risk factors, with an increased risk of cardiovascular diseases. The aim of this manuscript is to review the epidemiology, risk factors, pathogenesis, diagnostic approach, primary and secondary prevention strategies of cardiovascular disease in HIV-negative and HIV-positive female subjects. The ultimate goal is to promote knowledge and development of specific and appropriate clinical interventions and guidelines in this group of high-risk patients, mostly in view of the expected growth of ageing females with HIV.
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Affiliation(s)
- Massimo Volpe
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, University of Rome Sapienza, Italy; IRCCS Neuromed, IS, Italy.
| | | | | | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Teresa Bini
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
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Raposeiras-Roubín S, Triant V. Cardiopatía isquémica en el VIH: profundizando en el conocimiento del riesgo cardiovascular. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.08.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Raposeiras-Roubín S, Triant V. Ischemic Heart Disease in HIV: An In-depth Look at Cardiovascular Risk. ACTA ACUST UNITED AC 2016; 69:1204-1213. [PMID: 27840147 DOI: 10.1016/j.rec.2016.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/19/2016] [Indexed: 12/13/2022]
Abstract
Although the incidence of cardiovascular diseases classically associated with human immunodeficiency virus (HIV) has decreased considerably with antiretroviral therapy, cardiovascular risk, and especially ischemic heart disease, are higher in HIV-infected patients than in uninfected individuals. This is due to the interaction of patient-dependent factors with virus-dependent factors, as well as factors associated with antiretroviral therapy. With increasing of life expectancy and the chronicity of HIV infection, cardiovascular disease has emerged as an important cause of morbidity and mortality in HIV patients. In developed countries, the most common cardiovascular manifestation of HIV is ischemic heart disease. Currently, it is not uncommon to find HIV patients with acute coronary syndrome and, given the important pharmacokinetic interactions of antiretroviral drugs, it is important to know which cardiovascular treatments are safe in this group of patients. The ideal approach would be to mitigate the cardiovascular risk in HIV patients with specific primary prevention measures. All these issues are discussed in this review, which aims to aid clinical cardiologists faced with HIV patients with ischemic heart disease or with high cardiovascular risk in daily clinical practice.
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Affiliation(s)
| | - Virginia Triant
- Massachusetts General Hospital Divisions of General Internal Medicine and Infectious Diseases and Harvard Medical School, Boston, Massachusetts, United States
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Ryscavage P, Macharia T, Trinidad LR, Lovelace S, Tepper V, Redfield R. Patterns of Systemic Hypertension among Adults with Perinatally Acquired HIV. J Int Assoc Provid AIDS Care 2016; 16:3-7. [PMID: 27644759 DOI: 10.1177/2325957416668034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Patients with perinatally acquired HIV may be at risk for the development of age-related non-AIDS diseases. The primary aim of this study was to describe patterns of systemic hypertension among a cohort of adults (≥18 years) with perinatally acquired HIV. A retrospective cohort study was conducted among adults (≥18 years) with perinatally acquired HIV infection. Primary outcomes included documentation of systemic hypertension as well as several additional non-AIDS-associated illnesses. Systemic hypertension incidence rates and rate ratios (RRs) were calculated among groups aged ≥18 and <18 years at the time of hypertension diagnosis. The overall prevalence of hypertension in the cohort (N = 109) was 26.6%, and the incidence rate of hypertension was significantly higher among those aged ≥18 years compared to those who are aged <18 years at the time of diagnosis (RR: 10.0, CI: 7.29-13.71). By multivariable analysis, only coexisting renal disease was associated with an increased risk of hypertension diagnosis.
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Affiliation(s)
- Patrick Ryscavage
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas Macharia
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lino R Trinidad
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Susan Lovelace
- 2 Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vicki Tepper
- 2 Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert Redfield
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Papagianni M, Tziomalos K. Obesity in patients with HIV infection: epidemiology, consequences and treatment options. Expert Rev Endocrinol Metab 2016; 11:395-402. [PMID: 30058909 DOI: 10.1080/17446651.2016.1220297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Even though wasting used to characterize patients with HIV infection prior to the antiretroviral therapy (ART) era, obesity is becoming increasingly prevalent in this population. Areas covered: In the present review, we discuss the epidemiology, consequences and treatment options for obesity in patients with HIV infection. Expert commentary: Obesity exerts a multitude of detrimental cardiometabolic effects and appears to contribute to the increasing cardiovascular mortality of this population. However, there are very limited data on the optimal management of obesity in patients with HIV infection. Given the potential for interactions between antiobesity agents and ART that might compromise viral control, lifestyle changes should represent the cornerstone for the prevention and management of obesity in HIV infection.
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Affiliation(s)
- Marianthi Papagianni
- a First Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Konstantinos Tziomalos
- a First Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
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Martin-Iguacel R, Negredo E, Peck R, Friis-Møller N. Hypertension Is a Key Feature of the Metabolic Syndrome in Subjects Aging with HIV. Curr Hypertens Rep 2016; 18:46. [PMID: 27131801 PMCID: PMC5546311 DOI: 10.1007/s11906-016-0656-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With widespread and effective antiretroviral therapy, the life expectancy in the HIV population has dramatically improved over the last two decades. Consequently, as patients are aging with HIV, other age-related comorbidities, such as metabolic disturbances and cardiovascular disease (CVD), have emerged as important causes of morbidity and mortality. An overrepresentation of traditional cardiovascular risk factors (RF), toxicities associated with long exposure to antiretroviral therapy, together with residual chronic inflammation and immune activation associated with HIV infection are thought to predispose to these metabolic complications and to the excess risk of CVD observed in the HIV population. The metabolic syndrome (MS) represents a clustering of RF for CVD that includes abdominal obesity, hypertension, dyslipidemia and insulin resistance. Hypertension is a prevalent feature of the MS in HIV, in particular in the aging population, and constitutes an important RF for CVD. Physicians should screen their patients for metabolic and cardiovascular risk at the regular visits to reduce MS and the associated CVD risk among people aging with HIV, since many of RF are under-diagnosed and under-treated conditions. Interventions to reduce these RF can include lifestyle changes and pharmacological interventions such as antihypertensive and lipid-lowering therapy, and treatment of glucose metabolism disturbances. Changes in antiretroviral therapy to more metabolic neutral antiretroviral drugs may also be considered.
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Affiliation(s)
- Raquel Martin-Iguacel
- Infectious Diseases Department, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark.
| | - Eugènia Negredo
- "Lluita contra la SIDA" Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - Robert Peck
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Nina Friis-Møller
- Infectious Diseases Department, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark
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van Zoest RA, Wit FW, Kooij KW, van der Valk M, Schouten J, Kootstra NA, Wiersinga WJ, Prins M, van den Born BJH, Reiss P. Higher Prevalence of Hypertension in HIV-1-Infected Patients on Combination Antiretroviral Therapy Is Associated With Changes in Body Composition and Prior Stavudine Exposure. Clin Infect Dis 2016; 63:205-13. [PMID: 27143668 DOI: 10.1093/cid/ciw285] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/16/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Individuals infected with human immunodeficiency virus (HIV) have a higher risk of cardiovascular disease, potentially partly mediated by a higher prevalence of hypertension. We therefore examined the prevalence and determinants of hypertension in HIV-1-infected patients compared with appropriate HIV-negative controls. METHODS Data from 527 HIV-1-infected and 517 HIV-uninfected participants at the time of enrollment into the ongoing AGEhIV Cohort Study were analyzed. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, and/or self-reported use of antihypertensive drugs. RESULTS Hypertension prevalence was higher among HIV-1-infected individuals compared with controls (48.2% vs 36.4%; odds ratio [OR], 1.63; 95% confidence interval [CI], 1.27-2.09). In logistic regression models adjusted for age, sex, ethnicity, family history of hypertension, smoking, alcohol use, physical activity, and body mass index, the association between HIV and hypertension remained statistically significant (ORHIV, 1.65; 95% CI, 1.25-2.19), but was attenuated after additional adjustment for waist-to-hip ratio (ORHIV, 1.29; 95% CI, .95-1.76). Among HIV-1-infected individuals, particularly among those with mono/dual nucleoside reverse transcriptase inhibitor therapy prior to combination antiretroviral therapy, stavudine exposure was independently associated with hypertension (ORstavudine, 1.54; 95% CI, 1.04-2.30). This association was attenuated after additional adjustment for either waist-to-hip ratio (ORstavudine, 1.30; 95% CI, .85-1.96) or hip circumference (ORstavudine, 1.40; 95% CI, .93-2.11). CONCLUSIONS Our findings suggest that changes in body composition, involving both abdominal obesity and stavudine-induced peripheral lipoatrophy, might contribute to the higher prevalence of hypertension in HIV-1-infected patients. CLINICAL TRIALS REGISTRATION NCT01466582.
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Affiliation(s)
- Rosan A van Zoest
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
| | - Ferdinand W Wit
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center HIV Monitoring Foundation
| | - Katherine W Kooij
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
| | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center
| | | | | | - W Joost Wiersinga
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center
| | - Maria Prins
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center Department of Infectious Diseases Research Cluster, Public Health Service Amsterdam
| | | | - Peter Reiss
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center HIV Monitoring Foundation
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De Socio GV, Ricci E, Parruti G, Calza L, Maggi P, Celesia BM, Orofino G, Madeddu G, Martinelli C, Menzaghi B, Taramasso L, Penco G, Carenzi L, Franzetti M, Bonfanti P. Statins and Aspirin use in HIV-infected people: gap between European AIDS Clinical Society guidelines and clinical practice: the results from HIV-HY study. Infection 2016; 44:589-97. [PMID: 27048184 DOI: 10.1007/s15010-016-0893-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/23/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the use of statins and acetylsalicylic acid (ASA) in HIV people in clinical practice. DESIGN A multicenter, nationwide, prospective cohort study, including 1182 consecutive HIV patients was conducted. METHODS Statin and ASA prescription was evaluated in primary and secondary cardiovascular disease prevention, according to the European AIDS Clinical Society (EACS) guidelines. RESULTS Followed-up patients (998) were mostly males (70.9 %) with a mean age at enrolment of 46.5 years (SD 9.5). The mean time of follow-up was 3.3 years (SD 0.8). At the last follow-up visit, statins would have been recommended for 31.2 % and ASA for 16 % by EACS guidelines. Conversely, only 15.6 and 7.6 % of patients were on statin and ASA treatment, respectively; only 50.3 % of patients treated with statins achieved recommended low-density lipoprotein cholesterol (LDL-c) levels. At the last follow-up visit, agreement between statin therapy and EACS recommendation was 0.58 (95 % CI 0.52-0.63). The corresponding figure for ASA therapy was 0.50 (95 % CI 0.42-0.58), whereas the agreement for ASA therapy in secondary prevention was 0.59 (95 % CI 0.50-0.68). CONCLUSIONS The prescription of statins and ASA in HIV-infected patients remains largely suboptimal, as only about 50 % of patients requiring statins and ASA are properly treated. Higher attention on this relevant issue and further investigation are warranted in this at risk population.
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Affiliation(s)
- Giuseppe Vittorio De Socio
- Clinica di Malattie Infettive, Azienda Ospedaliero-Universitaria di Perugia, Piazzale Menghini 1, 06129, Perugia, Italy.
| | - Elena Ricci
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Giustino Parruti
- Department of Infectious Diseases, Pescara Hospital, Pescara, Italy
| | - Leonardo Calza
- Infectious Diseases Clinic, University of Bologna, Bologna, Italy
| | - Paolo Maggi
- Unit of Infectious Diseases, University of Bari, Bari, Italy
| | | | - Giancarlo Orofino
- Department of Infectious Diseases, Amedeo di Savoia Hospital, Turin, Italy
| | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Canio Martinelli
- Department of Infectious Diseases, Careggi Hospital, Florence, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Lucia Taramasso
- Infectious Diseases, Hospital University San Martino Genoa, Genoa, Italy
| | - Giovanni Penco
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Laura Carenzi
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Marco Franzetti
- Unit of Infectious Diseases, University of Milan, Milan, Italy
| | - Paolo Bonfanti
- Unit of Infectious Diseases, Manzoni Hospital, Lecco, Italy
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Nguyen KA, Peer N, Mills EJ, Kengne AP. A Meta-Analysis of the Metabolic Syndrome Prevalence in the Global HIV-Infected Population. PLoS One 2016; 11:e0150970. [PMID: 27008536 PMCID: PMC4805252 DOI: 10.1371/journal.pone.0150970] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/22/2016] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Kim A Nguyen
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Kent ST, Burkholder GA, Tajeu GS, Overton ET, Muntner P. Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV. Curr Hypertens Rep 2016; 17:88. [PMID: 26429228 DOI: 10.1007/s11906-015-0598-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
HIV+ individuals have an increased risk for cardiovascular disease (CVD), but the mechanisms behind this association are poorly understood. While hypertension is a well-established CVD risk factor, clinic-based blood pressure (BP) assessment by itself cannot identify several important BP patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime BP dipping. These BP patterns can be identified over a 24-h period by ambulatory BP monitoring (ABPM). In this review, we provide an overview of the potential value of conducting ABPM in HIV+ individuals. ABPM phenotypes associated with increased CVD risk include masked hypertension (i.e., elevated out-of-clinic BP despite non-elevated clinic BP), nighttime hypertension, and a non-dipping BP pattern (i.e., a drop in BP of <10 % from daytime to nighttime). These adverse ABPM phenotypes may be highly relevant in the setting of HIV infection, given that increased levels of inflammatory biomarkers, high psychosocial burden, high prevalence of sleep disturbance, and autonomic dysfunction have been commonly reported in HIV+ persons. Additionally, although antiretroviral therapy (ART) is associated with lower AIDS-related morbidity and CVD risk, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance associated with long-term ART use potentially lead to adverse ABPM phenotypes. Existing data on ABPM phenotypes in the setting of HIV are limited, but suggest an increased prevalence of a non-dipping BP pattern. In conclusion, identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess CVD risk in HIV+ individuals.
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Affiliation(s)
- Shia T Kent
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA.
| | - Greer A Burkholder
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabriel S Tajeu
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA
| | - E Turner Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA
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Begovac J, Dragović G, Višković K, Kušić J, Perović Mihanović M, Lukas D, Jevtović Đ. Comparison of four international cardiovascular disease prediction models and the prevalence of eligibility for lipid lowering therapy in HIV infected patients on antiretroviral therapy. Croat Med J 2015; 56:14-23. [PMID: 25727038 PMCID: PMC4364353 DOI: 10.3325/cmj.2015.56.14] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AIM To compare four cardiovascular disease (CVD) risk models and to assess the prevalence of eligibility for lipid lowering therapy according to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, European AIDS Clinical Society Guidelines (EACS), and European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS) guidelines for CVD prevention in HIV infected patients on antiretroviral therapy. METHODS We performed a cross-sectional analysis of 254 consecutive HIV infected patients aged 40 to 79 years who received antiretroviral therapy for at least 12 months. The patients were examined at the HIV-treatment centers in Belgrade and Zagreb in the period February-April 2011. We compared the following four CVD risk models: the Framingham risk score (FRS), European Systematic Coronary Risk Evaluation Score (SCORE), the Data Collection on Adverse Effects of Anti-HIV Drugs study (DAD), and the Pooled Cohort Atherosclerotic CVD risk (ASCVD) equations. RESULTS The prevalence of current smoking was 42.9%, hypertension 31.5%, and hypercholesterolemia (>6.2 mmol/L) 35.4%; 33.1% persons were overweight, 11.8% were obese, and 30.3% had metabolic syndrome. A high 5-year DAD CVD risk score (>5%) had substantial agreement with the elevated (≥7.5%) 10-year ASCVD risk equation score (kappa=0.63). 21.3% persons were eligible for statin therapy according to EACS (95% confidence intervals [CI], 16.3% to 27.4%), 25.6% according to ESC/EAS (95% CI, 20.2% to 31.9%), and 37.9% according to ACC/AHA guidelines (95% CI, 31.6 to 44.6%). CONCLUSION In our sample, agreement between the high DAD CVD risk score and other CVD high risk scores was not very good. The ACC/AHA guidelines would recommend statins more often than ESC/EAS and EACS guidelines. Current recommendations on treatment of dyslipidemia should be applied with caution in the HIV infected population.
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Affiliation(s)
| | | | - Klaudija Višković
- Klaudija Višković, University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Mirogojska 8, 10000 Zagreb, Croatia,
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Abstract
INTRODUCTION After the introduction of highly active antiretroviral treatment, the course of HIV infection turned into a chronic disease and most of HIV-positive patients will soon be over 50 years old. MATERIAL AND METHODS This paper reviews the multiple aspects that physicians have to face while taking care of HIV-positive ageing patients including the definitions of frailty and the prevalence and risk factors of concomitant diseases. From a therapeutic point of view pharmacokinetic changes and antiretroviral-specific toxicities associated with ageing are discussed; finally therapeutic approaches to frailty are reviewed both in HIV-positive and negative patients. CONCLUSION AND DISCUSSION We conclude by suggesting that the combined use of drugs with the least toxicity potential and the promotion of healthy behaviours (including appropriate nutrition and exercise) might be the best practice for ageing HIV-positive subjects.
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47
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Antonello VS, Antonello ICF, Grossmann TK, Tovo CV, Pupo BBD, Winckler LDQ. Hypertension--an emerging cardiovascular risk factor in HIV infection. ACTA ACUST UNITED AC 2015; 9:403-7. [PMID: 25979413 DOI: 10.1016/j.jash.2015.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 10/23/2022]
Abstract
Patients with HIV may have an increased risk of hypertension and cardiovascular disease (CVD). The objective of this study was to determine the prevalence and risk factors for hypertension in a population of HIV-infected patients at an HIV/AIDS clinic in southern Brazil. We reviewed medical records of 1009 HIV-infected patients aged 18 years or more in an urban HIV/AIDS clinic based in Porto Alegre, southern Brazil. Hypertension was defined according to the Eighth Joint National Committee criteria. The prevalence of hypertension in this study cohort was 22.5% (95% confidence interval, 20%-25.2%). Individuals were significantly older in the hypertensive group (P < .001). After adjustment using a Poisson regression model of all variables that presented P < .2 in the univariate analysis, the variables that were significantly associated with hypertension were only age ≥40 years and obesity. Also in this setting, dyslipidemia (P = .068) showed a tendency of association with hypertension. Compared with HIV-infected persons aged 18-39 years, those aged 40-59 years presented a 2-fold higher prevalence of hypertension (95% confidence interval, 1.2-3.3).The present study showed a high prevalence of hypertension among HIV-infected persons, similar to other studies, ranging from 13% to 45%, and also similar to the HIV-negative general population. Age and obesity were the factors associated with hypertension. Finally, the present study indicates a similar pattern of behavior and comorbidities for HIV-positive and -negative patients in relation to hypertension.
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Affiliation(s)
- Vicente Sperb Antonello
- IAPI HIV Clinic, Porto Alegre, Brazil; Department of Infection Prevention and Control, Hospital Fêmina, Porto Alegre, Brazil; Post Graduate Course in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
| | - Ivan Carlos Ferreira Antonello
- Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Thiago Kreutz Grossmann
- Graduate Program in Medicine and Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Cristiane Valle Tovo
- Post Graduate Course in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Graduate Program in Medicine and Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Bruna Brasil Dal Pupo
- Graduate Program in Medicine and Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Pourcher G, Costagliola D, Martinez V. Obesity in HIV-infected patients in France: prevalence and surgical treatment options. J Visc Surg 2015; 152:33-7. [PMID: 25662869 DOI: 10.1016/j.jviscsurg.2014.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Increasing rate of obesity was reported in HIV-infected patients in USA. In France, no data are available to date. Bariatric surgery is the best option for morbid obesity in general population but few data exist in HIV-infected patients. We describe the prevalence of obesity in France in HIV-infected patients. The prevalence of obesity is 15.1% in women and 5.3% in men. Moreover, we described our experience and point of view in the management of HIV infected patients with morbid obesity. Prospective studies are needed for an optimal management of HIV-infected patients with morbid obesity.
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Affiliation(s)
- G Pourcher
- Service de Chirurgie Digestive minimale invasive, AP-HP, Université Paris Sud, Inserm U972, Hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France.
| | - D Costagliola
- Inserm U943, 75013 Paris, France; UPMC Université Paris 06 UMR S943, 75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladies Infectieuses, 75013 Paris, France
| | - V Martinez
- UPMC Université Paris 06 UMR S943, 75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladies Infectieuses, 75013 Paris, France
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Chow FC, He W, Bacchetti P, Regan S, Feske SK, Meigs JB, Grinspoon SK, Triant VA. Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort. Neurology 2014; 83:1705-11. [PMID: 25280902 DOI: 10.1212/wnl.0000000000000958] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To compare rates of intracerebral hemorrhage (ICH) in HIV-infected and uninfected individuals in a large clinical care cohort and to assess risk factors associated with ICH. METHODS We identified incident ICH in HIV-infected and uninfected control cohorts from the Partners Health Care system using ICD-9-CM codes. We constructed Cox proportional hazards models to estimate adjusted hazard ratios for HIV infection and other predictors of ICH. RESULTS The incidence rate of ICH was 2.29 per 1,000 person-years in HIV-infected individuals compared with 1.23 per 1,000 person-years in uninfected individuals, with an unadjusted incidence rate ratio of 1.85 (95% confidence interval 1.37-2.47, p < 0.001). In a multivariable model, HIV infection was independently associated with a higher hazard of ICH, although its effect diminished with increasing age. Female sex was associated with a lower hazard of ICH in the uninfected cohort but not in the HIV cohort. CD4 count <200 × 10(6) cells/L and anticoagulant use were predictive of ICH. CONCLUSIONS HIV infection conferred an increased adjusted hazard of ICH, which was more pronounced in young patients and in women.
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Affiliation(s)
- Felicia C Chow
- From the Departments of Neurology (F.C.C.) and Epidemiology and Biostatistics (P.B.), University of California San Francisco; the Department of Neurology (S.K.F.), Brigham and Women's Hospital, Boston; and the Division of General Medicine (W.H., S.R., J.B.M., V.A.T.), Program in Nutritional Metabolism (S.K.G., V.A.T.), and Division of Infectious Diseases (V.A.T.), Massachusetts General Hospital, Boston.
| | - Wei He
- From the Departments of Neurology (F.C.C.) and Epidemiology and Biostatistics (P.B.), University of California San Francisco; the Department of Neurology (S.K.F.), Brigham and Women's Hospital, Boston; and the Division of General Medicine (W.H., S.R., J.B.M., V.A.T.), Program in Nutritional Metabolism (S.K.G., V.A.T.), and Division of Infectious Diseases (V.A.T.), Massachusetts General Hospital, Boston
| | - Peter Bacchetti
- From the Departments of Neurology (F.C.C.) and Epidemiology and Biostatistics (P.B.), University of California San Francisco; the Department of Neurology (S.K.F.), Brigham and Women's Hospital, Boston; and the Division of General Medicine (W.H., S.R., J.B.M., V.A.T.), Program in Nutritional Metabolism (S.K.G., V.A.T.), and Division of Infectious Diseases (V.A.T.), Massachusetts General Hospital, Boston
| | - Susan Regan
- From the Departments of Neurology (F.C.C.) and Epidemiology and Biostatistics (P.B.), University of California San Francisco; the Department of Neurology (S.K.F.), Brigham and Women's Hospital, Boston; and the Division of General Medicine (W.H., S.R., J.B.M., V.A.T.), Program in Nutritional Metabolism (S.K.G., V.A.T.), and Division of Infectious Diseases (V.A.T.), Massachusetts General Hospital, Boston
| | - Steven K Feske
- From the Departments of Neurology (F.C.C.) and Epidemiology and Biostatistics (P.B.), University of California San Francisco; the Department of Neurology (S.K.F.), Brigham and Women's Hospital, Boston; and the Division of General Medicine (W.H., S.R., J.B.M., V.A.T.), Program in Nutritional Metabolism (S.K.G., V.A.T.), and Division of Infectious Diseases (V.A.T.), Massachusetts General Hospital, Boston
| | - James B Meigs
- From the Departments of Neurology (F.C.C.) and Epidemiology and Biostatistics (P.B.), University of California San Francisco; the Department of Neurology (S.K.F.), Brigham and Women's Hospital, Boston; and the Division of General Medicine (W.H., S.R., J.B.M., V.A.T.), Program in Nutritional Metabolism (S.K.G., V.A.T.), and Division of Infectious Diseases (V.A.T.), Massachusetts General Hospital, Boston
| | - Steven K Grinspoon
- From the Departments of Neurology (F.C.C.) and Epidemiology and Biostatistics (P.B.), University of California San Francisco; the Department of Neurology (S.K.F.), Brigham and Women's Hospital, Boston; and the Division of General Medicine (W.H., S.R., J.B.M., V.A.T.), Program in Nutritional Metabolism (S.K.G., V.A.T.), and Division of Infectious Diseases (V.A.T.), Massachusetts General Hospital, Boston
| | - Virginia A Triant
- From the Departments of Neurology (F.C.C.) and Epidemiology and Biostatistics (P.B.), University of California San Francisco; the Department of Neurology (S.K.F.), Brigham and Women's Hospital, Boston; and the Division of General Medicine (W.H., S.R., J.B.M., V.A.T.), Program in Nutritional Metabolism (S.K.G., V.A.T.), and Division of Infectious Diseases (V.A.T.), Massachusetts General Hospital, Boston
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Serhal M, Longenecker CT. Preventing Heart Failure in Inflammatory and Immune Disorders. CURRENT CARDIOVASCULAR RISK REPORTS 2014; 8. [PMID: 26316924 DOI: 10.1007/s12170-014-0392-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with chronic inflammatory diseases are at increased risk for heart failure due to ischemic heart disease and other causes including heart failure with preserved ejection fraction. Using rheumatoid arthritis and treated HIV infection as two prototypical examples, we review the epidemiology and potential therapies to prevent heart failure in these populations. Particular focus is given to anti-inflammatory therapies including statins and biologic disease modifying drugs. There is also limited evidence for lifestyle changes and blockade of the renin-angiotensin-aldosterone system. We conclude by proposing how a strategy for heart failure prevention, such as the model tested in the Screening To Prevent Heart Failure (STOP-HF) trial, may be adapted to chronic inflammatory disease.
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Affiliation(s)
- Maya Serhal
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Chris T Longenecker
- University Hospitals Case Medical Center, Cleveland, OH, USA ; Case Western Reserve University School of Medicine, Cleveland, OH, USA
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