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Batterham RL, Bedimo RJ, Diaz RS, Guaraldi G, Lo J, Martínez E, McComsey GA, Milinkovic A, Naito T, Noe S, O'Shea D, Paredes R, Schapiro JM, Sulkowski MS, Venter F, Waters L, Yoruk IU, Young B. Cardiometabolic health in people with HIV: expert consensus review. J Antimicrob Chemother 2024; 79:1218-1233. [PMID: 38656584 PMCID: PMC11144490 DOI: 10.1093/jac/dkae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To develop consensus data statements and clinical recommendations to provide guidance for improving cardiometabolic health outcomes in people with HIV based on the knowledge and experience of an international panel of experts. METHODS A targeted literature review including 281 conference presentations, peer-reviewed articles, and background references on cardiometabolic health in adults with HIV published between January 2016 and April 2022 was conducted and used to develop draft consensus data statements. Using a modified Delphi method, an international panel of 16 experts convened in workshops and completed surveys to refine consensus data statements and generate clinical recommendations. RESULTS Overall, 10 data statements, five data gaps and 14 clinical recommendations achieved consensus. In the data statements, the panel describes increased risk of cardiometabolic health concerns in people with HIV compared with the general population, known risk factors, and the potential impact of antiretroviral therapy. The panel also identified data gaps to inform future research in people with HIV. Finally, in the clinical recommendations, the panel emphasizes the need for a holistic approach to comprehensive care that includes regular assessment of cardiometabolic health, access to cardiometabolic health services, counselling on potential changes in weight after initiating or switching antiretroviral therapy and encouraging a healthy lifestyle to lower cardiometabolic health risk. CONCLUSIONS On the basis of available data and expert consensus, an international panel developed clinical recommendations to address the increased risk of cardiometabolic disorders in people with HIV to ensure appropriate cardiometabolic health management for this population.
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Affiliation(s)
- Rachel L Batterham
- UCL Division of Medicine, UCL School of Life and Medical Sciences, University College London, Gower Street, London WC1E 6BT, UK
- University College London Hospitals Biomedical Research Centre, National Institute for Health and Care Research, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Roger J Bedimo
- Infectious Disease Section, VA North Texas Health Care System, 4500 S Lancaster Road, Dallas, TX 75216, USA
- Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Ricardo S Diaz
- Infectious Diseases Department, Paulista School of Medicine, Federal University of São Paulo, R. Sena Madureira, 1500 Vila Clementino, São Paulo, 04021-001, Brazil
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Via Università 4, 41121 Modena, Italy
| | - Janet Lo
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Esteban Martínez
- Infectious Diseases Unit, Hospital Clinic and University of Barcelona, C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Grace A McComsey
- Case Center for Diabetes, Obesity and Metabolism, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ana Milinkovic
- Global Medical, ViiV Healthcare, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
- HIV Services, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
- Imperial College London, Exhibition Road, South Kensington, London SW7 2BX, UK
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan
| | - Sebastian Noe
- MVZ Karlsplatz, MVZ Karlsplatz 8, 80335, Munich, Germany
| | - Donal O'Shea
- Health Sciences Centre, University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
| | - Roger Paredes
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Jonathan M Schapiro
- National Hemophilia Center, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Tel Aviv, Israel
| | - Mark S Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - François Venter
- Ezintsha, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
| | - Laura Waters
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, 350 Euston Road, Regent's Place, London NW1 3AX, UK
| | - Ilksen Ungan Yoruk
- General Medicines Europe, GSK, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Benjamin Young
- Global Medical, ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA
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Zewdie K, Kiweewa FM, Ssebuliba T, Morrison SA, Muwonge TR, Boyer J, Bambia F, Badaru J, Stein G, Mugwanya KK, Wyatt C, Yin MT, Mujugira A, Heffron R. The effect of daily oral PrEP use during pregnancy on bone mineral density among adolescent girls and young women in Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 5:1240990. [PMID: 38260049 PMCID: PMC10801233 DOI: 10.3389/frph.2023.1240990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Oral pre-exposure prophylaxis (PrEP) is recommended during pregnancy for at-risk cisgender women. Pregnancy is known to impede bone growth and tenofovir-based PrEP may also yield detrimental changes to bone health. Thus, we evaluated the effect of PrEP use during pregnancy on bone mineral density (BMD). Methods We used data from a cohort of women who were sexually active, HIV-negative, ages 16-25 years, initiating DMPA or choosing condoms for contraception and enrolled in the Kampala Women's Bone Study. Women were followed quarterly with rapid testing for HIV and pregnancy, PrEP dispensation, and adherence counseling. Those who became pregnant were counseled on PrEP use during pregnancy per national guidelines. BMD of the neck of the hip, total hip, and lumbar spine was measured using dual-energy x-ray absorptiometry at baseline and annually. We compared the mean percent change in BMD from baseline to month 24. Results Among 499 women enrolled in the study, 105 pregnancies occurred in 90 women. At enrollment, the median age was 20 years (IQR: 19-21) and 89% initiated PrEP. During pregnancy, 67% of women continued using PrEP and PrEP was dispensed in 64% of visits. BMD declined significantly in women using PrEP during pregnancy compared to women who were not pregnant nor used PrEP: relative BMD change was -2.26% (95% CI: -4.63 to 0.11, p = 0.06) in the femoral neck, -2.57% (95% CI: -4.48 to -0.66, p = 0.01) in total hip, -3.06% (95% CI: -5.49 to -0.63, p = 0.001) lumbar spine. There was no significant difference in BMD loss when comparing PrEP-exposed pregnant women to pregnant women who never used PrEP. Women who became pregnant were less likely to continue PrEP at subsequent study visits than women who did not become pregnant (adjOR: 0.25, 95% CI: 0.16-0.37, p < 0.001). Based on pill counts, there was a 62% reduction in the odds of high PrEP adherence during pregnancy (adjOR = 0.38, 95% CI: 0.27-0.58, p < 0.001). Conclusion Women who used PrEP during pregnancy experienced a similar reduction in BMD as pregnant women with no PrEP exposure, indicating that BMD loss in PrEP-using pregnant women is largely driven by pregnancy and not PrEP.
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Affiliation(s)
- Kidist Zewdie
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Flavia M. Kiweewa
- MakerereUniversity-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Susan A. Morrison
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Jade Boyer
- Department of Medicine, Division of Infectious Disease, Columbia University, New York, NY, United States
| | - Felix Bambia
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Josephine Badaru
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Gabrielle Stein
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kenneth K. Mugwanya
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Christina Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, United States
| | - Michael T. Yin
- Department of Medicine, Division of Infectious Disease, Columbia University, New York, NY, United States
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA, United States
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Petkov S, Herrera C, Else L, Mugaba S, Namubiru P, Odoch G, Opoka D, Pillay ADAP, Seiphetlo TB, Serwanga J, Ssemata AS, Kaleebu P, Webb EL, Khoo S, Lebina L, Gray CM, Martinson N, Fox J, Chiodi F. Mobilization of systemic CCL4 following HIV pre-exposure prophylaxis in young men in Africa. Front Immunol 2022; 13:965214. [PMID: 35967369 PMCID: PMC9363563 DOI: 10.3389/fimmu.2022.965214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
HIV-1 pre-exposure prophylaxis (PrEP) relies on inhibition of HIV-1 replication steps. To understand how PrEP modulates the immunological environment, we derived the plasma proteomic profile of men receiving emtricitabine-tenofovir (FTC-TDF) or emtricitabine-tenofovir alafenamide (FTC-TAF) during the CHAPS trial in South Africa and Uganda (NCT03986970). The CHAPS trial randomized 144 participants to one control and 8 PrEP arms, differing by drug type, number of PrEP doses and timing from final PrEP dose to sampling. Blood was collected pre- and post-PrEP. The inflammatory profile of plasma samples was analyzed using Olink (N=92 proteins) and Luminex (N=33) and associated with plasma drug concentrations using mass spectrometry. The proteins whose levels changed most significantly from pre- to post-PrEP were CCL4, CCL3 and TNF-α; CCL4 was the key discriminator between pre- and post-PrEP samples. CCL4 and CCL3 levels were significantly increased in post-PrEP samples compared to control specimens. CCL4 was significantly correlated with FTC drug levels in plasma. Production of inflammatory chemokines CCL4 and CCL3 in response to short-term PrEP indicates the mobilization of ligands which potentially block virus attachment to CCR5 HIV-1 co-receptor. The significant correlation between CCL4 and FTC levels suggests that CCL4 increase is modulated as an inflammatory response to PrEP.
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Affiliation(s)
- Stefan Petkov
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Carolina Herrera
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Laura Else
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Susan Mugaba
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Patricia Namubiru
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Geoffrey Odoch
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniel Opoka
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Azure-Dee A P Pillay
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Thabiso B Seiphetlo
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Jennifer Serwanga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrew S Ssemata
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Limakatso Lebina
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Clive M Gray
- Division of Molecular Biology and Human Genetics, Biomedical Research Institute, Stellenbosch University, Cape Town, South Africa
| | - Neil Martinson
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Julie Fox
- Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Francesca Chiodi
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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