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Moschopoulos CD, Protopapas K, Thomas K, Kavatha D, Papadopoulos A, Antoniadou A. Switching from Tenofovir Disoproxil to Tenofovir Alafenamide Fumarate: Impact on Cardiovascular Risk and Lipid Profile in People Living with HIV, an Observational Study. AIDS Res Hum Retroviruses 2023; 39:68-75. [PMID: 36401506 DOI: 10.1089/aid.2022.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the era of combination antiretroviral therapy (ART), people living with HIV (PLHIV) still face an increased risk of cardiovascular disease (CVD). Tenofovir alafenamide fumarate (TAF) is superior to its precursor tenofovir disoproxil fumarate (TDF) regarding bone and renal toxicity, but there are concerns about a negative effect on lipid profile. This observational, single-center study investigates the effects on lipid profile and cardiovascular (CVD) risk of the switch from TDF to TAF, in combination with emtricitabine/elvitegravir/cobicistat (FTC/EVG/c), in patients with no exposure to other antiretrovirals. Routine laboratory measurements, somatometric characteristics, and smoking status were analyzed for the assessment of CVD risk changes, using D:A:D and ATP III scores pre- and postswitch. A total of 62 patients with a mean age of 32.9 years were included in this study. Sixty-one patients (98.4%) were men, 38 (61.3%) late presenters, and 39 (62.9%) active smokers. A year after the switch, there was a significant increase in total cholesterol (178 ± 38 to 194 ± 40 mg/dL, p < .001), high-density lipoprotein (45 ± 12 to 48 ± 13 mg/dL, p = .001), and low-density lipoprotein (117 ± 32 to 137 ± 36 mg/dL, p < .001). Mean increase of the 10-year D:A:D score was 1.13% (95% confidence interval, 1.05-1.22, p = .002). Changes were more prominent in nonsmokers. Body mass index and average weight showed an upward trend. Switching from TDF to TAF caused significant changes in lipid profile at 14 months of follow-up, in young, otherwise healthy PLHIV. CVD risk, as measured by D:A:D, showed a statistically significant increase, but more data are needed to determine clinical significance. These results point toward a patient-centered approach when selecting an ART regimen.
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Affiliation(s)
- Charalampos D Moschopoulos
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Konstantinos Protopapas
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Konstantinos Thomas
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Dimitra Kavatha
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Antonios Papadopoulos
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
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Chu JH, Michos ED, Ouyang P, Vaidya D, Blumenthal RS, Budoff MJ, Blaha MJ, Whelton SP. Coronary artery calcium and atherosclerotic cardiovascular disease risk in women with early menopause: The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Prev Cardiol 2022; 11:100362. [PMID: 35769201 PMCID: PMC9234594 DOI: 10.1016/j.ajpc.2022.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 11/26/2022] Open
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Kuniholm MH, Vásquez E, Appleton AA, Kingsley L, Palella FJ, Budoff M, Michos ED, Fox E, Jones D, Adimora AA, Ofotokun I, D'souza G, Weber KM, Tien PC, Plankey M, Sharma A, Gustafson DR. Cardiovascular risk score associations with frailty in men and women with or at risk for HIV. AIDS 2022; 36:237-347. [PMID: 34934019 PMCID: PMC8711611 DOI: 10.1097/qad.0000000000003107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. DESIGN We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). METHODS FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011-2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4+ cell count/μl, antiretroviral therapy, and HIV viral load. RESULTS There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) = 2.12, 95% confidence interval (CI):1.22-3.69] and MWH (aHR = 2.19, 95% CI: 1.33-3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR = 1.88, 95% CI: 1.48-2.39) and MWH (aHR = 1.59, 95% CI: 1.26-2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) = 1.43, 95% CI: 1.02-2.00] and WWH (aOR = 1.36, 95% CI: 1.08-1.71); however, high-risk FRS was not (seronegative: aOR = 1.03, 95% CI: 0.30-3.49; WWH: aOR = 0.86, 95% CI: 0.23-3.20). CONCLUSION Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.
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Affiliation(s)
- Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Budoff
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Ervin Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Deborah Jones
- Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gypsyamber D'souza
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, and Department of Veterans Affairs, San Francisco, California
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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Shaikh K, Bhondoekhan F, Haberlen S, Nakanishi R, Roy SK, Alla VM, Brown TT, Lee J, Osawa K, Almeida S, Rahmani S, Nezarat N, Sheidaee N, Kim M, Jayawardena E, Kim N, Hathiramani N, Palella FJ, Witt M, Ahmad K, Kingsley L, Post WS, Budoff MJ. Coronary artery plaque progression and cardiovascular risk scores in men with and without HIV-infection. AIDS 2022; 36:215-224. [PMID: 34608042 PMCID: PMC8702479 DOI: 10.1097/qad.0000000000003093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to assess the association of cardiovascular disease (CVD) risk scores and coronary artery plaque (CAP) progression in HIV-infected participants. METHODS We studied men with and without HIV-infection enrolled in the Multicenter AIDS Cohort Study (MACS) CVD study. CAP at baseline and follow-up was assessed with cardiac computed tomography angiography (CCTA). We examined the association between baseline risk scores including pooled cohort equation (PCE), Framingham risk score (FRS), and Data collect of Adverse effects of anti-HIV drugs equation (D:A:D) and CAP progression. RESULTS We studied 495 men (211 HIV-uninfected, 284 HIV-infected). The adjusted odds ratio (aOR) of total plaque volume (TPV) and noncalcified plaque volume (NCPV) progression in the highest relative to lowest tertile was 9.4 [95% confidence interval (95% CI) 2.4-12.1, P < 0.001)] and 7.7 (95% CI 3.1-19.1, P < 0.001) times greater, respectively, among HIV-uninfected men in the PCE atherosclerotic cardiovascular disease (ASCVD) high vs. low-risk category. Among HIV-infected men, the association for TPV and NCPV progression for the same PCE risk categories, odds ratio (OR) 2.8 (95% CI 1.4-5.8, P < 0.01) and OR 2.4 (95% CI 1.2-4.8, P < 0.05), respectively (P values for interaction by HIV = 0.02 and 0.08, respectively). Similar results were seen for the FRS risk scores. Among HIV-uninfected men, PCE high risk category identified the highest proportion of men with plaque progression in the highest tertile, although in HIV-infected men, high-risk category by D:A:D identified the greatest percentage of men with plaque progression albeit with lower specificity than FRS and PCE. CONCLUSION PCE and FRS categories predict CAP progression better in HIV-uninfected than in HIV-infected men. Improved CVD risk scores are needed to identify high-risk HIV-infected men for more aggressive CVD risk prevention strategies.
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Affiliation(s)
- Kashif Shaikh
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
- Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska
| | - Fiona Bhondoekhan
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Rine Nakanishi
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Sion K Roy
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Venkata M Alla
- Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Juhwan Lee
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Kazuhiro Osawa
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Shone Almeida
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Sina Rahmani
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Negin Nezarat
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Nasim Sheidaee
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Michael Kim
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Eranthi Jayawardena
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Nicolas Kim
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Nicolai Hathiramani
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Frank J. Palella
- Feinberg School of Medicine, Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Mallory Witt
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Khadije Ahmad
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Wendy S. Post
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew J. Budoff
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
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Grand M, Díaz A, Bia D. Cardiovascular risk prediction equations underestimate risk in people living with HIV: Comparison and cut-point redefinition for 19 cardiovascular risk equations. Curr HIV Res 2022; 20:137-151. [PMID: 35081893 DOI: 10.2174/1570162x20666220126124149] [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: 09/18/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rates of cardiovascular disease are higher in people living with HIV. Early detection of high-risk subjects (applying cardiovascular risk equations) would allow preventive actions. D:A:D, ASCVD and FRS:CVD equations are the most recommended. However, controversies surround these equations and cut-points, which have the greatest capacity to discriminate high-risk subjects. OBJECTIVES The study aims (i) to assess the association/agreement between cardiovascular risk levels obtained with D:A:D and fifteen other cardiovascular risk equations, (ii) to detect cardiovascular risk equations capability to detect high-risk subjects, and (iii) to specify the optimal cardiovascular risk equation´s cut points for the prediction of carotid plaque presence, as a surrogate of high cardiovascular risk. METHODS 86 adults with HIV were submitted to the clinical, laboratory and cardiovascular risk evaluation (including carotid ultrasound measurements). Cardiovascular risk was evaluated through multiple risk equations (e.g., D.A.D, ASCVD and FRS equations). Association and agreement between equations (Correlation, Bland-Altman, Williams´test) and equations capacity to detect plaque presence (ROC curves, sensitivity, specificity) were evaluated. RESULTS Cardiovascular risk equations showed a significant and positive correlation with plaque presence. Higher high-cardiovascular risk detection capability was obtained for ASCVD and D:A:D. Full D:A:D5y>0.88%, ASCVD>2.80% and FRS:CVD>2.77% correspond to a 80% sensitivity. CONCLUSION All cardiovascular risk equations underestimate the true risk in HIV subjects. The cut-points for high cardiovascular risk were found to vary greatly from recommended in clinical guidelines.
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Affiliation(s)
- Marina Grand
- Instituto de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Pringles 4375, Olavarría (7400), Argentina
| | - Alejandro Díaz
- Instituto de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Pringles 4375, Olavarría (7400), Argentina
| | - Daniel Bia
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República. General Flores 2125, 11800 Montevideo, Uruguay
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Domingo P, Mateo MG, Villarroya J, Cereijo R, Torres F, Domingo JC, Campderrós L, Gallego-Escuredo JM, Gutierrez MDM, Mur I, Corbacho N, Vidal F, Villarroya F, Giralt M. Increased Circulating Levels of Growth Differentiation Factor 15 in Association with Metabolic Disorders in People Living with HIV Receiving Combined Antiretroviral Therapy. J Clin Med 2022; 11:jcm11030549. [PMID: 35160008 PMCID: PMC8836868 DOI: 10.3390/jcm11030549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 02/07/2023] Open
Abstract
Objective: People living with HIV (PLWH) have an increased cardiovascular risk (CVR) owing to dyslipidemia, insulin resistance, metabolic syndrome, and HIV/combination antiretroviral therapy (cART)-associated lipodystrophy (HALS). Atherosclerosis and inflammation are related to growth differentiation factor-15 (GDF15). The relationship between metabolic disturbances, HALS, and CVR with GDF15 in PLWH is not known. Research design and methods: Circulating GDF15 levels in 152 PLWH (with HALS = 60, without HALS = 43, cART-naïve = 49) and 34 healthy controls were assessed in a cross-sectional study. Correlations with lipids, glucose homeostasis, fat distribution, and CVR were explored. Results: PLWH had increased circulating GDF15 levels relative to controls. The increase was the largest in cART-treated PLWH. Age, homeostatic model assessment of insulin resistance 1 (HOMA1-IR), HALS, dyslipidemia, C-reactive protein, and CVR estimated with the Framingham score correlated with GDF15 levels. The GDF15-Framingham correlation was lost after age adjustment. No correlation was found between GDF15 and the D:A:D Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) score estimated CVR. CVR independent predictors were patient group (naïve, HALS−, and HALS+) and cumulated protease inhibitor or nucleoside reverse transcriptase inhibitor exposure. Conclusions: PLWH, especially when cART-treated, has increased GDF15 levels—this increase is associated with dyslipidemia, insulin resistance, metabolic syndrome, HALS, and inflammation-related parameters. GDF15 is unassociated with CVR when age-adjusted.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.G.M.); (J.V.); (R.C.); (J.M.G.-E.); (M.d.M.G.); (I.M.); (N.C.)
- Correspondence: ; Tel.: +34-93-556-5624; Fax: +34-93-556-5938
| | - María Gracia Mateo
- Infectious Diseases Unit, Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.G.M.); (J.V.); (R.C.); (J.M.G.-E.); (M.d.M.G.); (I.M.); (N.C.)
| | - Joan Villarroya
- Infectious Diseases Unit, Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.G.M.); (J.V.); (R.C.); (J.M.G.-E.); (M.d.M.G.); (I.M.); (N.C.)
- Department of Biochemistry and Molecular Biomedicine, Institut de Biomedicina Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08028 Barcelona, Spain; (J.C.D.); (L.C.); (F.V.); (M.G.)
| | - Rubén Cereijo
- Infectious Diseases Unit, Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.G.M.); (J.V.); (R.C.); (J.M.G.-E.); (M.d.M.G.); (I.M.); (N.C.)
- Department of Biochemistry and Molecular Biomedicine, Institut de Biomedicina Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08028 Barcelona, Spain; (J.C.D.); (L.C.); (F.V.); (M.G.)
| | - Ferran Torres
- Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic Barcelona, 08036 Barcelona, Spain;
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Joan C. Domingo
- Department of Biochemistry and Molecular Biomedicine, Institut de Biomedicina Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08028 Barcelona, Spain; (J.C.D.); (L.C.); (F.V.); (M.G.)
| | - Laura Campderrós
- Department of Biochemistry and Molecular Biomedicine, Institut de Biomedicina Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08028 Barcelona, Spain; (J.C.D.); (L.C.); (F.V.); (M.G.)
| | - José M. Gallego-Escuredo
- Infectious Diseases Unit, Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.G.M.); (J.V.); (R.C.); (J.M.G.-E.); (M.d.M.G.); (I.M.); (N.C.)
- Department of Biochemistry and Molecular Biomedicine, Institut de Biomedicina Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08028 Barcelona, Spain; (J.C.D.); (L.C.); (F.V.); (M.G.)
| | - María del Mar Gutierrez
- Infectious Diseases Unit, Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.G.M.); (J.V.); (R.C.); (J.M.G.-E.); (M.d.M.G.); (I.M.); (N.C.)
| | - Isabel Mur
- Infectious Diseases Unit, Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.G.M.); (J.V.); (R.C.); (J.M.G.-E.); (M.d.M.G.); (I.M.); (N.C.)
| | - Noemí Corbacho
- Infectious Diseases Unit, Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.G.M.); (J.V.); (R.C.); (J.M.G.-E.); (M.d.M.G.); (I.M.); (N.C.)
| | - Francesc Vidal
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
| | - Francesc Villarroya
- Department of Biochemistry and Molecular Biomedicine, Institut de Biomedicina Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08028 Barcelona, Spain; (J.C.D.); (L.C.); (F.V.); (M.G.)
| | - Marta Giralt
- Department of Biochemistry and Molecular Biomedicine, Institut de Biomedicina Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08028 Barcelona, Spain; (J.C.D.); (L.C.); (F.V.); (M.G.)
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Predicting the risk of atherosclerotic cardiovascular disease among adults living with HIV/AIDS in Addis Ababa, Ethiopia: A hospital-based study. PLoS One 2021; 16:e0260109. [PMID: 34843544 PMCID: PMC8629213 DOI: 10.1371/journal.pone.0260109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Atherosclerotic Cardiovascular Disease (ASCVD) is an emerging problem among People living with HIV/AIDS (PLWHA). The current study aimed at determining the risk of ASCVD among PLWHA using the Pooled Cohort Equation (PCE) and the Framingham Risk score (FRS). Methods A hospital-based study was carried out from January 2019 to February 2020 in PLWHA. The prevalence of ASCVD risk was determined in individuals aged between 20 to 79 and 40 to 79 years using the FRS and PCE as appropriate. Chi-square, univariate and multivariate logistic regressions were employed for analysis. Results The prevalence of high-risk ASCVD for subjects aged 20 and above using both tools was 11.5 %. For those aged 40 to 79 years, PCE yielded an increased risk (28%) than FRS (17.7%). Using both tools; advanced age, male gender, smoking, and increased systolic blood pressure were associated with an increased risk of ASCVD. Younger age (adjusted odds ratio, AOR) 0.20, 95%CI: 0.004, 0.091; P< 0.001), lower systolic blood pressure (AOR 0.221, 95%CI: 0.074, 0.605 P< 0.004), and lower total cholesterol (AOR 0.270, 95%CI: 0.073, 0.997; p<0.049) were found to be independent predictors of reduced risk of ASCVD. Likewise, younger age (40 to 64 years), female gender, and lower systolic blood pressure were significantly associated with lower risk of ASCVD among patients aged 40 to 79 years using both PCE and FRS. Conclusions A considerable number of PLWHA have been identified to be at risk for ASCVD. ASCVD risk was significantly associated with advanced age, male gender, higher blood pressure, and smoking using both FRS and PCE. These factors should therefore be taken into account for designing management strategies.
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D'Souza G, Bhondoekhan F, Benning L, Margolick JB, Adedimeji AA, Adimora AA, Alcaide ML, Cohen MH, Detels R, Friedman MR, Holman S, Konkle-Parker DJ, Merenstein D, Ofotokun I, Palella F, Altekruse S, Brown TT, Tien PC. Characteristics of the MACS/WIHS Combined Cohort Study: Opportunities for Research on Aging With HIV in the Longest US Observational Study of HIV. Am J Epidemiol 2021; 190:1457-1475. [PMID: 33675224 DOI: 10.1093/aje/kwab050] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 01/16/2023] Open
Abstract
In 2019, the National Institutes of Health combined the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS) into the MACS/WIHS Combined Cohort Study (MWCCS). In this paper, participants who made a study visit during October 2018-September 2019 (targeted for MWCCS enrollment) are described by human immunodeficiency virus (HIV) serostatus and compared with people living with HIV (PLWH) in the United States. Participants include 2,115 women and 1,901 men with a median age of 56 years (interquartile range, 48-63); 62% are PLWH. Study sites encompass the South (18%), the Mid-Atlantic/Northeast (45%), the West Coast (22%), and the Midwest (15%). Participant race/ethnicity approximates that of PLWH throughout the United States. Longitudinal data and specimens collected for 35 years (men) and 25 years (women) were combined. Differences in data collection and coding were reviewed, and key risk factor and comorbidity data were harmonized. For example, recent use of alcohol (62%) and tobacco (28%) are common, as are dyslipidemia (64%), hypertension (56%), obesity (42%), mildly or severely impaired daily activities (31%), depressive symptoms (28%), and diabetes (22%). The MWCCS repository includes serum, plasma, peripheral blood mononuclear cells, cell pellets, urine, cervicovaginal lavage samples, oral samples, B-cell lines, stool, and semen specimens. Demographic differences between the MACS and WIHS can confound analyses by sex. The merged MWCCS is both an ongoing observational cohort study and a valuable resource for harmonized longitudinal data and specimens for HIV-related research.
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Kelly SG, Wu K, Tassiopoulos K, Erlandson KM, Koletar SL, Palella FJ. Incorporating Frailty Into the Pooled Cohort Equations to Predict Cardiovascular Disease Among Persons With HIV. J Acquir Immune Defic Syndr 2021; 87:971-977. [PMID: 33625065 PMCID: PMC8192418 DOI: 10.1097/qai.0000000000002662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The 2013 Pooled Cohort Equations (PCEs) have underestimated cardiovascular disease (CVD) events among persons with HIV (PWH). We evaluate whether the addition of frailty improves PCE's ability to estimate CVD risk among aging PWH. SETTING Multicenter study. METHODS We assessed baseline frailty and 5-year atherosclerotic CVD risk using PCEs for participants in the AIDS Clinical Trials Group A5322 observational study. The primary outcome was incident CVD. We fit Cox proportional hazards regression models for incident CVD with (1) PCEs alone and (2) PCEs and frailty together (which included separate models for frailty score, frailty status, slow gait speed, and weak grip strength). We evaluated discrimination ability for the models with and without frailty by comparing their areas under receiver operating characteristic curve (AUCs) and Uno C-statistics, as well as by calculating the net reclassification improvement and integrated discrimination improvement. RESULTS The analysis included 944 A5322 participants (759 men, 185 women, median age 50 years, 47% White non-Hispanic). Thirty-nine participants experienced incident CVD during the study period. PCEs predicted 5-year CVD risk in all models. With frailty score, frailty status, slow gait speed, or weak grip strength added, the AUC and C-statistics were relatively unchanged, and the NRI and integrated discrimination improvement indicated little improvement in model discrimination. However, frailty score independently predicted CVD risk [frailty score: hazard ratio = 1.30, 95% confidence interval (CI) = 1.00 to 1.70, P = 0.05]. CONCLUSIONS Frailty did not improve the predictive ability of PCEs. Baseline PCEs and frailty score independently predicted CVD. Incorporation of frailty assessment into clinical practice may provide corroborative and independent CVD risk estimation.
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Affiliation(s)
- Sean G Kelly
- Vanderbilt University Medical Center, Division of Infectious Diseases, Nashville, TN
| | - Kunling Wu
- Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Kristine M Erlandson
- University of Colorado School of Medicine, Division of Infectious Diseases, Denver, CO
| | - Susan L Koletar
- The Ohio State University, Division of Infectious Diseases, Columbus, OH; and
| | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Division of Infectious Diseases Chicago, IL
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Grand M, Bia D, Diaz A. Cardiovascular Risk Assessment in People Living With HIV: A Systematic Review and Meta-Analysis of Real-Life Data. Curr HIV Res 2021; 18:5-18. [PMID: 31830884 DOI: 10.2174/1570162x17666191212091618] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND People living with HIV (PLWHIV) have a 2-fold higher risk of having a cardiovascular event than HIV-negative individuals. OBJECTIVE The objective of this article is to estimate the pooled proportion of moderate-high cardiovascular risk in PLWHIV obtained through different scores. In addition, this study also aims to establish the prevalence of dyslipidemia, smoking habits, diabetes and high blood pressure in the included studies. METHODS A bibliographic search was conducted in MEDLINE for studies on cardiovascular risk assessment in PLWHVI that took place during the period of inception to July 2018. The eligibility criteria for inclusion were: cross-sectional or longitudinal studies on HIV-positive adults in which the prevalence of moderate-high cardiovascular risk (or data to calculate it) was reported, and included at least one of the following cardiovascular risk scores: Framingham, ASCVD, D:A:D, Progetto Cuore, PROCAM, SCORE, Regicor, and World Health Organization scores. RESULTS Bibliographic search identified 278 studies. Finally, thirty-nine peer-reviewed publications were identified for a collective total of 13698 subjects. The pooled prevalence of moderate-high cardiovascular risk in PLWHIV obtained with nine different scores through random-effect modeling was 20.41% (95% CI: 16.77-24.31). The most prevalent concomitant cardiovascular risk factor was dyslipidemia (39.5%), smoking (33.0 %), high blood pressure (19.8%) and diabetes (7.24%). CONCLUSION Data obtained in this systematic review indicate that more than 1 in every five subjects with HIV have a moderate-high cardiovascular risk. In consequence, the burden of cardiovascular disease in PLWHIV represents a public health problem. There is an urgent need to develop strategies to prevent and detect cardiovascular risk effectively in PLWHIV.
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Affiliation(s)
- Marina Grand
- Instituto de Investigacion en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Pringles 4375, Olavarría (7400), Argentina
| | - Daniel Bia
- Departamento de Fisiologia, Facultad de Medicina, Universidad de la Republica, Centro Universitario de Investigacion, Innovacion y Diagnostico Arterial (CUiiDARTE), Universidad de la Republica General Flores 2125, PC 11800 Montevideo, Uruguay
| | - Alejandro Diaz
- Instituto de Investigacion en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Pringles 4375, Olavarría (7400), Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET, Centro Científico Tecnológico Tandil) 4 de abril 618, Tandil (7000), Argentina
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11
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Progression of Subclinical Vascular Damage in People Living With HIV Is Not Predicted by Current Cardiovascular Risk Scores: A Prospective 3-Year Study. J Acquir Immune Defic Syndr 2020; 83:504-512. [PMID: 31923089 DOI: 10.1097/qai.0000000000002286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND People living with HIV (PLWH) are at high cardiovascular disease (CVD) risk. Traditional CVD risk scores do not accurately reflect their CVD risk. Noninvasive subclinical vascular damage (SVD) biomarkers are valid surrogates of CVD and able to stratify CVD risk. SETTING We tested whether 4 widely applied CVD risk scores [Framingham (FRS), Atherosclerotic CVD, Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D), and Greek-specific European Society of Cardiology (ESC) risk scores] are associated with or detect the presence, incidence, and progression of arteriosclerosis, atheromatosis, and arterial hypertrophy in PLWH and uninfected individuals. METHODS We prospectively examined (at baseline and 3-year follow-up) 10 different arterial sites applying 5 different noninvasive vascular biomarkers and measured all 4 CVD risk scores at baseline. RESULTS In both PLWH (n = 138) and uninfected (n = 664) individuals, the CVD risk scores (except the ESC) performed differently but reasonably well in identifying the presence of SVD, but all scores failed to predict the incidence/progression of overall SVD. The most clinically useful biomarkers (carotid plaque/atheromatosis) revealed that in PLWH, only the FRS was able to stratify the progression (11% of the low-risk, 33.3% of the medium-risk, and 0% of the high-risk group). CONCLUSIONS This extensive vascular phenotyping study demonstrated the clear need to incorporate vascular imaging in CVD risk stratification, in addition to designing more accurate HIV-specific CVD risk models. The use of FRS would further enable treatment optimization and CVD prevention strategies in PLWH at medium CVD risk because one-third of carotid atheromatosis progresses within 3 years.
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Predictive Performance of Cardiovascular Disease Risk Prediction Algorithms in People Living With HIV. J Acquir Immune Defic Syndr 2020; 81:562-571. [PMID: 31045648 DOI: 10.1097/qai.0000000000002069] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND People living with HIV (PLWH) experience a higher cardiovascular disease (CVD) risk. Yet, traditional algorithms are often used to estimate CVD risk. We evaluated the performance of 4 commonly used algorithms. SETTING The Netherlands. METHODS We used data from 16,070 PLWH aged ≥18 years, who were in care between 2000 and 2016, had no pre-existing CVD, had initiated first combination antiretroviral therapy >1 year ago, and had available data on CD4 count, smoking status, cholesterol, and blood pressure. Predictive performance of 4 algorithms [Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D); Systematic COronary Risk Evaluation adjusted for national data (SCORE-NL); Framingham CVD Risk Score (FRS); and American College of Cardiology and American Heart Association Pooled Cohort Equations (PCE)] was evaluated using a Kaplan-Meier approach. Model discrimination was assessed using Harrell's C-statistic. Calibration was assessed using observed-versus-expected ratios, calibration plots, and Greenwood-Nam-D'Agostino goodness-of-fit tests. RESULTS All algorithms showed acceptable discrimination (Harrell's C-statistic 0.73-0.79). On a population level, D:A:D, SCORE-NL, and PCE slightly underestimated, whereas FRS slightly overestimated CVD risk (observed-versus-expected ratios 1.35, 1.38, 1.14, and 0.92, respectively). D:A:D, FRS, and PCE best fitted our data but still yielded a statistically significant lack of fit (Greenwood-Nam-D'Agostino χ ranged from 24.57 to 34.22, P < 0.05). Underestimation of CVD risk was particularly observed in low-predicted CVD risk groups. CONCLUSIONS All algorithms perform reasonably well in PLWH, with SCORE-NL performing poorest. Prediction algorithms are useful for clinical practice, but clinicians should be aware of their limitations (ie, lack of fit and slight underestimation of CVD risk in low-risk groups).
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13
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Tziomalos K. Cardiovascular risk prediction in patients with HIV infection. Future Virol 2019. [DOI: 10.2217/fvl-2019-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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14
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Schoepf IC, Buechel RR, Kovari H, Hammoud DA, Tarr PE. Subclinical Atherosclerosis Imaging in People Living with HIV. J Clin Med 2019; 8:E1125. [PMID: 31362391 PMCID: PMC6723163 DOI: 10.3390/jcm8081125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
In many, but not all studies, people living with HIV (PLWH) have an increased risk of coronary artery disease (CAD) events compared to the general population. This has generated considerable interest in the early, non-invasive detection of asymptomatic (subclinical) atherosclerosis in PLWH. Ultrasound studies assessing carotid artery intima-media thickness (CIMT) have tended to show a somewhat greater thickness in HIV+ compared to HIV-, likely due to an increased prevalence of cardiovascular (CV) risk factors in PLWH. Coronary artery calcification (CAC) determination by non-contrast computed tomography (CT) seems promising to predict CV events but is limited to the detection of calcified plaque. Coronary CT angiography (CCTA) detects calcified and non-calcified plaque and predicts CAD better than either CAC or CIMT. A normal CCTA predicts survival free of CV events over a very long time-span. Research imaging techniques, including black-blood magnetic resonance imaging of the vessel wall and 18F-fluorodeoxyglucose positron emission tomography for the assessment of arterial inflammation have provided insights into the prevalence of HIV-vasculopathy and associated risk factors, but their clinical applicability remains limited. Therefore, CCTA currently appears as the most promising cardiac imaging modality in PLWH for the evaluation of suspected CAD, particularly in patients <50 years, in whom most atherosclerotic coronary lesions are non-calcified.
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Affiliation(s)
- Isabella C Schoepf
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, 8091 Zurich, Switzerland
| | - Dima A Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland.
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15
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Whelton SP, Deal JA, Zikusoka M, Jacobson LP, Sarkar S, Palella FJ, Kingsley L, Budoff M, Witt MD, Brown TT, Post WS. Associations between lipids and subclinical coronary atherosclerosis. AIDS 2019; 33:1053-1061. [PMID: 30946159 PMCID: PMC6457132 DOI: 10.1097/qad.0000000000002151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Whether HIV modifies the relationship of serum lipids with coronary atherosclerosis and coronary plaque subtypes is uncertain. We examined the associations between traditional lipids and coronary atherosclerosis among HIV-infected (HIV+) and HIV-uninfected (HIV-) men. DESIGN The Multicenter AIDS Cohort Study is an observational cohort with a total of 429 HIV+ and 303 HIV- men who had non-contrast cardiac computed tomography performed to measure coronary artery calcium and coronary computed tomography angiography to measure coronary stenosis, coronary plaque presence, and composition. METHODS We used multivariable adjusted prevalence ratios to examine the relationship between the SD difference in each lipid parameter and coronary atherosclerosis. RESULTS Total cholesterol (TC)/HDL-cholesterol had the strongest associations with coronary atherosclerosis regardless of HIV status. Overall, lipid parameters were most strongly associated with the presence of mixed plaque, stenosis more than 50%, and coronary artery calcium for both HIV+ and HIV- men. HIV+ men had similar, but weaker associations, between lipid parameters and coronary atherosclerosis compared with HIV- men. The strongest association was between the TC/HDL-cholesterol and stenosis more than 50% for both HIV+ [prevalence ratios 1.25 per SD (95% confidence interval 1.07-1.43)] and HIV- men [prevalence ratios 1.46 per SD (95% confidence interval 1.08-1.85)]. CONCLUSION The associations between lipids and coronary atherosclerosis tended to be weaker for HIV+ compared with HIV- men, although TC/HDL had the strongest association for both HIV+ and HIV- men. A weaker association between lipid levels and coronary atherosclerosis for HIV+ men may contribute to the decreased discrimination of cardiovascular disease risk observed in HIV+ individuals.
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Affiliation(s)
- Seamus P. Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine. 600 North Wolfe Street, Baltimore, MD 21287
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 2024 E. Monument St, Suite 2-700, Baltimore, MD 21205
| | - Michelle Zikusoka
- MedStar Health System, 5601 Lock Raven Boulevard, Baltimore, MD 21239
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 2024 E. Monument St, Suite 2-700, Baltimore, MD 21205
| | - Sudipa Sarkar
- Division of Endocrinology, Department of Medicine, Johns Hopkins University School of Medicine. 600 North Wolfe Street, Baltimore, MD 21287
| | - Frank J. Palella
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University. 645 N. Michigan Ave, Chicago, IL 60611
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health. 130 De Soto Street, Pittsburgh, PA 15261
| | - Matthew Budoff
- Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center. 1124 West Carson St. Torrance, CA 90502
| | - Mallory D. Witt
- Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center. 1124 West Carson St. Torrance, CA 90502
| | - Todd T. Brown
- Division of Endocrinology, Department of Medicine, Johns Hopkins University School of Medicine. 600 North Wolfe Street, Baltimore, MD 21287
| | - Wendy S. Post
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine. 600 North Wolfe Street, Baltimore, MD 21287
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 2024 E. Monument St, Suite 2-700, Baltimore, MD 21205
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16
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Belgrave K, Shaikh K, Budoff MJ. Risk of peripheral artery disease in human immunodeficiency virus infected individuals. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S46. [PMID: 30613621 DOI: 10.21037/atm.2018.10.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kevin Belgrave
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Kashif Shaikh
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
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17
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The HIV patient profile in 2013 and 2003: Results from the Greek AMACS cohort. PLoS One 2018; 13:e0203601. [PMID: 30208097 PMCID: PMC6135491 DOI: 10.1371/journal.pone.0203601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/23/2018] [Indexed: 01/10/2023] Open
Abstract
Combined Antiretroviral therapy (cART) has improved life-expectancy of people living with HIV (PLHIV) but as they age, prevalence of chronic non-AIDS related comorbidities may increase. We study the evolution of HIV-disease markers and comorbidities’ prevalence in PLHIV in Greece. Two cross-sectional analyses (2003 and 2013) on data from the AMACS cohort were performed. Comparisons were based on population average models and were repeated for subjects under follow-up at both 2003 and 2013. 2,403 PLHIV were identified in 2003 and 4,910 in 2013 (1,730 contributing for both cross-sections). Individuals in 2013 were on average older, diagnosed/treated for HIV for longer, more likely to be on cART, virologically suppressed, and with higher CD4 counts. Chronic kidney disease, dyslipidemia and hypertension prevalence increased over time. There was an increase in prescription of lipid-lowering treatment (3.5% in 2003 vs. 7.7% 2013, p<0.001). Among 220 and 879 individuals eligible for Framingham 10-year Event Risk calculation, the proportion of patients in the high-risk group (>20%) increased from 18.2% to 22.2% (p = 0.002). Increase in the prevalence of comorbidities was more pronounced in the subset of patients who were followed in both 2003 and 2013. The increased availability and uptake of cART led to significant improvements in the immuno-virological status of PLHIV in Greece, but they aged alongside an increase in prevalence of non-AIDS related comorbidities. These results highlight the need for appropriate monitoring, optimal cART selection and long-term management and prevention strategies for such comorbidities.
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18
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Abstract
PURPOSE OF REVIEW The aim of this study was to discuss the most recent research in the management of cardiovascular disease (CVD) in people living with HIV (PLWHIV) with a focus on screening, primary and secondary prevention. RECENT FINDINGS The cause of CVD in PLWHIV is complex and multifactorial and creates a demand for a multifaceted approach to screening and prevention. Current screening and management of CVD risk factors in PLWHIV is suboptimal, reasons for this are not clear and the data are still scarce both in the primary and secondary preventive setting. There are no optimal routine risk screening tools available to accurately detect early and subclinical disease; PLWHIV are undertreated with preventive drugs such as statins and aspirin and antihypertensives; there are still no programmes that have been shown significantly efficient over time with regards to improved smoking cessation, increased physical activity and optimal diet, and recent reports call for intensified focus on HIV-positive women as a particularly vulnerable subgroup. SUMMARY There is a need for further studies investigating barriers to optimal CVD risk factor management in PLWHIV and an increased focus of CVD prevention in HIV-positive women.
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19
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Smit M, van Zoest RA, Nichols BE, Vaartjes I, Smit C, van der Valk M, van Sighem A, Wit FW, Hallett TB, Reiss P. Cardiovascular Disease Prevention Policy in Human Immunodeficiency Virus: Recommendations From a Modeling Study. Clin Infect Dis 2018; 66:743-750. [PMID: 29029103 PMCID: PMC5850014 DOI: 10.1093/cid/cix858] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/03/2017] [Indexed: 12/31/2022] Open
Abstract
Background Cardiovascular disease (CVD) is expected to contribute a large noncommunicable disease burden among human immunodeficiency virus (HIV)-infected people. We quantify the impact of prevention interventions on annual CVD burden and costs among HIV-infected people in the Netherlands. Methods We constructed an individual-based model of CVD in HIV-infected people using national ATHENA (AIDS Therapy Evaluation in The Netherlands) cohort data on 8791 patients on combination antiretroviral therapy (cART). The model follows patients as they age, develop CVD (by incorporating a CVD risk equation), and start cardiovascular medication. Four prevention interventions were evaluated: (1) increasing the rate of earlier HIV diagnosis and treatment; (2) avoiding use of cART with increased CVD risk; (3) smoking cessation; and (4) intensified monitoring and drug treatment of hypertension and dyslipidemia, quantifying annual number of averted CVDs and costs. Results The model predicts that annual CVD incidence and costs will increase by 55% and 36% between 2015 and 2030. Traditional prevention interventions (ie, smoking cessation and intensified monitoring and treatment of hypertension and dyslipidemia) will avert the largest number of annual CVD cases (13.1% and 20.0%) compared with HIV-related interventions-that is, earlier HIV diagnosis and treatment and avoiding cART with increased CVD risk (0.8% and 3.7%, respectively)-as well as reduce cumulative CVD-related costs. Targeting high-risk patients could avert the majority of events and costs. Conclusions Traditional CVD prevention interventions can maximize cardiovascular health and defray future costs, particularly if targeting high-risk patients. Quantifying additional public health benefits, beyond CVD, is likely to provide further evidence for policy development.
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Affiliation(s)
- Mikaela Smit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Rosan A van Zoest
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
| | | | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Ferdinand W Wit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
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Bedimo R, Abodunde O. Metabolic and Cardiovascular Complications in HIV/HCV-Co-infected Patients. Curr HIV/AIDS Rep 2017; 13:328-339. [PMID: 27595755 DOI: 10.1007/s11904-016-0333-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Fifteen to thirty percent of HIV-infected persons in North America and Europe are co-infected with chronic hepatitis C (HCV). The latter is associated with a significant number of extra-hepatic metabolic complications that could compound HIV-associated increased cardiovascular risk. This article reviews the basic science and epidemiologic and clinical evidence for increased cardio-metabolic risk among HIV/HCV-co-infected patients and discusses potential underlying mechanisms. We will finally review the impact of control of HCV viremia on the cardio-metabolic morbidity and mortality of HIV/HCV-co-infected patients. RECENT FINDINGS HCV infection is associated with a number of immune-related complications such as cryoglobulinemia but also metabolic complications including dyslipidemias, hepatic steatosis, insulin resistance, diabetes, and chronic kidney disease. The incidence of these complications is higher among HIV-co-infected patients and might contribute to increased mortality. The potential mechanisms of increased cardiovascular risk among HIV/HCV-co-infected subjects include endothelial dysfunction, chronic inflammation and immune activation, the cardio-metabolic effects of HCV-induced hepatic steatosis and fibrosis or insulin resistance, and chronic kidney disease. However, epidemiologic studies show discordant findings as to whether HCV co-infection further increases the risk of atherosclerotic cardiovascular diseases (acute myocardial infarctions and strokes) among HIV-infected patients. Nonetheless, successful treatment of HCV is associated with significant improvements in cardio-metabolic risk factors including diabetes mellitus. HCV co-infection is associated with a higher incidence of metabolic complications-and likely increased risk of cardiovascular events-that might contribute to increased mortality in HIV. These appear to improve with successful HCV therapy.
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Affiliation(s)
- Roger Bedimo
- Infectious Diseases Section, Medical Service, Veterans Affairs North Texas Healthcare System, Dallas, TX, USA. .,Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Oladapo Abodunde
- Infectious Diseases Section, Medical Service, Veterans Affairs North Texas Healthcare System, Dallas, TX, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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Hanna DB, Lin J, Post WS, Hodis HN, Xue X, Anastos K, Cohen MH, Gange SJ, Haberlen SA, Heath SL, Lazar JM, Liu C, Mack WJ, Ofotokun I, Palella FJ, Tien PC, Witt MD, Landay AL, Kingsley LA, Tracy RP, Kaplan RC. Association of Macrophage Inflammation Biomarkers With Progression of Subclinical Carotid Artery Atherosclerosis in HIV-Infected Women and Men. J Infect Dis 2017; 215:1352-1361. [PMID: 28199691 DOI: 10.1093/infdis/jix082] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/08/2017] [Indexed: 12/30/2022] Open
Abstract
Background Monocytes and monocyte-derived macrophages promote atherosclerosis through increased inflammation and vascular remodeling. This may be especially true in chronic human immunodeficiency virus (HIV) infection. Methods We examined 778 women (74% HIV+) in the Women's Interagency HIV Study and 503 men (65% HIV+) in the Multicenter AIDS Cohort Study who underwent repeated B-mode carotid artery ultrasound imaging in 2004-2013. We assessed baseline associations of the serum macrophage inflammation markers soluble (s)CD163, sCD14, galectin-3 (Gal-3), and Gal-3 binding protein (Gal-3BP) with carotid plaque formation (focal intima-media thickness >1.5 mm) over 7 years. Results Marker levels were higher in HIV+ persons versus HIV- persons. Presence of focal plaque increased over time: from 8% to 15% in women, and 24% to 34% in men. After adjustment for demographic, behavioral, and cardiometabolic factors, and CRP and interleukin-6, each standard deviation increase in sCD14 was associated with increased plaque formation (risk ratio [RR] 1.24, 95% confidence interval [CI] 1.07-1.43). This pattern was consistentby sex. sCD163 was associated with plaque formation in virally suppressed HIV+ men (RR 1.52, 95% CI 1.04-2.22); Gal-3BP and Gal-3 were not associated with increased plaque. Conclusions sCD14 and sCD163 may play important roles in atherogenesis among HIV+ persons.
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Affiliation(s)
- David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Howard N Hodis
- Department of Medicine, University of Southern California, Los Angeles
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Mardge H Cohen
- Department of Medicine, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Sonya L Heath
- Department of Medicine, University of Alabama at Birmingham
| | - Jason M Lazar
- Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Chenglong Liu
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Wendy J Mack
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Igho Ofotokun
- Department of Medicine, Emory University and Grady Healthcare System, Atlanta, Georgia
| | - Frank J Palella
- Department of Medicine, Northwestern University Medical Center, Chicago, Illinois
| | - Phyllis C Tien
- Department of Medicine, University of California-San Francisco and the Department of Veterans Affairs
| | - Mallory D Witt
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
| | - Alan L Landay
- Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Illinois
| | - Lawrence A Kingsley
- Departments of Epidemiology and Infectious Diseases and Microbiology, University of Pittsburgh, Pennsylvania; and
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Colchester
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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22
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Lorenz DR, Dutta A, Mukerji SS, Holman A, Uno H, Gabuzda D. Marijuana Use Impacts Midlife Cardiovascular Events in HIV-Infected Men. Clin Infect Dis 2017; 65:626-635. [PMID: 28449059 PMCID: PMC5850013 DOI: 10.1093/cid/cix391] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/21/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Marijuana use is prevalent among persons infected with human immunodeficiency virus (HIV), but its long-term effects on HIV disease progression and comorbidities are unknown. METHODS In this prospective study of 558 HIV-infected men enrolled in the Multicenter AIDS Cohort Study between 1990 and 2010, there were 182 HIV seroconverters and 376 with viral suppression on combination antiretroviral therapy (ART). Associations between heavy marijuana use and HIV disease markers or white blood cell (WBC) count were examined using mixed-effects and linear regression models. Effects of marijuana use on cardiovascular (CV) events and other endpoints were estimated using Kaplan-Meier and logistic regression analyses. RESULTS The median baseline age of participants was 41, 66% were white, 79% had education >12 years, and 20% reported heavy marijuana use at ≥50% of biannual visits during follow-up. Long-term heavy marijuana use showed no significant associations with viral load, CD4 counts, AIDS, cancer, or mortality in both cohorts but was independently associated with increased CV events between ages 40-60 after adjusting for age, tobacco smoking, viral load, and traditional risk factors (odds ratio [OR], 2.5; 95% confidence interval [CI] 1.3, 5.1). Marijuana and tobacco use were each independently associated with higher WBC counts in adjusted models (P < .01); the highest quartile of WBC counts (≥6500 cells/µL) was associated with increased CV events (OR 4.3; 95% CI, 1.5, 12.9). CONCLUSIONS Heavy marijuana use is a risk factor for CV disease in HIV-infected men ages 40-60, independent of tobacco smoking and traditional risk factors.
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Affiliation(s)
- David R Lorenz
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
| | - Anupriya Dutta
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
| | - Shibani S Mukerji
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
- Department of Neurology, Massachusetts General Hospital
| | - Alex Holman
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
| | - Hajime Uno
- Department of Population Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
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23
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Non LR, Escota GV, Powderly WG. HIV and its relationship to insulin resistance and lipid abnormalities. Transl Res 2017; 183:41-56. [PMID: 28068521 DOI: 10.1016/j.trsl.2016.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/18/2016] [Accepted: 12/15/2016] [Indexed: 12/19/2022]
Abstract
Antiretroviral therapy has revolutionized the care of people with human immunodeficiency virus (HIV) by reducing morbidity and mortality from acquired immunodeficiency syndrome-related conditions. Despite longer life expectancy, however, HIV-infected individuals continue to have a higher risk of death compared with the general population. This has been attributed to the increasing incidence of noncommunicable diseases, in particular, atherosclerotic cardiovascular diseases. This is driven, in part, by the emergence of metabolic disorders, particularly dyslipidemia, insulin resistance, and lipodystrophy, in those on antiretroviral therapy. The pathogenesis of these metabolic derangements is complex and multifactorial, and could be a consequence of an interplay between traditional age-related risk factors, HIV infection, antiretroviral therapy effects, and the inflammatory state and immune activation in this population. Understanding the contributions of each of these factors could not just impact the current management of these individuals and help mitigate the risk for premature cardiovascular disease, but also shape the future direction of research in HIV.
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Affiliation(s)
- Lemuel R Non
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Mo.
| | - Gerome V Escota
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Mo
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