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Datla S, Kumar S. PCSK9 Inhibitors-A New Hope for Dyslipidemia in HIV. Cardiol Rev 2023:00045415-990000000-00177. [PMID: 38019027 DOI: 10.1097/crd.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Cardiovascular disease has become increasingly prevalent in the HIV population. Antiretroviral therapy and HIV itself independently increase the risk of dyslipidemia. While statins are currently the predominant therapy to treat dyslipidemia in HIV patients, drug-drug interactions and adverse drug events can limit their use. Proprotein convertase subtilisin/kexin type 9 inhibitors have shown promising results in preliminary trials by significantly reducing low density lipoprotein and other atherogenic lipid levels. They should be considered as an early intervention alongside statins in HIV patients with dyslipidemia.
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Affiliation(s)
- Sanjana Datla
- From the University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Sundeep Kumar
- From the University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
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Li Q, Chen D, Ye F, Wang X, Yang S, Wang L, Wen W. Effect of Highly Active Antiretroviral Therapy on Fundus Images and Retinal Microvessel Diameter in HIV/AIDS Patients. HIV AIDS (Auckl) 2023; 15:1-9. [PMID: 36628326 PMCID: PMC9826604 DOI: 10.2147/hiv.s387454] [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: 08/24/2022] [Accepted: 12/01/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction We aimed to investigate whether there were changes in fundus picture and retinal microvascularity of patients with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) who were treated with highly active antiretroviral therapy (HAART). Methods From July 2015 to November 2016, 130 HIV/AIDS patients were collected by the Yunnan Institute of Traditional Chinese Medicine, including 63 treatment-naïve patients and 67 that received HAART for 12 months. Fundus picture lesions, retinal microvascular diameters, CD4+ T lymphocyte count and HIV-1 plasma viral loads were compared between the two groups. The recruited patients were mainly young and middle-aged, with more males than females. There were no significant differences in smoking history, comorbidities and opportunistic infections between the two groups. Results According to the analysis results from SPSS 20.0 software, the number of CD4+ T lymphocytes in the treated patients (563.34±2.56 cells/μL) increased significantly (P=0.009) as compared with untreated patients (451.37±2.10 cells/μL), and the HIV-1 plasma viral load reduced considerably (4794 vs 0 copy/mL, P=0.000). No significant differences were observed from the fundus picture of patients after effective HAART therapy, including the retinal artery diameter, venous diameter and arteriovenous diameter ratio.
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Affiliation(s)
- Qin Li
- Department of Basic Theory of Traditional Chinese Medicine, Yunnan University of Traditional Chinese Medicine, Kunming, People’s Republic of China
| | - Dongqiong Chen
- Department of Gynecology, the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, Kunming, People’s Republic of China
| | - Fang Ye
- TCM for AIDS Project Office, Linxiang Hospital of Traditional Chinese Medicine, Lincang, People’s Republic of China
| | - Xiaoying Wang
- Research and Teaching Management Section, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, People’s Republic of China
| | - Shangsong Yang
- Department of Basic Theory of Traditional Chinese Medicine, Yunnan University of Traditional Chinese Medicine, Kunming, People’s Republic of China
| | - Li Wang
- Clinical Research Centre for the Prevention and Treatment of AIDS in Chinese Medicine, Yunnan Institute of Traditional Chinese Medicine, Kunming, People’s Republic of China,Li Wang, Clinical Research Centre for the Prevention and Treatment of AIDS in Chinese Medicine, Yunnan Institute of Traditional Chinese Medicine, Kunming, People’s Republic of China, Email
| | - Weibo Wen
- Department of Gynecology, the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, Kunming, People’s Republic of China,Correspondence: Weibo Wen, Department of Gynecology, the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, People’s Republic of China, Email
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Buendia J, Sears S, Mgbere O. Prevalence and risk factors of high cholesterol and triglycerides among people with HIV in Texas. AIDS Res Ther 2022; 19:43. [PMID: 36123679 PMCID: PMC9484232 DOI: 10.1186/s12981-022-00467-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background People with HIV (PWH) commonly have elevated cholesterol and triglycerides levels that have been linked to medications. However, healthy behaviors including lifestyle changes can lower high cholesterol (CHOL) or high triglycerides (TG), thereby reducing individual risk for cardiovascular diseases. This study aimed to determine the prevalence and risk factors associated with high CHOL or TG among PWH in Texas. Methods Cross-sectional data of 981 PWH from the 2015–2017 Texas and Houston Medical Monitoring Projects were examined. High CHOL or TG was identified by medical chart diagnosis, CHOL or TG medication use, or most recent fasting lab ≥ 200 mg/dl (total CHOL) or ≥ 150 mg/dl (TG). High CHOL or TG associations with sociodemographic and clinical characteristics were assessed using Rao-Scott chi-square tests. Prevalence of high CHOL or TG development was calculated using multivariable logistic regression model. Results High CHOL or TG prevalence was 41% with participants being mostly male (73%), ≥ 40 years (68%), with overweight (31%) or obesity (28%), and virally suppressed (62%). Compared with PWH < 40 years of age, PWH in their 40s, 50s, and ≥ 60s were 57%, 64%, and 62% more likely to have high CHOL or TG, respectively. Participants with overweight and obesity were 41% and 30% more likely to have high CHOL or TG than those with normal weight (BMI: 18.5– < 25), respectively. Conclusion Since high CHOL and TG are modifiable CVD risk factors, increased education and lifestyle modification interventions are warranted to prevent the development of high CHOL or TG among PWH. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-022-00467-y.
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Affiliation(s)
- Justin Buendia
- Texas Department of State Health Services, Austin, TX, USA
| | - Sabeena Sears
- Texas Department of State Health Services, Austin, TX, USA
| | - Osaro Mgbere
- Disease Prevention and Control Division, Houston Health Department, Houston, TX, 77054, USA.
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Yang C, Wang D, Ma Y, Liu Z, Guo H, Sang F, Xu Q, Jin Y. Effectors of Hyperlipidemia among HIV/AIDS patients with second-line antiretroviral therapy based on register data. Curr HIV Res 2022; 20:CHR-EPUB-125359. [PMID: 35929632 PMCID: PMC9933044 DOI: 10.2174/1570162x20666220805103411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/31/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, we aimed to determine the prevalence and effectors of hyperlipidemia among people living with HIV/AIDS (PLWHA) and taking second-line antiretroviral therapy (ART) using registry data in central China. METHODS We conducted a cross-sectional study and collected information of PLWHA on second-line ART during 2018 from two medical registries. Hyperlipidemia was defined according to the 2016 Chinese guidelines for the management of dyslipidemia in adults. Univariate and multivariate logistic regression analyses were performed to explore the influencing factors of hyperlipidemia. We calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of 2886 PLWHA taking second-line ART were included in this study, and 978 (33.9%) had hyperlipidemia. Female patients, those with hyperglycemia, and patients with CD4+ cell counts >500 cells/μL had a higher prevalence of hyperlipidemia with 37.0%, 49.0%, and 41.3%, respectively. Multivariate analysis showed that CD4+ cell count 350-500 cells/μL (OR=1.72, 95% CI: 1.26-2.38), CD4+ cell count >500 cells/μL (OR=2.49, 95% CI: 1.85-3.38), and FPG >6.2 mmol/L (OR=2.08, 95% CI:1.64-2.65) were risk factors for hyperlipidemia. Male sex (OR=0.72, 95% CI: 0.61-0.85) and Hb <110 g/L (OR=0.59, 95% CI: 0.45-0.76) were protective factors against hyperlipidemia. CONCLUSIONS PLWHA on second-line ART had a higher prevalence of hyperlipidemia. Gender, CD4+ cell count, FPG, and hemoglobin were influencing factors of hyperlipidemia.
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Affiliation(s)
- Chunling Yang
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, China
| | - Dongli Wang
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yanmin Ma
- Center for AIDS/STD Control and Prevention, Center for Disease Control and Prevention of Henan Province, Zhengzhou, China
| | - Zhibin Liu
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Huijun Guo
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Feng Sang
- Henan Key Laboratory of Viral Diseases Prevention and Treatment of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Qianlei Xu
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yantao Jin
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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Knudsen AD, Graff C, Nielsen JB, Thomsen MT, Høgh J, Benfield T, Gerstoft J, Køber L, Kofoed KF, Nielsen SD. De novo electrocardiographic abnormalities in persons living with HIV. Sci Rep 2021; 11:20750. [PMID: 34675281 PMCID: PMC8531322 DOI: 10.1038/s41598-021-00290-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/23/2021] [Indexed: 12/17/2022] Open
Abstract
Persons living with HIV (PLWH) may have increased incidence of cardiovascular events and longer QTc intervals than uninfected persons. We aimed to investigate the incidence and risk factors of de novo major electrocardiogram (ECG) abnormalities and QTc prolongation in well-treated PLWH. We included virologically suppressed PLWH without major ECG abnormalities, who attended the 2-year follow-up in the Copenhagen comorbidity in HIV infection (COCOMO) study. ECGs were categorized according to Minnesota Code Manual. We defined de novo major ECG abnormalities as new major Minnesota Code Manual abnormalities. Prolonged QTc was defined as QTc > 460 ms in females and QTc > 450 ms in males. Of 667 PLWH without major ECG abnormalities at baseline, 34 (5%) developed de novo major ECG abnormalities after a median of 2.3 years. After adjustment, age (RR: 1.57 [1.08-2.28] per decade older), being underweight (RR: 5.79 [1.70-19.71]), current smoking (RR: 2.34 [1.06-5.16]), diabetes (RR: 3.89 [1.72-8.80]) and protease inhibitor use (RR: 2.45 [1.27-4.74) were associated with higher risk of getting de novo major ECG abnormalities. Of PLWH without prolonged QTc at baseline, only 11 (1.6%) participants developed de novo prolonged QTc. Five percent of well-treated PLWH acquired de novo major ECG abnormalities and protease inhibitor use was associated with more than twice the risk of de novo major ECG abnormalities. De novo prolonged QTc was rare and did not seem to constitute a problem in well-treated PLWH.
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Affiliation(s)
- Andreas D Knudsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, 2100, Copenhagen, Denmark
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas Bille Nielsen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Magda Teresa Thomsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, 2100, Copenhagen, Denmark
| | - Julie Høgh
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, 2100, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Jan Gerstoft
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, 2100, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne D Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, 2100, Copenhagen, Denmark.
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Abstract
Antiretroviral therapy has largely transformed HIV infection into a chronic disease condition. As such, physicians and other providers caring for individuals living with HIV infection need to be aware of the potential cardiovascular complications of HIV infection and the nuances of how HIV infection increases the risk of cardiovascular diseases, including acute myocardial infarction, stroke, peripheral artery disease, heart failure and sudden cardiac death, as well as how to select available therapies to reduce this risk. In this Review, we discuss the epidemiology and clinical features of cardiovascular disease, with a focus on coronary heart disease, in the setting of HIV infection, which includes a substantially increased risk of myocardial infarction even when the HIV infection is well controlled. We also discuss the mechanisms underlying HIV-associated atherosclerotic cardiovascular disease, such as the high rates of traditional cardiovascular risk factors in patients with HIV infection and HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection. Finally, we highlight available therapeutic strategies, as well as approaches under investigation, to reduce the risk of cardiovascular disease and lower inflammation in patients with HIV infection.
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Affiliation(s)
- Priscilla Y Hsue
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - David D Waters
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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Waters DD, Hsue PY. Lipid Abnormalities in Persons Living With HIV Infection. Can J Cardiol 2018; 35:249-259. [PMID: 30704819 DOI: 10.1016/j.cjca.2018.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/16/2023] Open
Abstract
Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug-drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.
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Affiliation(s)
- David D Waters
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA
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