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Nayak U, Dsouza NV, Rai PVS, Achappa B, Holla R, Murlimanju BV. Cardiovascular risk factors and carotid intima-media thickness with neurocognitive dysfunction in people living with HIV on stable combination anti-retroviral therapy. 3 Biotech 2024; 14:77. [PMID: 38371905 PMCID: PMC10869320 DOI: 10.1007/s13205-023-03865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/21/2023] [Indexed: 02/20/2024] Open
Abstract
The goal of this clinical research was to determine the relationship between carotid intima-media thickness (cIMT), cardiovascular risk factors, and neuro-cognitive function in people living with HIV (PLHIV) and were on stable combination anti-retroviral therapy (cART). This is a cross-sectional study performed at a single center, including 149 patients who visited the anti-retroviral therapy center of our tertiary care hospital. Among the PLHIV of our research, 62.4% had at least one associated cardiovascular risk factor, and 61.1% of them had abnormally high cIMT (โฅโ0.9ย mm on any one side, pโ=โ0.035). These factors and being the male gender (pโ=โ0.028) were associated with a greater Framingham 10-year risk percentage. Hypercholesterolemia was observed in 30.9% of the PLHIV and a higher body mass index (โฅโ25ย kg/m2) was found in 26.8% of them. The cognitive impairment was milder in 71.8% of cases and moderate in 9.4% of PLHIV. The Chi-square test revealed that a higher proportion of participants who had lower HDL-C levels (pโ=โ0.045), smokers (pโ=โ0.029), systolic blood pressureโโฅโ140ย mmHg (pโ=โ0.012), and lower educational status (pโ=โ0.017) had a poorer cognitive performance. In our sample population, a higher prevalence of elevated cIMT, cardiovascular risk factors, and mild and moderate cognitive deficiency was observed in PLHIV, who were on stable cART. However, routine assessment of the neuropsychological functions and management of modifiable risk factors are not performed in our patients. Further exploration of the relationship between cardiovascular risks, cIMT, and cognitive impairment in PLHIV is essential to formulate the guidelines and delay the onset of neurocognitive disorders in these patients.
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Affiliation(s)
- Unnathi Nayak
- Intern, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nikhil Victor Dsouza
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - P. V. Santosh Rai
- Department of Radiodiagnosis, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Basavaprabhu Achappa
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - B. V. Murlimanju
- Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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2
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Yeboah K, Essel S, Agyekum J, Dzudzor B. Association between cardio-ankle vascular index and cardiometabolic risk factors in HIV patients in Ghana. Libyan J Med 2023; 18:2215636. [PMID: 37207315 DOI: 10.1080/19932820.2023.2215636] [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: 01/23/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is associated with increased cardiovascular diseases (CVDs) even in patients with viral suppression by combination antiretroviral therapy (cART). Arterial stiffness is an independent predictor of CVDs in diseased individuals and the general population. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness that has been shown to predict target organ damage. CAVI is less studied in HIV patients. We compared the levels of arterial stiffness using CAVI and associated factors among cART-treated and cART-naรฏve HIV patients to those of non-HIV controls. In a case-control design, 158 cART-treated HIV patients, 150 cART-naรฏve HIV patients and 156 non-HIV controls were recruited from a periurban hospital. We collected data on CVD risk factors, anthropometric characteristics, CAVI, and fasting blood samples to measure plasma glucose, lipid profile, and CD4+ cell counts. Metabolic abnormalities were defined using the JIS criteria. CAVI increased in cART-treated HIV patients compared to cART-naรฏve HIV patients and non-HIV controls (7.8โยฑโ1.4 vs 6.6โยฑโ1.1 vs 6.7โยฑโ1.4 respectively, pโ<โ0.001). CAVI was associated with metabolic syndrome in non-HIV controls [OR (95% CI)โ=โ2.14 (1.04-4.4), pโ=โ0.039] and cART-naรฏve HIV patients [1.47 (1.21-2.38), pโ=โ0.015], but not in cART-treated HIV patients [0.81 (0.52-1.26), pโ=โ0.353]. In cART-treated HIV patients, a tenofovir (TDF)-based regimen (ฮฒโ=โ-0.46, pโ=โ0.023) was associated with decreased CAVI and decreased CD4+ cell count (ฮฒโ=โ-0.23, pโ=โ0.047) was associated with increased CAVI. In a periurban hospital in Ghana, compared to non-HIV controls or cART-naรฏve HIV patients, cART-treated HIV patients had increased arterial stiffness measured as CAVI. CAVI is associated with metabolic abnormalities in non-HIV controls and cART-naรฏve HIV patients, but not in cART-treated HIV patients. Patients on TDF-based regimens had decreased CAVI.
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Affiliation(s)
- Kwame Yeboah
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
| | - Samuel Essel
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Department of Physician Assistant Studies, Central University, Accra, Ghana
| | - Jennifer Agyekum
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Medical Laboratory Unit, Mamprobi Hospital, Ghana Health Service, Accra, Ghana
| | - Bartholomew Dzudzor
- Department of Medical Biochemistry, University of Ghana Medical School, Accra, Ghana
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3
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Lui G, Leung HS, Lee J, Wong CK, Li X, Ho M, Wong V, Li T, Ho T, Chan YY, Lee SS, Lee APW, Wong KT, Zee B. An efficient approach to estimate the risk of coronary artery disease for people living with HIV using machine-learning-based retinal image analysis. PLoS One 2023; 18:e0281701. [PMID: 36827291 PMCID: PMC9955663 DOI: 10.1371/journal.pone.0281701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND People living with HIV (PLWH) have increased risks of non-communicable diseases, especially cardiovascular diseases. Current HIV clinical management guidelines recommend regular cardiovascular risk screening, but the risk equation models are not specific for PLWH. Better tools are needed to assess cardiovascular risk among PLWH accurately. METHODS We performed a prospective study to determine the performance of automatic retinal image analysis in assessing coronary artery disease (CAD) in PLWH. We enrolled PLWH with โฅ1 cardiovascular risk factor. All participants had computerized tomography (CT) coronary angiogram and digital fundus photographs. The primary outcome was coronary atherosclerosis; secondary outcomes included obstructive CAD. In addition, we compared the performances of three models (traditional cardiovascular risk factors alone; retinal characteristics alone; and both traditional and retinal characteristics) by comparing the area under the curve (AUC) of receiver operating characteristic curves. RESULTS Among the 115 participants included in the analyses, with a mean age of 54 years, 89% were male, 95% had undetectable HIV RNA, 45% had hypertension, 40% had diabetes, 45% had dyslipidemia, and 55% had obesity, 71 (61.7%) had coronary atherosclerosis, and 23 (20.0%) had obstructive CAD. The machine-learning models, including retinal characteristics with and without traditional cardiovascular risk factors, had AUC of 0.987 and 0.979, respectively and had significantly better performance than the model including traditional cardiovascular risk factors alone (AUC 0.746) in assessing coronary artery disease atherosclerosis. The sensitivity and specificity for risk of coronary atherosclerosis in the combined model were 93.0% and 93.2%, respectively. For the assessment of obstructive CAD, models using retinal characteristics alone (AUC 0.986) or in combination with traditional risk factors (AUC 0.991) performed significantly better than traditional risk factors alone (AUC 0.777). The sensitivity and specificity for risk of obstructive CAD in the combined model were 95.7% and 97.8%, respectively. CONCLUSION In this cohort of Asian PLWH at risk of cardiovascular diseases, retinal characteristics, either alone or combined with traditional risk factors, had superior performance in assessing coronary atherosclerosis and obstructive CAD. SUMMARY People living with HIV in an Asian cohort with risk factors for cardiovascular disease had a high prevalence of coronary artery disease (CAD). A machine-learning-based retinal image analysis could increase the accuracy in assessing the risk of coronary atherosclerosis and obstructive CAD.
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Affiliation(s)
- Grace Lui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Ho Sang Leung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Jack Lee
- Centre for Clinical Research and Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Chun Kwok Wong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Xinxin Li
- Centre for Clinical Research and Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Mary Ho
- Department of Ophthalmology, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Vivian Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Timothy Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Tracy Ho
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Yin Yan Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Alex PW Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Ka Tak Wong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Benny Zee
- Centre for Clinical Research and Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
- * E-mail:
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Liu S, Wei B, Liang W, Chen T, Deng L, Zhao M, Wan J. The effects of ART on the dynamics of lipid profiles in Chinese Han HIV-infected patients: comparison between NRTI/NNRTI and NRTI/INSTI. Front Public Health 2023; 11:1161503. [PMID: 37181701 PMCID: PMC10174832 DOI: 10.3389/fpubh.2023.1161503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/30/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction This article aimed to compare the prevalence of dyslipidemia and determine risk factors associated with lipid levels in a cohort of HIV-infected patients receiving two different antiretroviral therapy (ART) regimens, nucleoside reverse transcriptase inhibitor/non-nucleoside reverse transcriptase inhibitor (NRTI/NNRTI) and nucleoside reverse transcriptase inhibitor/integrase strand transfer inhibitor (NRTI/INSTI). Methods This longitudinal study analyzed 633 HIV-infected patients with complete blood lipid profile records for at least 1โyear at the ART clinic of Zhongnan Hospital of Wuhan University, China, from June 2018 to March 2021. Demographic and clinical data, including age, gender, body weight, height, current/former/non-smoker, current drinker, diabetes mellitus, hypertension, were extracted from electronic medical records. Laboratory tests included hematology, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), Lipoprotein(a) and CD4 cell count. The observation duration of this study was a maximum of 33โmonths. Data comparisons were performed using the Chi-square test, Student's t-test and Mann-Whitney U test. Generalized linear mixed-effects model (GLMM) and value of p <โ0.05 were used to determine factors associated with serum lipid profiles. Results In this study, the effect of the NNRTIs group on the lipid profile over time was mainly an increase in TC and HDL-C, while a decrease in TC/HDL-C and LDL/HDL-C. However, the INSTIs group had higher mean TC and lower HDL-C compared to the NNRTIs group, with significantly increased levels of TC, TG, HDL-C, and LDL-C. In the analysis of dyslipidemia rates, there were significant differences in the prevalence of abnormal TG and TC/HDL-C in HIV-infected patients receiving two different ART regimen groups during different follow-up periods. Dyslipidemia, defined as hypercholesterolemia, hypertriglyceridemia, and low HDL-C, was more prevalent in the INSTIs group, with a higher risk of developing hypertriglyceridemia and a higher TC/HDL-C ratio compared to the NNRTIs group. GLMM analysis suggested significantly higher TG values in the INSTIs group (estimated 0.36[0.10, 0.63], SE 0.14, pโ=โ0.008) compared to the NNRTIs group, even after adjusting for other covariates. In addition, GLMM analysis also showed that age, gender, BMI, CD4 count, and ART duration were associated with dyslipidemia. Conclusion In conclusion, treatment with both commonly-used ART regimens can increase the mean values of lipid profiles and the risk of dyslipidemia. The findings indicated that TG values were significantly higher in the INSTIs group than in HIV-infected patients receiving the NNRTIs regimens. Longitudinal TG values are independently associated with the clinical types of ART regimens.Clinical Trial Number: ChiCTR2200059861.
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Affiliation(s)
- Shengnan Liu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Baozhu Wei
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Liang
- School of Health Sciences, Wuhan University School of Health Sciences, Wuhan, China
| | - Tielong Chen
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liping Deng
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Min Zhao
- Demonstration Center for Experimental Basic Medicine Education, School of Basic Medical Sciences, Wuhan University, Wuhan, China
- *Correspondence: Min Zhao,
| | - Jing Wan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Jing Wan,
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5
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Fitch KV, McCallum SA, Erlandson KM, Overton ET, Zanni MV, Fichtenbaum C, Aberg JA, Fulda ES, Kileel EM, Moran LE, Bloomfield GS, Novak RM, Pรฉrez-Frontera S, Abrams-Downey A, Pierone G, Kumarasamy N, Ruxrungtham K, Mngqibisa R, Douglas PS, Ribaudo HJ, Grinspoon SK. Diet in a global cohort of adults with HIV at low-to-moderate traditional cardiovascular disease risk. AIDS 2022; 36:1997-2003. [PMID: 35876637 PMCID: PMC9612704 DOI: 10.1097/qad.0000000000003344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To characterize diet quality across a global cohort of people with HIV (PWH). DESIGN Cross-sectional analysis. METHODS Leveraging REPRIEVE data from baseline across five Global Burden of Disease (GBD) regions, we analyzed participant responses to the Rapid Eating Assessment for Participants questionnaire. An overall diet quality score and scores for specific diet components were generated. Higher scores indicate better diet quality. RESULTS Among 7736 participants (median age 50 years, 30% women, median BMI 25.8โkg/m 2 ) overall diet quality score (max score 30) was optimal in 13% of participants and good, suboptimal or poor in 45%, 38%, and 4% of participants, respectively; saturated fat score (max score 18) was good, suboptimal, or poor in 38%, 40%, or 7% of participants, respectively. Diet quality scores differed across GBD region with the highest scores reported in the South Asia region [median 23 (21-25)] and lowest in the sub-Saharan Africa region [median 15 (12-18)]; 61% of participants in the South Asia region reported optimal diet quality compared with only 6% in the sub-Saharan Africa region. Higher atherosclerotic cardiovascular risk scores were seen with worsening diet quality. CONCLUSION Among PWH eligible for primary CVD prevention, diet quality was suboptimal or poor for almost half of participants, and there were substantial variations in diet quality reported by GBD region. TRIAL REGISTRATION NCT02344290.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Laura E. Moran
- Social & Scientific Systems, a DLH Company, Silver Spring, MD
| | - Gerald S. Bloomfield
- Duke Global Health Institute, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | | | - Gerald Pierone
- AIDS Research and Treatment Center of the Treasure Coast, Vero Beach, FL, USA
| | | | - Kiat Ruxrungtham
- School of Global Faculty of Medicine Chulalongkorn University and HIV-NAT Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Rosie Mngqibisa
- Enhancing Care Foundation (Wentworth Hospital), Durban, South Africa
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Heather J. Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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6
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Shim MS, Noh D. Effects of Physical Activity Interventions on Health Outcomes among Older Adults Living with HIV: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8439. [PMID: 35886293 PMCID: PMC9317429 DOI: 10.3390/ijerph19148439] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
There is a lack of evidence regarding the effects of exercise on older individuals living with HIV. This systematic review and meta-analysis examined previous studies on physical activity interventions for people living with HIV aged โฅ50 years. The effectiveness of the interventions on various physical and psychological health outcomes was evaluated. Databases used for this review included PubMed, EMBASE, CINAHL, and Cochrane Library CENTRAL. Twelve randomized controlled trials on physical activity interventions for people โฅ50 years and living with HIV were included. Standardized mean differences were calculated using random-effect models. All effect sizes were expressed using Cohen's d values and their 95% confidence intervals (CIs). Physical activity interventions had a significant effect on walking capacity (Cohen's d: 0.467; 95% CI [0.069, 0.865]). The effect sizes on cardiorespiratory fitness, weight, and health-related quality of life were not significant. These findings suggest that physical activity interventions for people living with HIV aged โฅ50 years are effective for the improvement of walking capacity. Further larger and higher-quality studies are required to determine the full effects of physical activity interventions on various health outcomes among older adults with HIV.
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Affiliation(s)
- Mi-So Shim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul 03722, Korea;
| | - Dabok Noh
- College of Nursing, Eulji University, Seongnam-si 13135, Korea
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7
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Valderrama-Beltrรกn S, Martรญnez-Vernaza S, Figueredo M, Martรญnez E, Blair KJ, Cuervo-Rojas J, Arรฉvalo L, De La Hoz A, Quiroga C, Mueses H, Sussmann O, Mantilla M, Ramรญrez C, Gonzalez C, Montero-Riascos L, Botero M, Alzate-รngel J, Garcรญa-Garzรณn M, Franco J, Lenis W, Galindo-Orrego X, Stand J, Fonseca N, Alzamora D, Ramos O, Tobon W, Ruiz J, Leรณn S, Rojas-Rojas M, Urrego-Reyes J, Beltrรกn-Rodrรญguez C, Rosselli D, Rodriguez-Lugo DA, Villamil-Castaรฑeda LP, รlvarez-Moreno C. Cardiovascular risk factors and comorbidities in people living with HIV: A cross-sectional multicenter study from Colombia comorbidities in a Colombian PLWHIV population. Int J STD AIDS 2022; 33:641-651. [PMID: 35502981 DOI: 10.1177/09564624221089456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. METHODS This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. RESULTS A total of 1616 patients were included. 83.2% were men, and the median age was 34ย years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively. CONCLUSIONS In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.
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Affiliation(s)
- Sandra Valderrama-Beltrรกn
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotรก, Colombia
| | - Samuel Martรญnez-Vernaza
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotรก, Colombia
| | - Marรญa Figueredo
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotรก, Colombia
| | - Ernesto Martรญnez
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, 28006Universidad Del Valle, Cali, Colombia
| | - Kevin J Blair
- Department of Surgery, David Geffen School of Medicine, 12222University of California, Los Angeles, CA, USA.,Division of Infectious Diseases, Department of Medicine, South American Program in HIV Prevention Research (SAPHIR), UCLA, Los Angeles, CA, USA
| | - Juliana Cuervo-Rojas
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, 27964Pontificia Universidad Javeriana, Bogotรก, Colombia
| | - Leonardo Arรฉvalo
- HIV Clinic, Centro de Expertos para Atenciรณn Integral, Cepain, Colombia
| | - Alejandro De La Hoz
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotรก, Colombia
| | - Camilo Quiroga
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotรก, Colombia
| | - Hรฉctor Mueses
- HIV Clinic, 456131Corporaciรณn de Lucha Contra El Sida, Cali, Colombia
| | - Otto Sussmann
- HIV Clinic, Infectoclรญnicos, Bogotรก, Colombia.,HIV Clinic, Asistencia Cientรญfica de Alta Complejidad, Bogotรก, Colombia
| | - Mรณnica Mantilla
- HIV Clinic, Centro de Expertos para Atenciรณn Integral, Cepain, Colombia.,HIV Clinic, SANAS IPS, Bogotรก, Colombia
| | | | | | - Leonardo Montero-Riascos
- Division of Infectious Diseases, School of Medicine, 67637Universidad Libre, Cali, Colombia.,HIV Clinic, Todomed Cali, Cali, Colombia
| | | | | | | | | | | | | | - Javier Stand
- HIV Clinic, Centro de Expertos para Atenciรณn Integral, Cepain, Colombia
| | - Norberto Fonseca
- HIV Clinic, Asistencia Cientรญfica de Alta Complejidad, Bogotรก, Colombia
| | | | - Olga Ramos
- HIV Clinic, Centro de Expertos para Atenciรณn Integral, Cepain, Colombia
| | - Wilmar Tobon
- HIV Clinic, Centro de Expertos para Atenciรณn Integral, Cepain, Colombia
| | - Jaime Ruiz
- Research Department, MSD Colombia, Bogotรก, Colombia
| | | | | | | | | | - Diego Rosselli
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, 27964Pontificia Universidad Javeriana, Bogotรก, Colombia
| | - Diego-Andres Rodriguez-Lugo
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotรก, Colombia
| | - Lina Paola Villamil-Castaรฑeda
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotรก, Colombia
| | - Carlos รlvarez-Moreno
- Vicepresidente Cientรญfico, Clรญnica Colsanitas, Bogotรก, Colombia.,Division of Infectious Diseases, Facultad de Medicina, 28021Universidad Nacional de Colombia, Bogotรก, Colombia
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8
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Rerkasem A, Tangmunkongvorakul A, Aurpibul L, Sripan P, Parklak W, Nantakool S, Srithanaviboonchai K, Rerkasem K. Association of cardio-ankle vascular index and future major adverse cardiovascular events in older adults living with HIV. AIDS Care 2022; 35:591-599. [PMID: 35499141 DOI: 10.1080/09540121.2022.2029820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACTIncreased arterial stiffness is an indicator of cardiovascular disease (CVD) and death in the general population. The cardio-ankle vascular index (CAVI) is a novel method for measuring arterial stiffness. This study investigated the utility of CAVI as a prognostic indicator of CVD and death in older adults living with HIV(OALHIV). Patients aged โฅ50 taking antiretroviral treatment with no history of cardiovascular events enrolled from multiple centers in Chiang Mai, Thailand. Participants (Nโ=โ347) who underwent CAVI were followed up for five years. The primary endpoint was major adverse cardiovascular events (MACE): a composite of total deaths and hospitalizations due to myocardial infarction, coronary revascularization, stroke, and heart failure. Cox regression analysis determined between normal (<8) and high (โฅ8) CAVI against the incidence of MACE. Forty-five participants (13.0%) were diagnosed with MACE. The risk of MACE was more significant in high CAVI than normal CAVI (adjusted HRโ=โ 2.11, 95% confidence interval 1.06-4.20, pโ=โ0.033). In OALHIV, CAVI was an independent prognosis of MACE, in addition to conventional CVD risk factors. CAVI-assisted to help identify high-risk patients showed the benefit of further evaluation and more intensive therapy to prevent CVD and death.
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Affiliation(s)
- Amaraporn Rerkasem
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Arunrat Tangmunkongvorakul
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Linda Aurpibul
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Wason Parklak
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sothida Nantakool
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kriengkrai Srithanaviboonchai
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipan Rerkasem
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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9
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Han WM, Law MG, Choi JY, Ditangco R, Kumarasamy N, Chaiwarith R, Ly PS, Khusuwan S, Merati TP, Do CD, Yunihastuti E, Azwa I, Lee MP, Pham TN, Chan YJ, Kiertiburanakul S, Ng OT, Tanuma J, Pujari S, Zhang F, Gani Y, Mave V, Ross J, Avihingsanon A. Weight changes, metabolic syndrome and all-cause mortality among Asian adults living with HIV. HIV Med 2022; 23:274-286. [PMID: 34816562 PMCID: PMC8847330 DOI: 10.1111/hiv.13211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We investigated weight changes following antiretroviral therapy (ART) initiation, the development of metabolic syndrome (MetS) and its association with all-cause mortality among Asian adults living with HIV. METHODS Participants enrolled in a regional Asian HIV-infected cohort with weight and height measurements at ART initiation were eligible for inclusion in the analysis. Factors associated with weight changes and incident MetS (according to the International Diabetic Federation (IDF) definition) were analysed using linear mixed models and Cox regression, respectively. Competing-risk regression models were used to investigate the association of MetS with all-cause mortality. RESULTS Among 4931 people living with HIV (PLWH), 66% were male. At ART initiation, the median age was 34 [interquartile range (IQR) 29-41] years, and the median (IQR) weight and body mass index (BMI) were 55 (48-63) kg and 20.5 (18.4-22.9) kg/m2 , respectively. At 1, 2 and 3ย years of ART, overall mean (ยฑ standard deviation) weight gain was 2.2 (ยฑ5.3), 3.0 (ยฑ6.2) and 3.7 (ยฑ6.5) kg, respectively. Participants with baseline CD4 countย โคย 200 cells/ยตL [weight difference (diff)ย =ย 2.2ย kg; 95% confidence interval (CI) 1.9-2.5 kg] and baseline HIV RNAย โฅย 100ย 000 HIV-1 RNA copies/mL (diffย =ย 0.6ย kg; 95% CI 0.2-1.0 kg), and those starting with integrase strand transfer inhibitor (INSTI)-based ART (diffย =ย 2.1ย kg; 95% CI 0.7-3.5 kg vs. nonnucleoside reverse transcriptase inhibitors) had greater weight gain. After exclusion of those with abnormal baseline levels of MetS components, 295/3503ย had incident MetS [1.18 (95% CI 1.05-1.32)/100 person-years (PY)]. The mortality rate was 0.7 (95% CI 0.6-0.8)/100 PY. MetS was not significantly associated with all-cause mortality in the adjusted model (Pย =ย 0.236). CONCLUSIONS Weight gain after ART initiation was significantly higher among those initiating ART with lower CD4 count, higher HIV RNA and an INSTI-based regimen after controlling for baseline BMI. Greater efforts to identify and manage MetS among PLWH are needed.
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Affiliation(s)
- Win Min Han
- The Kirby Institute, UNSW Sydney, Sydney, Australia,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | - Romanee Chaiwarith
- Chiang Mai University - Research Institute for Health Sciences, Chiang Mai, Thailand
| | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | | | | | | | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Iskandar Azwa
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Oon Tek Ng
- Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore
| | - Junko Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yasmin Gani
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - Vidya Mave
- BJ Government Medical College- Johns Hopkins University Clinical Research Site, Pune, India
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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10
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Park S, Park SY, Lee E, Kim TH, Lee E. The Role of Age in Subclinical Atherosclerosis in Asian People Living with Human Immunodeficiency Virus. Infect Chemother 2022; 54:308-315. [PMID: 35794717 PMCID: PMC9259902 DOI: 10.3947/ic.2022.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background People living with human immunodeficiency virus (PLHIV) have an increased risk of atherosclerosis and cardiovascular disease, but specific guidance on when to suspect the onset of these diseases is limited. Materials and Methods We aimed to identify cardiovascular risk factors in PLHIV using carotid intima-media thickness (IMT) through a cross-sectional, retrospective cohort study that enrolled 217 PLHIV who underwent carotid IMT measurement at a teaching hospital in Korea. We compared clinical characteristics between PLHIV with subclinical atherosclerosis and PLHIV with IMT within the normal range, and used a receiver operating characteristic curve to determine the cut-off age for predicting subclinical atherosclerosis. Results Among the study population, 115 participants (53.0%) had subclinical atherosclerosis. In logistic regression, age and dyslipidemia were significantly associated with increased carotid IMT even after adjusting for other variables (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.06 - 1.15, P <0.001; OR: 3.92, 95% CI: 1.87 - 8.22, P <0.001, respectively). The cut-off age for predicting subclinical atherosclerosis was 39.5 years (area under the curve 0.78, 95% CI: 0.72 - 0.84, P <0.001). Conclusion Conventional risk factors including age and dyslipidemia were associated with subclinical atherosclerosis in Asian PLHIV. In particular, Asian PLHIV older than 40 years had an increased risk of subclinical atherosclerosis and may benefit from carotid IMT screening.
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Affiliation(s)
- Sunghee Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Se Yoon Park
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- Centers for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eunyoung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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11
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Tasca KI, Fagundes Vidal VVM, Martinez Manfio V, Naime Barbosa A, de Souza LDR. Contributory role of ART in the development of non-AIDS comorbidities in asymptomatic PLWHA. J Appl Biomed 2021; 19:73-82. [PMID: 34907718 DOI: 10.32725/jab.2021.002] [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: 04/27/2020] [Accepted: 01/21/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite the many benefits that follow antiretroviral therapy (ART) initiation, its chronic use contributes to the early aging of people living with HIV/AIDS (PLWHA). The aim of this cross-sectional study was to trace the prevalence of and investigate possible renal, bone and metabolic changes, as well as cardiovascular risk in 94 asymptomatic PLWHA, relating them to the duration of ART use. METHODS Four groups were evaluated according to ART use: G1 (n = 21), ART-naรฏve individuals; G2 (n = 17), <2 years; G3 (n = 40), 2-10 years; and G4 (n = 16) on ART for more than 10 years. RESULTS Our results showed a high prevalence of dyslipidemic individuals (64%), especially in those under ART. Lower creatine phosphokinase levels were observed in G1 as compared to the others (p < 0.05). Regarding the Framingham score, 12.1% of PLWHA showed moderate and high risk, and the highest proportion (38.5%) occurred in G4 (p = 0.003). A decrease in glomerular filtration rates occurred in 20% of patients, which was also more significant in G3 and G4 (p = 0.007). High prevalences of osteopenia and osteoporosis (53.2%) were found, especially in G1 and G4; however, G1 showed the lowest means for alkaline phosphatases (AP, p = 0.04 and BAP, p = 0.005) and osteocalcin (p = 0.005), in addition to higher vitamin-D concentrations (p = 0.04). CONCLUSIONS Our study showed the possible contributory role of ART in these changes, which leads us to reflect on the need for specific conducts and patient care, pointing out the importance of individualized care in an attempt to increase life expectancy.
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Affiliation(s)
- Karen Ingrid Tasca
- Sao Paulo State University - UNESP, Institute of Biosciences of Botucatu, Department of Microbiology and Immunology, Botucatu, Sao Paulo State, Brazil
| | - Vania V M Fagundes Vidal
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil
| | - Vanessa Martinez Manfio
- Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Alexandre Naime Barbosa
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Lenice do Rosario de Souza
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
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12
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Choi JY, Lui GCY, Liao CT, Yang CJ. Managing cardiovascular risk in people living with HIV in Asia - where are we now? HIV Med 2021; 23:111-120. [PMID: 34494350 DOI: 10.1111/hiv.13164] [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: 06/24/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
As the life expectancy of people living with HIV (PLWH) approaches that of the general population, the burden of comorbidities such as cardiovascular disease (CVD) is increasing. Regardless of HIV status, about 50% of CVD deaths worldwide occur in Asia, and Asian PLWH have a high prevalence of conventional CVD risk factors, such as smoking, dyslipidaemia, hypertension and insulin resistance or diabetes. As well as conventional CVD risk factors, PLWH have HIV-specific risk factors such as chronic inflammation, immune activation and endothelial damage, as well as risk factors related to antiretroviral therapy. This review describes the current knowledge on the epidemiology and risk factors of CVD in Asian PLWH and provides an Asian perspective on the recommendations for managing CVD risk in PLWH.
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Affiliation(s)
- Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Grace Chung Yan Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chia-Te Liao
- Division of Cardiology, Chi-Mei Medical Centre, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chia-Jui Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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13
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Plasma hemoglobin and the risk of death in HIV/AIDS patients treated with antiretroviral therapy. Aging (Albany NY) 2021; 13:13061-13072. [PMID: 33971620 PMCID: PMC8148493 DOI: 10.18632/aging.202987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/26/2021] [Indexed: 12/05/2022]
Abstract
Background: Previous studies concerning the effect of plasma hemoglobin (HB) and other factors that may modify the risk of death in people living with HIV/AIDS (PLHIV) treated with antiretroviral therapy (ART) are limited. Results: Higher HB was independently linked to a lower death risk in PLHIV, with a decrease of 29% (13%, 43%) per standard deviation (SD) increment after adjusting for CD4, VL and other potential factors [hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.57-0.87, P<0.001]. In addition, the addition of HB to the predictive model containing VL and CD4 significantly improved the C-index, by 0.69% (95% CI: 0.68%-0.71%), and net discrimination, by 0.5% (95% CI: 0.0%-1.6%, P=0.040), when predicting the death risk of PLHIV. Conclusions: A lower level of HB was an independent risk factor for HIV/AIDS-associated death in PLHIV. HB combined with VL and CD4 may be an appropriate predictive model of the death risk of PLHIV. Materials and methods: A propensity-score matching (PSM) approach was applied to select a total of 750 PLHIV (150 deceased and 600 living) from the AIDS prevention and control information system in the Wenzhou area from 2006 to 2018. Multivariable Cox proportional hazards regression models were formulated to estimate the effect of HB. The predictive performance improvement contributed by HB was evaluated using the C-index and net reclassification improvement.
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14
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Boettiger DC, Kerr S, Chattranukulchai P, Siwamogsatham S, Avihingsanon A. Maintenance of statin therapy among people living with HIV. AIDS 2021; 35:567-574. [PMID: 33252492 DOI: 10.1097/qad.0000000000002769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Statins play a critical role in reducing the elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLHIV). However, maintaining statin therapy is difficult and may be impeded further in PLHIV due to the risk of antiretroviral therapy (ART)/statin interactions. We estimated rates of statin discontinuation and reinitiation, and the percentage of days covered by statin use among PLHIV on ART, and investigated factors associated with these outcomes. DESIGN Observational cohort study. METHODS Clinical data from individuals attending the HIV-NAT Centre in Bangkok, Thailand between 2001 and 2020 were analyzed using Kaplan-Meier curves, competing-risk regression, and generalized estimating equations. Discontinuation was defined as statin cessation lasting 90 days. RESULTS Data on 318 PLHIV were included. After 1, 3, and 5 years, 22.3, 50.8, and 61.1% had discontinued statin use, respectively. Among those who discontinued (nโ=โ178), 52.0% reinitiated statin use within 5 years. Factors associated with statin discontinuation were low education level, fewer concomitant medications, and lack of ASCVD. Factors associated with statin reinitiation were older age, diabetes, and high levels of LDL cholesterol. The adjusted mean percentage of days covered by a statin was 86.7, 61.1, and 58.1% in the 6 months prior to 1, 3, and 5 years of follow-up, respectively. CONCLUSION Maintenance of statin therapy is poor among PLHIV on ART but is not associated with using contraindicated antiretroviral/statin combinations. A better understanding of statin use in PLHIV will aid clinicians treating individuals and policy makers designing interventions for population-level ASCVD risk reduction.
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Affiliation(s)
- David C Boettiger
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA
- Faculty of Medicine, Biostatistics Excellence Centre, Chulalongkorn University, King Chulalongkorn Memorial Hospital
| | - Stephen Kerr
- Faculty of Medicine, Biostatistics Excellence Centre, Chulalongkorn University, King Chulalongkorn Memorial Hospital
- HIV-NAT Research Collaboration/Thai Red Cross AIDS Research Centre
| | | | | | - Anchalee Avihingsanon
- HIV-NAT Research Collaboration/Thai Red Cross AIDS Research Centre
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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15
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Han WM, Bijker R, Chandrasekaran E, Pujari S, Ng OT, Ly PS, Lee MP, Nguyen KV, Chan YJ, Do CD, Choi JY, Chaiwarith R, Merati TP, Kiertiburanakul S, Azwa I, Khusuwan S, Zhang F, Gani YM, Tanuma J, Sangle S, Ditangco R, Yunihastuti E, Ross J, Avihingsanon A. Validation of the D: A: D Chronic Kidney Disease Risk Score Model Among People Living With HIV in the Asia-Pacific. J Acquir Immune Defic Syndr 2020; 85:489-497. [PMID: 33136750 PMCID: PMC8018533 DOI: 10.1097/qai.0000000000002464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND We validated the Data collection on Adverse events of anti-HIV Drugs (D:A:D) full-risk and short-risk score models for chronic kidney disease (CKD) in the Asian HIV cohorts. SETTINGS A validation study among people living with HIV (PLHIV) aged โฅ18 years among the cohorts in the Asia-Pacific region. METHODS PLHIV with a baseline estimated glomerular filtration rate > 60 mL/min/1.73 m were included for validation of the D:A:D CKD full version and short version without cardiovascular risk factors. Those with <3 estimated glomerular filtration rate measurements from baseline or previous exposure to potentially nephrotoxic antiretrovirals were excluded. Kaplan-Meier methods were used to estimate the probability of CKD development. The area under the receiver operating characteristics was also used to validate the risk score. RESULTS We included 5701 participants in full model {median 8.1 [interquartile range (IQR) 4.8-10.9] years follow-up} and 9791 in short model validation [median 4.9 (IQR 2.5-7.3) years follow-up]. The crude incidence rate of CKD was 8.1 [95% confidence interval (CI): 7.3 to 8.9] per 1000 person-years in the full model cohort and 10.5 (95% CI: 9.6 to 11.4) per 1000 person-years in the short model cohort. The progression rates for CKD at 10 years in the full model cohort were 2.7%, 8.9%, and 26.1% for low-risk, medium-risk, and high-risk groups, and 3.5%, 11.7%, and 32.4% in the short model cohort. The area under the receiver operating characteristics for the full-risk and short-risk score was 0.81 (95% CI: 0.79 to 0.83) and 0.83 (95% CI: 0.81 to 0.85), respectively. CONCLUSION The D:A:D CKD full-risk and short-risk score performed well in predicting CKD events among Asian PLHIV. These risk prediction models may be useful to assist clinicians in identifying individuals at high risk of developing CKD.
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Affiliation(s)
- Win Min Han
- Kirby Institute, UNSW, Sydney, Australia
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Ezhilarasi Chandrasekaran
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | | | | | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | | | | | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | | | - Iskandar Azwa
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | | | - Junko Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Shashikala Sangle
- BJ Government Medical College and Sassoon General Hospital, Pune, India
| | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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16
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Palanuphap K, Sungkanuparph S. Switching protease inhibitors to rilpivirine in HIV-positive individuals with complete viral suppression and without prior HIV drug resistance in a resource-limited setting: a randomized controlled trial. J Int AIDS Soc 2020; 23:e25462. [PMID: 32277868 PMCID: PMC7150595 DOI: 10.1002/jia2.25462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/20/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Prior to the availability of rilpivirine (RPV), patients who could not tolerate efavirenz and nevirapine (NVP) were treated with protease inhibitor (PI)โbased antiretroviral therapy (ART). Dyslipidaemia and other metabolic complications are commonly associated with PI use. This study aimed to compare the efficacy and adverse events between switching from PIโbased to RPVโbased regimen, versus continuing PIโbased regimens in HIVโpositive individuals with complete viral suppression. Methods A randomized controlled trial was conducted in HIVโpositive individuals receiving PIโbased regimens with undetectable HIV RNA and without prior HIV drug resistance. Patients were enrolled between July and December 2017 in a university medical centre in Bangkok, Thailand. They were randomized to switch from PIs to RPV (switch group) or continue ritonavirโboosted PI (control group). Primary endpoint was the proportion of patients with undetectable HIV RNA at 48ย weeks. Changes in CD4 cell counts, lipid profiles and adverse events were also analysed. Results and discussion A total of 84 patients were enrolled, 42 in each group. Mean age was 47.7ย years and 53.6% were males. At 48ย weeks, 95.2% of patients in the switch group and 92.9% of control group had maintained undetectable HIV RNA (difference rate 2.4%; 95% CI, โ9.6 to 14.7). Means of CD4 cell counts were 611 and 641 cells/mm3 in switch and control groups respectively (pย =ย 0.632). Mean changes in lipid profiles (switch vs. control groups) were: total cholesterol, โ12.5 versusย +ย 12.2 (pย =ย 0.024); LDL, โ3.4 versusย +ย 6.2 (pย =ย 0.040); HDL, +1.6 versusย +ย 1.9 (pย =ย 0.887); and triglycerides, โ82.6 versusย โย 24.4ย mg/dL (pย =ย 0.031). The mean changes of glucose and eGFR were similar (pย >ย 0.05) between the two groups. The mean change of ALT was significantly greater in switch group (18.2 vs. 4.0 U/L, pย =ย 0.017). One patient in switch group had anorexia and elevated ALT at 14ย weeks and completely recovered after RPV discontinuation. Conclusions Switching PIs to RPV, in patients with complete viral suppression and without prior HIV drug resistance, sustains viral suppression and yields better lipid profiles. This finding supports its use as switching therapy in patients receiving PIโbased regimens due to intolerance to efavirenz and NVP and previous alternatives limited to PI in resourceโlimited settings.
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Affiliation(s)
- Kulissara Palanuphap
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somnuek Sungkanuparph
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
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17
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Meng Li C, Jie Ying F, Raj D, Pui Li W, Kukreja A, Omar SFS, Kamarulzaman A, Rajasuriar R. A retrospective analysis of the care cascades for non-communicable disease and mental health among people living with HIV at a tertiary-care centre in Malaysia: opportunities to identify gaps and optimize care. J Int AIDS Soc 2020; 23:e25638. [PMID: 33206473 PMCID: PMC7673263 DOI: 10.1002/jia2.25638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/05/2020] [Accepted: 10/20/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The rapidly growing epidemic of non-communicable diseases (NCDs) including mental health among aging people living with HIV (PLWH) has put a significant strain on the provision of health services in many HIV clinics globally. We constructed care cascades for specific NCDs and mental health among PLWH attending our centre to identify potential areas for programmatic improvement. METHODS This was a follow-up study of participants recruited in the Malaysian HIV & Aging study (MHIVA) from 2014 to 2016 at the University Malaya Medical Centre (nย =ย 336). PLWH on suppressive antiretroviral therapy (ART) for a minimum of 12ย months were invited to participate. At study entry, all participants underwent screening for diabetes (DM), hypertension (HTN) and dyslipidaemia; and completed assessments using the depression, anxiety and stress scale (DASS-21). Screening results were recorded in medical charts and clinical management provided as per standard of care. A subsequent review of medical records was performed at 24ย months following study completion among participants who remained on active follow-up. Treatment pathways for NCD treatment and psychiatric referrals were assessed based on local practice guidelines to construct the care cascade. RESULTS A total of 329 participants (median ageย =ย 43ย years, 83% male, 100% on ART) completed follow-up at 24ย months. The prevalence of diabetes was 13%, dyslipidaemia 88% and hypertension 44%, whereas 23% presented with severe/extremely severe symptoms of depression, anxiety and/or stress. More than 50% of participants with dyslipidaemia and hypertension were not diagnosed until study screening, whereas over 80% with prevalent psychiatric symptoms were not previously recognized clinically. Suboptimal control of fasting lipids, sugar and blood pressure were found in the majority of participants despite optimal HIV treatment outcomes maintained over this same period. Only 32% of participants with severe/extremely severe mental health symptoms received psychiatric referrals and 83% of these attended their psychiatry clinic appointments. CONCLUSIONS Systematic screening must be introduced to identify NCDs and mental health issues among PLWH followed by proper linkage and referrals for management of screen-positive cases. Assessment of factors associated with attrition at each step of the care cascade is critically needed to improve health outcomes in our aging patients.
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Affiliation(s)
- Chong Meng Li
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
| | - Fong Jie Ying
- Department of PharmacyUniversity of MalayaKuala LumpurMalaysia
| | - Dhevann Raj
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
| | - Wong Pui Li
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
- Department of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Anjanna Kukreja
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
- Department of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Sharifah FS Omar
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
- Department of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
- Department of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
- Department of MedicineUniversity of MalayaKuala LumpurMalaysia
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18
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Boettiger DC, Escuder MM, Law MG, Veloso V, Souza RA, Ikeda MLR, deAlencastro PR, Tupinambรกs U, Brites C, Grinsztejn B, Ggomes JO, Ribeiro S, McGowan CC, Jayathilake K, Castilho JL, Grangeiro A. Cardiovascular disease among people living with HIV in Brazil. Trop Med Int Health 2020; 25:886-896. [PMID: 32306480 PMCID: PMC7547667 DOI: 10.1111/tmi.13405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There is a paucity of data on cardiovascular disease (CVD) among people living with HIV (PLHIV) in resource-limited countries. We assessed factors associated with CVD and the impact of prevalent CVD on all-cause mortality in PLHIV on antiretroviral therapy in Brazil. METHODS Competing risk regression to assess factors associated with CVD and all-cause mortality in the HIV-Brazil Cohort Study between 2003 and 2014. RESULTS Among 5614 patients, the rate of CVD was 3.5 (95% confidence interval [95% CI] 2.9-4.3) per 1000 person-years. CVD was associated with older age (adjusted hazard ratio [aHR] 6.4 for โฅ55ย years vs. <35ย years, 95% CI: 2.5-16.3, Pย <ย 0.01), black race (aHR 1.8 vs. white race, 95% CI: 1.0-3.1, Pย =ย 0.04), past CVD (aHR 3.0 vs. no past CVD, 95% CI: 1.4-6.2, Pย <ย 0.01), hypertension (aHR 1.8 vs. no hypertension, 95% CI: 1.0-3.1, Pย =ย 0.04), high-grade dyslipidemia (aHR 9.3 vs. no high-grade dyslipidemia, 95% CI: 6.0-14.6, Pย <ย 0.01), ever smoking (aHR 2.4 vs. never, 95% CI: 1.2-5.0, Pย =ย 0.02) and low nadir CD4 cell count (aHR 1.8 for 100-250ย cells/mm3 vs. >250ย cells/mm3 , 95% CI: 1.0-3.2, Pย =ย 0.05). The rate of death was 16.6 (95% CI: 15.1-18.3) per 1000 person-years. Death was strongly associated with having had a past CVD event (aHR 1.7 vs. no past CVD event, 95% CI: 1.1-2.7, Pย =ย 0.01). CONCLUSIONS Traditional and HIV-specific factors associated with CVD among PLHIV in Brazil are similar to those identified among PLHIV in high-income countries. PLHIV in Brazil with a history of CVD have a high risk of death. CVD care and treatment remain priorities for PLHIV in Brazil as this population ages and antiretroviral therapy use expands.
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Affiliation(s)
- David C. Boettiger
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Matthew G. Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Valdilรฉa Veloso
- National Institute of Infectology โ Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rosa A. Souza
- Sรฃo Paulo State Department of Health, AIDS Reference and Training Center, Sรฃo Paulo, Brazil
| | - Maria L. R. Ikeda
- School of Health, University do Vale do Rio dos Sinos, Porto Alegre, Brazil
| | - Paulo R. deAlencastro
- Care and Treatment Clinic of the Hospital Sanatรณrio Partenon, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil
| | - Unai Tupinambรกs
- Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carlos Brites
- Edgar Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil
| | - Beatriz Grinsztejn
- National Institute of Infectology โ Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jackeline O. Ggomes
- Sรฃo Paulo State Department of Health, Institute of Health, Sรฃo Paulo, Brazil
| | - Sayonara Ribeiro
- National Institute of Infectology โ Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Catherine C. McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karu Jayathilake
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica L. Castilho
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandre Grangeiro
- Department of Preventive Medicine, University of Sรฃo Paulo School of Medicine, Sรฃo Paulo, Brazil
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19
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Boettiger DC, Newall AT, Chattranukulchai P, Chaiwarith R, Khusuwan S, Avihingsanon A, Phillips A, Bendavid E, Law MG, Kahn JG, Ross J, BautistaโArredondo S, Kiertiburanakul S. Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost-effectiveness analysis. J Int AIDS Soc 2020; 23 Suppl 1:e25494. [PMID: 32562359 PMCID: PMC7305414 DOI: 10.1002/jia2.25494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/20/2020] [Accepted: 03/31/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (CVD) compared to their HIV-negative peers. Expanding statin use may help alleviate this burden. However, the choice of statin in the context of antiretroviral therapy is challenging. Pravastatin and pitavastatin improve cholesterol levels in PLHIV without interacting substantially with antiretroviral therapy. They are also more expensive than most statins. We evaluated the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid-lowering therapy. METHODS We developed a discrete-state microsimulation model that randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database cohort who were aged 40 to 75ย years, receiving antiretroviral therapy in Thailand, and not using lipid-lowering therapy. The model simulated each individual's probability of experiencing CVD. We evaluated: (1) treating no one with statins; (2) treating everyone with pravastatin 20mg/day (drug cost 7568 Thai Baht ($US243)/year) and (3) treating everyone with pitavastatin 2ย mg/day (drug cost 8182 Baht ($US263)/year). Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles over a 20-year time horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective. RESULTS Pravastatin was estimated to be less effective and less cost-effective than pitavastatin and was therefore dominated (extended) by pitavastatin. Patients receiving pitavastatin accumulated 0.042 additional QALYs compared with those not using a statin, at an extra cost of 96,442 Baht ($US3095), giving an incremental cost-effectiveness ratio of 2,300,000 Baht ($US73,812)/QALY gained. These findings were sensitive to statin costs and statin efficacy, pill burden, and targeting of PLHIV based on CVD risk. At a willingness-to-pay threshold of 160,000 Baht ($US5135)/QALY gained, we estimated that pravastatin would become cost-effective at an annual cost of 415 Baht ($US13.30)/year and pitavastatin would become cost-effective at an annual cost of 600 Baht ($US19.30)/year. CONCLUSIONS Neither pravastatin nor pitavastatin were projected to be cost-effective for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid-lowering therapy. We do not recommend expanding current use of these drugs among PLHIV in Thailand without substantial price reduction.
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Affiliation(s)
- David C Boettiger
- Kirby InstituteUNSW SydneySydneyNSWAustralia
- Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Anthony T Newall
- The School of Public Health and Community MedicineUNSW SydneySydneyNSWAustralia
| | | | - Romanee Chaiwarith
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
| | | | - Anchalee Avihingsanon
- The Thai Red Cross AIDS Research Centre and Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Andrew Phillips
- Institute for Global HealthUniversity College LondonUnited Kingdom
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes ResearchStanford UniversityStanfordCAUSA
| | | | - James G Kahn
- Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Jeremy Ross
- TREAT Asia/amfARโFoundation for AIDS ResearchBangkokThailand
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20
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Boettiger DC, Law MG, Ross J, Huy BV, Heng BSL, Ditangco R, Kiertiburanakul S, Avihingsanon A, Cuong DD, Kumarasamy N, Kamarulzaman A, Ly PS, Yunihastuti E, Parwati Merati T, Zhang F, Khusuwan S, Chaiwarith R, Lee MP, Sangle S, Choi JY, Ku WW, Tanuma J, Ng OT, Sohn AH, Wester CW, Nash D, Mugglin C, Pujari S. Atherosclerotic cardiovascular disease screening and management protocols among adult HIV clinics in Asia. J Virus Erad 2020; 6:11-18. [PMID: 32175086 PMCID: PMC7043905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES Integration of HIV and non-communicable disease services improves the quality and efficiency of care in low- and middle-income countries (LMICs). We aimed to describe current practices for the screening and management of atherosclerotic cardiovascular disease (ASCVD) among adult HIV clinics in Asia. METHODS Sixteen LMIC sites included in the International Epidemiology Databases to Evaluate AIDS - Asia-Pacific network were surveyed. RESULTS Sites were mostly (81%) based in urban public referral hospitals. Half had protocols to assess tobacco and alcohol use. Protocols for assessing physical inactivity and obesity were in place at 31% and 38% of sites, respectively. Most sites provided educational material on ASCVD risk factors (between 56% and 75% depending on risk factors). A total of 94% reported performing routine screening for hypertension, 100% for hyperlipidaemia and 88% for diabetes. Routine ASCVD risk assessment was reported by 94% of sites. Protocols for the management of hypertension, hyperlipidaemia, diabetes, high ASCVD risk and chronic ischaemic stroke were in place at 50%, 69%, 56%, 19% and 38% of sites, respectively. Blood pressure monitoring was free for patients at 69% of sites; however, most required patients to pay some or all the costs for other ASCVD-related procedures. Medications available in the clinic or within the same facility included angiotensin-converting enzyme inhibitors (81%), statins (94%) and sulphonylureas (94%). CONCLUSION The consistent availability of clinical screening, diagnostic testing and procedures and the availability of ASCVD medications in the Asian LMIC clinics surveyed are strengths that should be leveraged to improve the implementation of cardiovascular care protocols.
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Affiliation(s)
- DC Boettiger
- Kirby Institute,
UNSW Sydney,
Australia,Institute for Health Policy Studies,
University of California, San Francisco,
USA,Corresponding author:โDavid C Boettiger
Institute for Health Policy Studies,
University of California, San Francisco,
3333 California Street,
94118,
USA
โ
| | - MG Law
- Kirby Institute,
UNSW Sydney,
Australia
| | - J Ross
- TREAT Asia/amfAR,
The Foundation for AIDS Research,
Bangkok,
Thailand
| | - BV Huy
- National Hospital for Tropical Disease,
Hanoi,
Vietnam
| | - BSL Heng
- Hospital Sungai Buloh,
Kuala Lumpur,
Malaysia
| | - R Ditangco
- Research Institute for Tropical Medicine,
Manila,
Philippines
| | | | - A Avihingsanon
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - DD Cuong
- Bach Mai Hospital,
Hanoi,
Vietnam
| | - N Kumarasamy
- CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services,
Chennai,
India
| | - A Kamarulzaman
- University Malaya Medical Centre,
Kuala Lumpur,
Malaysia
| | - PS Ly
- Social Health Clinic,
National Center for HIV/AIDS, Dermatology and STDs,
Phnom Penh,
Cambodia
| | - E Yunihastuti
- Faculty of Medicine Universitas Indonesia,
Cipto Mangunkusumo General Hospital,
Jakarta,
Indonesia
| | | | - F Zhang
- Beijing Ditan Hospital,
Capital Medical University,
Beijing,
China
| | - S Khusuwan
- Chiangrai Prachanukhor Hospital,
Chiangrai,
Thailand
| | - R Chaiwarith
- Research Institute for Health Sciences,
Chiangmai,
Thailand
| | - MP Lee
- Queen Elizabeth Hospital,
Hong Kong
| | - S Sangle
- BJ Government Medical College and Sassoon General Hospitals,
Pune,
India
| | - JY Choi
- Severance Hospital,
Seoul,
South Korea
| | - WW Ku
- Taipei Veterans General Hospital,
Taipei,
Taiwan
| | - J Tanuma
- National Center for Global Health and Medicine,
Tokyo,
Japan
| | - OT Ng
- Tan Tock Seng Hospital,
Singapore
| | - AH Sohn
- TREAT Asia/amfAR,
The Foundation for AIDS Research,
Bangkok,
Thailand
| | - CW Wester
- Vanderbilt University Medical Center,
Institute for Global Health,
Nashville,
USA
| | - D Nash
- Institute for Implementation Science in Population Health,
City University of New York,
New York,
USA,Department of Epidemiology and Biostatistics,
City University of New York,
New York,
USA
| | - C Mugglin
- Institute of Social and Preventative Medicine,
University of Bern,
Switzerland
| | - S Pujari
- Institute for Infectious Diseases,
Pune,
India
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21
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Boettiger D, Law M, Ross J, Huy B, Heng B, Ditangco R, Kiertiburanakul S, Avihingsanon A, Cuong D, Kumarasamy N, Kamarulzaman A, Ly P, Yunihastuti E, Parwati Merati T, Zhang F, Khusuwan S, Chaiwarith R, Lee M, Sangle S, Choi J, Ku W, Tanuma J, Ng O, Sohn A, Wester C, Nash D, Mugglin C, Pujari S. Atherosclerotic cardiovascular disease screening and management protocols among adult HIV clinics in Asia. J Virus Erad 2020. [DOI: 10.1016/s2055-6640(20)30005-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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22
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Onyegbutulem H, Pillatar B, Afiomah E, Sagay F, Amadi O, Dankyau M. Impacts of a pilot of community antiretroviral group initiative on HIV-positive patients in a tertiary health facility in Abuja, North Central Nigeria. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_69_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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23
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Abstract
PURPOSE OF REVIEW Hypertriglyceridemia occurs mainly because of metabolic disorders secondary to diabetes, alcohol intake, and/or overweight. Genetic factors have also been clearly identified in most severe cases. Triglycerides are generally considered as 'bystanders' for cardiovascular diseases. However, biological and basic research provides strong data suggesting that triglyceride-rich lipoproteins could be involved in the pathophysiology of cardiovascular diseases. RECENT FINDINGS The REDUCE-IT trial recently showed that icosapent ethyl reduces major cardiovascular events and related death. SUMMARY For many years, low-density lipoproteins (LDLs) have been considered the Holy Grail for atherosclerotic cardiovascular disease management. New data from basic research in biology, epidemiology, genetics, and preliminary clinical trials support the hypothesis that triglyceride-rich lipoproteins could be the causal factors for atherosclerotic cardiovascular disease; hence, triglyceride should be taken into consideration in the management of these patients. Omega-3-fatty acids used in the REDUCE-IT trial reduced the residual cardiovascular risk efficiently beyond statins. However, its effect has to be completely understood as it seems to be unrelated to LDLc or triglyceride reduction, but linked to pleiotropic effects involving inflammation, platelet adhesion, and plaque instability reduction, paving the way for trials that will target more specific potential pathophysiologic pathways.
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Affiliation(s)
- Fabien Huet
- Department of Cardiology, Montpellier University Hospital, Montpellier
- PhyMedExp, Universitรฉ de Montpellier, INSERM, CNRS
| | - Camille Roubille
- PhyMedExp, Universitรฉ de Montpellier, INSERM, CNRS
- Department of Internal Medicine, Montpellier University Hospital, Montpellier, France
| | - Franรงois Roubille
- Department of Cardiology, Montpellier University Hospital, Montpellier
- PhyMedExp, Universitรฉ de Montpellier, INSERM, CNRS
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24
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Lin HL, Muo CH, Lin CY, Chen HJ, Chen PC. Incidence of stroke in patients with HIV infection: A population-based study in Taiwan. PLoS One 2019; 14:e0217147. [PMID: 31116762 PMCID: PMC6530842 DOI: 10.1371/journal.pone.0217147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 05/06/2019] [Indexed: 12/25/2022] Open
Abstract
Background Few studies have evaluated whether people infected with human immunodeficiency virus (HIV) are at an increased risk of stroke in an Asian population. We investigated the association between HIV infection and the risk of developing stroke by age, calendar year of HIV diagnosis, and follow-up duration in Taiwan. Methods Using the claims data of a universal health insurance program, we identified 5,961 patients with HIV and 23,844 matched non-HIV subjects without previous stroke from 1998 to 2005 and followed them up until the end of 2011 to measure the incidence of stroke. Cox proportional hazards models adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (CI), with the non-HIV group as reference. Results During a median follow-up of 8 years, the incidence rates for total, ischemic, and hemorrhagic stroke per 1000 person-years were 2.12, 1.22, and 0.60, respectively, in patients with HIV infection, and 1.98, 1.14, and 0.54, respectively, in the comparison group. HIV infection was associated with an elevated risk of developing total stroke (adjusted HR [95% CI], 1.57 [1.15โ2.14]) and ischemic stroke (1.91 [1.25โ2.91]) in patients aged less than 45 years, but no association was observed in other age groups (P for interaction with age, p = 0.048 and 0.024, respectively). Patients diagnosed with HIV infection in 1998โ1999 had a greater HR for total stroke and ischemic stroke than those diagnosed in 2000โ2002 and 2003โ2005 (P for interaction, for total stroke p = 0.034, for ischemic stroke p = 0.056). The HRs did not differ by follow-up duration. Conclusions HIV infection among a young age group is associated with increased risk of developing overall and ischemic stroke. The findings highlight the importance of screening and correcting risk factors for young stroke prevention immediately and aggressively.
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Affiliation(s)
- Hui-Lin Lin
- PHD Program for Aging, China Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Lin Shin Hospital, Taichung, Taiwan
| | - Chih-Hsin Muo
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Yu Lin
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
- * E-mail:
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25
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Teer E, Joseph DE, Driescher N, Nell TA, Dominick L, Midgley N, Deshpande G, Page MJ, Pretorius E, Woudberg NJ, Lecour S, Glashoff RH, Essop MF. HIV and cardiovascular diseases risk: exploring the interplay between T-cell activation, coagulation, monocyte subsets, and lipid subclass alterations. Am J Physiol Heart Circ Physiol 2019; 316:H1146-H1157. [PMID: 30768357 DOI: 10.1152/ajpheart.00797.2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Although rollout of combined antiretroviral treatment (cART) has blunted human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) onset, there is increased development of cardiovascular diseases (CVDs) in HIV-infected individuals. While most HIV-infected individuals on cART achieve viral suppression, this may not necessarily result in complete immunological recovery. This study therefore evaluated T-cell-mediated changes and coagulation markers in HIV-positive individuals to ascertain their potential to increase CVD risk. Eighty participants were recruited (Worcester, South Africa), and fasted blood was collected to evaluate: 1) immune activation (CD38 expression on CD4+ and CD8+ T cells) and thrombus formation [tissue factor (CD142)] on CD4+ and CD8+ T cells; 2) monocyte subpopulations (nonclassical, intermediate, and classical); and 3) classical regulatory T (Treg) cells with activation markers [glycoprotein A repetitions predominant (GARP) and special AT-rich sequence-binding protein 1 (SATB-1)]. High- and low-density lipoprotein subclasses (Lipoprint) were also determined. This study revealed four key findings for HIV-positive patients: 1) coexpression of the CD142 coagulation marker together with immune activation on both CD4+ and CD8+ T cells during chronic infection stages; 2) Treg cell activation and upregulated GARP and SATB-1 contributing to Treg dysfunction in chronic HIV; 3) proatherogenic monocyte subset expansion with significant correlation between T-cell activation and macrophage activation (marker: CD163); and 4) significant correlation between immune activation and lipid subclasses, revealing crucial changes that can be missed by traditional lipid marker assessments (LDL and HDL). These data also implicate lipopolysaccharide-binding protein as a crucial link between immune activation, lipid alterations, and increased CVD risk. NEW & NOTEWORTHY With combined antiretroviral treatment rollout, HIV-AIDS patients are increasingly associated with cardiovascular diseases onset. This study demonstrated the significant interplay between adaptive immune cell activation and monocyte/macrophage markers in especially HIV-positive individuals with virological failure and on second line treatment. Our data also show a unique link between immune activation and lipid subclass alterations, revealing important changes that can be missed by traditional lipid marker assessments (e.g., LDL and HDL).
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Affiliation(s)
- Eman Teer
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
| | - Danzil E Joseph
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
| | - Natasha Driescher
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
| | - Theo A Nell
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
| | - Leanne Dominick
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
| | - Natasha Midgley
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
| | - Gaurang Deshpande
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
| | - Martin J Page
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
| | - Etheresia Pretorius
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
| | - Nicholas J Woudberg
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town , Cape Town , South Africa
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town , Cape Town , South Africa
| | - Richard H Glashoff
- Division of Medical Microbiology and Immunology, Department of Pathology, Stellenbosch University and National Health Laboratory Service , Cape Town , South Africa
| | - M Faadiel Essop
- Cardio-Metabolic Research Group, Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa
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