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Lee KK, Stelzle D, Bing R, Anwar M, Strachan F, Bashir S, Newby DE, Shah JS, Chung MH, Bloomfield GS, Longenecker CT, Bagchi S, Kottilil S, Blach S, Razavi H, Mills PR, Mills NL, McAllister DA, Shah ASV. Global burden of atherosclerotic cardiovascular disease in people with hepatitis C virus infection: a systematic review, meta-analysis, and modelling study. Lancet Gastroenterol Hepatol 2019; 4:794-804. [PMID: 31377134 PMCID: PMC6734111 DOI: 10.1016/s2468-1253(19)30227-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND More than 70 million people worldwide are estimated to have hepatitis C virus (HCV) infection. Emerging evidence indicates an association between HCV and atherosclerotic cardiovascular disease. We aimed to determine the association between HCV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HCV. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, Ovid Global Health, and Web of Science databases from inception to May 9, 2018, without language restrictions, for longitudinal studies that evaluated the risk ratio (RR) of cardiovascular disease in people with HCV compared with those without HCV. Two investigators independently reviewed and extracted data from published reports. The main outcome was cardiovascular disease, defined as hospital admission with, or mortality from, acute myocardial infarction or stroke. We calculated the pooled RR of cardiovascular disease associated with HCV using a random-effects model. Additionally, we calculated the population attributable fraction and disability-adjusted life-years (DALYs) from HCV-associated cardiovascular disease at the national, regional, and global level. We also used age-stratified and sex-stratified HCV prevalence estimates and cardiovascular DALYs for 100 countries to estimate country-level burden associated with HCV. This study is registered with PROSPERO, number CRD42018091857. FINDINGS Our search identified 16 639 records, of which 36 studies were included for analysis, including 341 739 people with HCV. The pooled RR for cardiovascular disease was 1·28 (95% CI 1·18-1·39). Globally, 1·5 million (95% CI 0·9-2·1) DALYs per year were lost due to HCV-associated cardiovascular disease. Low-income and middle-income countries had the highest disease burden with south Asian, eastern European, north African, and Middle Eastern regions accounting for two-thirds of all HCV-associated cardiovascular DALYs. INTERPRETATION HCV infection is associated with an increased risk of cardiovascular disease. The global burden of cardiovascular disease associated with HCV infection was responsible for 1·5 million DALYs, with the highest burden in low-income and middle-income countries. FUNDING British Heart Foundation and Wellcome Trust.
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Affiliation(s)
- Kuan Ken Lee
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Dominik Stelzle
- Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Mohamed Anwar
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fiona Strachan
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sophia Bashir
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jasmit S Shah
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | | | - Gerald S Bloomfield
- Department of Medicine, Duke Clinical Research Institute and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Chris T Longenecker
- Division of Cardiology, University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Shashwatee Bagchi
- Division of Infectious Diseases and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shyamasundaran Kottilil
- Division of Infectious Diseases and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah Blach
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Peter R Mills
- Department of Gastroenterology, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
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Abstract
Alcohol is prevalent among people living with HIV and can lead to multiple comorbid conditions (multimorbidity). The purpose of this study was to examine the relationship between alcohol use history and multimorbidity among people living with HIV. A retrospective cohort study design was conducted at an urban, academic infectious disease clinic in Kentucky. Individuals seeking care between 2010 and 2014 were included. Modified Poisson regression was used to examine the relationship between alcohol use history (never, current, and former use) and multimorbidity (≥ 2 conditions). A total of 949 individuals were included in the study, with 5.1 and 17.6% reporting former and current alcohol use, respectively. Sixty-five percent had ≥ 1 condition and 82.6% of those had ≥ 2 conditions diagnosed. The risk of multimorbidity was 1.70 (95% CI 1.35-2.14) times higher for a current user compared to a never user. Reductions in alcohol use may lead to lower rates of multimorbidity.
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Affiliation(s)
- Timothy N Crawford
- Department of Population and Public Health Sciences, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA.
- Department of Family Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA.
- Department of Population and Public and Public Health Sciences, 3123 Research Blvd #200, Kettering, OH, 45420, USA.
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Kelso-Chichetto NE, Plankey M, Sheps DS, Abraham AG, Chen X, Shoptaw S, Kaplan RC, Post WS, Cook RL. The impact of long-term moderate and heavy alcohol consumption on incident atherosclerosis among persons living with HIV. Drug Alcohol Depend 2017; 181:235-241. [PMID: 29121596 PMCID: PMC5789452 DOI: 10.1016/j.drugalcdep.2017.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Level of alcohol consumption is associated with differential risk of atherosclerosis, but little research has investigated this association among HIV+ persons. We evaluated the association between long-term alcohol use and incident atherosclerosis among HIV+ persons. METHODS We utilized data from HIV+ participants of the Women's Interagency HIV Study (n=483) and the Multicenter AIDS Cohort Study (n=305) without history of cardiovascular disease. Atherosclerosis was assessed two times by B-mode carotid artery ultrasound imaging from 2004 to 2013. Presence of plaque was defined as focal carotid intima-media thickness over 1.5mm. Those with no plaque at baseline and plaque at follow-up were considered incident cases of atherosclerosis. Group-based trajectory models were used to categorize participants into 10-year drinking patterns representing heavy, moderate, or abstinent-low. Multivariable logistic regressions were conducted to assess the association of long-term moderate and heavy use on atherosclerosis, compared to abstinent-low. RESULTS Heavy alcohol consumption was not statistically significantly associated with risk for incident atherosclerosis in women (AOR 1.10, CI 0.40-3.02) or men (AOR 1.31, CI 0.43-4.00), compared to abstinence-low. Moderate consumption was associated with 54% lower odds for incident disease in men (AOR 0.46, CI 0.21-1.00), but not in women (AOR 1.08, CI 0.58-2.00). In cohort-combined analyses, alcohol consumption was not statistically significantly association with incident atherosclerosis (moderate AOR 0.78, CI 0.48-1.27; heavy AOR 1.33, CI 0.66-2.69). CONCLUSION Moderate alcohol consumption was associated with a significant protective effect on incident atherosclerosis in men only. No other levels of alcohol consumption significantly predicted atherosclerosis in men and women compared to abstinent-low.
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Affiliation(s)
- N E Kelso-Chichetto
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, United States; Department of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - M Plankey
- Department of Medicine, Georgetown University Medical Center, Washington DC, United States
| | - D S Sheps
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, United States
| | - A G Abraham
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - X Chen
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, United States
| | - S Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA, United States
| | - R C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States
| | - W S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - R L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, United States
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Williams EC, Hahn JA, Saitz R, Bryant K, Lira MC, Samet JH. Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions. Alcohol Clin Exp Res 2016; 40:2056-2072. [PMID: 27696523 PMCID: PMC5119641 DOI: 10.1111/acer.13204] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/28/2016] [Indexed: 12/20/2022]
Abstract
Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol's impact on transmission, care, coinfections, and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV. Alcohol use appears to have additive and potentially synergistic effects on common HIV-related comorbidities. We find that interventions to modify drinking and improve HIV-related risks and outcomes have had limited success to date, and we recommend research in several areas. Consistent with Office of AIDS Research/National Institutes of Health priorities, we suggest research to better understand how and at what levels alcohol influences comorbid conditions among PLWH, to elucidate the mechanisms by which alcohol use is impacting comorbidities, and to understand whether decreases in alcohol use improve HIV-relevant outcomes. This should include studies regarding whether state-of-the-art medications used to treat common coinfections are safe for PLWH who drink alcohol. We recommend that future research among PLWH include validated self-report measures of alcohol use and/or biological measurements, ideally both. Additionally, subgroup variation in associations should be identified to ensure that the risks of particularly vulnerable populations are understood. This body of research should serve as a foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol-related interventions and treatments for PLWH in healthcare settings. By making further progress on understanding how alcohol use affects PLWH in the era of HIV as a chronic condition, this research should inform how we can mitigate transmission, achieve viral suppression, and avoid exacerbating common comorbidities of HIV and alcohol use and make progress toward the 90-90-90 goals for engagement in the HIV treatment cascade.
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Affiliation(s)
- Emily C Williams
- Veterans Health Administration (VA) Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Judith A Hahn
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.,Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kendall Bryant
- Consortiums for HIV/AIDS and Alcohol Research Translation (CHAART) National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Marlene C Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey H Samet
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts. .,Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
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The J-Curve in HIV: Low and Moderate Alcohol Intake Predicts Mortality but Not the Occurrence of Major Cardiovascular Events. J Acquir Immune Defic Syndr 2016; 71:302-9. [PMID: 26444500 PMCID: PMC4770349 DOI: 10.1097/qai.0000000000000864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In HIV-negative populations, light-to-moderate alcohol consumption is associated with a lower cardiovascular morbidity and mortality than alcohol abstention. Whether the same holds true for HIV-infected individuals has not been evaluated in detail. DESIGN Cohort study. METHODS Adults on antiretroviral therapy in the Swiss HIV Cohort Study with follow-up after August 2005 were included. We categorized alcohol consumption into: abstention or very low (<1 g/d), low (1-9 g/d), moderate (10-29 g/d in women and 10-39 g/d in men), and high alcohol intake. Cox proportional hazards models were used to describe the association between alcohol consumption and cardiovascular disease-free survival (combined endpoint), cardiovascular disease events (CADE) and overall survival. Baseline and time-updated risk factors for CADE were included in the models. RESULTS Among 9741 individuals included, there were 788 events of major CADE or death during 46,719 patient-years of follow-up, corresponding to an incidence of 1.69 events/100 person-years. Follow-up according to alcohol consumption level was 51% no or very low, 20% low, 23% moderate, and 6% high intake. As compared with no or very low alcohol intake, low (hazard ratio 0.79, 95% confidence interval 0.63 to 0.98) and moderate alcohol intakes (0.78, 0.64 to 0.95) were associated with a lower incidence of the combined endpoint. There was no significant association between alcohol consumption and CADE. CONCLUSIONS Compared with no or very low alcohol consumption, low and moderate intake associated with a better CADE-free survival. However, this result was mainly driven by mortality and the specific impact of drinking patterns and type of alcoholic beverage on this outcome remains to be determined.
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Mukherjee A, Talukdar P, Khanra D, Ghosh P, Chakraborty A, Karak A, Samanta B, Singha S, Talukdar A, Saha M. Does non-protease inhibitor based anti-retroviral therapy modify peripheral arterial disease? A vision from eastern India. HIV & AIDS REVIEW 2016. [DOI: 10.1016/j.hivar.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kelso NE, Sheps DS, Cook RL. The association between alcohol use and cardiovascular disease among people living with HIV: a systematic review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:479-88. [PMID: 26286352 DOI: 10.3109/00952990.2015.1058812] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND People living with HIV-infection (PLWH) have higher prevalence and earlier onset of cardiovascular disease (CVD), compared to uninfected populations. It is unclear how alcohol consumption is related to CVD among PLWH. OBJECTIVES To summarize the current literature and strength of evidence regarding alcohol consumption as a risk factor for CVD among PLWH, to generate summary estimates for the effect of alcohol consumption on CVD outcomes, and to make recommendations for clinical practice and future research based on the findings and limitations of existing studies. METHODS A systematic review was conducted using Pubmed/Medline to identify relevant peer-reviewed articles published between 1 January 1999 and 1 January 2014. After critical review of the literature, 13 studies were identified. Risk ratios were extracted or calculated and sample size weighted summary estimates were calculated. RESULTS The prevalence of a CVD diagnosis or event ranged from 5.7-24.0%. The weighted pooled crude effect sizes were 1.75 (95% CI 1.06, 3.17) for general and 1.78 (95% CI 1.09, 2.93) for heavy alcohol use on CVD. The pooled adjusted effect size was 1.37 (95% CI 1.02, 1.84) for heavy alcohol use on CVD. Pooled estimates differed by CVD outcome and alcohol measure; alcohol consumption was most significant for cerebral/ischemic events. CONCLUSION HIV clinicians should consider risk factors that are not included in the traditional risk factor framework, particularly heavy alcohol consumption. Neglect of this risk factor may lead to underestimation of risk, and thus under-treatment among PLWH.
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Affiliation(s)
- Natalie E Kelso
- a Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA
| | - David S Sheps
- a Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA
| | - Robert L Cook
- a Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA
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Bastard JP, Fellahi S, Couffignal C, Raffi F, Gras G, Hardel L, Sobel A, Leport C, Fardet L, Capeau J. Increased systemic immune activation and inflammatory profile of long-term HIV-infected ART-controlled patients is related to personal factors, but not to markers of HIV infection severity. J Antimicrob Chemother 2015; 70:1816-24. [PMID: 25733587 DOI: 10.1093/jac/dkv036] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/25/2015] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The objective of this study was to analyse the respective roles of personal factors and HIV infection markers on the systemic immune activation/inflammatory profile of long-term antiretroviral treatment-controlled patients. PATIENTS AND METHODS A panel of soluble immune activation/inflammatory biomarkers was measured in 352 HIV-infected treatment-controlled patients from the APROCO-COPILOTE cohort, all of whom were started on a PI in 1997-99 and had a final evaluation 11 years later, and in 59 healthy controls. RESULTS A total of 81.5% of the patients were male, with the following characteristics: median age 49 years; 620 CD4 cells/mm(3); 756 CD8 cells/mm(3); CD4/CD8 ratio 0.81; BMI 23.0 kg/m(2); waist-to-hip ratio 0.95. Markers of inflammation-high-sensitivity (hs) IL-6 (median and IQR) (1.3 pg/L, 0.7-2.6), hs C-reactive protein (CRP) (2.1 mg/L, 0.9-4.5) and D-dimer (252 ng/mL, 177-374)-were elevated compared with healthy controls (P < 0.001) and strongly related to each other, as were markers of immune activation [soluble (s) CD14 (1356 ng/mL, 1027-1818), β2-microglobulin (2.4 mg/L, 2.0-3.1) and cystatin-C (0.93 mg/L, 0.82-1.1)]. Inflammatory and immune activation markers were also associated with each other. In HIV-infected patients: age was related to D-dimer, β2-microglobulin and cystatin-C levels; being a smoker was related to increased IL-6 and cystatin-C; and BMI and waist-to-hip ratio were related to CRP. Conversely, markers of HIV infection, current CD4 or CD8 values, CD4 nadir, CD4/CD8 ratio, AIDS stage at initiation of PIs, current viral load and duration of ART were not associated with immune activation/inflammation markers. CONCLUSIONS In these long-term treatment-controlled HIV-infected patients, all systemic markers of inflammation and immune activation were increased compared with healthy controls. This was related to demographic and behavioural factors, but not to markers of severity of the HIV infection. Intervention to decrease low-grade inflammation must thus prioritize modifiable personal factors.
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Affiliation(s)
- Jean-Philippe Bastard
- Sorbonne Universités, UPMC Univ Paris-6, Inserm UMR_S938, ICAN, APHP Hôpital Tenon and Saint-Antoine, 27 rue Chaligny, F-75571 Paris cedex 12, France
| | - Soraya Fellahi
- Sorbonne Universités, UPMC Univ Paris-6, Inserm UMR_S938, ICAN, APHP Hôpital Tenon and Saint-Antoine, 27 rue Chaligny, F-75571 Paris cedex 12, France
| | - Camille Couffignal
- IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Unité de Coordination du Risque Épidémique et Biologique, Assistance Publique-Hôpitaux de Paris, 16 rue Henri Huchard, F-75890 Paris cedex 18, France
| | | | - Guillaume Gras
- University Hospital of Tours, CHRU, F-37044 Tours cedex 9, France
| | - Lucile Hardel
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 146 rue Léo Saignat, F-33076 Bordeaux cedex, France
| | - Alain Sobel
- Hotel-Dieu Hospital, 1 Parvis Notre-Dame, Place Jean-Paul II, F-75004 Paris, France
| | - Catherine Leport
- IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Unité de Coordination du Risque Épidémique et Biologique, Assistance Publique-Hôpitaux de Paris, 16 rue Henri Huchard, F-75890 Paris cedex 18, France
| | - Laurence Fardet
- Sorbonne Universités, UPMC Univ Paris-6, Inserm UMR_S938, ICAN, APHP Hôpital Tenon and Saint-Antoine, 27 rue Chaligny, F-75571 Paris cedex 12, France
| | - Jacqueline Capeau
- Sorbonne Universités, UPMC Univ Paris-6, Inserm UMR_S938, ICAN, APHP Hôpital Tenon and Saint-Antoine, 27 rue Chaligny, F-75571 Paris cedex 12, France
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Carrieri MP, Protopopescu C, Raffi F, March L, Reboud P, Spire B, Leport C. Low alcohol consumption as a predictor of higher CD4+ cell count in HIV-treated patients: a french paradox or a proxy of healthy behaviors? The ANRS APROCO-COPILOTE CO-08 cohort. J Acquir Immune Defic Syndr 2014; 65:e148-50. [PMID: 24346641 DOI: 10.1097/qai.0000000000000087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Maria Patrizia Carrieri
- *INSERM, UMR912 (SESSTIM), Marseille, France †Aix Marseille Université, UMR_S912, IRD, Marseille, France ‡ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France §CHU Hôtel-Dieu, Nantes, France ‖INSERM, U897, Université Bordeaux Segalen, ISPED, Bordeaux, France ¶Université Paris Diderot, Sorbonne Paris Cité, UMR 738, Paris, France #INSERM, UMR 738, Paris, France
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