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Estrada V, Bernardino JI, Masiá M, Iribarren JA, Ortega A, Lozano F, Miralles C, Olalla J, Santos J, Elías MJP, Domingo P, Cruz AF. Cardiovascular risk factors and lifetime risk estimation in HIV-infected patients under antiretroviral treatment in Spain. HIV CLINICAL TRIALS 2015; 16:57-65. [PMID: 25874992 DOI: 10.1179/1528433614z.0000000008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular disease is a major concern in HIV-infected patients. Lifetime risk estimations use the risk of developing it over the course of remaining lifetime, and are useful in communicating this risk to young patients. We aim to describe the prevalence of cardiovascular risk factors among a representative sample of HIV-infected subjects under antiretroviral therapy in Spain, and to estimate their lifetime risk of cardiovascular disease. METHODS Cross-sectional survey about cardiovascular risk factors in 10 HIV units across Spain. Lifetime risk assessed according to Barry was classified in two major categories: low and high lifetime risk. RESULTS We included 895 subjects, 72% men, median age 45.7 years; median CD4 lymphocyte count 598 cells/μl, median time since HIV diagnosis 11 years, median time on antiretroviral treatment 6.3 years, 87% had undetectable HIV viral load. Tobacco smoking was the most frequent risk factor (54%), followed by dyslipidemia (48.6%) and hypertension (38.6%). Estimated 10-year coronary risk (Framingham/Regicor Risk Score) risk was low ( < 5%) in 78% of the patients, and intermediate (5-10%) in 20%. Lifetime risk estimation showed a high risk profile for 71.4% of the population studied, which was associated with increasing age, prolonged antiretroviral therapy and patient's place of origin. CONCLUSIONS Modifiable cardiovascular risk factors in this population are very common. There are significant disparities between the low 10-year risk estimated with the Framingham/Regicor score and the higher lifetime risk in HIV patients on antiretroviral therapy. A more aggressive management of modifiable cardiovascular risk factors in these patients seems advisable.
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Prevalence of ischemic heart disease and management of coronary risk in daily clinical practice: results from a Mediterranean cohort of HIV-infected patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:823058. [PMID: 25170515 PMCID: PMC4142151 DOI: 10.1155/2014/823058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/10/2014] [Accepted: 07/13/2014] [Indexed: 01/16/2023]
Abstract
Background. There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) in HIV-infected patients. Methods. We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results. We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus). Other CVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol (P = 0.025) and LDL-cholesterol (P = 0.004) was observed. However, the percentage of patients who maintained LDL-cholesterol > 100 mg/dL remained stable (from 46% to 41%, P = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time (P = 0.028). Conclusions. The prevalence of coronary events in our cohort is low. CVRF prevalence is high and their management is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.
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Mauri Pont M, Borrallo Almansa RM, Almada Rivas G, Carbó Díez M, Solé Arnau R, García Restoy E. [Peripheral arterial disease and cardiovascular risk factors among patients infected with human immunodeficiency virus: a comparison between hospital out-patients and patients in a prison]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2014; 26:115-21. [PMID: 24461720 DOI: 10.1016/j.arteri.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cardiovascular disease among human immunodeficiency virus (HIV) infected patients is more frequent than in the general population. Peripheral arterial disease measured by ankle-brachial index (ABI) and cardiovascular risk factors (CVRF) is not well known in all groups of HIV-infected patients. METHODS Transversal study of HIV-infected patients >45 years, seen as outpatients in hospital (HO) in 2008 and patients institutionalized in a prison in 2009. Cardiovascular risk factors, information on the HIV infection and healthy lifestyles were evaluated. ABI was measured at rest and was considered pathological when a value ≤ 0.9 or ≥ 1.3 was obtained. RESULTS We included 71 patients (mean age of 50.6 ± 6.9 years, 86% male), 32 HO and 39 in prison. The most prevalent CVRF was smoking (80.2%) followed by an altered lipid profile (63.3%). The evolution time of HIV infection was 13.1 ± 7.1 years. 74.6% of patients didn't follow a heart-healthy diet and 25% were sedentary. The ABI was low in 7 cases (9.8%) and ≥ 1.3 in one. Patients in prison were younger, the rate of smokers and of individuals with low HDL were higher, the time of evolution of the HIV infections was longer and they were less adherent to a heart-healthy diet than in HO, reaching in all cases statistical significance (P<.05). CONCLUSIONS In our study there is a high prevalence of altered ABI. The most common CVRF is smoking, followed by the alteration of lipids. Patients in prison are more likely to be smokers, to have low HDL and they are less adherence to a heart-healthy diet.
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Affiliation(s)
- Marta Mauri Pont
- Medicina Interna, Hospital de Terrassa, Terrassa, Barcelona, España.
| | | | - Guido Almada Rivas
- Instituciones penitenciarias, Centro Penitenciario Brians I, Sant Esteve Sesrovires, Barcelona, España
| | | | - Rosa Solé Arnau
- Medicina Interna, Hospital de Terrassa, Terrassa, Barcelona, España
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Masiá M, Pérez-Cachafeiro S, Leyes M, López-Aldeguer J, López M, Segura F, Blanco JR, Peña A, Rodríguez F, Vera M, Del Amo J, Gutiérrez F. Riesgo cardiovascular en pacientes con infección por el virus de la inmunodeficiencia humana en España. Cohorte CoRIS, 2011. Enferm Infecc Microbiol Clin 2012; 30:517-27. [DOI: 10.1016/j.eimc.2012.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/18/2012] [Accepted: 02/28/2012] [Indexed: 11/26/2022]
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Oka F, Naito T, Oike M, Imai R, Saita M, Inui A, Mitsuhashi K, Isonuma H, Shimbo T. Correlation between HIV disease and lipid metabolism in antiretroviral-naïve HIV-infected patients in Japan. J Infect Chemother 2011; 18:17-21. [PMID: 21735099 PMCID: PMC3278606 DOI: 10.1007/s10156-011-0275-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 06/09/2011] [Indexed: 11/25/2022]
Abstract
Antiretroviral therapy alters lipid metabolism in HIV-infected patients. However, interpreting the impact of HIV infection on lipid metabolism is difficult because of various associated factors, including antiretroviral drugs and demographic characteristics. A few studies have associated HIV infection with lipid metabolism in antiretroviral-naïve HIV-infected patients. Because there were no data in this regard from Japan, the present study examined the impact of HIV infection, as well as demographic and clinical features, on lipid metabolism in antiretroviral-naïve HIV-infected patients in Japan. We performed a cross-sectional study to examine the impact of HIV disease, demographic and clinical characteristics on lipid metabolism among 168 HIV-infected Japanese men who were antiretroviral naïve and who did not have hemophilia, including patients who took medication for dyslipidemia. The mean age of the patients was 45.7 years; 0.6% of the patients took medication to dyslipidemia. The mean CD4 lymphocyte count was 289/μL, the mean baseline log10 HIV viral load was 4.2 HIV-1 RNA copies/mL, and 22% of the patients had a history of AIDS-defining events. A higher HDL-C concentration was associated with a higher CD4 lymphocyte count (p = 0.043). Also, a higher LDL-C concentration was associated with a higher CD4 lymphocyte count (p = 0.003). Infection with HIV was associated with dyslipidemia in antiretroviral-naïve patients. More advanced HIV disease was associated with less favorable lipid homeostatic profiles. These results are similar to findings from other countries.
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Affiliation(s)
- Fukuko Oka
- Department of General Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Mínguez Gallego C, Vera-Remartínez E, García-Guerrero J, Rincón S, Martínez-Ródenas C, Herrero A. Factores de riesgo vascular en pacientes infectados por el VIH en un centro penitenciario. Rev Clin Esp 2011; 211:9-16. [DOI: 10.1016/j.rce.2010.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 04/05/2010] [Accepted: 04/19/2010] [Indexed: 02/06/2023]
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Gallego M, Palacios R, Olalla J, Orihuela F, Roldán J, Santos J, Grana M. Colesterol ligado a lipoproteínas de baja densidad en una serie de pacientes con infección por el virus de la inmunodeficiencia humana. Med Clin (Barc) 2010; 135:202-4. [DOI: 10.1016/j.medcli.2009.10.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 10/25/2009] [Accepted: 10/29/2009] [Indexed: 01/28/2023]
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Bernardino de la Serna JI, Arribas López JR. [Controversies and future of the approach to cardiovascular disease in HIV patients]. Enferm Infecc Microbiol Clin 2010; 27 Suppl 1:48-53. [PMID: 20172415 DOI: 10.1016/s0213-005x(09)73445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiovascular diseases are an increasing problem in patients with HIV infection. The causes of the increased cardiovascular risk in HIV-infected patients are multifactorial. Currently, the question of which factor has the most weight in this equation - whether traditional risk factors, the virus per se or antiretroviral therapy - remains to be determined. The absolute risk of cardiovascular disease in a particular patient depends on the composite risk profile. At present, there are no data to support a distinct approach to cardiovascular risk evaluation in HIV-infected patients. Cardiovascular risk equations should be incorporated into routine daily clinical assessment in order to identify patients in need of specific interventions.
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Fourie CMT, Van Rooyen JM, Kruger A, Schutte AE. Lipid abnormalities in a never-treated HIV-1 subtype C-infected African population. Lipids 2009; 45:73-80. [PMID: 19916038 DOI: 10.1007/s11745-009-3369-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 10/23/2009] [Indexed: 12/25/2022]
Abstract
Dyslipidemia has been documented worldwide among human immunodeficiency virus-infected (HIV) individuals and these changes are reminiscent of the metabolic syndrome (MetS). In South Africa, with the highest number of HIV infections worldwide, HIV-1 subtype C is prevalent, while HIV-1 subtype B (genetically different from C) prevails in Europe and the United States. We aimed to evaluate if HIV infection (subtype C) is associated with dyslipidemia, inflammation and the occurrence of the MetS in Africans. Three hundred newly diagnosed HIV-infected participants were compared to 300 age, gender, body mass index and locality matched uninfected controls. MetS was defined according to the Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. The HIV-infected group showed lower high density lipoprotein cholesterol (1.23 vs. 1.70 mmol/L) and low density lipoprotein cholesterol (2.60 vs. 2.80 mmol/L) and higher triglycerides (1.29 vs. 1.15 mmol/L), C-reactive protein (3.31 vs. 2.13 mg/L) and interleukin 6 (4.70 vs. 3.72 pg/L) levels compared to the uninfected group. No difference in the prevalence of the MetS was seen between the two groups (ATP III, 15.2 vs. 11.5%; IDF, 21.1 vs. 22.6%). This study shows that HIV-1 subtype C is associated with dyslipidemia, but not with a higher incidence of MetS in never antiretroviral-treated HIV-infected Africans.
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Affiliation(s)
- Carla Maria T Fourie
- HART (Hypertension in Africa Research Team), Subject Group Physiology, North-West University, Potchefstroom, South Africa.
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Bernardino de la Serna JI, Zamora FX, Montes ML, García-Puig J, Arribas JR. [Hypertension, HIV infection, and highly active antiretroviral therapy]. Enferm Infecc Microbiol Clin 2009; 28:32-7. [PMID: 19409669 DOI: 10.1016/j.eimc.2008.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 07/10/2008] [Indexed: 12/31/2022]
Abstract
The decline in mortality resulting from the use of highly active antiretroviral therapy (HAART) has been accompanied by an increase in metabolic complications that produce accelerated atherosclerosis. Hypertension is one of the most important cardiovascular risk factors. Little is known about the impact of HAART on blood pressure, and it is uncertain whether chronic HIV infection or HAART have a role in the development of hypertension. In this study, the research on the relationships between hypertension and HIV infection published to date is reviewed. Antiretroviral therapy appears to have a modest impact on blood pressure and to be partially mediated by the metabolic changes occurring with this treatment.
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Palacios R, Alonso I, Hidalgo A, Aguilar I, Sánchez MA, Valdivielso P, González-Santos P, Santos J. Peripheral arterial disease in HIV patients older than 50 years of age. AIDS Res Hum Retroviruses 2008; 24:1043-6. [PMID: 18620492 DOI: 10.1089/aid.2008.0001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our objective was to analyze the prevalence of peripheral arterial disease (PAD) in HIV patients at risk and to compare them with the general population. All HIV patients older than 50 years who attended our unit from October 2005-July 2006 and all persons attending for an annual medical checkup at an employees' insurance association during the same period were invited to participate in the study. Of the latter (n = 407), a person of the same sex and age (+/-5 years) was included for each HIV patient. PAD was assessed by the ankle-brachial index (ABI) in all subjects, and all completed the Edinburgh questionnaire. Ninety-nine HIV patients and 99 persons from the general population of the same age and sex were included in the study. The HIV patients had a greater prevalence of dyslipidemia, diabetes, and PAD, which was symptomatic in five of them and in one subject from the general population. Patients with HIV infection older than 50 had a high prevalence of PAD, and as it was asymptomatic in half the cases, an ABI may be performed in this population to actively look for PAD. Control of cardiovascular risk factors and the use of such drugs as platelet antiaggregation agents should therefore be optimized in this population.
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Affiliation(s)
- Rosario Palacios
- Infectious Diseases Unit, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Inmaculada Alonso
- Centro de Prevención de Riesgos Laborales, Consejeria de Empleo. 29010 Málaga, Spain
| | - Ana Hidalgo
- Infectious Diseases Unit, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Isabel Aguilar
- Infectious Diseases Unit, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Miguel A. Sánchez
- Internal Medicine Department, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Pedro Valdivielso
- Internal Medicine Department, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Pedro González-Santos
- Internal Medicine Department, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Jesús Santos
- Infectious Diseases Unit, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
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Tornero Estébanez C, Santamaría Martín A, Gil Tomás E, Lapuebla Ferri C. Índices de riesgo cardiovascular en pacientes con infección por el virus de la inmunodeficiencia humana en tratamiento antirretroviral efectivo. Med Clin (Barc) 2008; 130:797. [DOI: 10.1157/13121107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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