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Seplowe M, Goyal A, Fowler T, Michaud L, Glassman R, Frishman WH, Aronow WS. Atherosclerosis and HIV: Exploring Cardiovascular Risks and Management. Cardiol Rev 2024:00045415-990000000-00296. [PMID: 38980010 DOI: 10.1097/crd.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
The advent of antiretroviral therapy has markedly improved the life expectancy of individuals with HIV, leading to a shift in clinical focus from managing opportunistic infections to addressing chronic conditions, such as atherosclerotic cardiovascular disease (ASCVD). Emerging evidence highlights an elevated risk of ASCVD among people living with HIV, characterized by a higher incidence of acute myocardial infarction, ischemic stroke, and heart failure compared with the general population. This review examines the epidemiology, pathophysiology, and management of ASCVD in the context of HIV. It explores the interplay between HIV infection, antiretroviral therapy, and traditional cardiovascular risk factors, underscoring the need for comprehensive cardiovascular risk reduction strategies tailored to people living with HIV. Through synthesizing data from clinical trials, observational studies, and basic research, the review aims to enhance understanding of HIV-associated ASCVD and inform healthcare practices to improve the longevity and quality of life for this patient population.
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Affiliation(s)
- Matthew Seplowe
- From the Department of Hospital Medicine, Mount Sinai Morningside, New York, NY
| | - Anjali Goyal
- Department of Medicine, New York Medical College, Valhalla, NY
| | - Tolison Fowler
- Department of General Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Liana Michaud
- Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Rebecca Glassman
- Department of General Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | | | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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2
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Abd-Elmoniem KZ, Ishaq H, Purdy J, Matta J, Hamimi A, Hannoush H, Hadigan C, Gharib AM. Association of Coronary Wall Thickening and Diminished Diastolic Function in Asymptomatic, Low Cardiovascular Disease-Risk Persons Living with HIV. Radiol Cardiothorac Imaging 2024; 6:e230102. [PMID: 38573125 PMCID: PMC11056756 DOI: 10.1148/ryct.230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 12/19/2023] [Accepted: 02/14/2024] [Indexed: 04/05/2024]
Abstract
Purpose To assess early subclinical coronary artery disease (CAD) burden and its relation to myocardial function in asymptomatic persons living with HIV (PLWH) who are at low risk for cardiovascular disease (CVD). Materials and Methods In this prospective, HIPAA-compliant study (ClinicalTrials.gov NCT01656564 and NCT01399385) conducted from April 2010 to May 2013, 74 adult PLWH without known CVD and 25 matched healthy controls underwent coronary MRI to measure coronary vessel wall thickness (VWT) and echocardiography to assess left ventricular function. Univariable and multivariable linear regression analyses were used to evaluate statistical associations. Results For PLWH, the mean age was 49 years ± 11 (SD), and the median Framingham risk score was 3.2 (IQR, 0.5-6.6); for matched healthy controls, the mean age was 46 years ± 8 and Framingham risk score was 2.3 (IQR, 0.6-6.1). PLWH demonstrated significantly greater coronary artery VWT than did controls (1.47 mm ± 0.22 vs 1.34 mm ± 0.18; P = .006) and a higher left ventricular mass index (LVMI) (77 ± 16 vs 70 ± 13; P = .04). Compared with controls, PLWH showed altered association between coronary artery VWT and both E/A (ratio of left ventricular-filling peak blood flow velocity in early diastole [E wave] to that in late diastole [A wave]) (P = .03) and LVMI (P = .04). In the PLWH subgroup analysis, coronary artery VWT increase was associated with lower E/A (P < .001) and higher LVMI (P = .03), indicating restricted diastolic function. In addition, didanosine exposure was associated with increased coronary artery VWT and decreased E/A ratio. Conclusion Asymptomatic low-CVD-risk PLWH demonstrated increased coronary artery VWT in association with impaired diastolic function, which may be amenable to follow-up studies of coronary pathogenesis to identify potential effects on the myocardium and risk modification strategies. Keywords: Coronary Vessel Wall Thickness, Diastolic Function, HIV, MRI, Echocardiography, Atherosclerosis Clinical trial registration nos. NCT01656564 and NCT01399385 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Khaled Z. Abd-Elmoniem
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Hadjira Ishaq
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Julia Purdy
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Jatin Matta
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Ahmed Hamimi
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Hwaida Hannoush
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Colleen Hadigan
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Ahmed M. Gharib
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
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3
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Batta Y, King C, Cooper F, Johnson J, Haddad N, Boueri MG, DeBerry E, Haddad GE. Direct and indirect cardiovascular and cardiometabolic sequelae of the combined anti-retroviral therapy on people living with HIV. Front Physiol 2023; 14:1118653. [PMID: 37078025 PMCID: PMC10107050 DOI: 10.3389/fphys.2023.1118653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
With reports of its emergence as far back as the early 1900s, human immunodeficiency virus (HIV) has become one of the deadliest and most difficult viruses to treat in the era of modern medicine. Although not always effective, HIV treatment has evolved and improved substantially over the past few decades. Despite the major advancements in the efficacy of HIV therapy, there are mounting concerns about the physiological, cardiovascular, and neurological sequelae of current treatments. The objective of this review is to (Blattner et al., Cancer Res., 1985, 45(9 Suppl), 4598s-601s) highlight the different forms of antiretroviral therapy, how they work, and any effects that they may have on the cardiovascular health of patients living with HIV, and to (Mann et al., J Infect Dis, 1992, 165(2), 245-50) explore the new, more common therapeutic combinations currently available and their effects on cardiovascular and neurological health. We executed a computer-based literature search using databases such as PubMed to look for relevant, original articles that were published after 1998 to current year. Articles that had relevance, in any capacity, to the field of HIV therapy and its intersection with cardiovascular and neurological health were included. Amongst currently used classes of HIV therapies, protease inhibitors (PIs) and combined anti-retroviral therapy (cART) were found to have an overall negative effect on the cardiovascular system related to increased cardiac apoptosis, reduced repair mechanisms, block hyperplasia/hypertrophy, decreased ATP production in the heart tissue, increased total cholesterol, low-density lipoproteins, triglycerides, and gross endothelial dysfunction. The review of Integrase Strand Transfer Inhibitors (INSTI), Nucleoside Reverse Transcriptase Inhibitors (NRTI), and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) revealed mixed results, in which both positive and negative effects on cardiovascular health were observed. In parallel, studies suggest that autonomic dysfunction caused by these drugs is a frequent and significant occurrence that needs to be closely monitored in all HIV + patients. While still a relatively nascent field, more research on the cardiovascular and neurological implications of HIV therapy is crucial to accurately evaluate patient risk.
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Affiliation(s)
- Yashvardhan Batta
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Cody King
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Farion Cooper
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - John Johnson
- Delaware Psychiatric Center, New Castle, DE, United States
| | - Natasha Haddad
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | | | - Ella DeBerry
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Georges E. Haddad
- Department of Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
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4
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Vander-Pallen R, Domfeh EA, Hayford FEA, Asante M, Amoah AGB, Asare GA, Wiredu EK. Nutritional status and effect of highly active anti-retroviral therapy (HAART) on selected trace elements in people living with HIV in Ghana. SCIENTIFIC AFRICAN 2023. [DOI: 10.1016/j.sciaf.2023.e01586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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5
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Chitinase-3-like Protein 1 Is Associated with Poor Virologic Control and Immune Activation in Children Living with HIV. Viruses 2022; 14:v14122602. [PMID: 36560606 PMCID: PMC9786985 DOI: 10.3390/v14122602] [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: 10/10/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Perinatally infected children living with HIV (CLWH) face lifelong infection and associated inflammatory injury. Chitinase-like 3 protein-1 (CHI3L1) is expressed by activated neutrophils and may be a clinically informative marker of systemic inflammation in CLWH. We conducted a multi-centre, cross-sectional study of CLWH, enrolled in the Early Pediatric Initiation Canadian Child Cure Cohort Study (EPIC4). Plasma levels of CHI3L1, pro-inflammatory cytokines, and markers of microbial translocation were measured by enzyme-linked immunosorbent assays. Longitudinal clinical characteristics (viral load, neutrophil count, CD4+ and CD8+ T-lymphocyte counts, and antiretroviral (ARV) regimen) were abstracted from patient medical records. One-hundred-and-five (105) CLWH (median age 13 years, 62% female) were included in the study. Seventy-seven (81%) had viral suppression on combination antiviral therapy (cART). The median CHI3L1 level was 25 μg/L (IQR 19-39). CHI3L1 was directly correlated with neutrophil count (ρ = 0.22, p = 0.023) and inversely correlated with CD4/CD8 lymphocyte ratio (ρ = -0.35, p = 0.00040). Children with detectable viral load had higher levels of CHI3L1 (40 μg/L (interquartile range, IQR 33-44) versus 24 μg/L (IQR 19-35), p = 0.0047). CHI3L1 levels were also correlated with markers of microbial translocation soluble CD14 (ρ = 0.26, p = 0.010) and lipopolysaccharide-binding protein (ρ = 0.23, p = 0.023). We did not detect differences in CHI3L1 between different cART regimens. High levels of neutrophil activation marker CHI3L1 are associated with poor virologic control, immune dysregulation, and microbial translocation in CLWH on cART.
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Wagle A, Goerlich E, Post WS, Woldu B, Wu KC, Hays AG. HIV and Global Cardiovascular Health. Curr Cardiol Rep 2022; 24:1149-1157. [PMID: 35802233 DOI: 10.1007/s11886-022-01741-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Because of effective combination antiretroviral therapy, people living with HIV (PLWH) are living longer but developing chronic age-related conditions including cardiovascular disease (CVD), the leading cause of death globally. This review aims to discuss the epidemiology, mechanisms, and clinical considerations of CVD in PLWH from a global perspective. RECENT FINDINGS PLWH are at greater risk for CVD at chronologically younger ages than those without HIV. Potential underlying mechanisms for CVD in PLWH include systemic inflammation, comorbidities, immune-mediated, or treatment-related mechanisms. There is also risk factor variation based on geographical location, including non-traditional CVD risk factors. CVD is prevalent in PLWH and increasing on a global scale. Further understanding the unique epidemiology, risk factors, and treatment of CVD in this population will improve the care of PLWH.
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Affiliation(s)
- Anjali Wagle
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA
| | - Erin Goerlich
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA
| | - Wendy S Post
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bethel Woldu
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA.,MedStar Heart and Vascular Institute, Baltimore, MD, USA.,Department of Medicine, Division of Cardiology, MedStar Georgetown University, Washington, DC, USA
| | - Katherine C Wu
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison G Hays
- Department of Medicine, Johns Hopkins Division of Cardiology, Baltimore, MD, USA. .,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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7
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Zarinsefat A, Gulati A, Shui A, Braun H, Rogers R, Hirose R, Ascher N, Stock P. Long-term Outcomes Following Kidney and Liver Transplant in Recipients With HIV. JAMA Surg 2022; 157:240-247. [PMID: 34985513 PMCID: PMC8733865 DOI: 10.1001/jamasurg.2021.6798] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Kidney transplant (KT) and liver transplant (LT) in HIV-positive patients have become more widely adopted. Data looking at long-term outcomes of patient and graft survival are lacking. Objective To compare the long-term outcomes of KT and LT in HIV-positive recipients with matched HIV-negative recipients. Design, Setting, and Participants Retrospective, single-center, cohort, study using data from 2000 to 2019. Patients were observed until death, or graft failure requiring retransplant. All HIV-positive patients who underwent KT and/or LT between 2000 and 2019 were included. Propensity matching was performed to the corresponding HIV-negative cohort, which was obtained from the University of California, San Francisco's transplant recipient registry. The data were analyzed from 2020 to 2021. Exposures HIV infection. Main Outcomes and Measures Patient and graft survival for KT and patient survival for LT. Incidence of acute rejection and its association with KT graft survival. Results For KT, 655 HIV-negative recipients (mean [SD] age, 52.3 [13.6] years; 450 [68.7%] were men) and 119 HIV-positive recipients (mean [SD] age, 51.7 [9.4] years; 86 [72.3%] were men) were included. Patient survival was 79.6% (95% CI, 73.6%-86.1%) and 53.6% (95% CI, 38.9%-74.0%) at 15 years posttransplant, respectively. Graft survival was 57.0% (95% CI, 47.8%-68.0%) and 75.0% (95% CI, 65.3%-86.2%) at 15 years posttransplant, respectively. Diagnosis of HIV was not associated with worse graft survival (hazard ratio, 1.09; 95% CI, 0.61-1.97; P = .77). For LT, 80 HIV-positive recipients (mean [SD] age, 52.6 [8.2] years; 53 [66.3%] were men) and 440 HIV-negative recipients (mean [SD] age, 54.6 [12.8] years; 291 [66.1%] were men) were included. Patient survival was 75.7% (95% CI, 71.8%-79.8%) for HIV-negative LT recipients and 70.0% (95% CI, 60.6%-80.8%) for HIV-positive LT recipients at 15 years posttransplant. Diagnosis of HIV was not a statistically significant predictor of patient survival (hazard ratio, 1.36; 95% CI, 0.83-2.24; P = .22). In KT, HIV-positive patients with at least 1 episode of acute rejection had a graft survival of 52.8% (95% CI, 38.4%-72.5%; P < .001) at 15 years posttransplant, compared with 91.8% in those without AR. Conclusions and Relevance In this single-center cohort study, KT and LT in HIV-positive patients had comparable long-term outcomes with those in matched HIV-negative patients. The high incidence of acute rejection was associated with reduced graft survival. The findings support providing transplant to HIV-positive patients, which may be an appropriate use of transplant resources and provides equitable access for HIV-positive patients.
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Affiliation(s)
- Arya Zarinsefat
- Department of Surgery, University of California, San Francisco
| | - Arushi Gulati
- School of Medicine, University of California, San Francisco
| | - Amy Shui
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Hillary Braun
- Department of Surgery, University of California, San Francisco
| | - Rodney Rogers
- Department of Surgery, University of California, San Francisco
| | - Ryutaro Hirose
- Department of Surgery, University of California, San Francisco
| | - Nancy Ascher
- Department of Surgery, University of California, San Francisco
| | - Peter Stock
- Department of Surgery, University of California, San Francisco
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Larson D, Won SH, Ganesan A, Maves RC, Kronmann K, Okulicz JF, Chu X, Schofield C, O’Bryan T, Agan BK, Deiss R. Statin usage and cardiovascular risk among people living with HIV in the U.S. Military HIV Natural History Study. HIV Med 2022; 23:249-258. [PMID: 34704330 PMCID: PMC8847313 DOI: 10.1111/hiv.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Using the American College of Cardiology/American Heart Association 2013 atherosclerotic cardiovascular disease (ASCVD) management guidelines, we conducted a retrospective cross-sectional analysis of people living with HIV in the US Military HIV Natural History Study to determine whether individuals were receiving statins when indicated. METHODS Prescription data was taken from Military Health System data. Statin eligibility was defined by ASCVD guidelines. We used the 10-year ASCVD pooled cohorts' equation to evaluate risk for each participant. RESULTS Across all categories, 31.9% (n = 390) of individuals met criteria for statin use, and when adding these subjects to the number of those already receiving statins (n = 96), 62.1% of all eligible subjects (n = 302/486) were actually receiving statin therapy. In multivariable analysis, individuals of African American race [odds ratio (OR) = 0.48, 95% confidence interval (CI): 0.31-0.73] or Hispanic ethnicity (OR = 0.42, 95% CI: 0.19-0.94) were less likely to receive statin prescriptions than white individuals. Individuals with a higher CD4 count (OR = 1.12, 95% CI: 1.05-1.20 per 100 cells/μL]) were significantly more likely to receive a statin prescription. CONCLUSIONS These data highlight discrepancies between ASCVD guidelines and primary care management of people living with HIV (PLWH) in the military health system, along with important racial differences. Targeted interventions are critical to identify and treat appropriate candidates for statin therapy among PLWH in the military and other settings.
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Affiliation(s)
- Derek Larson
- Fort Belvoir Community Hospital, Fort Belvoir, VA,Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD
| | - Seung Hyun Won
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD,Walter Reed National Military Medical Center, Bethesda,
MD
| | - Ryan C. Maves
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,Naval Medical Center San Diego, San Diego, CA
| | | | - Jason F. Okulicz
- Infectious Disease Service, Brooke Army Medical Center, San
Antonio, Texas
| | - Xiuping Chu
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD
| | | | - Thomas O’Bryan
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD,Infectious Disease Service, Brooke Army Medical Center, San
Antonio, Texas
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD
| | - Robert Deiss
- University of California, San Diego, La Jolla, CA
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9
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Predicting the risk of atherosclerotic cardiovascular disease among adults living with HIV/AIDS in Addis Ababa, Ethiopia: A hospital-based study. PLoS One 2021; 16:e0260109. [PMID: 34843544 PMCID: PMC8629213 DOI: 10.1371/journal.pone.0260109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Atherosclerotic Cardiovascular Disease (ASCVD) is an emerging problem among People living with HIV/AIDS (PLWHA). The current study aimed at determining the risk of ASCVD among PLWHA using the Pooled Cohort Equation (PCE) and the Framingham Risk score (FRS). Methods A hospital-based study was carried out from January 2019 to February 2020 in PLWHA. The prevalence of ASCVD risk was determined in individuals aged between 20 to 79 and 40 to 79 years using the FRS and PCE as appropriate. Chi-square, univariate and multivariate logistic regressions were employed for analysis. Results The prevalence of high-risk ASCVD for subjects aged 20 and above using both tools was 11.5 %. For those aged 40 to 79 years, PCE yielded an increased risk (28%) than FRS (17.7%). Using both tools; advanced age, male gender, smoking, and increased systolic blood pressure were associated with an increased risk of ASCVD. Younger age (adjusted odds ratio, AOR) 0.20, 95%CI: 0.004, 0.091; P< 0.001), lower systolic blood pressure (AOR 0.221, 95%CI: 0.074, 0.605 P< 0.004), and lower total cholesterol (AOR 0.270, 95%CI: 0.073, 0.997; p<0.049) were found to be independent predictors of reduced risk of ASCVD. Likewise, younger age (40 to 64 years), female gender, and lower systolic blood pressure were significantly associated with lower risk of ASCVD among patients aged 40 to 79 years using both PCE and FRS. Conclusions A considerable number of PLWHA have been identified to be at risk for ASCVD. ASCVD risk was significantly associated with advanced age, male gender, higher blood pressure, and smoking using both FRS and PCE. These factors should therefore be taken into account for designing management strategies.
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10
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Nguyen KA, Peer N, Kengne AP. Associations of gamma-glutamyl transferase with cardio-metabolic diseases in people living with HIV infection in South Africa. PLoS One 2021; 16:e0246131. [PMID: 33544719 PMCID: PMC7864415 DOI: 10.1371/journal.pone.0246131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Gamma-glutamyl transferase (GGT) has recently been reported as a biomarker for cardiovascular (CVD) risk in general populations. We investigated the associations of GGT with cardio-metabolic diseases and CVD risk in South Africans living with HIV. Methods In this cross-sectional study, HIV-infected adults were randomly recruited across 17 HIV clinics in the Western Cape Province. Homeostatic model assessment for insulin resistance (HOMA-IR), hypertension, diabetes, metabolic syndrome by Joint Interim Statement criteria (JIS-MS), a ≥5% and ≥10% predicted risk for a CVD event within 10 years by the Framingham risk score (10-years-CVD risk) were computed. Associations between GGT and cardio-metabolic trait were explored using linear and binomial logistic regressions adjusted for age, gender, lifestyle behaviours and HIV-related characteristics. Results Among 709 participants (561 women, mean age 38.6 years), log-GGT was positively associated with waist circumference (β=2.75; p<0.001), diastolic blood pressure (β=1.65; p=0.006), total cholesterol (β=0.21; p<0.001), low-density lipoprotein-cholesterol (β=0.16; p<0.001), high-density lipoprotein-cholesterol and log-triglycerides (both β=0.12; p<0.001), fasting plasma glucose (β=0.19; p=0.031), 2-hour-post-glucose-load plasma glucose (β=0.26; p=0.007), HOMA-IR (β=0.13; p=0.001), log-high-sensitivity C-reactive-protein (β=0.3; p<0.001) in linear regression analyses; with hypertension [OR=1.41 (95%CI, 1.13-1.75); p=0.001], JIS-MS [OR=1.33 (1.05-1.68); p=0.016], ≥5% 10-year-CVD risk [OR=1.55 (1.24-1.9400); p<0.001] and ≥10% 10-year-CVD risk [OR=1.56 (1.08-2.23); p=0.016] but not with diabetes [OR=1.24 (0.88-1.71), p=0.205] in logistic regression analyses. Conclusions In this study, GGT levels were associated with cardio-metabolic variables independent of HIV specific attributes. If confirmed in longitudinal studies, GGT evaluation maybe included in CVD risk monitoring strategies in people living with HIV.
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Affiliation(s)
- Kim A. Nguyen
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town and Durban, South Africa
- * E-mail:
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town and Durban, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town and Durban, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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11
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Ashwitha SK, Jacob PA, Ajaj A, Shirke MM, Harky A. Management of cardiovascular diseases in HIV/AIDS patients. J Card Surg 2020; 36:236-243. [PMID: 33225472 DOI: 10.1111/jocs.15213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome, a pandemic in the current population causes severe weakness of the body's immune system making the infected patient more vulnerable to life-threatening conditions. The disease predisposes the infected patient to several cardiovascular diseases and cerebrovascular diseases such as heart failure and stroke. The decline in CD4 cells following HIV infection, vulnerability to opportunistic infections and underlying HIV pathology plays a major role in the development of cardiovascular manifestations, and treatment targeting cardiomyopathy in this specific patient subset is not well recognized. Patients living with HIV (PLWH) also experience discrimination in receiving cardiovascular disease care and this needs to be addressed by strengthening frameworks for monitoring and providing nonjudgmental healthcare. This review aims to study the profile of the cardiovascular disease in HIV patients, treatment, and provide evidence of the disparity in the provision of healthcare with regard to PLWH.
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Affiliation(s)
- Santoshi K Ashwitha
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Preethi A Jacob
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Abdullah Ajaj
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Manasi M Shirke
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Heart and Chest Hospital, Department of Cardiovascular Science, University of Liverpool, Liverpool, UK.,Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
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12
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Choudhury B, Brown J, Ransy DG, Brophy J, Kakkar F, Bitnun A, Samson L, Read S, Soudeyns H, Vaudry W, Houston S, Hawkes MT. Endothelial activation is associated with intestinal epithelial injury, systemic inflammation and treatment regimen in children living with vertically acquired HIV-1 infection. HIV Med 2020; 22:273-282. [PMID: 33151601 DOI: 10.1111/hiv.13012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/17/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Premature development of cardiovascular disease in children living with HIV-1 (CLWH) may be associated with compromised gut barrier function, microbial translocation, immune activation, systemic inflammation and endothelial activation. Biomarkers of these pathways may provide insights into pathogenesis of atherosclerotic disease in CLWH. METHODS This was a cross-sectional study of CLWH enrolled in the multicentre Early Pediatric Initiation-Canadian Child Cure Cohort (EPIC4 ) who were on antiretroviral therapy (ART) with undetectable viral load. Plasma biomarkers of intestinal epithelial injury [intestinal fatty acid binding protein-1 (IFABP)], systemic inflammation [tumour necrosis factor (TNF) and interleukin-6 (IL-6)] and endothelial activation [angiopoietin-2 (Ang2), soluble vascular endothelial growth factor-1 (sVEGFR1) and soluble endoglin (sEng)] were quantified by enzyme-linked immunosorbent assay. Correlation and factor analysis of biomarkers were used to examine associations between innate immune pathways. RESULTS Among 90 CLWH, 16% of Ang2, 15% of sVEGFR1 and 23% of sEng levels were elevated relative to healthy historic controls. Pairwise rank correlations between the three markers of endothelial activation were statistically significant (ρ = 0.69, ρ = 0.61 and ρ = 0.65, P < 0.001 for all correlations). An endothelial activation index, derived by factor analysis of the three endothelial biomarkers, was correlated with TNF (ρ = 0.47, P < 0.001), IL-6 (ρ = 0.60, P < 0.001) and intestinal fatty acid binding protein-1 (ρ = 0.67, P < 0.001). Current or past treatment with ritonavir-boosted lopinavir (LPV/r) was associated with endothelial activation (odds ratio = 5.0, 95% CI: 1.7-17, P = 0.0020). CONCLUSIONS Endothelial activation is prevalent in CLWH despite viral suppression with combination ART and is associated with intestinal epithelial injury, systemic inflammation and treatment with LPV/r.
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Affiliation(s)
- B Choudhury
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - J Brown
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - D G Ransy
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montréal, QC, Canada
| | - J Brophy
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - F Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - A Bitnun
- Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - L Samson
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - S Read
- Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - H Soudeyns
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montréal, QC, Canada.,Department of Microbiology, Infectiology & Immunology, Université de Montréal, Montréal, QC, Canada
| | - W Vaudry
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - S Houston
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - M T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada.,Stollery Science Lab, Edmonton, AB, Canada.,Women and Children's Health Research Institute, Edmonton, AB, Canada
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13
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Myerson M, Kaplan-Lewis E, Poltavskiy E, Ferris D, Bang H. Prolonged QTc in HIV-Infected Patients: A Need for Routine ECG Screening. J Int Assoc Provid AIDS Care 2020; 18:2325958219833926. [PMID: 30907255 PMCID: PMC6435291 DOI: 10.1177/2325958219833926] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND With HIV-infected patients living longer, there is an increased burden of comorbidities related to aging, HIV itself, and polypharmacy. Cardiac morbidity is of particular importance. METHODS This 2-group comparison study (156 HIV-positive and 105 HIV-negative patients) investigated the prevalence of abnormalities in and factors associated with an electrocardiogram (ECG) measure, corrected QT interval (QTc), where prolongation can lead to arrhythmia and sudden death. Medications prescribed (antiretroviral therapy, psychiatric medications, methadone, and antibiotics) at the time of ECG were noted. Patient characteristics, medications, QTc, and ECG characteristics were compared between the 2 groups. RESULTS Prolongation (29% versus 19%) and extreme prolongation (6% versus 1%) in QTc were more frequent in those with HIV. Antiretroviral therapy was associated with lower odds of prolonged QTc (odds ratio [OR] = 0.35; P = .04), while methadone with higher odds (OR = 4.6; P = .01) in HIV-positive patients. With methadone and medication groups adjusted, HIV status was still associated with 17-millisecond longer QTc ( P = .04). CONCLUSION This study provides evidence that patients with HIV may have clinically relevant longer QTc interval on ECG. Baseline and routine ECG monitoring may be warranted among patients living with HIV in clinical practice based on cumulative evidence.
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Affiliation(s)
- Merle Myerson
- 1 Cardiovascular Service Line and Research Institute, Bassett Medical Center, Cooperstown, NY, USA
| | - Emma Kaplan-Lewis
- 2 Department of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eduard Poltavskiy
- 3 Department of Public Health Sciences, University of California, Davis, CA, USA.,4 Center for Healthcare Policy and Research, School of Medicine, University of California, Sacramento, CA, USA
| | - David Ferris
- 5 Division of Infectious Diseases, AIDS Program, BronxCare Health System, Bronx, NY, USA
| | - Heejung Bang
- 3 Department of Public Health Sciences, University of California, Davis, CA, USA.,4 Center for Healthcare Policy and Research, School of Medicine, University of California, Sacramento, CA, USA.,6 Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
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14
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Gamble-George JC, Longenecker CT, Webel AR, Au DH, Brown AF, Bosworth H, Crothers K, Cunningham WE, Fiscella KA, Hamilton AB, Helfrich CD, Ladapo JA, Luque A, Tobin JN, Wyatt GE. ImPlementation REsearCh to DEvelop Interventions for People Living with HIV (the PRECluDE consortium): Combatting chronic disease comorbidities in HIV populations through implementation research. Prog Cardiovasc Dis 2020; 63:79-91. [PMID: 32199901 PMCID: PMC7237329 DOI: 10.1016/j.pcad.2020.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 02/08/2023]
Abstract
Antiretroviral therapy (ART) prevented premature mortality and improved the quality of life among people living with the human immunodeficiency virus (PLWH), such that now more than half of PLWH in the United States are 50 years of age and older. Increased longevity among PLWH has resulted in a significant rise in chronic, comorbid diseases. However, the implementation of guideline-based interventions for preventing, treating, and managing such age-related, chronic conditions among the HIV population is lacking. The PRECluDE consortium supported by the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute catalyzes implementation research on proven-effective interventions for co-occurring heart, lung, blood, and sleep diseases and conditions among PLWH. These collaborative research studies use novel implementation frameworks with HIV, mental health, cardiovascular, and pulmonary care to advance comprehensive HIV and chronic disease healthcare in a variety of settings and among diverse populations.
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Affiliation(s)
- Joyonna Carrie Gamble-George
- Health Scientist Administrator and AAAS Science and Technology Policy Fellow, Implementation Science Branch (ISB), Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), U.S. Department of Health and Human Services, Bethesda, MD 20892, United States of America; Office of Science Policy (OSP), Office of the Director (OD), National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD 20892, United States of America.
| | - Christopher T Longenecker
- Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States of America
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - David H Au
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA 98195, United States of America; Seattle-Denver Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, United States of America
| | - Arleen F Brown
- Department of Medicine, Division of General Internal Medicine and Health Services Research (GIM and HSR), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, United States of America; GIM and HSR, Olive View-UCLA Medical Center Sylmar, Los Angeles, CA 90095, United States of America; Community Engagement and Research Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA 90095, United States of America
| | - Hayden Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, NC 27701, United States of America; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701, United States of America
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA 98195, United States of America; Pulmonary and Critical Care Section, VA Puget Sound Health Care System, Seattle, WA 98108, United States of America
| | - William E Cunningham
- Department of Medicine, GIM and HSR, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, United States of America; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, United States of America
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Center for Communication and Disparities Research, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Greater Rochester Practice-Based Research Network, Clinical and Translational Science Institute (CTSI), University of Rochester Medical Center, Rochester, NY 14642, United States of America
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States of America; VA Health Services Research and Development (HSR&D) Service, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, North Hills, CA 91343, United States of America
| | - Christian D Helfrich
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA 98101, United States of America; Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration (VA) Puget Sound Health Care System, Seattle, WA 98108, United States of America
| | - Joseph A Ladapo
- Department of Medicine, GIM and HSR, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, United States of America; Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY 10016, United States of America
| | - Amneris Luque
- HIV Clinical Services, Parkland Health and Hospital System, Dallas, TX 75235, United States of America; Department of Internal Medicine, University of Texas (UT) Southwestern Medical Center, Dallas, TX 75390, United States of America
| | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY 10018; Community-Engaged Research, The Rockefeller University Center for Clinical and Translational Science, New York, NY 10065, United States of America
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States of America; Sexual Health Programs, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States of America; The Center for Culture, Trauma, and Mental Health Disparities, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, United States of America; University of Cape Town, Rondebosch, Cape Town 7701, South Africa
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15
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Dominick L, Midgley N, Swart LM, Sprake D, Deshpande G, Laher I, Joseph D, Teer E, Essop MF. HIV-related cardiovascular diseases: the search for a unifying hypothesis. Am J Physiol Heart Circ Physiol 2020; 318:H731-H746. [PMID: 32083970 DOI: 10.1152/ajpheart.00549.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although the extensive rollout of antiretroviral (ARV) therapy resulted in a longer life expectancy for people living with human immunodeficiency virus (PLHIV), such individuals display a relatively increased occurrence of cardiovascular diseases (CVD). This health challenge stimulated significant research interests in the field, leading to an improved understanding of both lifestyle-related risk factors and the underlying mechanisms of CVD onset in PLHIV. However, despite such progress, the precise role of various risk factors and mechanisms underlying the development of HIV-mediated CVD still remains relatively poorly understood. Therefore, we review CVD onset in PLHIV and focus on 1) the spectrum of cardiovascular complications that typically manifest in such persons and 2) underlying mechanisms that are implicated in this process. Here, the contributions of such factors and modulators and underlying mechanisms are considered in a holistic and integrative manner to generate a unifying hypothesis that includes identification of the core pathways mediating CVD onset. The review focuses on the sub-Saharan African context, as there are relatively high numbers of PLHIV residing within this region, indicating that the greater CVD risk will increasingly threaten the well-being and health of its citizens. It is our opinion that such an approach helps point the way for future research efforts to improve treatment strategies and/or lifestyle-related modifications for PLHIV.
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Affiliation(s)
- Leanne Dominick
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Natasha Midgley
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lisa-Mari Swart
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Devon Sprake
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Gaurang Deshpande
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ismail Laher
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa.,Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danzil Joseph
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eman Teer
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - M Faadiel Essop
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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16
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Brief Report: Higher Levels of Angiopoietin-1 Are Associated With Early and Sustained Viral Suppression in Children Living With Vertically Acquired HIV. J Acquir Immune Defic Syndr 2019; 80:590-595. [PMID: 30865052 DOI: 10.1097/qai.0000000000001955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Systemic inflammation, platelet dysfunction, and endothelial activation persist in people living with HIV despite sustained virologic suppression (SVS) with combined antiretroviral therapy (cART) and may lead to complications such as atherosclerosis and cardiovascular disease. Angiopoietin-1 (Ang-1) is a key regulator of angiogenesis and endothelial activation and has been studied as an objective biomarker in disease states such as atherosclerosis, sepsis, and severe malaria. SETTING Eight pediatric HIV care centers across Canada. METHODS Cross-sectional study of 61 children living with vertically acquired HIV on cART with undetectable RNA viral load. Plasma levels of Ang-1 were measured by ELISA and analyzed in relation to clinical characteristics abstracted from medical records. RESULTS Ang-1 levels were directly correlated with clinical indices of virologic control: cumulative proportion of life on effective cART (ρ = +0.35, P = 0.0078) and cumulative proportion of life with SVS (ρ = +0.36, P = 0.0049). Furthermore, higher Ang-1 levels were associated with younger age at SVS (ρ = -0.56, P < 0.0001). These associations remained statistically significant in multivariable linear regression models adjusting for potential confounders (P < 0.05 for all associations). CONCLUSIONS Early effective cART and SVS were associated with higher Ang-1 levels in children living with vertically acquired HIV-1.
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17
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Pontes PS, Melo ES, Costa CRB, Antonini M, Sousa LRM, Gir E, Reis RK. Estimativa da taxa de filtração glomerular em pessoas vivendo com HIV. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Avaliar os fatores associados à estimativa da Taxa de Filtração Glomerular (eTFG) em pessoas vivendo com HIV. Métodos Estudo transversal e analítico, com avaliação de 340 pessoas em atendimento ambulatorial no município de Ribeirão Preto-SP. Calculou-se a eTFG através da fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Foi realizado análise univariada com os testes Qui-quadrado e Exato de Fisher, com p<0,05. Resultados Identificou que 114 (34,1%) dos participantes apresentaram alterações na Filtração Glomerular, dos quais (90) 27,5% foram classificadas em estágio 2, 15 (4,5%) em estágio 3A e 07 (2,1%) em estágio 3B. Conclusão O estudo evidenciou que as variáveis sexo, idade, hipertensão, diabetes, IMC e tempo de diagnóstico apresentaram associação com a Taxa de Filtração Glomerular. Ressalta-se a importância do acompanhamento integral de PVHIV para a tomada de decisões de modo a prevenir a ocorrência de disfunções renais.
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18
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Alenezi F, Bloomfield GS, Okeke NL, Velagapudi P, Abudaqa L, Ijioma N, Dunning A, Alajmi H, Clement ME, Shah SH, Naggie S, Velazquez EJ. Global Longitudinal Strain and Immune Status in Patients Living With Human Immunodeficiency Virus. Am J Cardiol 2019; 124:966-971. [PMID: 31371060 DOI: 10.1016/j.amjcard.2019.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 11/29/2022]
Abstract
Improvement in survival in patients living with human immunodeficiency virus (PLHIV) has led to increased prevalence of cardiovascular disease. Whether HIV-associated immune dysfunction is associated with preclinical left ventricular (LV) dysfunction despite normal LV ejection fraction (LVEF) is unclear. Accordingly, we investigated the relation of immune status and LV function in PLHIV. Global longitudinal strain (GLS) analyses were performed retrospectively on all echocardiograms for PLHIV who had available HIV-1 RNA viral load, nadir, and proximal CD4 cell count data at Duke University Medical Center between 2001 and 2012. The relation between HIV-1 RNA viral load, nadir, and proximal CD4 count and GLS as a continuous dependent variable was assessed with unadjusted and adjusted linear regression. GLS was calculated for 253 PLHIV. Median GLS in our cohort was - 15.1% with interquartile range from (-16.7 to -13.6). All participants had an LVEF ≥50%. In adjusted analyses, proximal CD4 <500 cells/mm3 and nadir CD4 <250 cells/mm3 were significantly inversely correlated with GLS (p = 0.01 and p = 0.004, respectively). In PLHIV, patient with plasma HIV RNA <400 copies/ml at baseline had a trend toward significantly more negative values of GLS compared with those patients without viral suppression at baseline (p = 0.08). In conclusion, this study is the first to demonstrate such a high prevalence of abnormal GLS in PLHIV, and the first to identify that proximal and nadir CD4 cell count are independently associated with GLS despite normal LVEF.
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Affiliation(s)
- Fawaz Alenezi
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Gerald S Bloomfield
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Nwora Lance Okeke
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Poonam Velagapudi
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Loai Abudaqa
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | | | - Allison Dunning
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Hasan Alajmi
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Meredith E Clement
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Svati H Shah
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Susanna Naggie
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Eric J Velazquez
- Division of Cardiology, Department of Medicine, Yale University, Yale New Haven Health System, New Haven, Connecticut.
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19
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Webel AR, Schreiner N, Salata RA, Friedman J, Jack AI, Sattar A, Fresco DM, Rodriguez M, Moore S. The Effect of an HIV Self-Management Intervention on Neurocognitive Behavioral Processing. West J Nurs Res 2019; 41:990-1008. [PMID: 30654713 PMCID: PMC6570548 DOI: 10.1177/0193945918823347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People living with HIV (PLHIV) are increasingly diagnosed with comorbidities which require increasing self-management. We examined the effect of a self-management intervention on neurocognitive behavioral processing. Twenty-nine PLHIV completed a two-group, 3-month randomized clinical trial testing a self-management intervention to improve physical activity and dietary intake. At baseline and 3 months later, everyone completed validated assessments of physical, diet, and neurocognitive processing (functional magnetic resonance imaging [fMRI]-derived network analyses). We used linear mixed effects modeling with a random intercept to examine the effect of the intervention. The intervention improved healthy eating (p = .08) but did not improve other self-management behaviors. There was a significant effect of the intervention on several aspects of neurocognitive processing including in the task positive network (TPN) differentiation (p = .047) and an increase in the default mode network (DMN) differentiation (p = .10). Self-management interventions may influence neurocognitive processing in PLHIV, but those changes were not associated with positive changes in self-management behavior.
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Affiliation(s)
- Allison R Webel
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Nathaniel Schreiner
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Robert A Salata
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
- 2 University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, USA
| | - Jared Friedman
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Anthony I Jack
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Abdus Sattar
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Margaret Rodriguez
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Shirley Moore
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Peyracchia M, Verardi R, Rubin SR, Abu-Assi E, Montrucchio C, Perl L, Grossomarra W, Calcagno A, Omedè P, Montefusco A, Bonora S, Moretti C, D'Amico M, Mauro R, D'Ascenzo F. In-hospital and long-term outcomes of HIV-positive patients undergoing PCI according to kind of stent: a meta-analysis. J Cardiovasc Med (Hagerstown) 2019; 20:321-326. [PMID: 30664538 DOI: 10.2459/jcm.0000000000000767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pathogenesis of cardiovascular disease in HIV-positive patients is related to the interaction between traditional and HIV-specific factors. Limited data are available regarding the prognosis of HIV-positive patients undergoing percutaneous coronary intervention (PCI). METHODS All observational studies evaluating the prognosis of HIV-positive patients treated with PCI were included. In-hospital and long-term major adverse cardiac events (MACE) [composite endpoint of all-cause death or myocardial infarction (MI)] were the primary endpoints, whereas in-hospital and long-term all-cause death, cardiovascular death, MI, stent thrombosis, target vessel revascularization (TVR), target lesion revascularization (TLR), and bleeding complications were the secondary ones. FINDINGS In all, 1243 patients in nine studies were included, with a mean age of 54 years. Among them, 12% were female and 91% were admitted for acute coronary syndromes. In-hospital MACE occurred in 6.0% (5.4-6.6), death in 4.2% (2.6-5.9), and MI in 1.3% (0-2.8), whereas major bleeding occurred in 2.0% (1.7-2.3) of the patients. After 2 years (1.6-3.1), long-term MACE occurred in 17.4% (11.9-22.3), all-cause death in 8.7% (3.2-14.2), and MI in 7.8% (5.5-10.1) of the patients, whereas stent thrombosis and TVR in 3.4% (1.5-5.3) and 10.5% (7.5-13.4), respectively. In patients treated with drug-eluting stents (DES), the rate of long-term MACE was 22.3% (10.1-34.4), with an incidence of 4.9% (0.0-11.4) of MI and 5.7% (2.3-13.7, all 95% confidence intervals of TLR. INTERPRETATION HIV-positive patients have a high risk of in-hospital and long-term MACE after PCI, partially reduced by the use of DES. Further studies on the risk of recurrent ischemic events with current generation stents are needed, to offer a tailored therapy in this high-risk population.
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Affiliation(s)
- Mattia Peyracchia
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Roberto Verardi
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sergio Raposeiras Rubin
- Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña
| | - Emad Abu-Assi
- Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Leor Perl
- Cardiology Department, Rabin Medical Center, Petach-Tikva and the "Sackler" Faculty of Medicine, Tel-Aviv University, Israel
| | - Walter Grossomarra
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Division of Infectious Disease, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Bonora
- Division of Infectious Disease, University of Turin, Turin, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Rinaldi Mauro
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
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Randomized Controlled Trial of the SystemCHANGE Intervention on Behaviors Related to Cardiovascular Risk in HIV+ Adults. J Acquir Immune Defic Syndr 2019; 78:23-33. [PMID: 29373392 DOI: 10.1097/qai.0000000000001635] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine the effect of a lifestyle behavior intervention (SystemCHANGE) on physical activity and diet quality among sedentary people living with HIV (PLHIV). All participants expressed a desire to improve lifestyle health behaviors. METHODS One hundred and seven HIV+ adults were randomized to either the intervention (6, in-person, standardized group sessions focusing on improving lifestyle behaviors) or a control condition (general advice on AHA diet and exercise guidelines). All participants wore an ActiGraph accelerometer and completed 24-hour dietary recalls at baseline, 3, and 6 months. Generalized estimating equations were used to examine intervention effects. The primary activity outcome was time spent in moderate-to-vigorous physical activity, and the primary dietary outcome was Healthy Eating Index. RESULTS Mean age was 53 years, 65% were male, and 86% African American. Approximately 90% attended at least half of the sessions and 60% attended 5 or more sessions. The intervention did not significantly improve our primary lifestyle behavior endpoints (P ≥ 0.05); however, intervention participants consumed fewer carbohydrates-primarily sugar-sweetened beverages-per day and lost 0.732 kg body weight compared with a 0.153 weight gain in the control group (P = 0.03). CONCLUSIONS Among sedentary PLHIV at high risk of cardiovascular disease, the SystemCHANGE intervention reduced daily carbohydrate intake and body weight, but did not increase physical activity or improve overall diet quality. Future work should identify fundamental personal, interpersonal, and contextual factors that will increase physical activity and improve overall diet quality among this population, and integrate these factors into tailored, lifestyle interventions for aging PLHIV.
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Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, Grunberger G, Guerin CK, Bell DSH, Mechanick JI, Pessah-Pollack R, Wyne K, Smith D, Brinton EA, Fazio S, Davidson M. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF DYSLIPIDEMIA AND PREVENTION OF CARDIOVASCULAR DISEASE. Endocr Pract 2019; 23:1-87. [PMID: 28437620 DOI: 10.4158/ep171764.appgl] [Citation(s) in RCA: 632] [Impact Index Per Article: 126.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). METHODS Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. RESULTS The Executive Summary of this document contains 87 recommendations of which 45 are Grade A (51.7%), 18 are Grade B (20.7%), 15 are Grade C (17.2%), and 9 (10.3%) are Grade D. These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world medical care. The evidence base presented in the subsequent Appendix provides relevant supporting information for Executive Summary Recommendations. This update contains 695 citations of which 203 (29.2 %) are EL 1 (strong), 137 (19.7%) are EL 2 (intermediate), 119 (17.1%) are EL 3 (weak), and 236 (34.0%) are EL 4 (no clinical evidence). CONCLUSION This CPG is a practical tool that endocrinologists, other health care professionals, health-related organizations, and regulatory bodies can use to reduce the risks and consequences of dyslipidemia. It provides guidance on screening, risk assessment, and treatment recommendations for a range of individuals with various lipid disorders. The recommendations emphasize the importance of treating low-density lipoprotein cholesterol (LDL-C) in some individuals to lower goals than previously endorsed and support the measurement of coronary artery calcium scores and inflammatory markers to help stratify risk. Special consideration is given to individuals with diabetes, familial hypercholesterolemia, women, and youth with dyslipidemia. Both clinical and cost-effectiveness data are provided to support treatment decisions. ABBREVIATIONS 4S = Scandinavian Simvastatin Survival Study A1C = glycated hemoglobin AACE = American Association of Clinical Endocrinologists AAP = American Academy of Pediatrics ACC = American College of Cardiology ACE = American College of Endocrinology ACS = acute coronary syndrome ADMIT = Arterial Disease Multiple Intervention Trial ADVENT = Assessment of Diabetes Control and Evaluation of the Efficacy of Niaspan Trial AFCAPS/TexCAPS = Air Force/Texas Coronary Atherosclerosis Prevention Study AHA = American Heart Association AHRQ = Agency for Healthcare Research and Quality AIM-HIGH = Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides trial ASCVD = atherosclerotic cardiovascular disease ATP = Adult Treatment Panel apo = apolipoprotein BEL = best evidence level BIP = Bezafibrate Infarction Prevention trial BMI = body mass index CABG = coronary artery bypass graft CAC = coronary artery calcification CARDS = Collaborative Atorvastatin Diabetes Study CDP = Coronary Drug Project trial CI = confidence interval CIMT = carotid intimal media thickness CKD = chronic kidney disease CPG(s) = clinical practice guideline(s) CRP = C-reactive protein CTT = Cholesterol Treatment Trialists CV = cerebrovascular CVA = cerebrovascular accident EL = evidence level FH = familial hypercholesterolemia FIELD = Secondary Endpoints from the Fenofibrate Intervention and Event Lowering in Diabetes trial FOURIER = Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects With Elevated Risk trial HATS = HDL-Atherosclerosis Treatment Study HDL-C = high-density lipoprotein cholesterol HeFH = heterozygous familial hypercholesterolemia HHS = Helsinki Heart Study HIV = human immunodeficiency virus HoFH = homozygous familial hypercholesterolemia HPS = Heart Protection Study HPS2-THRIVE = Treatment of HDL to Reduce the Incidence of Vascular Events trial HR = hazard ratio HRT = hormone replacement therapy hsCRP = high-sensitivity CRP IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial IRAS = Insulin Resistance Atherosclerosis Study JUPITER = Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin LDL-C = low-density lipoprotein cholesterol Lp-PLA2 = lipoprotein-associated phospholipase A2 MACE = major cardiovascular events MESA = Multi-Ethnic Study of Atherosclerosis MetS = metabolic syndrome MI = myocardial infarction MRFIT = Multiple Risk Factor Intervention Trial NCEP = National Cholesterol Education Program NHLBI = National Heart, Lung, and Blood Institute PCOS = polycystic ovary syndrome PCSK9 = proprotein convertase subtilisin/kexin type 9 Post CABG = Post Coronary Artery Bypass Graft trial PROSPER = Prospective Study of Pravastatin in the Elderly at Risk trial QALY = quality-adjusted life-year ROC = receiver-operator characteristic SOC = standard of care SHARP = Study of Heart and Renal Protection T1DM = type 1 diabetes mellitus T2DM = type 2 diabetes mellitus TG = triglycerides TNT = Treating to New Targets trial VA-HIT = Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial VLDL-C = very low-density lipoprotein cholesterol WHI = Women's Health Initiative.
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Rinella ME, Trotter JF, Abdelmalek MF, Paredes AH, Connelly MA, Jaros MJ, Ling L, Rossi SJ, DePaoli AM, Harrison SA. Rosuvastatin improves the FGF19 analogue NGM282-associated lipid changes in patients with non-alcoholic steatohepatitis. J Hepatol 2019; 70:735-744. [PMID: 30529590 DOI: 10.1016/j.jhep.2018.11.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/28/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND NGM282, an engineered analogue of the gut hormone FGF19, improves hepatic steatosis and fibrosis biomarkers in patients with non-alcoholic steatohepatitis (NASH). However, NGM282 increases serum cholesterol levels by inhibiting CYP7A1, which encodes the rate-limiting enzyme in the conversion of cholesterol to bile acids. Herein, we investigate whether administration of a statin can manage the cholesterol increase seen in patients with NASH receiving treatment with NGM282. METHODS In this phase II, open-label, multicenter study, patients with biopsy-confirmed NASH were treated with subcutaneous NGM282 once daily for 12 weeks. After 2 weeks, rosuvastatin was added in stepwise, biweekly incremental doses to a maximum of 40 mg daily. Both drugs were continued until the end of treatment at week 12. We evaluated plasma lipids, lipoprotein particles and liver fat content. RESULTS In 66 patients who received NGM282 0.3 mg (n = 23), NGM282 1 mg (n = 21), or NGM282 3 mg (n = 22), circulating cholesterol increased from baseline at week 2. Initiation of rosuvastatin resulted in rapid decline in plasma levels of total cholesterol and low-density lipoprotein cholesterol. At week 12, reductions from baseline in total cholesterol levels of up to 18% (p <0.001), low-density lipoprotein cholesterol of up to 28% (p <0.001), triglycerides of up to 34% (p <0.001) and an increase in high-density lipoprotein cholesterol of up to 16% (p <0.001), with similar changes in lipoprotein particles, were observed in these patients. Robust decreases from baseline in 7alpha-hydroxy-4-cholesten-3-one (p <0.001) and liver fat content (p <0.001) were also observed. Rosuvastatin was safe and well-tolerated when co-administered with NGM282 in patients with NASH. CONCLUSIONS In this multicenter study, NGM282-associated elevation of cholesterol was effectively managed with rosuvastatin. Co-administration of rosuvastatin with NGM282 may be a reasonable strategy to optimize the cardiovascular risk profile in patients with NASH. LAY SUMMARY Non-alcoholic steatohepatitis (NASH) represents a large and growing public health concern with no approved therapy. NGM282, an engineered analogue of the gut hormone FGF19, reduces liver fat, liver injury and inflammation in patients with NASH. However, NGM282 increases cholesterol levels. Here we show that co-administration of a statin can manage the cholesterol increase seen in patients with NASH receiving treatment with NGM282, producing a favorable overall lipid profile.
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Affiliation(s)
- Mary E Rinella
- Division of Gastroenterology and Hepatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
| | - James F Trotter
- Clinical Research and Education, Texas Digestive Disease Consultants, Dallas, TX, United States
| | - Manal F Abdelmalek
- Division of Gastroenterology and Hepatology, Duke University, Durham, NC, United States
| | - Angelo H Paredes
- Division of Gastroenterology and Hepatology, Brooke Army Medical Center, San Antonio, TX, United States
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | | | - Lei Ling
- NGM Biopharmaceuticals, South San Francisco, CA, United States
| | - Stephen J Rossi
- NGM Biopharmaceuticals, South San Francisco, CA, United States
| | - Alex M DePaoli
- NGM Biopharmaceuticals, South San Francisco, CA, United States
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Anand AR, Rachel G, Parthasarathy D. HIV Proteins and Endothelial Dysfunction: Implications in Cardiovascular Disease. Front Cardiovasc Med 2018; 5:185. [PMID: 30619892 PMCID: PMC6305718 DOI: 10.3389/fcvm.2018.00185] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/06/2018] [Indexed: 12/17/2022] Open
Abstract
With the success of antiretroviral therapy (ART), a dramatic decrease in viral burden and opportunistic infections and an increase in life expectancy has been observed in human immunodeficiency virus (HIV) infected individuals. However, it is now clear that HIV- infected individuals have enhanced susceptibility to non-AIDS (Acquired immunodeficiency syndrome)-related complications such as cardiovascular disease (CVD). CVDs such as atherosclerosis have become a significant cause of morbidity and mortality in individuals with HIV infection. Though studies indicate that ART itself may increase the risk to develop CVD, recent studies suggest a more important role for HIV infection in contributing to CVD independently of the traditional risk factors. Endothelial dysfunction triggered by HIV infection has been identified as a critical link between infection, inflammation/immune activation, and atherosclerosis. Considering the inability of HIV to actively replicate in endothelial cells, endothelial dysfunction depends on both HIV-encoded proteins as well as inflammatory mediators released in the microenvironment by HIV-infected cells. Indeed, the HIV proteins, gp120 (envelope glycoprotein) and Tat (transactivator of transcription), are actively secreted into the endothelial cell micro-environment during HIV infection, while Nef can be actively transferred onto endothelial cells during HIV infection. These proteins can have significant direct effects on the endothelium. These include a range of responses that contribute to endothelial dysfunction, including enhanced adhesiveness, permeability, cell proliferation, apoptosis, oxidative stress as well as activation of cytokine secretion. This review summarizes the current understanding of the interactions of HIV, specifically its proteins with endothelial cells and its implications in cardiovascular disease. We analyze recent in vitro and in vivo studies examining endothelial dysfunction in response to HIV proteins. Furthermore, we discuss the multiple mechanisms by which these viral proteins damage the vascular endothelium in HIV patients. A better understanding of the molecular mechanisms of HIV protein associated endothelial dysfunction leading to cardiovascular disease is likely to be pivotal in devising new strategies to treat and prevent cardiovascular disease in HIV-infected patients.
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Affiliation(s)
- Appakkudal R Anand
- L&T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, India.,Department of HIV/AIDS, National Institute for Research in Tuberculosis, Chennai, India
| | - Gladys Rachel
- Department of HIV/AIDS, National Institute for Research in Tuberculosis, Chennai, India
| | - Durgadevi Parthasarathy
- L&T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Yildiz SS, Cetin S, Keskin K, Gunduz A, Cetinkal G, Bulbun G, Sigirci S, Pilten S, Kilickesmez KO. Pregnancy-associated plasma protein-a is associated with subclinical atherosclerosis in men with HIV infection. J Investig Med 2018; 67:821-825. [PMID: 30487186 DOI: 10.1136/jim-2018-000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2018] [Indexed: 11/04/2022]
Abstract
The pathophysiology of an early and accelerated atherosclerotic process is complex and multifactorial in HIV-infected men compared with HIV-non-infected men. Several biomarkers have been well studied in the detection of the early stage of atherosclerosis, but studies are limited in HIV-infected men. The objective of this study was to investigate the association between serum pregnancy-associated plasma protein-A (PAPP-A) and carotid intima-media wall thickness (CIMT) in asymptomatic HIV-infected men. This a case-control study group comprising 118 HIV-infected men and 60 age-matched and gender-matched HIV-non-infected men. Serum PAPP-A was measured using an ELISA kit and carotid IMT was evaluated by Doppler ultrasonography in all subjects. Statistical analysis included receiver-operating characteristic (ROC) analysis, Pearson correlation and logistic regression analysis. Serum PAPP-A level was significantly higher in HIV +CIMT+ group compared with HIV +CIMT group and HIV-CIMT- group. We found a positive correlation between PAPP-A and increased CIMT (r=0.737, p<0.0001), and a negative correlation between nadir CD4 T cell counts and increased CIMT (r=-0.526, p<0.001). In multivariate logistic regression analyses, PAPP-A, nadir CD4 T cell count and age were significantly associated with subclinical atherosclerosis (p<0.001, p=0.006 and p=0.032, respectively). In ROC analysis, PAPP-A levels of >3.70 µg/mL were associated with subclinical atherosclerosis in HIV+ men with a specificity of 100% and a sensitivity of 71% (area under the curve: 0.949, 95% CI 0.875 to 1.000, p<0.001). Serum PAPP-A level was strongly correlated with increased CIMT in HIV-infected men. PAPP-A might be used as an early biomarker to identify atherosclerosis in asymptomatic HIV-infected men.
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Affiliation(s)
- Suleyman Sezai Yildiz
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sukru Cetin
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Alper Gunduz
- Infectious Diseases, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Cetinkal
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Goncagul Bulbun
- Radiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Serhat Sigirci
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Saadet Pilten
- Medical Biochemistry, University of Health Science, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kilickesmez
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Cibrián-Ponce A, Sánchez-Alemán MA, García-Jiménez S, Pérez-Martínez E, Bernal-Fernández G, Castañon-Mayo M, Ávila-Jiménez L, Toledano-Jaimes CD. Changes in cardiovascular risk and clinical outcomes in a HIV/AIDS cohort study over a 1-year period at a specialized clinic in Mexico. Ther Clin Risk Manag 2018; 14:1757-1764. [PMID: 30288045 PMCID: PMC6161730 DOI: 10.2147/tcrm.s170536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The third report of the National Cholesterol Education Program guidelines recommends calculating the 10-year morbidity of atherosclerotic cardiovascular disease (ASCVD) using risk calculators when treating high blood cholesterol in adults. We analyzed the changes in cardiovascular risk (CVR) among Mexican patients with HIV. PATIENTS AND METHODS This observational, prospective cohort study compared the CVR after 1 year of antiretroviral treatment among 460 HIV patients from a Mexican clinic. Changes using the ASCVD risk estimator and changes in clinical outcomes were analyzed. The results were categorized as low or high CVR using a cutoff of 7.5%. RESULTS The CVR initially had a median of 2.3% (interquartile range [IQR]: 1%-4.8%), which changed to 2.4% (IQR: 1.5%-5.5%) after 1 year (P=0.001). After CVR stratification, we found that 84.3% of the patients had a low CVR, and 18% in this subgroup had metabolic syndrome (MS). Moreover, 15.7% had high CVR, and 47% in this subgroup had MS. The 4.3% of patients had an increase in CVR from the low to high subgroup, and 2.6% had a decrease in CVR from the high to low subgroup. Out of all patients, 22.3% had MS. CONCLUSION More than 50% of the population had an increase in CVR after 1 year. Of these patients, 4.3% changed from the low to high CVR group. Although the guidelines proposed different time periods for performing CVR estimations, this study showed that such assessments offered valuable clinical data over a relatively short-term period.
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Affiliation(s)
| | - Miguel A Sánchez-Alemán
- Center for Infectious Diseases Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | | | - Miguel Castañon-Mayo
- Nephrology Service, Regional General Hospital Number 1, Mexican Institute of Social Security, Morelos, Mexico
| | - Laura Ávila-Jiménez
- Health Research Morelos, Mexican Institute of Social Security, Morelos, Mexico
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Mirza FS, Luthra P, Chirch L. Endocrinological aspects of HIV infection. J Endocrinol Invest 2018; 41:881-899. [PMID: 29313284 DOI: 10.1007/s40618-017-0812-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/16/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients with human immunodeficiency virus (HIV) are living longer with effective antiretroviral therapies and are enjoying near normal life span. Therefore, they are encountering endocrine issues faced by the general population along with those specific to HIV infection. The purpose of this article is to review the common endocrine aspects of HIV infection, and the early detection and management strategies for these complications. METHODS Recent literature on HIV and endocrine disease was reviewed. RESULTS HIV can influence endocrine glands at several levels. Endocrine glandular function may be altered by the direct effect of HIV viral proteins, through generation of systemic and local cytokines and the inflammatory response and via glandular involvement with opportunistic infections and HIV-related malignancies. Endocrine disorders seen in people with HIV include metabolic issues related to obesity such as diabetes, hyperlipidemia, lipohypertrophy, lipoatrophy and lipodystrophy and contribute significantly to quality of life, morbidity and mortality. In addition, hypogonadism, osteopenia and osteoporosis are also more prevalent in the patients with HIV. Although disorders of hypothalamic-pituitary-adrenal axis resulting in adrenal insufficiency can be life threatening, these along with thyroid dysfunction are being seen less commonly in the antiretroviral therapy (ART) era. ARTs have greatly improved life expectancy in people living with HIV but can also have adverse endocrine effects. CONCLUSIONS Clinicians need to have a high index of suspicion for endocrine abnormalities in people with HIV as they can be potentially life threatening if untreated. Endocrine evaluation should be pursued as in the general population, with focus on prevention, early detection and treatment to improve quality of life and longevity.
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Affiliation(s)
- F S Mirza
- Division of Endocrinology and Metabolism, Department of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-5456, USA.
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA.
| | - P Luthra
- Division of Endocrinology and Metabolism, Department of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-5456, USA
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA
| | - L Chirch
- Division of Infectious Diseases, UConn Health, Farmington, CT, 06030, USA
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA
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Tsabedze N, Vachiat A, Zachariah D, Manga P. A New Face of Cardiac Emergencies: Human Immunodeficiency Virus-Related Cardiac Disease. Cardiol Clin 2018; 36:161-170. [PMID: 29173676 DOI: 10.1016/j.ccl.2017.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The human immunodeficiency virus epidemic is a major health challenge of the twenty-first century as the transition from infectious complications to noncommunicable disease becomes more evident. These patients may present to the emergency department with a variety of cardiovascular diseases, such as acute coronary syndromes, heart failure, pericardial disease, infective endocarditis, venothromboembolism, and other conditions. Increased awareness is needed among health care professionals to enhance adequate identification and promote prompt management of these patients.
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Affiliation(s)
- Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa
| | - Ahmed Vachiat
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa
| | - Don Zachariah
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa
| | - Pravin Manga
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa.
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Hinojosa CA, Nunez-Salgado AE, Anaya-Ayala JE, Laparra-Escareno H, Ortiz-Lopez LJ, Herrera-Caceres JO, Crabtree-Ramirez BE, Sierra-Madero JG. Prevalence and variables associated with an abnormal ankle-brachial index among patients with human immunodeficiency virus/acquired immunodeficiency syndrome. Vascular 2018; 26:540-546. [PMID: 29649953 DOI: 10.1177/1708538118770542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The longer survival of patients with human immunodeficiency virus/acquired immunodeficiency syndrome and the introduction of the highly active antiretroviral therapy have increased the number of chronic conditions; among these, cardiovascular diseases. The aim of this study is to determine patient, disease, and factors associated with peripheral arterial disease in a population of patients with human immunodeficiency virus/acquired immunodeficiency syndrome. Methods A prospective nested case-control study of a cohort of patients with human immunodeficiency virus/acquired immunodeficiency syndrome was conducted in a tertiary medical center in Mexico City. A sample size of 206 patients was calculated. Medical history, relevant laboratory data, peripheral arterial exam, and screening ankle-brachial index tests were obtained. Results The prevalence of abnormal ankle-brachial indexes was 20% (42 patients). Patient's mean age was 44 years ±13. The majority (98.5%) were actively receiving highly active antiretroviral therapy; active smoking was reported in 55 (27%), arterial hypertension and type 2 diabetes mellitus were found in 24 (12%) and 22 (11%) patients. Median time from the human immunodeficiency virus diagnosis was eight years (Interquartile range ±11); the mean CD4 count was 481, with a mean viral load of 13,557 copies (SD ± 69025.27) and 1889.18 (SD ± 9052.77) for patients with normal and abnormal ankle-brachial index and a median of 40 (IQ ± 2). Viral load ( p = 0.04) and number of years with human immunodeficiency virus/acquired immunodeficiency syndrome ( p = 0.04) were significantly associated with abnormal ankle-brachial indexes. Conclusions Abnormal ankle-brachial index seems to be more frequent in Mexican patients with human immunodeficiency virus/acquired immunodeficiency syndrome when compared with the general population at the same age. The most important factors associated with arterial disease were the viral load and the number of years with human immunodeficiency virus/acquired immunodeficiency syndrome. TRIAL REGISTRATION ClinicalTrials.gov NCT02264509.
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Affiliation(s)
- Carlos A Hinojosa
- 1 Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico City, Mexico
| | - Ana E Nunez-Salgado
- 1 Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico City, Mexico
| | - Javier E Anaya-Ayala
- 1 Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico City, Mexico
| | - Hugo Laparra-Escareno
- 1 Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico City, Mexico
| | - Laura J Ortiz-Lopez
- 1 Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico City, Mexico
| | - Jaime O Herrera-Caceres
- 2 Department of Urology, 42559 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico City, Mexico
| | - Brenda E Crabtree-Ramirez
- 3 Department of Medicine, Division of Infectious Diseases, 42559 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico City, Mexico
| | - Juan G Sierra-Madero
- 3 Department of Medicine, Division of Infectious Diseases, 42559 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico City, Mexico
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Bares SH, Smeaton LM, Xu A, Godfrey C, McComsey GA. HIV-Infected Women Gain More Weight than HIV-Infected Men Following the Initiation of Antiretroviral Therapy. J Womens Health (Larchmt) 2018; 27:1162-1169. [PMID: 29608129 DOI: 10.1089/jwh.2017.6717] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Obesity is prevalent among HIV-infected individuals on antiretroviral therapy (ART). Cross-sectional studies have suggested that HIV-infected women are more likely to be overweight than men, but observational studies evaluating sex differences in body mass index (BMI) increases following ART initiation are conflicting. MATERIALS AND METHODS We pooled data from three randomized clinical trials of ART initiation in persons with HIV in the United States. BMIs were compared between 760 women and 3041 men to test whether BMI changes in the first 96 weeks following initiation of ART differed by sex at birth. Linear regression estimated the relationship between sex and change in BMI from pre-ART initiation to week 96. RESULTS After 96 weeks, women gained an average of 1.91 kg/m2 (95% confidence interval [CI] 1.64-2.19), men gained an average of 1.39 kg/m2 (95% CI 1.30-1.48); p for sex difference <0.001; the sex difference persisted within each pre-ART initiation BMI subgroup. After adjusting for pre-ART initiation age, CD4+ count, HIV-1 viral load, race/ethnicity, study, and ART regimen, mean BMI change for women was 0.59 kg/m2 (95% CI 0.37-0.81) more than for men (p < 0.001). Statistical interactions were observed between sex and both pre-ART CD4+ count and HIV-1 viral load and suggest that for subgroups with higher viral load and lower CD4+ at baseline, the estimated BMI changes in women are even larger than the average estimated difference. CONCLUSIONS HIV-1-infected women experienced a significantly greater increase in BMI following ART initiation than men. These differences are a problem of clinical significance to women living with HIV.
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Affiliation(s)
- Sara H Bares
- 1 Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center , Omaha, Nebraska
| | - Laura M Smeaton
- 2 Statistical Data Analysis Center , Harvard School of Public Health, Boston, Massachusetts
| | - Ai Xu
- 2 Statistical Data Analysis Center , Harvard School of Public Health, Boston, Massachusetts
| | - Catherine Godfrey
- 3 Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland
| | - Grace A McComsey
- 4 Division of Infectious Diseases, Department of Pediatrics and Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland, Ohio
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Escota GV, O'Halloran JA, Powderly WG, Presti RM. Understanding mechanisms to promote successful aging in persons living with HIV. Int J Infect Dis 2017; 66:56-64. [PMID: 29154830 DOI: 10.1016/j.ijid.2017.11.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/26/2017] [Accepted: 11/03/2017] [Indexed: 01/05/2023] Open
Abstract
The mortality rate associated with HIV infection plummeted after the introduction of effective antiretroviral therapy pioneered two decades ago. As a result, HIV-infected people now have life expectancies comparable to that of HIV-uninfected individuals. Despite this, increased rates of osteoporosis, chronic liver disease, and in particular cardiovascular disease have been reported among people living with HIV infection. With the aging HIV-infected population, the burden of these comorbid illnesses may continue to accrue over time. In this paper, we present an overview of the aging HIV-infected population, its epidemiology and the many challenges faced. How to define and measure successful aging will also be reviewed. Finally, opportunities that may help mitigate the challenges identified and ensure successful aging among people living with HIV infection will be examined.
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Affiliation(s)
- Gerome V Escota
- Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, USA.
| | - Jane A O'Halloran
- Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, USA
| | - William G Powderly
- Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, USA
| | - Rachel M Presti
- Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, USA
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Losina E, Hyle EP, Borre ED, Linas BP, Sax PE, Weinstein MC, Rusu C, Ciaranello AL, Walensky RP, Freedberg KA. Projecting 10-year, 20-year, and Lifetime Risks of Cardiovascular Disease in Persons Living With Human Immunodeficiency Virus in the United States. Clin Infect Dis 2017; 65:1266-1271. [PMID: 28605504 PMCID: PMC5850036 DOI: 10.1093/cid/cix547] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/10/2017] [Indexed: 01/02/2023] Open
Abstract
Background Cardiovascular disease (CVD) is an increasing cause of morbidity among persons living with human immunodeficiency virus (HIV; PLWH). We projected cumulative CVD risk in PLWH in care compared to the US general population and persons HIV-uninfected, but at high risk for HIV. Methods We used a mathematical model to project cumulative CVD incidence. We simulated a male and female cohort for each of 3 populations: US general population; HIV-uninfected, at high risk for HIV; and PLWH. We incorporated the higher smoking prevalence and increased CVD risk due to smoking into the HIV-infected and HIV-uninfected, at high risk for HIV populations. We incorporated HIV-attributable CVD risk, independent of smoking. Results For men, life expectancy ranged from 70.2 to 77.5 years and for women from 67.0 to 81.1 years (PLWH, US general population). Without antiretroviral therapy, lifetime CVD risk for HIV-infected males and females was 12.9% and 9.0%. For males, by age 60, cumulative CVD incidence was estimated at 20.5% in PLWH in care, 14.6% in HIV-uninfected high-risk persons, and 12.8% in the US general population. For females, cumulative CVD incidence was projected to be 13.8% in PLWH in care, 9.7% for high-risk HIV-uninfected persons, and 9.4% in the US general population. Lifetime CVD risk was 64.8% for HIV-infected males compared to 54.8% for males in the US general population, but similar among females. Conclusions CVD risks should be a part of treatment evaluation among PLWH. CVD prevention strategies could offer important health benefits for PLWH and should be evaluated.
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Affiliation(s)
- Elena Losina
- Center for AIDS Research, Harvard University
- Department of Orthopedic Surgery, Brigham and Women’s Hospital
- The Medical Practice Evaluation Center, Massachusetts General Hospital
- Department of Biostatistics, Boston University School of Public Health
| | - Emily P Hyle
- The Medical Practice Evaluation Center, Massachusetts General Hospital
- Divisions of General Internal Medicine and
- Infectious Disease, Massachusetts General Hospital
| | - Ethan D Borre
- The Medical Practice Evaluation Center, Massachusetts General Hospital
| | - Benjamin P Linas
- Center for AIDS Research, Brown-Boston University
- HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center
- Department of Epidemiology, Boston University School of Public Health
| | - Paul E Sax
- Center for AIDS Research, Harvard University
- Division of Infectious Disease, Brigham and Women’s Hospital, and
| | - Milton C Weinstein
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Corinna Rusu
- The Medical Practice Evaluation Center, Massachusetts General Hospital
- Divisions of General Internal Medicine and
| | - Andrea L Ciaranello
- Center for AIDS Research, Harvard University
- The Medical Practice Evaluation Center, Massachusetts General Hospital
- Divisions of General Internal Medicine and
- Infectious Disease, Massachusetts General Hospital
| | - Rochelle P Walensky
- Center for AIDS Research, Harvard University
- The Medical Practice Evaluation Center, Massachusetts General Hospital
- Divisions of General Internal Medicine and
- Infectious Disease, Massachusetts General Hospital
- Division of Infectious Disease, Brigham and Women’s Hospital, and
| | - Kenneth A Freedberg
- Center for AIDS Research, Harvard University
- The Medical Practice Evaluation Center, Massachusetts General Hospital
- Divisions of General Internal Medicine and
- Infectious Disease, Massachusetts General Hospital
- Department of Epidemiology, Boston University School of Public Health
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Abstract
The objectives of this study, presented as part of a plenary session at WW7 in Hyderabad, India were to review (i) the epidemiology and current clinical issues of HIV infection with regard to HIV and older populations and (ii) models for increased morbidity and mortality in older HIV-positive individuals with implications for clinical care. HIV infection for those in treatment has become a complex chronic disease in which end-organ injury and resulting morbidity, functional decline, and mortality do not have a single etiology but reflect cumulative loss of organ system reserve from multiple interacting sources leading to functional decline, organ system failure, and death. Emerging guidelines and recommendations suggest a need for increased awareness and treatment of the multifaceted needs of the aging HIV-infected patient.
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Affiliation(s)
- M John
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
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34
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Zizza A, Guido M, Tumolo M, De Donno A, Bagordo F, Grima P. Atherosclerosis is associated with a higher risk of hepatic steatosis in HIV-infected patients. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2017; 58:E219-E224. [PMID: 29123368 PMCID: PMC5668931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
INTRODUCTION Cardiovascular Diseases (CD) have emerged as a leading cause of morbidity and mortality in HIV population. Some studies have reported higher carotid Intima Media Thickness (c-IMT), a measure of subclinical atherosclerosis (AT), in this cohort of patients. METHODS Here, we evaluate the role of Hepatic Steatosis (HS) as likely marker for AT in 128 HIV-infected patients without hepatitis C infection. c-IMT has been detected non-invasively by carotid ultrasonography to assess the progression of AT. HS has been evaluated using a process based on vibration-controlled transient elastography (Fibroscan) by a novel ultrasonic controlled attenuation parameter (CAP). The cut-off value for defining the presence of significant HS was CAP > 259 dBm-1. RESULTS AT has been detected in 26 patients (20.3%), whereas steatosis of grade 2 (S2) in 31 (24.2%). The variables statistically related to AT were age, obesity, diabetes, hypertension and S2. In the multivariate analysis, AT was only associated (p < 0.001) with age and S2. The optimal cut-off value indicated by ROC curve for predicting AT was CAP > 250 dB/m-1. DISCUSSION Our results highlight the presence of AT in HIVinfected persons and its association with fatty liver disease; therefore, HS assessment in HIV population results crucial to predict AT and CD.
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Affiliation(s)
- A. Zizza
- National Research Council, Institute of Clinical Physiology, Campus Ecotekne, Lecce, Italy;,Correspondence: Antonella Zizza, National Research Council, Institute of Clinical Physiology, Campus Ecotekne via Lecce- Monteroni, 73100 Lecce, Italy - Tel. +39 0832 422306 - Fax +39 0832 422340 - E-mail:
| | - M. Guido
- Department of Biological and Environmental Sciences and Technologies, Laboratory of Hygiene, University of the Salento, Lecce, Italy
| | - M.R. Tumolo
- National Research Council, Institute of Clinical Physiology, Campus Ecotekne, Lecce, Italy
| | - A. De Donno
- Department of Biological and Environmental Sciences and Technologies, Laboratory of Hygiene, University of the Salento, Lecce, Italy
| | - F. Bagordo
- Department of Biological and Environmental Sciences and Technologies, Laboratory of Hygiene, University of the Salento, Lecce, Italy
| | - P. Grima
- Division of Infectious Diseases, S. Caterina Novella Hospital, Galatina (LE), Italy
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Cardiovascular toxicity of abacavir: a clinical controversy in need of a pharmacological explanation. AIDS 2017; 31:1781-1795. [PMID: 28537935 DOI: 10.1097/qad.0000000000001547] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
: There is a long-lasting controversy surrounding an association between abacavir (ABC) and an increased risk of cardiovascular disease in HIV-positive patients. Although differing in their specifics, a number of published cohort studies and clinical trials support such an association, usually relating it to recent exposure to the drug, independently of traditional predisposing factors. However, other clinical trials have failed to reveal such a relation and have pointed to methodological differences to explain discrepancies. Significantly, the controversy has been fueled by the lack of a credible mechanism of action to justify the putative detrimental actions of ABC. There is a myriad of contradictory clinical indicators which are not clearly compatible with known profiles of either vascular physiopathology or pharmacological interference. However, basic research has recently hinted at altered homeostatic mechanisms, though this requires clinical validation. In particular, recurrent evidence - both clinical and experimental - relates ABC with vascular inflammation, a leading contributor to the atherosclerotic plaque and thrombosis. ABC's chemical structure is very close to that of endogenous purines (ATP, ADP and AMP), major paracrine signaling molecules capable of triggering prothrombotic and proinflammatory vascular programs. Other proposed mechanisms are a competitive inhibition of guanylyl cyclase in platelets and a subsequent decrease in cyclic guanosine monophosphate (cGMP). The present review aims to shed light on this complex subject by summarizing and critically evaluating all the available clinical data regarding a relationship between ABC and cardiovascular disease, and to put forward potential pharmacological explanations compatible with both the clinical scenario and experimental findings.
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36
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Metabolic clinic for individuals with HIV/AIDS: a commitment and vision to the future of HIV services. Cardiovasc Endocrinol 2017; 6:109-112. [PMID: 31646127 DOI: 10.1097/xce.0000000000000128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/30/2017] [Indexed: 12/17/2022] Open
Abstract
One of the biggest current challenges in managing an ageing cohort living with the HIV is handling dyslipidaemia, diabetes, metabolic syndrome and nonalcoholic fatty liver disease. Combination antiretroviral therapy decrease mortality and morbidity in HIV patients, but lead to increase in insulin resistance, dyslipidaemia, abnormalities of fat distribution and high risk of cardiovascular disease. Therefore, a metabolic clinic was established for individuals living with HIV in the Milton Keynes University Hospital NHS Foundation Trust. The clinic meets considerable demands by service users and hence has the potential to be popular. This review focuses on the importance of the development of a metabolic clinic for the purpose of audit, research, teaching and exchange of knowledge between HIV specialists and the metabolic team in the management of complex cases. Therefore, the metabolic clinic should be an integral part of HIV services especially as the cohort of the 'older' HIV population increases.
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Modeling aging in HIV infection in nonhuman primates to address an emerging challenge of the post-ART era. Curr Opin Virol 2017; 25:66-75. [PMID: 28803049 DOI: 10.1016/j.coviro.2017.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/22/2022]
Abstract
The advent of antiretroviral therapy (ART) has dramatically improved both quality and length of life for subjects infected with human immunodeficiency virus (HIV), delaying or preventing progression to acquired immunodeficiency syndrome (AIDS). However, the virus induces aging-related changes to the immune system which confound treatment. Additionally, the normal physiologic events that occur during aging lead to deficiencies in immunity which not only exacerbate HIV pathogenesis but also trigger a variety of comorbidities. Here, the synergistic linkage between aging and HIV infection is examined in regard to the immunological and pathological mechanisms that drive both senescence and disease progression. The use of NHPs to investigate potential therapeutic strategies to control the deleterious consequences of aging with HIV infection is also reviewed.
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Ballocca F, D'Ascenzo F, Gili S, Grosso Marra W, Gaita F. Cardiovascular disease in patients with HIV. Trends Cardiovasc Med 2017; 27:558-563. [PMID: 28779949 DOI: 10.1016/j.tcm.2017.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 01/13/2023]
Abstract
With the progressive increase in life expectancy of HIV-positive patient, thanks to "highly active antiretroviral therapy" (HAART), new comorbidities, and especially cardiovascular diseases (CVDs) are emerging as an important concern. An increased risk of coronary artery disease, often in a younger age, has been observed in this population. The underlying pathophysiology is complex and partially still unclear, with the interaction of viral infection-and systemic inflammation-antiretroviral therapy and traditional risk factors. After an accurate risk stratification, primary prevention should balance the optimal HAART to suppress the virus-avoiding side-effects-the intervention on life-style and the treatment of traditional risk factors (hypertension, dyslipidemia, and diabetes). Also the management after a cardiovascular event is challenging: revascularization strategies-both percutaneous and surgical-are valuable options, keeping in mind the higher rates of recurrent events, and caution is essential to avoid drug-drug interactions. Large evidence-based data on HIV-infected patients are still lacking, and recommendations often follow those of general population. Therefore we performed a comprehensive evaluation of the literature to analyze the current knowledge on CVD's prevalence, prevention and treatment in HIV-infected patients.
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Affiliation(s)
- Flavia Ballocca
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy.
| | - Sebastiano Gili
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Walter Grosso Marra
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
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Behavioral Interventions for Tobacco Use in HIV-Infected Smokers: A Meta-Analysis. J Acquir Immune Defic Syndr 2017; 72:527-33. [PMID: 27028502 DOI: 10.1097/qai.0000000000001007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Smoking is responsible for increased morbidity and mortality in HIV-infected smokers. OBJECTIVE To assess the efficacy of behavioral interventions for smoking cessation among HIV-infected smokers compared with the standard care. DATA SOURCES PubMed, Cochrane, CINHAL, PsychINFO, and Google Scholar were searched for randomized controlled trials published in English. STUDY SELECTION Eligibility criteria were randomized controlled trials with targeted behavioral interventions compared with standard of care (or enhanced standard of care) aimed at promoting abstinence in HIV-infected smokers. A total of 17,384 articles were found and 17,371 were excluded; 13 full text articles were obtained and reviewed, and 8 met the eligibility criteria (Κ = 0.94). DATA EXTRACTION The primary outcome was expired carbon monoxide-verified 7-day point prevalence abstinence rates. Adequate sequence generation and freedom from incomplete or selective outcome reporting was used to assess study quality. RESULTS A total of 1822 subjects from 8 studies yielded a statistically significant effect of behavioral interventions in increasing abstinence in HIV-infected smokers with a moderate effect size (relative risk: 1.51; 95% confidence interval: 1.17 to 1.95). Those studies with interventions of 8 sessions or more had a large effect size for abstinence (relative risk: 2.88; 95% confidence interval: 1.89 to 4.61). When stratified by the number of sessions, there was no heterogeneity. CONCLUSIONS Targeted behavioral smoking cessation interventions are efficacious. Interventions consisting of 8 sessions or more had the greatest treatment efficacy.
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Guo F, Hsieh E, Lv W, Han Y, Xie J, Li Y, Song X, Li T. Cardiovascular disease risk among Chinese antiretroviral-naïve adults with advanced HIV disease. BMC Infect Dis 2017; 17:287. [PMID: 28427339 PMCID: PMC5397830 DOI: 10.1186/s12879-017-2358-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/28/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is an important cause of mortality among HIV-infected patients, however little is known about the burden of CVD among this population in Asia. We sought to quantify prevalence of CVD risk factors, 10-year CVD risk, and patterns of CVD risk factor treatment in a group of individuals with HIV in China. METHODS We retrospectively analyzed baseline data from treatment-naïve HIV-infected adults enrolled in two multicenter clinical trials in China. Data regarding CVD risk factors such as smoking, hypertension, diabetes, dyslipidemia and obesity were assessed. The Framingham Risk Score (FRS) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk scores were calculated to estimate 10-year CVD risk. The American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score was used to identify individuals meeting criteria for lipid-lowering therapy. RESULTS In total, 973 patients were included in the analysis. Mean age was 36.0 ± 10.2 years and 74.2% were men. The most common CVD risk factors were dyslipidemia (51.7%) and smoking (23.7%). Prevalence of hypertension, diabetes and obesity were 8.4%, 4.6% and 1.0%, respectively. Over 65% of patients had at least one CVD risk factor. The prevalence of 10-year risk of CVD ≥10% was 4.5% based upon FRS and was 3.3% based upon D:A:D risk score. Few patients with dyslipidemia, hypertension or diabetes were on treatment. CONCLUSIONS CVD risk factors are common but under-treated among Chinese treatment-naïve individuals with HIV. Future interventions should focus on training HIV providers to appropriately recognize and manage CVD risk factors during routine clinical assessments.
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Affiliation(s)
- Fuping Guo
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Evelyn Hsieh
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Wei Lv
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Han
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Xie
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanling Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojing Song
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Danoff A, Kendall MA, Currier JS, Kelesidis T, Schmidt AM, Aberg JA. Soluble Levels of Receptor for Advanced Glycation Endproducts (RAGE) and Progression of Atherosclerosis in Individuals Infected with Human Immunodeficiency Virus: ACTG NWCS 332. Inflammation 2017; 39:1354-62. [PMID: 27216802 DOI: 10.1007/s10753-016-0367-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Identification of biomarkers and/or mediators of cardiovascular disease (CVD) associated with HIV infection would be of diagnostic and therapeutic value. As soluble receptor for advanced glycation endproducts (sRAGE) and endogenous secretory (esRAGE) have been implicated in vascular complications in other settings, we investigated whether either soluble form of RAGE was associated with changes in carotid intima-media thickness (CIMT) in HIV-infected patients and HIV-uninfected controls. We found no differences in sRAGE, esRAGE, or CIMT among groups at study entry, or in yearly rates of change in sRAGE, esRAGE, or CIMT by HIV-serostatus (all p > 0.10). However, yearly rates of change in sRAGE (p = 0.07) and esRAGE (p < 0.001) were higher in those taking protease inhibitors, and lower baseline esRAGE levels (p = 0.06) were associated with increased odds of CIMT progression in HIV-infected individuals. Although esRAGE was not altered by HIV-serostatus (p = 0.17), its inverse relationship with CIMT progression in HIV-infected patients suggests a possible role as a mediator of CVD in HIV-infected persons.
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Affiliation(s)
- Ann Danoff
- Department of Medicine, VA Corporal Michael J Crecenz VA Medical Center, and Department of Medicine, Division of Endocrinology, Perelman School of Medicine, 3900 Woodland Ave, Philadelphia, 19104, PA, USA.
| | - Michelle A Kendall
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ann Marie Schmidt
- Department of Medicine, Division of Endocrinology, New York University School of Medicine, New York, NY, USA
| | - Judith A Aberg
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Raposeiras-Roubín S, Triant V. Cardiopatía isquémica en el VIH: profundizando en el conocimiento del riesgo cardiovascular. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.08.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Raposeiras-Roubín S, Triant V. Ischemic Heart Disease in HIV: An In-depth Look at Cardiovascular Risk. ACTA ACUST UNITED AC 2016; 69:1204-1213. [PMID: 27840147 DOI: 10.1016/j.rec.2016.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/19/2016] [Indexed: 12/13/2022]
Abstract
Although the incidence of cardiovascular diseases classically associated with human immunodeficiency virus (HIV) has decreased considerably with antiretroviral therapy, cardiovascular risk, and especially ischemic heart disease, are higher in HIV-infected patients than in uninfected individuals. This is due to the interaction of patient-dependent factors with virus-dependent factors, as well as factors associated with antiretroviral therapy. With increasing of life expectancy and the chronicity of HIV infection, cardiovascular disease has emerged as an important cause of morbidity and mortality in HIV patients. In developed countries, the most common cardiovascular manifestation of HIV is ischemic heart disease. Currently, it is not uncommon to find HIV patients with acute coronary syndrome and, given the important pharmacokinetic interactions of antiretroviral drugs, it is important to know which cardiovascular treatments are safe in this group of patients. The ideal approach would be to mitigate the cardiovascular risk in HIV patients with specific primary prevention measures. All these issues are discussed in this review, which aims to aid clinical cardiologists faced with HIV patients with ischemic heart disease or with high cardiovascular risk in daily clinical practice.
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Affiliation(s)
| | - Virginia Triant
- Massachusetts General Hospital Divisions of General Internal Medicine and Infectious Diseases and Harvard Medical School, Boston, Massachusetts, United States
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Bernell S, Howard SW. Use Your Words Carefully: What Is a Chronic Disease? Front Public Health 2016; 4:159. [PMID: 27532034 PMCID: PMC4969287 DOI: 10.3389/fpubh.2016.00159] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
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Bahrami H, Budoff M, Haberlen SA, Rezaeian P, Ketlogetswe K, Tracy R, Palella F, Witt MD, McConnell MV, Kingsley L, Post WS. Inflammatory Markers Associated With Subclinical Coronary Artery Disease: The Multicenter AIDS Cohort Study. J Am Heart Assoc 2016; 5:JAHA.116.003371. [PMID: 27353609 PMCID: PMC4937277 DOI: 10.1161/jaha.116.003371] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Despite evidence for higher risk of coronary artery disease among HIV+ individuals, the underlying mechanisms are not well understood. We investigated associations of inflammatory markers with subclinical coronary artery disease in 923 participants of the Multicenter AIDS Cohort Study (575 HIV+ and 348 HIV− men) who underwent noncontrast computed tomography scans for coronary artery calcification, the majority (n=692) also undergoing coronary computed tomography angiography. Methods and Results Outcomes included presence and extent of coronary artery calcification, plus computed tomography angiography analysis of presence, composition, and extent of coronary plaques and severity of coronary stenosis. HIV+ men had significantly higher levels of interleukin‐6 (IL‐6), intercellular adhesion molecule‐1, C‐reactive protein, and soluble‐tumor necrosis factor‐α receptor (sTNFαR) I and II (all P<0.01) and a higher prevalence of noncalcified plaque (63% versus 54%, P=0.02) on computed tomography angiography. Among HIV+ men, for every SD increase in log‐interleukin‐6 and log intercellular adhesion molecule‐1, there was a 30% and 60% increase, respectively, in the prevalence of coronary stenosis ≥50% (all P<0.05). Similarly, sTNFαR I and II in HIV+ participants were associated with an increase in prevalence of coronary stenosis ≥70% (P<0.05). Higher levels of interleukin‐6, sTNFαR I, and sTNFαR II were also associated with greater coronary artery calcification score in HIV+ men (P<0.01). Conclusions Higher inflammatory marker levels are associated with greater prevalence of coronary stenosis in HIV+ men. Our findings underscore the need for further study to elucidate the relationships of inflammatory pathways with coronary artery disease in HIV+ individuals.
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Affiliation(s)
- Hossein Bahrami
- Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Matthew Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Pantea Rezaeian
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA
| | - Kerunne Ketlogetswe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Russell Tracy
- Departments of Pathology & Laboratory Medicine, and Biochemistry, University of Vermont College of Medicine, Colchester, VT
| | | | | | - Michael V McConnell
- Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | | | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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Effect of Chocolate and Yerba Mate Phenolic Compounds on Inflammatory and Oxidative Biomarkers in HIV/AIDS Individuals. Nutrients 2016; 8:nu8050132. [PMID: 27223302 PMCID: PMC4882654 DOI: 10.3390/nu8050132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 11/17/2022] Open
Abstract
Flavonoids in cocoa and yerba mate have a beneficial role on inflammation and oxidative disorders. Their effect on HIV individuals has not been studied yet, despite the high cardiovascular risk of this population. This study investigated the role of cocoa and yerba mate consumption on oxidative and inflammatory biomarkers in HIV+ individuals. A cross-over, placebo-controlled, double-blind, randomized clinical trial was conducted in 92 individuals on antiretroviral therapy for at least six months and at viral suppression. Participants were randomized to receive either 65 g of chocolate or chocolate-placebo or 3 g of yerba mate or mate-placebo for 15 days each, alternating by a washout period of 15 days. At baseline, and at the end of each intervention regimen, data regarding anthropometry, inflammatory, oxidative and immunological parameters were collected. High-sensitivity C-reactive protein, fibrinogen, lipid profile, white blood cell profile and thiobarbituric acid reactive substances were assessed. There was a difference between mean concentrations of HDL-c (ANOVA; p ≤ 0.05) among the different regimens: dark chocolate, chocolate-placebo, yerba mate and mate-placebo. When a paired Student t-test was used for comparisons between mean HDL-c at baseline and after each regimen, the mean concentration of HDL-c was higher after supplementation with dark chocolate (p = 0.008).
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Nitric oxide levels in HIV-infected, untreated patients and HIV-infected patients receiving antiretroviral therapy. Biomed Pharmacother 2016; 79:302-7. [PMID: 27044841 DOI: 10.1016/j.biopha.2016.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022] Open
Abstract
The role of nitric oxide (NO) in HIV infection is ambiguous; controversy exists around whether the levels of serum NO are increased or decreased in HIV-infected patients. Thus, it is necessary to reassess NO levels in HIV-infected patients. The aim of this study was to investigate the nitrite/nitrate metabolite (NOx) levels in HIV-infected untreated patients and in HIV-infected patients receiving highly active antiretroviral therapy (HAART), compared with HIV-uninfected individuals (control group). The HIV-infected patients enrolled in this study had been receiving HAART for at least 6 months (HIV-treated) or had not received HAART for at least 6 months (HIV-untreated group). New recommendations encourage initiating treatment in HIV-infected adults at a CD4 cell count of 500 cells/mm(3) or less. We also investigated whether levels of NOx were associated with immunophenotypic characteristic of HIV-infected patients. Our results showed a statistically significant increase in NOx levels in the HIV-untreated group (164.0 ± 166.6 μmol/L), compared with both the control (98.9 ± 59.4 μmol/L) and HIV-treated group (71.7 ± 53.3 μmol/L). Multiple regression analysis showed that the differences in NOx level were independent of gender, liver enzyme level, lipid measurement, and hematological parameters. In addition, a lower CD4/CD8 ratio was associated with higher NOx levels in HIV-infected patients. The results further revealed that NOx levels were increased in HIV infection, and that derangement of immune system function was associated with increased NO levels. The levels of NOx were found to decline with the use of HAART, which may contribute to cardiovascular disease in HIV-infected patients.
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Ballocca F, Gili S, D'Ascenzo F, Marra WG, Cannillo M, Calcagno A, Bonora S, Flammer A, Coppola J, Moretti C, Gaita F. HIV Infection and Primary Prevention of Cardiovascular Disease: Lights and Shadows in the HAART Era. Prog Cardiovasc Dis 2016; 58:565-76. [PMID: 26943980 DOI: 10.1016/j.pcad.2016.02.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 02/28/2016] [Indexed: 12/20/2022]
Abstract
With the progressive increase in life-expectancy of human immunodeficiency virus (HIV)-positive patients in the "highly active antiretroviral therapy" (HAART) era, co-morbidities, particularly cardiovascular (CV) diseases (CVD) are emerging as an important concern. The pathophysiology of CVD in this population is complex, due to the interaction of classical CV risk factors, viral infection and the effects of antiretroviral therapy (ARV). The role of ARV drugs in HIV is double edged. While these drugs reduce systemic inflammation, an important factor in CV development, they may at the same time be proatherogenic by inducing dyslipidemia, body fat redistribution and insulin resistance. In these patients primary prevention is challenging, considering the lower median age at which acute coronary syndromes occur. Furthermore prevention is still limited by the lack of robust evidence-based, HIV-specific recommendations. Therefore we performed a comprehensive evaluation of the literature to analyze current knowledge on CVD prevalence in HIV-infected patients, traditional and HIV-specific risk factors and risk stratification, and to summarize the recommendations for primary prevention of CVD in this HIV population.
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Affiliation(s)
- Flavia Ballocca
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Sebastiano Gili
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy.
| | - Walter Grosso Marra
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Margherita Cannillo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Calcagno
- Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Stefano Bonora
- Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Andreas Flammer
- University Heart Center, University Hospital Zurich, Switzerland
| | - John Coppola
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Claudio Moretti
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
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Abstract
The development and use of antiretroviral medications to treat patients infected with human immunodeficiency virus (HIV) has dramatically changed the course of this disease from one that was fatal to a chronic and more manageable condition. Recommendations and guidelines for the general population are presented in this review with suggestions as to how they may be applied to this patient population. Issues for which there is little or no information available are noted to highlight the many gaps in our knowledge regarding diagnosis and management of dyslipidemia for patients living with HIV.
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Affiliation(s)
- Merle Myerson
- Cardiovascular Disease Prevention Program & Lipid Clinic, Cardiology Section, Institute for Advanced Medicine (HIV), Mount Sinai St. Luke's, Mount Sinai Roosevelt, 1111 Amsterdam Avenue, New York, NY 10025, USA.
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50
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Kato H, Ohata A, Samukawa S, Ueda A, Ishigatsubo Y. Effect of adiponectin-encoding gene ADIPOQ single nucleotide polymorphisms +45 and +276 on serum lipid levels after antiretroviral therapy in Japanese patients with HIV-1-infection. J Int Med Res 2016; 44:297-306. [PMID: 26831403 PMCID: PMC5580050 DOI: 10.1177/0300060515621444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/13/2015] [Indexed: 12/28/2022] Open
Abstract
Objectives To investigate the association between single nucleotide polymorphisms (SNPs) in the adiponectin-encoding gene ADIPOQ and changes in serum lipid levels in HIV-1-infected patients after antiretroviral therapy (ART). Methods ART-naïve HIV-1-infected patients were recruited to this prospective analysis. SNP +45 and SNP +276 genotype was determined by direct sequencing. Multivariate linear regression analysis was performed to analyse the effects of genotype, and predisposing conditions on serum total cholesterol and triglyceride in the 4 months before and after ART initiation. Results The study enrolled 78 patients with HIV-1-infection (73 male, five female; age range 22–67 years). HIV-1 viral load ≥5 log10 copies/ml, baseline total cholesterol ≥160 mg/dl, and CD4+ lymphocyte count <200/µl were associated with increased serum total cholesterol levels after ART initiation. Protease inhibitor treatment and body mass index ≥25 kg/m2 were associated with increased triglyceride levels after ART initiation. There were no significant associations between SNP +45 or SNP +276 genotype and serum total cholesterol or triglyceride levels. Conclusions SNP +45 and SNP +276 genotype is not associated with changes in serum total cholesterol or triglyceride levels after ART initiation.
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Affiliation(s)
- Hideaki Kato
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan Infection Control Department, Yokohama City University Medical Centre, Minami-ku, Yokohama, Japan
| | - Aya Ohata
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Sei Samukawa
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Atsuhisa Ueda
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Yoshiaki Ishigatsubo
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
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