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Scott GY, Worku D. HIV vaccination: Navigating the path to a transformative breakthrough-A review of current evidence. Health Sci Rep 2024; 7:e70089. [PMID: 39319247 PMCID: PMC11420300 DOI: 10.1002/hsr2.70089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 08/09/2024] [Accepted: 09/05/2024] [Indexed: 09/26/2024] Open
Abstract
Background and Aim Human immunodeficiency virus (HIV) remains a significant global health challenge, with approximately 39 million people living with HIV worldwide as of 2022. Despite progress in antiretroviral therapy, achieving the UNAIDS "95-95-95" target to end the HIV epidemic by 2025 faces challenges, particularly in sub-Saharan Africa. The pursuit of an HIV vaccine is crucial, offering durable immunity and the potential to end the epidemic. Challenges in vaccine development include the lack of known immune correlates, suitable animal models, and HIV's high mutation rate. This study aims to explore the current state of HIV vaccine development, focusing on the challenges and innovative approaches being investigated. Methods In writing this review, we conducted a search of medical databases such as PubMed, ResearchGate, Web of Science, Google Scholar, and Scopus. The exploration of messenger ribonucleic acid vaccines, which have proven successful in the SARS-CoV-2 pandemic, presents a promising avenue for HIV vaccine development. Understanding HIV-1's ability to infiltrate various bodily compartments, establish reservoirs, and manipulate immune responses is critical. Robust cytotoxic T lymphocytes and broadly neutralizing antibodies are identified as key components, though their production faces challenges. Innovative approaches, including computational learning and advanced drug delivery systems, are being investigated to effectively activate the immune system. Results and Conclusions Discrepancies between animal models and human responses have hindered the progress of vaccine development. Despite these challenges, ongoing research is focused on overcoming these obstacles through advanced methodologies and technologies. Addressing the challenges in HIV vaccine development is paramount to realizing an effective HIV-1 vaccine and achieving the goal of ending the epidemic. The integration of innovative approaches and a deeper understanding of HIV-1's mechanisms are essential steps toward this transformative breakthrough.
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Affiliation(s)
- Godfred Yawson Scott
- Department of Medical DiagnosticsKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Dominic Worku
- Infectious Diseases DepartmentMorriston Hospital, Heol Maes EglwysMorristonUnited Kingdom
- Public Health WalesCardiffUnited Kingdom
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Ruedisueli I, Shi K, Lopez S, Gornbein J, Middlekauff HR. Arrhythmogenic effects of acute electronic cigarette compared to tobacco cigarette smoking in people living with HIV. Physiol Rep 2024; 12:e16158. [PMID: 39044007 PMCID: PMC11265994 DOI: 10.14814/phy2.16158] [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: 04/03/2024] [Revised: 06/21/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
The leading cause of death in people living with HIV (PLWH) is cardiovascular disease, and the high prevalence of tobacco cigarette (TC) smoking is a major contributor. Switching to electronic cigarettes (ECs) has been promoted as a harm reduction strategy. We sought to determine if acute EC compared to TC smoking had less harmful effects on arrhythmogenic risk factors including acute changes in hemodynamics, heart rate variability (HRV), and ventricular repolarization (VR). In PLWH who smoke, changes in hemodynamics, HRV, and VR were compared pre/post acutely using an EC, TC, or puffing on an empty straw on different days in random order, in a crossover study. Thirty-seven PLWH (36 males, mean age 40.5 ± 9.1 years) participated. Plasma nicotine was greater after TC versus EC use (10.12 ± 0.96 vs. 6.18 ± 0.99 ng/mL, respectively, p = 0.004). HR increased significantly, and similarly, after acute EC and TC smoking compared to control. Changes in HRV that confer increased cardiac risk (LF/HF ratio) were significantly smaller after acute EC versus TC use, consistent with a harm reduction effect. In a post-hoc analysis of PLWH with and without positive concurrent recreational drug use as indicated by point of care urine toxicology testing, this differential effect was only seen in PLWH not currently using recreational drugs. Changes in VR were not different among the three exposures. In PLWH who smoke, EC compared to TC smoking resulted in smaller adverse changes in HRV. This differential effect was accompanied by a smaller increase in plasma nicotine, and was negated by concurrent recreational drug use. Additional studies are warranted in this vulnerable population disproportionately affected by tobacco-related health disparities.
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Affiliation(s)
- Isabelle Ruedisueli
- Department of Medicine, Division of CardiologyUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Katie Shi
- Department of Medicine, Division of CardiologyUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Samuel Lopez
- Department of Medicine, Division of CardiologyUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Jeffrey Gornbein
- Departments of Medicine and Computational MedicineUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Holly R. Middlekauff
- Department of Medicine, Division of CardiologyUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
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Hinton AO, N'jai AU, Vue Z, Wanjalla C. Connection Between HIV and Mitochondria in Cardiovascular Disease and Implications for Treatments. Circ Res 2024; 134:1581-1606. [PMID: 38781302 PMCID: PMC11122810 DOI: 10.1161/circresaha.124.324296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
HIV infection and antiretroviral therapy alter mitochondrial function, which can progressively lead to mitochondrial damage and accelerated aging. The interaction between persistent HIV reservoirs and mitochondria may provide insight into the relatively high rates of cardiovascular disease and mortality in persons living with HIV. In this review, we explore the intricate relationship between HIV and mitochondrial function, highlighting the potential for novel therapeutic strategies in the context of cardiovascular diseases. We reflect on mitochondrial dynamics, mitochondrial DNA, and mitochondrial antiviral signaling protein in the context of HIV. Furthermore, we summarize how toxicities related to early antiretroviral therapy and current highly active antiretroviral therapy can contribute to mitochondrial dysregulation, chronic inflammation, and poor clinical outcomes. There is a need to understand the mechanisms and develop new targeted therapies. We further consider current and potential future therapies for HIV and their interplay with mitochondria. We reflect on the next-generation antiretroviral therapies and HIV cure due to the direct and indirect effects of HIV persistence, associated comorbidities, coinfections, and the advancement of interdisciplinary research fields. This includes exploring novel and creative approaches to target mitochondria for therapeutic intervention.
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Affiliation(s)
- Antentor O Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN (A.O.H., Z.V.)
| | - Alhaji U N'jai
- Biological Sciences, Fourah Bay College and College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Freetown, Sierra Leone and Koinadugu College, Kabala (A.U.N.)
| | - Zer Vue
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN (A.O.H., Z.V.)
| | - Celestine Wanjalla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (C.W.)
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Haji M, Capilupi M, Kwok M, Ibrahim N, Bloomfield GS, Longenecker CT, Rodriguez-Barradas MC, Ashong CN, Jutkowitz E, Taveira TH, Richard M, Sullivan JL, Rudolph JL, Wu WC, Erqou S. Clinical Outcomes After Acute Coronary Syndromes or Revascularization Among People Living With HIV: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2411159. [PMID: 38743421 PMCID: PMC11094563 DOI: 10.1001/jamanetworkopen.2024.11159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/07/2024] [Indexed: 05/16/2024] Open
Abstract
Importance Clinical outcomes after acute coronary syndromes (ACS) or percutaneous coronary interventions (PCIs) in people living with HIV have not been characterized in sufficient detail, and extant data have not been synthesized adequately. Objective To better characterize clinical outcomes and postdischarge treatment of patients living with HIV after ACS or PCIs compared with patients in an HIV-negative control group. Data Sources Ovid MEDLINE, Embase, and Web of Science were searched for all available longitudinal studies of patients living with HIV after ACS or PCIs from inception until August 2023. Study Selection Included studies met the following criteria: patients living with HIV and HIV-negative comparator group included, patients presenting with ACS or undergoing PCI included, and longitudinal follow-up data collected after the initial event. Data Extraction and Synthesis Data extraction was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Clinical outcome data were pooled using a random-effects model meta-analysis. Main Outcome and Measures The following clinical outcomes were studied: all-cause mortality, major adverse cardiovascular events, cardiovascular death, recurrent ACS, stroke, new heart failure, total lesion revascularization, and total vessel revascularization. The maximally adjusted relative risk (RR) of clinical outcomes on follow-up comparing patients living with HIV with patients in control groups was taken as the main outcome measure. Results A total of 15 studies including 9499 patients living with HIV (pooled proportion [range], 76.4% [64.3%-100%] male; pooled mean [range] age, 56.2 [47.0-63.0] years) and 1 531 117 patients without HIV in a control group (pooled proportion [range], 61.7% [59.7%-100%] male; pooled mean [range] age, 67.7 [42.0-69.4] years) were included; both populations were predominantly male, but patients living with HIV were younger by approximately 11 years. Patients living with HIV were also significantly more likely to be current smokers (pooled proportion [range], 59.1% [24.0%-75.0%] smokers vs 42.8% [26.0%-64.1%] smokers) and engage in illicit drug use (pooled proportion [range], 31.2% [2.0%-33.7%] drug use vs 6.8% [0%-11.5%] drug use) and had higher triglyceride (pooled mean [range], 233 [167-268] vs 171 [148-220] mg/dL) and lower high-density lipoprotein-cholesterol (pooled mean [range], 40 [26-43] vs 46 [29-46] mg/dL) levels. Populations with and without HIV were followed up for a pooled mean (range) of 16.2 (3.0-60.8) months and 11.9 (3.0-60.8) months, respectively. On postdischarge follow-up, patients living with HIV had lower prevalence of statin (pooled proportion [range], 53.3% [45.8%-96.1%] vs 59.9% [58.4%-99.0%]) and β-blocker (pooled proportion [range], 54.0% [51.3%-90.0%] vs 60.6% [59.6%-93.6%]) prescriptions compared with those in the control group, but these differences were not statistically significant. There was a significantly increased risk among patients living with HIV vs those without HIV for all-cause mortality (RR, 1.64; 95% CI, 1.32-2.04), major adverse cardiovascular events (RR, 1.11; 95% CI, 1.01-1.22), recurrent ACS (RR, 1.83; 95% CI, 1.12-2.97), and admissions for new heart failure (RR, 3.39; 95% CI, 1.73-6.62). Conclusions and Relevance These findings suggest the need for attention toward secondary prevention strategies to address poor outcomes of cardiovascular disease among patients living with HIV.
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Affiliation(s)
- Mohammed Haji
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael Capilupi
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael Kwok
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nouran Ibrahim
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gerald S. Bloomfield
- Department of Medicine, Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | | | - Maria C. Rodriguez-Barradas
- Infectious Disease Section, Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Chester N. Ashong
- Pharmacy Service, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Eric Jutkowitz
- Center of Innovation, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center, Providence VA Health Care System, Providence, Rhode Island
| | - Tracey H. Taveira
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
- Department of Pharmacy, University of Rhode Island, Providence
| | - Michelle Richard
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
| | - Jennifer L. Sullivan
- Center of Innovation, Providence VA Medical Center, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| | - James L. Rudolph
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Center of Innovation, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center, Providence VA Health Care System, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
| | - Wen-Chih Wu
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Center of Innovation, Providence VA Medical Center, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
| | - Sebhat Erqou
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Center of Innovation, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center, Providence VA Health Care System, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
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Chen W, Petoumenos K, Somia A, Edmiston N, Chaiwarith R, Woolley I, Ross J, Pujari S, Boettiger DC. Changes in atherosclerotic cardiovascular disease risk over time among people living with HIV. J Antimicrob Chemother 2024; 79:897-902. [PMID: 38416697 PMCID: PMC10984948 DOI: 10.1093/jac/dkae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/06/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVE To describe changes in atherosclerotic cardiovascular disease (ASCVD) risk over time among people living with HIV (PLHIV). METHODS We used data from the TREAT Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD). Five-year ASCVD risk was calculated using the D:A:D equation. Individuals were eligible for inclusion if they were aged ≥18 years, had started ART, had no previous history of ASCVD and had complete ASCVD risk factor data available within the first 5 years of ART initiation. RESULTS A total of 3368 adults contributed data, 3221 were from TAHOD and 147 were from AHOD. The median age at ART initiation was 36 [IQR 31-43] years for TAHOD participants, and 42 [IQR 35-50] years for AHOD participants. Most TAHOD (70.4%) and AHOD (91.8%) participants were male. Overall, ASCVD risk increased from 0.84% (95% CI 0.81%-0.87%) at ART initiation to 1.34% (95% CI 1.29%-1.39%) after 5 years on ART. After adjusting for traditional and HIV-associated ASCVD risk factors, ASCVD risk increased at a similar rate among sub-populations defined by HIV exposure (heterosexuals, men who have sex with men, people who inject drugs), race/ethnicity (Caucasian and Asian) and nadir CD4 at ART initiation (<200 and ≥200 cells/mm3). CONCLUSIONS These findings emphasize the growing burden of ASCVD risk among PLHIV and the need to develop interventions that are effective across a broad range of HIV sub-populations.
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Affiliation(s)
- Weisi Chen
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Agus Somia
- Department of Tropical and Infectious Diseases, Udayana University, Denpasar, Indonesia
| | - Natalie Edmiston
- School of Medicine, Rural Research, Western Sydney University, Sydney, Australia
| | - Romanee Chaiwarith
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ian Woolley
- Monash Infectious Diseases, Monash Health and Monash University, Melbourne, Australia
| | - Jeremy Ross
- TREAT Asia, amfAR—The Foundation for AIDS Research, Bangkok, Thailand
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Drago F, Soshnik-Schierling L, Cabling ML, Pattarabanjird T, Desderius B, Nyanza E, Raymond H, McNamara CA, Peck RN, Shiau S. Characterizing blood pressure trajectories in people living with HIV following antiretroviral therapy: A systematic review. HIV Med 2023; 24:1106-1114. [PMID: 37474730 PMCID: PMC10799172 DOI: 10.1111/hiv.13524] [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: 11/25/2022] [Accepted: 06/19/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The advent of antiretroviral therapy (ART) has reduced AIDS-related morbidity and mortality among people living with HIV (PLWH). Due to increased survival, PLWH have now been found to be at risk of chronic conditions related to ageing, such as cardiovascular disease (CVD). Hypertension is common in PLWH and is a major risk factor for the development of CVD. We conducted a systematic literature review to evaluate the research evidence on longitudinal blood pressure (BP) trajectories following ART initiation in PLWH. METHODS We searched the following databases: PubMed, CINHAL, Scopus, and Web of Science (up to 15 March 2021) for peer-reviewed published studies that reported BP trajectories following ART initiation in PLWH. Three reviewers independently screened all studies by title and abstract. We included articles in English, published up to March 2021, that report office BP trajectories in PLWH initiating ART. A total of 10 publications met our inclusion criteria. Eight studies were prospective cohorts and two were retrospective. RESULTS Nine out of 10 studies in the literature reported an increase in systolic BP (4.7-10.0 mmHg in studies with a follow-up range of 6 months to 8 years, and 3.0-4.7 mmHg/year in time-averaged studies). In addition, four out of 10 studies reported increases in diastolic BP (2.3-8.0 mmHg for a 6 month to 6.8-year follow-up range and 2.3 mmHg/year). CONCLUSION Systolic BP consistently increases while diastolic BP changes are more heterogeneous following ART initiation in PLWH. However, the studies were highly variable with respect to population demographics, ART regimen and duration, and follow-up time. Nevertheless, given the risks of CVD complications, such as stroke, heart failure and myocardial infarction, associated with elevated BP, results highlight the importance of future research in this area. It will be important to better characterize BP trajectories over time, identify the most critical times for interventions to reduce BP, determine the long-term CVD consequences in PLWH with elevated BP, and understand how different ART regimens may or may not influence BP and CVD disease.
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Affiliation(s)
- Fabrizio Drago
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Carter Immunology Center, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | | | - Mark L. Cabling
- Department of English, Communication, and Society, King’s College London, London, United Kingdom
| | - Tanyaporn Pattarabanjird
- Carter Immunology Center, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Bernard Desderius
- School of medicine, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Elias Nyanza
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
| | - Henry Raymond
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Coleen A. McNamara
- Carter Immunology Center, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Robert N. Peck
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, NY, United State
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
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Pan M, Manza-A. Agovi A, Anikpo IO, Fasanmi EO, Thompson EL, Reeves JM, Thompson CT, Johnson ME, Golub V, Ojha RP. Effect of 2018 American College of Cardiology/American Heart Association Guideline Change on Statin Prescription for People Living with HIV. Prev Med Rep 2023; 33:102175. [PMID: 36968517 PMCID: PMC10034116 DOI: 10.1016/j.pmedr.2023.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/23/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines were updated in 2018 to explicitly recommend statin use for primary cardiovascular disease prevention among people living with HIV (PLWH), but little is known about the effect of this guideline change. We aimed to assess the effect of the 2018 ACC/AHA guideline change on statin prescription among PLWH. We used data from an institutional HIV registry to identify PLWH aged 40-75 years, engaged in HIV care between June 2016 and May 2021, had a LDL cholesterol between 70 and 189 mg/dl, 10-year atherosclerotic cardiovascular disease (ASCVD) risk score ≥7.5%, no prior statin prescription, and no history of diabetes or ASCVD. Our outcome of interest was a new statin prescription within 12 months of eligibility. We estimated standardized risk difference (RD) with 95% confidence limits (CL) by comparing prescription probabilities before and after guideline change. Our study population comprised 251 PLWH (171 before, 80 after the guideline change), of whom 57% were aged <55 years, 82% were male, and 45% were non-Hispanic black. The standardized 12-month statin prescription risk was 43% (95% CL: 31%, 60%) after the guideline change and 19% (95% CL: 13%, 26%) before the guideline change (RD = 25%, 95% CL: 9.1%, 40%). Our results suggest that the 2018 ACC/AHA guideline change increased statin prescription among PLWH, but a sizable proportion of eligible PLWH were not prescribed statin. Future studies are needed to identify strategies to enhance implementation of statin prescription guidelines among PLWH.
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Boczar KE, Faller E, Zeng W, Wang J, Small GR, Corrales-Medina VF, deKemp RA, Ward NC, Beanlands RSB, MacPherson P, Dwivedi G. Anti-inflammatory effect of rosuvastatin in patients with HIV infection: An FDG-PET pilot study. J Nucl Cardiol 2022; 29:3057-3068. [PMID: 34820771 DOI: 10.1007/s12350-021-02830-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 01/29/2023]
Abstract
AIMS This study aimed to evaluate markers of systemic as well as imaging markers of inflammation in the ascending aorta, bone marrow, and spleen measured by 18F-FDG PET/CT, in HIV+ patients at baseline and following therapy with rosuvastatin. METHODS AND RESULTS Of the 35 HIV+ patients enrolled, 17 were randomized to treatment with 10 mg/day rosuvastatin and 18 to usual care for 6 months. An HIV- control cohort was selected for baseline comparison of serum inflammatory markers and monocyte markers of inflammation. 18F-FDG-PET/CT imaging of bone marrow, spleen, and thoracic aorta was performed in the HIV+ cohort at baseline and 6 months. While CD14++CD16- and CCR2 expressions were reduced, serum levels of IL-7, IL-8, and MCP-1 were elevated in the HIV+ population compared to the controls. There was a significant drop in FDG uptake in the bone marrow (TBRmax), spleen (SUVmax) and thoracic aortic (TBRmax) in the statin-treated group compared to the control group (bone marrow: - 10.3 ± 16.9% versus 5.0 ± 18.9%, p = .0262; spleen: - 9.8 ± 20.3% versus 11.3 ± 28.8%, p = .0497; thoracic aorta: - 19.1 ± 24.2% versus 4.3 ± 15.4%, p = .003). CONCLUSIONS HIV+ patients had significantly markers of systemic inflammation including monocyte activation. Treatment with low-dose rosuvastatin in the HIV+ cohort significantly reduced bone marrow, spleen and thoracic aortic FDG uptake.
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Affiliation(s)
- Kevin E Boczar
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Elliot Faller
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Wanzhen Zeng
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jerry Wang
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gary R Small
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Vicente F Corrales-Medina
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Natalie C Ward
- School of Public Health, Curtin University, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Rob S B Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paul MacPherson
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Girish Dwivedi
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada.
- School of Medicine, University of Western Australia, Perth, Australia.
- Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, The University of Western Australia, Murdoch, Australia.
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, WA, 6009, Australia.
- School of Biomedical Sciences at Curtin University, Perth, WA, Australia.
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9
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Ramos SR, Fraser M, Araya F, Kim HY, Parrilla JAS, Sy KM, Nagpal RT, Camacho-Rivera M, Boutjdir M. Community-engaged Intervention Mapping for CVD-prevention in Black and Latinx Sexual Minority Men with HIV in New York City: Protocol for A Web-based Mixed Method Study. JMIR Res Protoc 2022; 11:e41602. [PMID: 36130735 PMCID: PMC9597416 DOI: 10.2196/41602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Approximately every 37 seconds, someone in the United States dies of cardiovascular disease (CVD). It has emerged as an important contributor to morbidity among persons with HIV. Black and Latinx sexual minority men are at higher risk of both HIV and CVD when compared to heterosexual, nonethnic or minority men. Persons with HIV have a 1.5 to 2-times risk of having CVD than do HIV-negative persons. Data suggest that by the year 2030, an estimated 78% of persons with HIV will have CVD. The relationship between HIV and CVD in marginalized populations is not well understood because overall awareness of HIV and CVD as comorbid conditions is low, which further heightens risk. This has created a critically pressing issue affecting underrepresented ethnic and racial populations with HIV and requires immediate efforts to mitigate risk. Objective The purpose of this formative, mixed methods study is to use a community-engaged approach to map a behavioral intervention for CVD prevention in Black and Latinx sexual minority men with HIV in New York City. Methods Literature reviews focused on behavioral prevention studies using intervention mapping. In Aim 1, we will use qualitative interviews with HIV program managers and community members to understand facilitators and barriers to CVD prevention, chronic illnesses of concern, and early design elements needed for a web-based CVD prevention intervention. In Aim 2, we will conduct qualitative interviews and administer cross-sectional validated surveys with 30 Black and Latinx sexual minority men with HIV. We will assess illness perceptions of chronic conditions, such as HIV, hypertension, and diabetes. A total of 40 participants (program managers and community members) for Aims 1 and 2 will be enrolled to participate. To develop the protocol, we will follow steps 1 through 3 (needs assessment, change objectives, implementation strategy) of intervention mapping, using mixed methods. Results The study was approved by New York University Institutional Review Board in February 2021 (IRB-FY2021-4772) and also by the Yale University Institutional Review Board in June 2022 (#2000031577). We anticipate completing data collection on or before December 2022. Early analyses suggested concerns about illnesses outside of HIV and associated comorbid conditions, such as COVID-19 and monkeypox. Additionally, we noted a strong interest in using a web-based platform for CVD prevention education. Conclusions Web-based, behavioral, CVD prevention interventions may be promising modalities to closing the cardiovascular health disparities gap in Black and Latinx sexual minority men with HIV by extending the reach of prevention interventions using community-informed approaches and technological modalities that have been underused in this population. International Registered Report Identifier (IRRID) RR1-10.2196/41602
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Affiliation(s)
- S Raquel Ramos
- School of Public Health, Social and Behavioral Sciences, School of Nursing, Yale University, 400 West Campus Drive, Orange, US
| | | | - Faven Araya
- Arthur Ashe Institute for Urban Health, Brooklyn, US
| | | | | | - Kalla Maxine Sy
- School of Public Health, Social and Behavioral Sciences, Yale University, New Haven, US
| | | | | | - Mohamed Boutjdir
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, US.,Department of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Medical Center, Brooklyn, US.,Department of Medicine, NYU School of Medicine, New York, US
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10
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Ramos SR, Johnson C, Melkus G, Kershaw T, Gwadz M, Reynolds H, Vorderstrasse A. Cardiovascular Disease Prevention Education Using a Virtual Environment in Sexual-Minority Men of Color With HIV: Protocol for a Sequential, Mixed Method, Waitlist Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38348. [PMID: 35579928 PMCID: PMC9157319 DOI: 10.2196/38348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It is estimated that 70% of all deaths each year in the United States are due to chronic conditions. Cardiovascular disease (CVD), a chronic condition, is the leading cause of death in ethnic and racial minority males. It has been identified as the second most common cause of death in persons with HIV. By the year 2030, it is estimated that 78% of persons with HIV will be diagnosed with CVD. OBJECTIVE We propose the first technology-based virtual environment intervention to address behavioral, modifiable risk factors associated with cardiovascular and metabolic comorbidities in sexual-minority men of color with HIV. METHODS This study will be guided using social cognitive theory and the Technology Acceptance Model. A sequential, mixed method, waitlist controlled randomized control feasibility trial will be conducted. Aim 1 is to qualitatively explore perceptions of cardiovascular risk in 15 participants. Aim 2 is to conduct a waitlist controlled comparison to test if a virtual environment is feasible and acceptable for CVD prevention, based on web-based, self-assessed, behavioral, and psychosocial outcomes in 80 sexual-minority men of color with HIV. RESULTS The study was approved by the New York University Institutional Review Board in 2019, University of Texas Health Science Center at Houston in 2020, and by the Yale University Institutional Review Board in February 2022. As of April 2022, aim 1 data collection is 87% completed. We expect to complete data collection for aim 1 by April 30, 2022. Recruitment for aim 2 will begin mid-May 2022. CONCLUSIONS This study will be the first online virtual environment intervention for CVD prevention in sexual-minority men of color with HIV. We anticipate that the intervention will be beneficial for CVD prevention education and building peer social supports, resulting in change or modification over time in risk behaviors for CVD. TRIAL REGISTRATION ClinicalTrials.gov NCT05242952; https://clinicaltrials.gov/ct2/show/NCT05242952. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38348.
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Affiliation(s)
- S Raquel Ramos
- School of Nursing, Yale University, Orange, CT, United States
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States
- The Center for Drug Use and HIV Research, New York University, New York, NY, United States
| | - Constance Johnson
- Cizik School of Nursing, University of Texas Houston, Houston, TX, United States
- School of Biomedical Informatics, University of Texas Houston, Houston, TX, United States
| | - Gail Melkus
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States
| | - Marya Gwadz
- The Center for Drug Use and HIV Research, New York University, New York, NY, United States
- Silver School of Social Work, New York University, New York, NY, United States
| | - Harmony Reynolds
- Department of Medicine, Grossman School of Medicine, New York University, New York, NY, United States
- NYU Langone Health, New York, NY, United States
| | - Allison Vorderstrasse
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
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11
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Li X, Zhong H, Brandeau ML. Quantile Markov Decision Processes. OPERATIONS RESEARCH 2022; 70:1428-1447. [PMID: 36034163 PMCID: PMC9401554 DOI: 10.1287/opre.2021.2123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The goal of a traditional Markov decision process (MDP) is to maximize expected cumulative reward over a defined horizon (possibly infinite). In many applications, however, a decision maker may be interested in optimizing a specific quantile of the cumulative reward instead of its expectation. In this paper we consider the problem of optimizing the quantiles of the cumulative rewards of a Markov decision process (MDP), which we refer to as a quantile Markov decision process (QMDP). We provide analytical results characterizing the optimal QMDP value function and present a dynamic programming-based algorithm to solve for the optimal policy. The algorithm also extends to the MDP problem with a conditional value-at-risk (CVaR) objective. We illustrate the practical relevance of our model by evaluating it on an HIV treatment initiation problem, where patients aim to balance the potential benefits and risks of the treatment.
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Affiliation(s)
- Xiaocheng Li
- Department of Management Science and Engineering, Stanford University, Stanford, CA, 94305
| | - Huaiyang Zhong
- Department of Management Science and Engineering, Stanford University, Stanford, CA, 94305
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, 94305
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12
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Kibuuka H, Musingye E, Mwesigwa B, Semwogerere M, Iroezindu M, Bahemana E, Maswai J, Owuoth J, Esber A, Dear N, Crowell TA, Polyak CS, Ake JA. Predictors of All-Cause Mortality among People with HIV in a Prospective Cohort Study in East Africa and Nigeria. Clin Infect Dis 2021; 75:657-664. [PMID: 34864933 PMCID: PMC9464064 DOI: 10.1093/cid/ciab995] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS). Methods AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality. Results From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were aged ≥ 50 years, and 98.3% were ART-experienced. We observed 11.42 deaths per 1000 person-years (95% CI: 9.53–13.68) with causes ascertained in 54% of participants. Deaths were caused by malignancy (28.1%), infections (29.7%), and other non-HIV related conditions. Predictors of mortality included CD4 ≤ 350 cells/µL (aHR 2.01 [95% CI: 1.31–3.08]), a log10copies/mL increase of viral load (aHR 1.36 [95% CI: 1.22–1.51]), recent fever (aHR 1.85[95% CI: 1.22–2.81]), body mass index < 18.5 kg/m2 (aHR 2.20 [95% CI: 1.44–3.38]), clinical depression (aHR 2.42 [95% CI: 1.40–4.18]), World Health Organization (WHO) stage III (aHR 2.18 [95% CI: 1.31–3.61]), a g/dL increase in hemoglobin (aHR 0.79 [95% CI: .72–.85]), and every year on ART (aHR 0.67 [95% CI: .56–.81]). Conclusions The mortality rate was low in this cohort of mostly virally suppressed PLWH. Patterns of deaths and identified predictors suggest multiple targets for interventions to reduce mortality.
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Affiliation(s)
- Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Ezra Musingye
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Betty Mwesigwa
- Makerere University Walter Reed Project, Kampala, Uganda
| | | | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Abuja, Nigeria
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Mbeya, Tanzania
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Kericho, Kenya
| | - John Owuoth
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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13
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24-h-Ambulatory Blood Pressure Monitoring in Sub-Saharan Africa: Hypertension Phenotypes and Dipping Patterns in Malawian HIV+ Patients on Antiretroviral Therapy. Glob Heart 2021; 16:67. [PMID: 34692392 PMCID: PMC8516010 DOI: 10.5334/gh.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Cardiovascular disease and especially hypertension are a growing problem among people living with HIV (PLHIV) on antiretroviral therapy (ART) in sub-Saharan Africa. Objectives: As robust data on hypertension phenotypes associated with distinct cardiovascular risks among PLHIV are limited, we aimed to assess the frequency of white-coat (WCH), masked (MH) hypertension, and blood pressure dipping-patterns in a group of Malawian PLHIV. Methods: As part of the prospective Lighthouse-Tenofovir-Cohort-Study, we analyzed clinical, laboratory and 24-h-ambulatory blood pressure monitoring (ABPM) data of PLHIV from urban Lilongwe with treated or untreated hypertension or raised office blood pressure (OBP) during routine study-visits. Results: 118 PLHIV were included and data of 117 participants could be analyzed. Twenty–four-hour ABPM normotension was found in a total of 73 PLHIV including 14/37 on antihypertensive treatment (37.8%). Using strict definitions, i.e. normal OBP plus normal mean BP for all periods of ABPM, controlled hypertension was found in only 4/37 (10.8%) PLHIV on antihypertensive treatment while true normotension was observed in 10/24 untreated patients (41.7%) with previously diagnosed hypertension and 22/56 patients (39.3%) without a medical history of hypertension. WCH with normal BP during all periods of 24-h-ABPM was identified in 12/64 OBP-hypertensive PLHIV (18.8%), primarily in patients with grade 1 hypertension (11/41 patients; 26.8%). MH was found in 17/53 PLHIV with OBP-normotension (32.1%), predominantly in patients with high normal BP (11/20 patients; 55%). The estimated glomerular filtration rate tended to be lower in MH compared to strictly defined normotensive PLHIV (92.0±20.4 vs. 104.8±15.7 ml/min/m²). 64.1 percent of PLHIV (59.5% with 24-h hypertension and 66.7% with 24-h normotension) had abnormal systolic dipping. Conclusion: The high prevalence of WCH and MH with signs of early renal end-organ damage and an abnormal dipping in approximately 2/3 of PLHIV warrants further investigation as these factors may contribute to the increased cardiovascular risk in PLHIV in resource-limited settings like Malawi. Clinical Trial Registration: https://clinicaltrials.gov (NCT02381275), registered March 6th, 2015.
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14
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Atherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis. PLoS One 2021; 16:e0256926. [PMID: 34499685 PMCID: PMC8428548 DOI: 10.1371/journal.pone.0256926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (ASCVD) compared to their uninfected peers. Expanding statin use may help alleviate this burden. We evaluated the cost-effectiveness of reducing the recommend statin initiation threshold for primary ASCVD prevention among PLHIV in Thailand. Methods Our decision analytic microsimulation model randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database (data collected between 1/January/2013 and 1/September/2019). Direct medical costs and quality-adjusted life-years were assigned in annual cycles over a lifetime horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective. The study population included PLHIV aged 35–75 years, without ASCVD, and receiving antiretroviral therapy. Statin initiation thresholds evaluated were 10-year ASCVD risk ≥10% (control), ≥7.5% and ≥5%. Results A statin initiation threshold of ASCVD risk ≥7.5% resulted in accumulation of 0.015 additional quality-adjusted life-years compared with an ASCVD risk threshold ≥10%, at an extra cost of 3,539 Baht ($US113), giving an incremental cost-effectiveness ratio of 239,000 Baht ($US7,670)/quality-adjusted life-year gained. The incremental cost-effectiveness ratio comparing ASCVD risk ≥5% to ≥7.5% was 349,000 Baht ($US11,200)/quality-adjusted life-year gained. At a willingness-to-pay threshold of 160,000 Baht ($US5,135)/quality-adjusted life-year gained, a 30.8% reduction in the average cost of low/moderate statin therapy led to the ASCVD risk threshold ≥7.5% becoming cost-effective compared with current practice. Conclusions Reducing the recommended 10-year ASCVD risk threshold for statin initiation among PLHIV in Thailand would not currently be cost-effective. However, a lower threshold could become cost-effective with greater preference for cheaper statins.
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15
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Nkeh-Chungag BN, Engwa GA, Businge C, Mdondolo M, Pajaro Medina M, Goswami N. Assessment of the impact of HIV infection and anti-retroviral treatment on the cardiometabolic health of pregnant mothers and their offspring (ARTMOMSBABES). BMC Cardiovasc Disord 2021; 21:322. [PMID: 34193034 PMCID: PMC8247111 DOI: 10.1186/s12872-021-02130-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The risk of cardiovascular diseases (CVDs) is becoming more prevalent in pregnant women though not much data is available for pregnant women with human immunodeficiency virus (HIV). Foetoplacental vascular endothelial dysfunction is thought to be at the origin of chronic diseases such as diabetes and obesity later on in life. Because HIV and anti-retroviral treatment (ARTs) are associated with endothelial dysfunction, children exposed in utero to these conditions may be at greater risk of developing CVDs. Despite the high prevalence of HIV in pregnant South African women, little is known about the effects of ART on the cardiovascular health of the mother and offspring. Hence, the proposed study intends to investigate how HIV/ARTs may affect the cardiovascular health of the mother and offspring at different time points during the pregnancy and up to 2 years after birth. METHODS A longitudinal case-control study in HIV positive pregnant women on ART and HIV negative pregnant women will be conducted. All pregnant women will be assessed for cardio-metabolic risk factors and markers (lipids, anthropometric and glycaemic indies, oxidative stress), hemodynamic status (blood pressure parameters) and vascular function (arterial compliance, retinal microvasculature, uterine artery mean pulsatility index). Child health will be monitored in utero and postnatally via routine foetal health screening, placental integrity, anthropometry, blood pressure parameters, markers of oxidative stress and endothelial function in cord blood and cardiovascular epigenetic markers in urine. DISCUSSION There is a paucity of studies in South Africa and sub-Sahara Africa as a whole that utilised a longitudinal study model to assess the effects of ARTs on vascular endothelial changes in pregnant women living with HIV and the cardiometabolic health of their offspring. This study will therefore help to monitor changes in cardiometabolic risk during pregnancy and in children exposed in utero to HIV-infection and ART use. Findings from this study will provide useful information for developing guidelines on the use of ARTs in pregnancy and management of cardiometabolic health of the offspring of HIV positive mothers.
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Affiliation(s)
- Benedicta Ngwenchi Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha, 5117 South Africa
| | - Godwill Azeh Engwa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha, 5117 South Africa
| | - Charles Businge
- Department of Obstetrics and Gynaecology, Walter Sisulu University, Nelson Mandela Academic Hospital, Mthatha, 5117 South Africa
| | - Mziwohlanga Mdondolo
- Department of Obstetrics and Gynaecology, Mthatha Regional Hospital, Private Bag x 5014, Mthatha, 5099 South Africa
| | - Magdevy Pajaro Medina
- Department of Peadiatrics, Mthatha Regional Hospital, Private Bag x 5014, Mthatha, 5099 South Africa
| | - Nandu Goswami
- Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, 8036 Graz, Austria
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16
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Boettiger DC, Newall AT, Phillips A, Bendavid E, Law MG, Ryom L, Reiss P, Mocroft A, Bonnet F, Weber R, El‐Sadr W, d’Arminio Monforte A, de Wit S, Pradier C, Hatleberg CI, Lundgren J, Sabin C, Kahn JG, Kazi DS. Cost-effectiveness of statins for primary prevention of atherosclerotic cardiovascular disease among people living with HIV in the United States. J Int AIDS Soc 2021; 24:e25690. [PMID: 33749164 PMCID: PMC7982504 DOI: 10.1002/jia2.25690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Expanding statin use may help to alleviate the excess burden of atherosclerotic cardiovascular disease in people living with HIV (PLHIV). Pravastatin and pitavastatin are preferred agents due to their lack of substantial interaction with antiretroviral therapy. We aimed to evaluate the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of atherosclerotic cardiovascular disease among PLHIV in the United States. METHODS We developed a microsimulation model that randomly selected (with replacement) individuals from the Data-collection on Adverse Effects of Anti-HIV Drugs study with follow-up between 2013 and 2016. Our study population was PLHIV aged 40 to 75 years, stable on antiretroviral therapy, and not currently using lipid-lowering therapy. Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles and discounted at 3% per year. We assumed a willingness-to-pay threshold of $100,000/QALY gained. The interventions assessed were as follows: (1) treating no one with statins; (2) treating everyone with generic pravastatin 40 mg/day (drug cost $236/year) and (3) treating everyone with branded pitavastatin 4 mg/day (drug cost $2,828/year). The model simulated each individual's probability of experiencing atherosclerotic cardiovascular disease over 20 years. RESULTS Persons receiving pravastatin accrued 0.024 additional QALYs compared with those not receiving a statin, at an incremental cost of $1338, giving an incremental cost-effectiveness ratio of $56,000/QALY gained. Individuals receiving pitavastatin accumulated 0.013 additional QALYs compared with those using pravastatin, at an additional cost of $18,251, giving an incremental cost-effectiveness ratio of $1,444,000/QALY gained. These findings were most sensitive to the pill burden associated with daily statin administration, statin costs, statin efficacy and baseline atherosclerotic cardiovascular disease risk. In probabilistic sensitivity analysis, no statin was optimal in 5.2% of simulations, pravastatin was optimal in 94.8% of simulations and pitavastatin was never optimal. CONCLUSIONS Pravastatin was projected to be cost-effective compared with no statin. With substantial price reduction, pitavastatin may be cost-effective compared with pravastatin. These findings bode well for the expanded use of statins among PLHIV in the United States. To gain greater confidence in our conclusions it is important to generate strong, HIV-specific estimates on the efficacy of statins and the quality-of-life burden associated with taking an additional daily pill.
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Affiliation(s)
- David C Boettiger
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
- Kirby InstituteUNSW SydneySydneyNSWAustralia
| | - Anthony T Newall
- The School of Public Health and Community MedicineUNSW SydneySydneyNSWAustralia
| | - Andrew Phillips
- Institute for Global HealthUniversity College LondonLondonUK
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes ResearchStanford UniversityStanfordCAUSA
| | | | - Lene Ryom
- RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Peter Reiss
- Amsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- HIV Monitoring FoundationAmsterdamThe Netherlands
| | - Amanda Mocroft
- Institute for Global HealthUniversity College LondonLondonUK
| | | | - Rainer Weber
- University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Wafaa El‐Sadr
- ICAP‐Columbia University and Harlem HospitalNew YorkNYUSA
| | | | - Stephane de Wit
- Saint Pierre University HospitalUniversité Libre de BruxellesBrusselsBelgium
| | | | | | - Jens Lundgren
- RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Caroline Sabin
- Institute for Global HealthUniversity College LondonLondonUK
| | - James G Kahn
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Dhruv S Kazi
- Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolHarvard UniversityBostonMAUSA
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Abstract
Introduction Over the past decade, the global response to HIV has led to a reduction in the number of new infections, and a decrease in associated mortality. Yet, the number of people living with HIV (PLHIV) is high, with an estimated 38 million infected worldwide. As HIV shifts from being an acute terminal illness to a chronic condition, evaluating programmatic responses to HIV with sole reliance on biological markers (such as viral load or CD4 cell count) as proxies for patient health may no longer be suitable. HIV affects the lives of those infected in myriad ways which should be reflected in programme evaluations by measuring health-related quality of life, in addition to biomarkers. Discussion In this commentary we argue that there is a pressing need to review how a "good" health outcome is defined and measured in light of care systems moving towards value-based frameworks that measure value in terms of the actual health outcomes achieved (rather than processes of care), global response shifting to providing long-term care for PLHIV in the community, and integrating HIV as part of universal health coverage plans. Efforts should be directed towards validating generic and disease specific patient-reported measures of PLHIV, to identify the most suitable tools. Such efforts will ensure that patient experience is appropriately captured, especially to be used in programme or economic evaluations. Conclusions It is only by recognising and measuring the full range of health, mental and social outcomes related to the disease that the health status of PLHIV can be fully understood.
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Lorenz DR, Misra V, Chettimada S, Uno H, Wang L, Blount BC, De Jesús VR, Gelman BB, Morgello S, Wolinsky SM, Gabuzda D. Acrolein and other toxicant exposures in relation to cardiovascular disease among marijuana and tobacco smokers in a longitudinal cohort of HIV-positive and negative adults. EClinicalMedicine 2021; 31:100697. [PMID: 33554087 PMCID: PMC7846668 DOI: 10.1016/j.eclinm.2020.100697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Marijuana smoke contains some of the same toxicants present in tobacco smoke. Marijuana smoking is prevalent among HIV+ individuals, but few studies have characterized smoke-related toxicants or associated health outcomes in exclusive marijuana users. METHODS This longitudinal study included 245 participants over age 40 (76% HIV+). 33 plasma and 28 urine metabolites of nicotine, ∆-9-trans-tetrahydrocannabinol, polycyclic aromatic hydrocarbons, and volatile organic compounds were assayed by liquid or gas chromatography/mass spectrometry. Exposures and health outcomes were assessed from surveys and medical records. FINDINGS At baseline, 18% of participants were marijuana-only smokers, 20% tobacco-only smokers, and 24% dual marijuana-tobacco smokers (median (IQR) age 53 (47-60) years, 78% male, 54% white race). Marijuana smoking was independently associated with elevated plasma naphthalenes, 2-hydroxyfluorene sulfate, 4-vinylphenol sulfate, and o-cresol sulfate (p<0·05) and urine acrylonitrile and acrylamide metabolites (p<0·05), but levels were lower than those associated with tobacco smoking. Acrolein metabolite N-Acetyl-S-(3-hydroxypropyl)-l-cysteine (3HPMA) was significantly elevated in plasma and urine in tobacco-only and dual but not marijuana-only smokers, and correlated with nicotine metabolites (p<0·05). The highest tertile of 3HPMA was associated with increased cardiovascular disease diagnoses independent of tobacco smoking, traditional risk factors, and HIV status (odds ratio [95% CI] 3·34 [1·31-8·57]; p = 0·012). INTERPRETATION Smoke-related toxicants, including acrylonitrile and acrylamide metabolites, are detectable in exclusive marijuana smokers, but exposures are lower compared with tobacco or dual smokers. Acrolein exposure is increased by tobacco smoking but not exclusive marijuana smoking in HIV+ and HIV- adults, and contributes to cardiovascular disease in tobacco smokers. FUNDING U.S. NIH.
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Affiliation(s)
- David R. Lorenz
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Vikas Misra
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Sukrutha Chettimada
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Hajime Uno
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lanqing Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin C. Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Víctor R. De Jesús
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin B. Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven M. Wolinsky
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215, USA
- Corresponding author.
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Lindayani L, purnama H, Nurhayati N, Sudrajat DA, Taryudi T. A 10-Years Risk of Cardiovascular Disease Among HIV-Positive Individuals Using BMI-Based Framingham Risk Score in Indonesia. SAGE Open Nurs 2021; 7:2377960821989135. [PMID: 35155766 PMCID: PMC8832318 DOI: 10.1177/2377960821989135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) is the primary cause of death in HIV patients. The number of HIV patients suffering from cardiovascular disease is almost twice as high as that of patients who are not HIV-positive. Objective The purpose of this study was to evaluate risk of cardiovascular disease among HIV-positive persons. Methods We conducted a cross-sectional study with HIV positive individuals at public health center and non-AIDS govermental organization. We enrolled people diagnosed with HIV, age over 30 years old, and on CVD medications. We collected data of demographic, anthropometric and clinical information, smoking history, and non-fasting cholesterol and blood glucose. Estimation of 10-years CVD risk was calculated using the BMI-based Framingham Risk Score. Results Of 150 participants enrolled, 66.7% were male and mean age was 38.09 (SD = 7.99) years. The mean current CD4 counts was 493.3 (SD = 139.8) cells/mm3. Female were younger, had a shorter duration living with HIV and a shorted duration of receiving ART than males. About 8.7% of respondents had a high risk of developing a CVD event in the next 10 years, and higher among females than males. The most common CVD risk factors were smoking, high blood pressure, and hypercholestrolemia. Conclusion Our study demonstrates that HIV positive persons who are at risk for developing CVD in the next 10-years. There is an increasing need for educational programs on CVD prevention for the HIV-positive person and to further facilitate the identification of persons at elevated risk in routine practice.
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Affiliation(s)
- Linlin Lindayani
- Department of Medical Surgical Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
| | - Heni purnama
- Department of Community and Psychiatric Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
| | - Nunung Nurhayati
- Department of maternity Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
| | - Diwa Agus Sudrajat
- Department of Medical Surgical Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
| | - Taryudi Taryudi
- Faculty of Engineering, Universitas Negeri Jakarta, Jakarta, Indonesia
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Severino P, D’Amato A, Pucci M, Infusino F, Adamo F, Birtolo LI, Netti L, Montefusco G, Chimenti C, Lavalle C, Maestrini V, Mancone M, Chilian WM, Fedele F. Ischemic Heart Disease Pathophysiology Paradigms Overview: From Plaque Activation to Microvascular Dysfunction. Int J Mol Sci 2020; 21:E8118. [PMID: 33143256 PMCID: PMC7663258 DOI: 10.3390/ijms21218118] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
Ischemic heart disease still represents a large burden on individuals and health care resources worldwide. By conventions, it is equated with atherosclerotic plaque due to flow-limiting obstruction in large-medium sized coronary arteries. However, clinical, angiographic and autoptic findings suggest a multifaceted pathophysiology for ischemic heart disease and just some cases are caused by severe or complicated atherosclerotic plaques. Currently there is no well-defined assessment of ischemic heart disease pathophysiology that satisfies all the observations and sometimes the underlying mechanism to everyday ischemic heart disease ward cases is misleading. In order to better examine this complicated disease and to provide future perspectives, it is important to know and analyze the pathophysiological mechanisms that underline it, because ischemic heart disease is not always determined by atherosclerotic plaque complication. Therefore, in order to have a more complete comprehension of ischemic heart disease we propose an overview of the available pathophysiological paradigms, from plaque activation to microvascular dysfunction.
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Affiliation(s)
- Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Andrea D’Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Mariateresa Pucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Fabio Infusino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Francesco Adamo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Lucrezia Netti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Giulio Montefusco
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - William M. Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
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Frazier EL, Sutton MY, Tie Y, Fagan J, Fanfair RN. Differences by Sex in Cardiovascular Comorbid Conditions Among Older Adults (Aged 50-64 or ≥65 Years) Receiving Care for Human Immunodeficiency Virus. Clin Infect Dis 2020; 69:2091-2100. [PMID: 31051034 DOI: 10.1093/cid/ciz126] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Differences by sex in cardiovascular comorbid conditions among human immunodeficiency virus (HIV)-infected persons aged 50-64 years have been understudied; even fewer data are available for persons aged ≥65 years. METHODS We used matched interview and medical record abstraction data from the 2009-2012 data cycles of the Medical Monitoring Project, a nationally representative sample of HIV-infected adults in care. We included men and women aged 50-64 and ≥65 years at time of interview. We calculated weighted prevalence estimates and used logistic regression to compute adjusted prevalence differences and 95% confidence intervals (CIs) assessing sex differences in various characteristics and cardiovascular comorbid conditions. Comorbid conditions included overweight/obesity (body mass index ≥25), abnormal total cholesterol level (defined as ≥200 mg/dL), diagnosed diabetes mellitus, or diagnosed hypertension. RESULTS Of 7436 participants, 89.5% were aged 50-64 years and 10.4% aged ≥65 years, 75.1% were men, 40.4% (95% CI, 33.5%-47.2%) were non-Hispanic black, 72.0% (70.4%-73.6%) had HIV infection diagnosed ≥10 years earlier. After adjustment for sociodemographic and behavioral factors, women aged 50-64 years were more likely than men to be obese (adjusted prevalence difference, 8.4; 95% CI, 4.4-12.3), have hypertension (3.9; .1-7.6), or have high total cholesterol levels (9.9; 6.2-13.6). Women aged ≥65 years had higher prevalences of diabetes mellitus and high total cholesterol levels than men. CONCLUSIONS Cardiovascular comorbid conditions were prevalent among older HIV-infected persons in care; disparities existed by sex. Closer monitoring and risk-reduction strategies for cardiovascular comorbid conditions are warranted for older HIV-infected persons, especially older women.
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Affiliation(s)
- Emma L Frazier
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention.,Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Jennifer Fagan
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Robyn Neblett Fanfair
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
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22
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Boettiger DC, Newall AT, Chattranukulchai P, Chaiwarith R, Khusuwan S, Avihingsanon A, Phillips A, Bendavid E, Law MG, Kahn JG, Ross J, Bautista‐Arredondo S, Kiertiburanakul S. Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost-effectiveness analysis. J Int AIDS Soc 2020; 23 Suppl 1:e25494. [PMID: 32562359 PMCID: PMC7305414 DOI: 10.1002/jia2.25494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/20/2020] [Accepted: 03/31/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (CVD) compared to their HIV-negative peers. Expanding statin use may help alleviate this burden. However, the choice of statin in the context of antiretroviral therapy is challenging. Pravastatin and pitavastatin improve cholesterol levels in PLHIV without interacting substantially with antiretroviral therapy. They are also more expensive than most statins. We evaluated the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid-lowering therapy. METHODS We developed a discrete-state microsimulation model that randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database cohort who were aged 40 to 75 years, receiving antiretroviral therapy in Thailand, and not using lipid-lowering therapy. The model simulated each individual's probability of experiencing CVD. We evaluated: (1) treating no one with statins; (2) treating everyone with pravastatin 20mg/day (drug cost 7568 Thai Baht ($US243)/year) and (3) treating everyone with pitavastatin 2 mg/day (drug cost 8182 Baht ($US263)/year). Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles over a 20-year time horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective. RESULTS Pravastatin was estimated to be less effective and less cost-effective than pitavastatin and was therefore dominated (extended) by pitavastatin. Patients receiving pitavastatin accumulated 0.042 additional QALYs compared with those not using a statin, at an extra cost of 96,442 Baht ($US3095), giving an incremental cost-effectiveness ratio of 2,300,000 Baht ($US73,812)/QALY gained. These findings were sensitive to statin costs and statin efficacy, pill burden, and targeting of PLHIV based on CVD risk. At a willingness-to-pay threshold of 160,000 Baht ($US5135)/QALY gained, we estimated that pravastatin would become cost-effective at an annual cost of 415 Baht ($US13.30)/year and pitavastatin would become cost-effective at an annual cost of 600 Baht ($US19.30)/year. CONCLUSIONS Neither pravastatin nor pitavastatin were projected to be cost-effective for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid-lowering therapy. We do not recommend expanding current use of these drugs among PLHIV in Thailand without substantial price reduction.
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Affiliation(s)
- David C Boettiger
- Kirby InstituteUNSW SydneySydneyNSWAustralia
- Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Anthony T Newall
- The School of Public Health and Community MedicineUNSW SydneySydneyNSWAustralia
| | | | - Romanee Chaiwarith
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
| | | | - Anchalee Avihingsanon
- The Thai Red Cross AIDS Research Centre and Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Andrew Phillips
- Institute for Global HealthUniversity College LondonUnited Kingdom
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes ResearchStanford UniversityStanfordCAUSA
| | | | - James G Kahn
- Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Jeremy Ross
- TREAT Asia/amfAR–Foundation for AIDS ResearchBangkokThailand
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23
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Factors Associated With Excess Myocardial Infarction Risk in HIV-Infected Adults: A Systematic Review and Meta-analysis. J Acquir Immune Defic Syndr 2020; 81:224-230. [PMID: 30865179 DOI: 10.1097/qai.0000000000001996] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To estimate the pooled relative risk (RR) of incident acute myocardial infarction (AMI) among HIV-infected adults compared with HIV-uninfected controls and explore the contribution of traditional and HIV-related risk factors. BACKGROUND Understanding AMI risk and associated risk factors in HIV-infected populations has the potential to inform clinical management and prevention strategies. METHODS We systematically identified cohort studies of HIV-infected or HIV-infected and matched uninfected adults reporting AMI incidence rates published up to January 1, 2017. Random-effects meta-analysis models were used to estimate the aggregate RR of AMI by HIV status. Subgroup analysis and meta-regression were used to explore factors affecting risk. RESULTS Sixteen studies (N = 1,619,690, median age 38.5 years, 78.9% male, mean follow-up of 6.5 years) were included. In pooled analyses of HIV-infected and matched uninfected cohorts (n = 5), HIV-infected individuals had higher AMI incidence rates (absolute risk difference = 2.2 cases per 1000 persons per year) and twice the risk of AMI [RR = 1.96 (1.5-2.6)] compared with matched HIV-uninfected controls. In a multivariate meta-regression, each additional percentage point in the proportion of male participants [odds ratio (OR) = 1.20 (1.14-1.27)] and each additional percentage point in the prevalence of hypertension [OR = 1.19 (1.12-1.27)], dyslipidemia [OR = 1.09 (1.07-1.11)], and smoking [OR = 1.09 (1.05-1.13)] were independently associated with increased AMI risk in HIV-infected adults. CONCLUSIONS AND RELEVANCE Chronic HIV infection is associated with a 2-fold higher AMI risk. Traditional risk factors such as hypertension, dyslipidemia, and smoking are significant contributors to AMI risk among HIV-infected adults and should be aggressively targeted in routine HIV care.
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24
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Boettiger DC, Law MG, Ross J, Huy BV, Heng BSL, Ditangco R, Kiertiburanakul S, Avihingsanon A, Cuong DD, Kumarasamy N, Kamarulzaman A, Ly PS, Yunihastuti E, Parwati Merati T, Zhang F, Khusuwan S, Chaiwarith R, Lee MP, Sangle S, Choi JY, Ku WW, Tanuma J, Ng OT, Sohn AH, Wester CW, Nash D, Mugglin C, Pujari S. Atherosclerotic cardiovascular disease screening and management protocols among adult HIV clinics in Asia. J Virus Erad 2020; 6:11-18. [PMID: 32175086 PMCID: PMC7043905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES Integration of HIV and non-communicable disease services improves the quality and efficiency of care in low- and middle-income countries (LMICs). We aimed to describe current practices for the screening and management of atherosclerotic cardiovascular disease (ASCVD) among adult HIV clinics in Asia. METHODS Sixteen LMIC sites included in the International Epidemiology Databases to Evaluate AIDS - Asia-Pacific network were surveyed. RESULTS Sites were mostly (81%) based in urban public referral hospitals. Half had protocols to assess tobacco and alcohol use. Protocols for assessing physical inactivity and obesity were in place at 31% and 38% of sites, respectively. Most sites provided educational material on ASCVD risk factors (between 56% and 75% depending on risk factors). A total of 94% reported performing routine screening for hypertension, 100% for hyperlipidaemia and 88% for diabetes. Routine ASCVD risk assessment was reported by 94% of sites. Protocols for the management of hypertension, hyperlipidaemia, diabetes, high ASCVD risk and chronic ischaemic stroke were in place at 50%, 69%, 56%, 19% and 38% of sites, respectively. Blood pressure monitoring was free for patients at 69% of sites; however, most required patients to pay some or all the costs for other ASCVD-related procedures. Medications available in the clinic or within the same facility included angiotensin-converting enzyme inhibitors (81%), statins (94%) and sulphonylureas (94%). CONCLUSION The consistent availability of clinical screening, diagnostic testing and procedures and the availability of ASCVD medications in the Asian LMIC clinics surveyed are strengths that should be leveraged to improve the implementation of cardiovascular care protocols.
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Affiliation(s)
- DC Boettiger
- Kirby Institute,
UNSW Sydney,
Australia,Institute for Health Policy Studies,
University of California, San Francisco,
USA,Corresponding author: David C Boettiger
Institute for Health Policy Studies,
University of California, San Francisco,
3333 California Street,
94118,
USA
| | - MG Law
- Kirby Institute,
UNSW Sydney,
Australia
| | - J Ross
- TREAT Asia/amfAR,
The Foundation for AIDS Research,
Bangkok,
Thailand
| | - BV Huy
- National Hospital for Tropical Disease,
Hanoi,
Vietnam
| | - BSL Heng
- Hospital Sungai Buloh,
Kuala Lumpur,
Malaysia
| | - R Ditangco
- Research Institute for Tropical Medicine,
Manila,
Philippines
| | | | - A Avihingsanon
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - DD Cuong
- Bach Mai Hospital,
Hanoi,
Vietnam
| | - N Kumarasamy
- CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services,
Chennai,
India
| | - A Kamarulzaman
- University Malaya Medical Centre,
Kuala Lumpur,
Malaysia
| | - PS Ly
- Social Health Clinic,
National Center for HIV/AIDS, Dermatology and STDs,
Phnom Penh,
Cambodia
| | - E Yunihastuti
- Faculty of Medicine Universitas Indonesia,
Cipto Mangunkusumo General Hospital,
Jakarta,
Indonesia
| | | | - F Zhang
- Beijing Ditan Hospital,
Capital Medical University,
Beijing,
China
| | - S Khusuwan
- Chiangrai Prachanukhor Hospital,
Chiangrai,
Thailand
| | - R Chaiwarith
- Research Institute for Health Sciences,
Chiangmai,
Thailand
| | - MP Lee
- Queen Elizabeth Hospital,
Hong Kong
| | - S Sangle
- BJ Government Medical College and Sassoon General Hospitals,
Pune,
India
| | - JY Choi
- Severance Hospital,
Seoul,
South Korea
| | - WW Ku
- Taipei Veterans General Hospital,
Taipei,
Taiwan
| | - J Tanuma
- National Center for Global Health and Medicine,
Tokyo,
Japan
| | - OT Ng
- Tan Tock Seng Hospital,
Singapore
| | - AH Sohn
- TREAT Asia/amfAR,
The Foundation for AIDS Research,
Bangkok,
Thailand
| | - CW Wester
- Vanderbilt University Medical Center,
Institute for Global Health,
Nashville,
USA
| | - D Nash
- Institute for Implementation Science in Population Health,
City University of New York,
New York,
USA,Department of Epidemiology and Biostatistics,
City University of New York,
New York,
USA
| | - C Mugglin
- Institute of Social and Preventative Medicine,
University of Bern,
Switzerland
| | - S Pujari
- Institute for Infectious Diseases,
Pune,
India
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25
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Dean O, Buda A, Adams HR, Mwanza-Kabaghe S, Potchen MJ, Mbewe EG, Kabundula PP, Moghaddam SM, Birbeck GL, Bearden DR. Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia. Pediatr Neurol 2020; 102:28-35. [PMID: 31604645 PMCID: PMC7924094 DOI: 10.1016/j.pediatrneurol.2019.08.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 08/24/2019] [Accepted: 08/29/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cognitive impairment is common in children and adolescents with human immunodeficiency virus (HIV). Brain magnetic resonance imaging (MRI) is a potentially useful tool to investigate the pathophysiology of HIV-associated cognitive impairment and may serve as a biomarker in future clinical trials. There are few published data on brain imaging in children with HIV in sub-Saharan Africa. METHODS Thirty-four perinatally infected subjects with HIV and age-matched HIV-exposed uninfected controls between the ages nine and 17 years were recruited from the Pediatric Center of Excellence in Lusaka, Zambia, as part of the HIV-associated Neurocognitive Disorders in Zambia study. Brain MRI sequences were acquired, and clinical and volumetric assessments were performed. Subjects underwent a comprehensive neuropsychologic battery, and cognitive impairment status was classified using a global deficit score approach. Regression models were used to evaluate relationships between MRI findings and cognitive function. RESULTS We identified cerebrovascular disease in seven of 34 subjects with HIV compared with zero of 17 controls (21% vs 0%, P = 0.04). We also identified decreased total brain volumes (1036 vs 1162 cm3, P = 0.03) and decreased cortical thickness in the right temporal lobes (3.12 vs 3.29 mm; P = 0.01) and right fusiform gyri (3.10 vs 3.25 mm; P = 0.02) of HIV-infected subjects with cognitive impairment. CONCLUSIONS These findings support the hypothesis that brain volumes may be useful biomarkers for cognitive outcomes in children with HIV. Further studies are necessary to investigate mechanisms of cerebrovascular disease and volume loss in children with HIV.
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Affiliation(s)
- Owen Dean
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Alexandra Buda
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Heather R. Adams
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, New York, USA
| | | | - Michael J. Potchen
- Department of Radiology, University of Rochester School of Medicine, Rochester, New York, USA
| | - Esau G. Mbewe
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | | | | | - Gretchen L. Birbeck
- Division of Epilepsy, Department of Neurology, Rochester, New York, USA,University of Zambia School of Medicine, Lusaka, Zambia
| | - David R. Bearden
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, New York, USA
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26
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Alvarado GR, Usry CR, Gore RS, Watts JA, Okulicz JF. Echocardiographic assessment of asymptomatic US Air Force members with early HIV infection. BMC Res Notes 2019; 12:783. [PMID: 31783911 PMCID: PMC6884824 DOI: 10.1186/s13104-019-4822-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/24/2019] [Indexed: 01/11/2023] Open
Abstract
Objective People living with HIV (PLHIV) are at increased risk for cardiovascular disease (CVD) and development of subclinical echocardiographic abnormalities. However, there is scant evidence of the echocardiographic changes that occur shortly after seroconversion. In this study we describe the echocardiographic evaluations of asymptomatic US Air Force members who were diagnosed with HIV infection and evaluated at the San Antonio Military Medical Center between September 1, 2015 and September 30, 2016. Results Patients (n = 50) were predominantly male (96%), mostly African American (60%), with a mean age of 28 years. At HIV diagnosis, the mean viral load was 112,585 copies/mL and CD4 count was 551 cells/μL. All were found to have normal left ventricular systolic ejection fraction (EF) and global longitudinal strain (GLS) however evidence of right ventricular dilatation and left ventricular remodeling was observed in 7 (14%) and 13 (26%) patients, respectively. Subgroup analyses showed no significant differences in echocardiographic findings by HIV disease severity or CVD risk factors (p > 0.05 for all).This study suggests that untreated HIV may have a low impact on the development of echocardiographic abnormalities shortly after seroconversion. Longitudinal studies are warranted to determine the optimal CVD risk assessment strategies for PLHIV.
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Affiliation(s)
- Gadiel R Alvarado
- Infectious Disease Department, San Antonio Military Medical Center, San Antonio, TX, 78234, USA.
| | - Courtney R Usry
- Cardiology Department, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Rosco S Gore
- Cardiology Department, San Antonio Military Medical Center, San Antonio, TX, USA
| | - James A Watts
- Cardiology Department, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Jason F Okulicz
- Infectious Disease Department, San Antonio Military Medical Center, San Antonio, TX, 78234, USA
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Lorenz DR, Misra V, Gabuzda D. Transcriptomic analysis of monocytes from HIV-positive men on antiretroviral therapy reveals effects of tobacco smoking on interferon and stress response systems associated with depressive symptoms. Hum Genomics 2019; 13:59. [PMID: 31779701 PMCID: PMC6883692 DOI: 10.1186/s40246-019-0247-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/17/2019] [Indexed: 02/08/2023] Open
Abstract
Background Tobacco smoking induces immunomodulatory and pro-inflammatory effects associated with transcriptome changes in monocytes and other immune cell types. While smoking is prevalent in HIV-infected (HIV+) individuals, few studies have investigated its effects on gene expression in this population. Here, we report whole-transcriptome analyses of 125 peripheral blood monocyte samples from ART-treated HIV+ and uninfected (HIV−) men enrolled in the Multicenter AIDS Cohort Study (MACS) (n = 25 HIV+ smokers, n = 60 HIV+ non-smokers, n = 40 HIV− non-smoking controls). Gene expression profiling was performed using Illumina HumanHT-12 Expression BeadChip microarrays. Differential expression analysis was performed with weighted linear regression models using the R limma package, followed by functional enrichment and Ingenuity Pathway analyses. Results A total of 286 genes were differentially expressed in monocytes from HIV+ smokers compared with HIV− non-smokers; upregulated genes (n = 180) were enriched for immune and interferon response, chemical/stress response, mitochondria, and extracellular vesicle gene ontology (GO) terms. Expression of genes related to immune/interferon responses (AIM2, FCGR1A-B, IFI16, SP100), stress/chemical responses (APAF1, HSPD1, KLF4), and mitochondrial function (CISD1, MTHFD2, SQOR) was upregulated in HIV+ non-smokers and further increased in HIV+ smokers. Gene expression changes associated with smoking in previous studies of human monocytes were also observed (SASH1, STAB1, PID1, MMP25). Depressive symptoms (CES-D scores ≥ 16) were more prevalent in HIV+ tobacco smokers compared with HIV+ and HIV− non-smokers (50% vs. 26% and 13%, respectively; p = 0.007), and upregulation of immune/interferon response genes, including IFI35, IFNAR1, OAS1-2, STAT1, and SP100, was associated with depressive symptoms in logistic regression models adjusted for HIV status and smoking (p < 0.05). Network models linked the Stat1-mediated interferon pathway to transcriptional regulator Klf4 and smoking-associated toll-like receptor scaffolding protein Sash1, suggesting inter-relationships between smoking-associated genes, control of monocyte differentiation, and interferon-mediated inflammatory responses. Conclusions This study characterizes immune, interferon, stress response, and mitochondrial-associated gene expression changes in monocytes from HIV+ tobacco smokers, and identifies augmented interferon and stress responses associated with depressive symptoms. These findings help to explain complex interrelationships between pro-inflammatory effects of HIV and smoking, and their combined impact on comorbidities prevalent in HIV+ individuals.
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Affiliation(s)
- David R Lorenz
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Vikas Misra
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA, 02215, USA.
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Heravi AS, Etzkorn LH, Urbanek JK, Crainiceanu CM, Punjabi NM, Ashikaga H, Brown TT, Budoff MJ, D'Souza G, Magnani JW, Palella FJ, Berger RD, Wu KC, Post WS. HIV Infection Is Associated With Variability in Ventricular Repolarization: The Multicenter AIDS Cohort Study (MACS). Circulation 2019; 141:176-187. [PMID: 31707799 DOI: 10.1161/circulationaha.119.043042] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV+) have greater risk for sudden arrhythmic death than HIV-uninfected (HIV-) individuals. HIV-associated abnormal cardiac repolarization may contribute to this risk. We investigated whether HIV serostatus is associated with ventricular repolarization lability by using the QT variability index (QTVI), defined as a log measure of QT-interval variance indexed to heart rate variance. METHODS We studied 1123 men (589 HIV+ and 534 HIV-) from MACS (Multicenter AIDS Cohort Study), using the ZioXT ambulatory electrocardiography patch. Beat-to-beat analysis of up to 4 full days of electrocardiographic data per participant was performed using an automated algorithm (median analyzed duration [quartile 1-quartile 3]: 78.3 [66.3-83.0] hours/person). QTVI was modeled using linear mixed-effects models adjusted for demographics, cardiac risk factors, and HIV-related and inflammatory biomarkers. RESULTS Mean (SD) age was 60.1 (11.9) years among HIV- and 54.2 (11.2) years among HIV+ participants (P<0.001), 83% of whom had undetectable (<20 copies/mL) HIV-1 viral load (VL). In comparison with HIV- men, HIV+ men had higher QTVI (adjusted difference of +0.077 [95% CI, +0.032 to +0.123]). The magnitude of this association depended on the degree of viremia, such that in HIV+ men with undetectable VL, adjusted QTVI was +0.064 (95% CI, +0.017 to +0.111) higher than in HIV- men, whereas, in HIV+ men with detectable VL, adjusted QTVI was higher by +0.150 (95% CI, 0.072-0.228) than in HIV- referents. Analysis of QTVI subcomponents showed that HIV+ men had: (1) lower heart rate variability irrespective of VL status, and (2) higher QT variability if they had detectable, but not with undetectable, VL, in comparison with HIV- men. Higher levels of C-reactive protein, interleukin-6, intercellular adhesion molecule-1, soluble tumor necrosis factor receptor 2, and soluble cluster of differentiation-163 (borderline), were associated with higher QTVI and partially attenuated the association with HIV serostatus. CONCLUSIONS HIV+ men have greater beat-to-beat variability in QT interval (QTVI) than HIV- men, especially in the setting of HIV viremia and heightened inflammation. Among HIV+ men, higher QTVI suggests ventricular repolarization lability, which can increase susceptibility to arrhythmias, whereas lower heart rate variability signals a component of autonomic dysfunction.
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Affiliation(s)
- Amir S Heravi
- School of Medicine (A.S.H.), Johns Hopkins University, Baltimore, MD
| | - Lacey H Etzkorn
- Department of Biostatistics (L.H.E., J.K.U., C.M.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jacek K Urbanek
- Department of Biostatistics (L.H.E., J.K.U., C.M.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ciprian M Crainiceanu
- Department of Biostatistics (L.H.E., J.K.U., C.M.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine (N.M.P.), Johns Hopkins University, Baltimore, MD
| | - Hiroshi Ashikaga
- Division of Cardiology, Department of Medicine (H.A., R.D.B., K.C.W., W.S.P.), Johns Hopkins University, Baltimore, MD
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism (T.T.B.), Johns Hopkins University, Baltimore, MD
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, CA (M.J.B.)
| | - Gypsyamber D'Souza
- Department of Epidemiology (G.D.. W.S.P.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jared W Magnani
- Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, PA (J.W.M.)
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (F.J.P.)
| | - Ronald D Berger
- Division of Cardiology, Department of Medicine (H.A., R.D.B., K.C.W., W.S.P.), Johns Hopkins University, Baltimore, MD
| | - Katherine C Wu
- Division of Cardiology, Department of Medicine (H.A., R.D.B., K.C.W., W.S.P.), Johns Hopkins University, Baltimore, MD
| | - Wendy S Post
- Division of Cardiology, Department of Medicine (H.A., R.D.B., K.C.W., W.S.P.), Johns Hopkins University, Baltimore, MD.,Department of Epidemiology (G.D.. W.S.P.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Nonterah EA, Boua PR, Klipstein-Grobusch K, Asiki G, Micklesfield LK, Agongo G, Ali SA, Mashinya F, Sorgho H, Nakanabo-Diallo S, Debpuur C, Kyobutungi C, Alberts M, Norris S, Tollman S, Tinto H, Soo CC, Mukomana F, Hazelhurst S, Wade AN, Kahn K, Oduro AR, Grobbee DE, Sankoh O, Ramsay M, Bots ML, Crowther NJ. Classical Cardiovascular Risk Factors and HIV are Associated With Carotid Intima-Media Thickness in Adults From Sub-Saharan Africa: Findings From H3Africa AWI-Gen Study. J Am Heart Assoc 2019; 8:e011506. [PMID: 31304842 PMCID: PMC6662137 DOI: 10.1161/jaha.118.011506] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Studies on the determinants of carotid intima-media thickness ( CIMT ), a marker of sub-clinical atherosclerosis, mostly come from white, Asian, and diasporan black populations. We present CIMT data from sub-Saharan Africa, which is experiencing a rising burden of cardiovascular diseases and infectious diseases. Methods and Results The H3 (Human Hereditary and Health) in Africa's AWI-Gen (African-Wits-INDEPTH partnership for Genomic) study is a cross-sectional study conducted in adults aged 40 to 60 years from Burkina Faso, Kenya, Ghana, and South Africa. Cardiovascular disease risk and ultrasonography of the CIMT of right and left common carotids were measured. Multivariable linear and mixed-effect multilevel regression modeling was applied to determine factors related to CIMT. Data included 8872 adults (50.8% men), mean age of 50±6 years with age- and sex-adjusted mean (±SE) CIMT of 640±123μm. Participants from Ghana and Burkina Faso had higher CIMT compared with other sites. Age (β = 6.77, 95%CI [6.34-7.19]), body mass index (17.6[12.5-22.8]), systolic blood pressure (7.52[6.21-8.83]), low-density lipoprotein cholesterol (5.08[2.10-8.06]) and men (10.3[4.75- 15.9]) were associated with higher CIMT. Smoking was associated with higher CIMT in men. High-density lipoprotein cholesterol (-12.2 [-17.9- -6.41]), alcohol consumption (-13.5 [-19.1--7.91]) and HIV (-8.86 [-15.7--2.03]) were inversely associated with CIMT. Conclusions Given the rising prevalence of cardiovascular diseases risk factors in sub-Saharan Africa, atherosclerotic diseases may become a major pan-African epidemic unless preventive measures are taken particularly for prevention of hypertension, obesity, and smoking. HIV -specific studies are needed to fully understand the association between HIV and CIMT in sub-Saharan Africa.
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Affiliation(s)
- Engelbert A Nonterah
- 1 Navrongo Health Research Centre Ghana Health Service Navrongo Ghana.,2 Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Palwende R Boua
- 3 Clinical Research Unit of Nanoro Institut de Recherche en Sciences de la Santé Nanoro Burkina Faso.,4 Sydney Brenner Institute of Molecular Bioscience Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,5 Division of Human Genetics Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Kerstin Klipstein-Grobusch
- 2 Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands.,6 Division of Epidemiology and Biostatistics School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Gershim Asiki
- 10 African Population and Health Research Centre (APHRC) Nairobi Kenya
| | - Lisa K Micklesfield
- 7 MRC/Wits Developmental Pathways for Health Research Unit Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Godfred Agongo
- 1 Navrongo Health Research Centre Ghana Health Service Navrongo Ghana
| | - Stuart A Ali
- 4 Sydney Brenner Institute of Molecular Bioscience Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Felistas Mashinya
- 11 Dikgale Health Demographic Surveillance Site Department of Pathology and Medical Sciences School of Health Care Sciences Faculty of Health Sciences University of Limpopo Polokwane South Africa
| | - Herman Sorgho
- 3 Clinical Research Unit of Nanoro Institut de Recherche en Sciences de la Santé Nanoro Burkina Faso
| | - Seydou Nakanabo-Diallo
- 3 Clinical Research Unit of Nanoro Institut de Recherche en Sciences de la Santé Nanoro Burkina Faso
| | - Cornelius Debpuur
- 1 Navrongo Health Research Centre Ghana Health Service Navrongo Ghana
| | | | - Marianne Alberts
- 11 Dikgale Health Demographic Surveillance Site Department of Pathology and Medical Sciences School of Health Care Sciences Faculty of Health Sciences University of Limpopo Polokwane South Africa
| | - Shane Norris
- 7 MRC/Wits Developmental Pathways for Health Research Unit Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Stephen Tollman
- 6 Division of Epidemiology and Biostatistics School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,8 MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,12 INDEPTH-Network Accra Ghana
| | - Halidou Tinto
- 3 Clinical Research Unit of Nanoro Institut de Recherche en Sciences de la Santé Nanoro Burkina Faso
| | - Cassandra C Soo
- 4 Sydney Brenner Institute of Molecular Bioscience Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,5 Division of Human Genetics Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Freedom Mukomana
- 4 Sydney Brenner Institute of Molecular Bioscience Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Scott Hazelhurst
- 4 Sydney Brenner Institute of Molecular Bioscience Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Alisha N Wade
- 8 MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Kathleen Kahn
- 6 Division of Epidemiology and Biostatistics School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,8 MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,12 INDEPTH-Network Accra Ghana
| | - Abraham R Oduro
- 1 Navrongo Health Research Centre Ghana Health Service Navrongo Ghana
| | - Diederick E Grobbee
- 2 Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Osman Sankoh
- 6 Division of Epidemiology and Biostatistics School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,12 INDEPTH-Network Accra Ghana
| | - Michèle Ramsay
- 4 Sydney Brenner Institute of Molecular Bioscience Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,5 Division of Human Genetics Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Michiel L Bots
- 2 Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Nigel J Crowther
- 9 Department of Chemical Pathology National Health Laboratory Services (NHLS) Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
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Brown DA, Simmons B, Boffito M, Aubry R, Nwokolo N, Harding R, O’Brien KK. Evaluation of the psychometric properties of the HIV Disability Questionnaire among adults living with HIV in the United Kingdom: A cross-sectional self-report measurement study. PLoS One 2019; 14:e0213222. [PMID: 31291243 PMCID: PMC6619602 DOI: 10.1371/journal.pone.0213222] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/06/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the psychometric properties of the HIV Disability Questionnaire (HDQ) among people living with HIV (PLHIV) in London, United Kingdom (UK). METHODS This is a cross-sectional measurement study. We recruited and administered the self-reported HDQ, seven criterion measures, and a demographic questionnaire with adults living with HIV accessing HIV care. We determined median and interquartile ranges (IQR) for disability presence, severity and episodic scores (range 0-100). We calculated Cronbach's alpha (α) Kuder-Richardson-20 (KR-20) statistics for disability and episodic scores respectively (internal consistency reliability), smallest detectable change (SDC) for each HDQ severity item and domain (precision), and tested 36 a priori hypotheses assessing correlations between HDQ and criterion scores (construct validity). RESULTS Of N = 243 participants, all were male, median age 40 years, 94% currently taking antiretroviral therapy, and 22% living with ≥2 concurrent health conditions. Median HDQ domain scores ranged from 0 (IQR: 0,7) (difficulties with day-to-day activities domain) to 27 (IQR: 14, 41) (uncertainty domain). Cronbach's alpha for the HDQ severity scale ranged from 0.85 (95% Confidence Interval (CI): 0.80-0.90) in the cognitive domain to 0.93 (95%CI: 0.91-0.94) in the mental-emotional domain. The KR-20 statistic for the HDQ episodic scale ranged from 0.74 (95%CI: 0.66-0.83) in the cognitive domain to 0.91 (95%CI: 0.89-0.94) in the uncertainty domain. SDC ranged from 7.3-15.0 points on the HDQ severity scale for difficulties with day-to-day activities and cognitive symptoms domains, respectively. The majority of the construct validity hypotheses (n = 30/36, 83%) were confirmed. CONCLUSIONS The HDQ possesses internal consistency reliability and construct validity with varied precision when administered to males living with HIV in London, UK. Clinicians and researchers may use the HDQ to measure the nature and extent of disability experienced by PLHIV in the UK, and to inform HIV service provision to address the health-related challenges among PLHIV.
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Affiliation(s)
- Darren A. Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, Therapies Department, London United Kingdom
| | - Bryony Simmons
- Imperial College London, Faculty of Medicine, Department of Medicine, London, United Kingdom
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, Department of HIV Medicine, London, United Kingdom
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
| | - Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
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Ramos SR, Warren R, Shedlin M, Melkus G, Kershaw T, Vorderstrasse A. A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions. Behav Med 2019; 45:166-176. [PMID: 31343963 PMCID: PMC6793989 DOI: 10.1080/08964289.2019.1570074] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 10/26/2022]
Abstract
The purpose of this paper is to present a stepwise, multi-construct, innovative framework that supports the use of eHealth technology to reach sexual minority populations of color to establish trustworthiness and build trust. The salience of eHealth interventions can be leveraged to minimize the existing paradigm of medical mistrust among sexual minority populations of color living with chronic illnesses. These interventions include virtual environments and avatar-led eHealth videos, which address psychosocial and structural-level challenges related to mistrust. Our proposed framework addresses how eHealth interventions enable technology adoption and usage, anonymity, co-presence, self-disclosure, and social support and establish trustworthiness and build trust.
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Affiliation(s)
| | - Rueben Warren
- b Tuskegee University National Center for Bioethics in Research and Health Care
| | | | - Gail Melkus
- a New York University Rory Meyers College of Nursing
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Todowede OO, Sartorius B, Magula N, Schutte AE. Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa. Diabetol Metab Syndr 2019; 11:105. [PMID: 31890039 PMCID: PMC6916025 DOI: 10.1186/s13098-019-0502-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/06/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND South Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, based on their observed metabolic risk factor profile. METHODS We extracted data from hospital medical charts for 384 randomly selected HIV-infected patients aged ≥ 30 years. We defined metabolic syndrome (MetS) subcomponents using the International Diabetes Federation definition. A validated non-laboratory-based model for predicting a 10-year CVD mortality risk was applied and categorised into five levels, with the thresholds ranging from very low-risk (< 5%) to very high-risk scores (> 30%). RESULTS Among the 384 patients, with a mean (± standard deviation) age of 42.90 ± 8.20 years, the proportion of patients that were overweight/obese was 53.3%, where 50.9% had low high-density lipoprotein (HDL) cholesterol and 21 (17.5%) had metabolic syndrome. A total of 144 patients with complete data allowed a definitive prediction of a 10-year CVD mortality risk. 52% (95% CI 44-60) of the patients were stratified to very low risk (< 5%) compared to 8% (95% CI 4-13) that were at a very high risk (> 30%) of 10-year CVD mortality. The CVD risk grows with increasing age (years), 57.82 ± 6.27 among very high risk and 37.52 ± 4.50; p < 0.001 in very low risk patients. Adjusting for age and analysing CVD risk mortality as a continuous risk score, increasing duration of HIV infection (p = 0.002) and ART (p = 0.007) were significantly associated with increased predicted 10 year CVD mortality risk. However, there was no association between these factors and categorised CVD mortality risk as per recommended scoring thresholds. CONCLUSIONS Approximately 1 in 10 HIV-infected patients is at very high risk of predicted 10-year CVD mortality in our study population. Like uninfected individuals, our study found increased age as a major predictor of 10-year mortality risk and high prevalence of metabolic syndrome. Additional CVD mortality risk due to the duration of HIV infection and ART was seen in our population, further studies in larger and more representative study samples are encouraged. It recommends an urgent need for early planning, prevention and management of metabolic risk factors in HIV populations, at the point of ART initiation.
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Affiliation(s)
- Olamide O. Todowede
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Benn Sartorius
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA
- Faculty of Infectious and Tropical Medicine, London School of Hygiene and Tropical Medicine, London, UK
| | - Nombulelo Magula
- Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Aletta E. Schutte
- Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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Combination ART-Induced Oxidative/Nitrosative Stress, Neurogenic Inflammation and Cardiac Dysfunction in HIV-1 Transgenic (Tg) Rats: Protection by Mg. Int J Mol Sci 2018; 19:ijms19082409. [PMID: 30111743 PMCID: PMC6121319 DOI: 10.3390/ijms19082409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
Chronic effects of a combination antiretroviral therapy (cART = tenofovir/emtricitatine + atazanavir/ritonavir) on systemic and cardiac oxidative stress/injury in HIV-1 transgenic (Tg) rats and protection by Mg-supplementation were assessed. cART (low doses) elicited no significant effects in normal rats, but induced time-dependent oxidative/nitrosative stresses: 2.64-fold increased plasma 8-isoprostane, 2.0-fold higher RBC oxidized glutathione (GSSG), 3.2-fold increased plasma 3-nitrotyrosine (NT), and 3-fold elevated basal neutrophil superoxide activity in Tg rats. Increased NT staining occurred within cART-treated HIV-Tg hearts, and significant decreases in cardiac systolic and diastolic contractile function occurred at 12 and 18 weeks. HIV-1 expression alone caused modest levels of oxidative stress and cardiac dysfunction. Significantly, cART caused up to 24% decreases in circulating Mg in HIV-1-Tg rats, associated with elevated renal NT staining, increased creatinine and urea levels, and elevated plasma substance P levels. Strikingly, Mg-supplementation (6-fold) suppressed all oxidative/nitrosative stress indices in the blood, heart and kidney and substantially attenuated contractile dysfunction (>75%) of cART-treated Tg rats. In conclusion, cART caused significant renal and cardiac oxidative/nitrosative stress/injury in Tg-rats, leading to renal Mg wasting and hypomagnesemia, triggering substance P-dependent neurogenic inflammation and cardiac dysfunction. These events were effectively attenuated by Mg-supplementation likely due to its substance P-suppressing and Mg’s intrinsic anti-peroxidative/anti-calcium properties.
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Tobacco, illicit drugs use and risk of cardiovascular disease in patients living with HIV. Curr Opin HIV AIDS 2018; 12:523-527. [PMID: 28799996 DOI: 10.1097/coh.0000000000000407] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW There is a strong link between HIV, smoking and illicit drugs. This association could be clinically relevant as it may potentiate the risk of cardiovascular diseases (CVD). The purpose of this review is to bring readers up to date on issues concerning the cardiovascular risk associated with tobacco and illicit drugs in patients living with HIV (PLHIV), examining the studies related to this topic published in the last year. RECENT FINDINGS There is a strong association between smoking and atherosclerotic disease in PLHIV, reducing life expectancy secondary to CVD by up to 6 years. Illicit drugs were associated with increased risk of atherosclerotic problems but to a lesser extent than smoking. A significant association of drugs such as cocaine with subclinical coronary atherosclerosis been demonstrated. The relation of marijuana, heroin and amphetamines with atherosclerosis generates more controversy. However, those drugs are associated with cardiovascular morbidity, independently of smoking and other traditional risk factors. SUMMARY Tobacco and illicit drugs are linked to CVD in HIV patients. This leads to the need to create special programs to address the addiction to smoking and illicit drugs, in order to mitigate their consequences and reduce cardiovascular risk.
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Abel JW, Allen O, Bullock D, Finley E, Walter EA, Schnarrs PW, Taylor BS. "I don't want to look sick skinny": Perceptions of Body Image and Weight Loss in Hispanics Living with HIV in South Texas. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2018; 12:9. [PMID: 38828271 PMCID: PMC11141404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Objective Obesity is rising in people with HIV (PLWH) and Hispanics. Both HIV and obesity are associated with cardiovascular disease morbidity and mortality. Our goal is to understand perceptions of body image and lifestyle in Hispanics with HIV to adapt interventions appropriately. Methods We conducted semi-structured interviews with 22 Hispanic PLWH and 6 providers. Purposive sampling selected patient participants across weights and genders. Interviews were coded and analyzed using grounded theory, comparing perspectives between patients with and without obesity, and patients and providers. Results Participants felt obesity and diabetes were "normal" in the community. Patients exhibited understanding of healthy diet and lifestyle but felt incapable of maintaining either. Traditionally Hispanic foods were blamed for local obesity prevalence. Five patients equated weight with health and weight loss with illness, and four expressed concerns that weight loss could lead to unintentional disclosure of HIV status. Participants with overweight or obesity expressed awareness of their weight and felt shamed by providers. Providers found weight loss interventions to be ineffective. Conclusion Interventions in this population must address identified barriers: overweight/obesity as a normative value, lack of self-efficacy, cultural beliefs surrounding food, fear of HIV-associated weight loss and stigma, and provider perspectives on intervention futility.
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Affiliation(s)
- Jordan W Abel
- Department of Medicine, Division of Hospital and General Medicine, University of Texas Health Science Center
| | - Omar Allen
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center
| | - Delia Bullock
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center
| | - Erin Finley
- Departments of Medicine and Psychiatry, University of Texas Health Science Center San Antonio and Veterans Evidence-Based Research Dissemination and Implementation Center (VERDICT), South Texas Veterans Health Care System
| | - Elizabeth A Walter
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center San Antonio and South Texas Veterans Health Care System
| | - Phillip W Schnarrs
- Department of Population Health, Dell Medical School, University of Texas
| | - Barbara S Taylor
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center San Antonio
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Muswe R, Oktedalen O, Zhou DT, Zinyando E, Shawarira-Bote S, Stray-Pedersen B, Siziba A, Gomo ZAR. Inflammatory Markers and Plasma Lipids in HIV Patients: A Correlation Analysis Study. Open Biochem J 2017; 11:105-118. [PMID: 29387269 PMCID: PMC5750726 DOI: 10.2174/1874091x01711010105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/18/2017] [Accepted: 11/10/2017] [Indexed: 12/16/2022] Open
Abstract
Background Recent evidence suggests that HIV infection, even with treatment, increases the risk of coronary heart disease (CHD) and that both chronic inflammation and traditional risk factors play key roles in HIV-associated CHD. Subjects and Methods Patients (N=152), attending Harare HIV clinic, 26% of them male and 82% of them on antiretroviral therapy (ART), were studied. Inflammatory markers comprising of cytokines such as pro-inflammatory tumor necrosis factor-α, (TNF-α), anti-inflammatory interleukin 10, (IL-10) and highly sensitive C reactive protein (hsCRP) together with lipids were assayed using enzyme linked immunosorbent assay (ELISA), immuno-turbidimetric and enzymatic assays, respectively. Correlation analysis of inflammatory markers versus lipid profiles was carried out using bivariate regression analysis. Results Anti-inflammatory cytokine IL-10 and inflammatory hsCRP levels were elevated when measured in all the HIV positive patients, while TNF-α and lipid levels were within normal ranges. Pro-inflammatory TNF-α was significantly higher in ART-naive patients than ART-experienced patients, whereas the reverse was observed for anti-inflammatory IL-10 and anti-atherogenic HDL-C. Correlation analysis indicated a significant positive linear association between IL-10 and total cholesterol (TC) levels but no other correlations were found. Conclusion High cytokine ratio (TNF-α/IL-10) indicates higher CHD risk in ART-naive patients compared to the ART-exposed. The CHD risk could be further strengthened by interplay between inflammatory markers and high prevalence of low HDL-C. Lack of correlation between pro-inflammatory markers (hsCRP and TNF-α) with lipid fractions and correlation between anti-inflammatory IL-10 with artherogenic TC were unexpected findings, necessitating further studies in future.
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Affiliation(s)
- Rudo Muswe
- Department of Chemical Pathology, University of Zimbabwe, Harare, Zimbabwe
| | - Olav Oktedalen
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Danai T Zhou
- Department of Medical Laboratory Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Enita Zinyando
- Department of Chemical Pathology, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Atipa Siziba
- Controlnet Consulting - Consultants Midrand, Gauteng, South Africa
| | - Zvenyika A R Gomo
- Department of Chemical Pathology, University of Zimbabwe, Harare, Zimbabwe
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Kelso-Chichetto NE, Plankey M, Sheps DS, Abraham AG, Chen X, Shoptaw S, Kaplan RC, Post WS, Cook RL. The impact of long-term moderate and heavy alcohol consumption on incident atherosclerosis among persons living with HIV. Drug Alcohol Depend 2017; 181:235-241. [PMID: 29121596 PMCID: PMC5789452 DOI: 10.1016/j.drugalcdep.2017.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Level of alcohol consumption is associated with differential risk of atherosclerosis, but little research has investigated this association among HIV+ persons. We evaluated the association between long-term alcohol use and incident atherosclerosis among HIV+ persons. METHODS We utilized data from HIV+ participants of the Women's Interagency HIV Study (n=483) and the Multicenter AIDS Cohort Study (n=305) without history of cardiovascular disease. Atherosclerosis was assessed two times by B-mode carotid artery ultrasound imaging from 2004 to 2013. Presence of plaque was defined as focal carotid intima-media thickness over 1.5mm. Those with no plaque at baseline and plaque at follow-up were considered incident cases of atherosclerosis. Group-based trajectory models were used to categorize participants into 10-year drinking patterns representing heavy, moderate, or abstinent-low. Multivariable logistic regressions were conducted to assess the association of long-term moderate and heavy use on atherosclerosis, compared to abstinent-low. RESULTS Heavy alcohol consumption was not statistically significantly associated with risk for incident atherosclerosis in women (AOR 1.10, CI 0.40-3.02) or men (AOR 1.31, CI 0.43-4.00), compared to abstinence-low. Moderate consumption was associated with 54% lower odds for incident disease in men (AOR 0.46, CI 0.21-1.00), but not in women (AOR 1.08, CI 0.58-2.00). In cohort-combined analyses, alcohol consumption was not statistically significantly association with incident atherosclerosis (moderate AOR 0.78, CI 0.48-1.27; heavy AOR 1.33, CI 0.66-2.69). CONCLUSION Moderate alcohol consumption was associated with a significant protective effect on incident atherosclerosis in men only. No other levels of alcohol consumption significantly predicted atherosclerosis in men and women compared to abstinent-low.
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Affiliation(s)
- N E Kelso-Chichetto
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, United States; Department of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - M Plankey
- Department of Medicine, Georgetown University Medical Center, Washington DC, United States
| | - D S Sheps
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, United States
| | - A G Abraham
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - X Chen
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, United States
| | - S Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA, United States
| | - R C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States
| | - W S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - R L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, United States
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Lorenz DR, Dutta A, Mukerji SS, Holman A, Uno H, Gabuzda D. Marijuana Use Impacts Midlife Cardiovascular Events in HIV-Infected Men. Clin Infect Dis 2017; 65:626-635. [PMID: 28449059 PMCID: PMC5850013 DOI: 10.1093/cid/cix391] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/21/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Marijuana use is prevalent among persons infected with human immunodeficiency virus (HIV), but its long-term effects on HIV disease progression and comorbidities are unknown. METHODS In this prospective study of 558 HIV-infected men enrolled in the Multicenter AIDS Cohort Study between 1990 and 2010, there were 182 HIV seroconverters and 376 with viral suppression on combination antiretroviral therapy (ART). Associations between heavy marijuana use and HIV disease markers or white blood cell (WBC) count were examined using mixed-effects and linear regression models. Effects of marijuana use on cardiovascular (CV) events and other endpoints were estimated using Kaplan-Meier and logistic regression analyses. RESULTS The median baseline age of participants was 41, 66% were white, 79% had education >12 years, and 20% reported heavy marijuana use at ≥50% of biannual visits during follow-up. Long-term heavy marijuana use showed no significant associations with viral load, CD4 counts, AIDS, cancer, or mortality in both cohorts but was independently associated with increased CV events between ages 40-60 after adjusting for age, tobacco smoking, viral load, and traditional risk factors (odds ratio [OR], 2.5; 95% confidence interval [CI] 1.3, 5.1). Marijuana and tobacco use were each independently associated with higher WBC counts in adjusted models (P < .01); the highest quartile of WBC counts (≥6500 cells/µL) was associated with increased CV events (OR 4.3; 95% CI, 1.5, 12.9). CONCLUSIONS Heavy marijuana use is a risk factor for CV disease in HIV-infected men ages 40-60, independent of tobacco smoking and traditional risk factors.
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Affiliation(s)
- David R Lorenz
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
| | - Anupriya Dutta
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
| | - Shibani S Mukerji
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
- Department of Neurology, Massachusetts General Hospital
| | - Alex Holman
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
| | - Hajime Uno
- Department of Population Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute
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Affiliation(s)
- Matthew S Freiberg
- Vanderbilt University Medical Center, VA Tennessee Valley Health Care System, Nashville, TN Geriatric Research Education and Clinical Care Service, VA Tennessee Valley Health Care System, Nashville, TN
| | - Kaku So-Armah
- Vanderbilt University Medical Center, VA Tennessee Valley Health Care System, Nashville, TN Geriatric Research Education and Clinical Care Service, VA Tennessee Valley Health Care System, Nashville, TN
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