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de Souza RG, Lima SS, Pinto AC, Souza JS, Moura TCF, da Silva Graça Amoras E, Machado LFA, Guerreiro JF, Vallinoto ACR, Queiroz MAF, Ishak R. Change in Nutritional and Biochemical Status in People Living with HIV-1 on Antiretroviral Therapy. Viruses 2022; 14:v14112573. [PMID: 36423182 PMCID: PMC9697288 DOI: 10.3390/v14112573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Antiretroviral therapy (ART) improves the quality of life of people living with HIV-1 (PLHIV) and reduces the mortality rate, but some individuals may develop metabolic abnormalities. This study evaluated changes in the nutritional status and biochemistry of PLHIV on antiretroviral therapy in a cohort that had not previously received ART and to follow up these individuals for 24 months after starting treatment. The initial cohort consisted of 110 individuals and ended with 42 people, assessed by a physical examination. A biochemical assay was performed using the colorimetric enzyme reaction technique, the proviral load was detected by qPCR and the quantification of the CD4/CD8 T lymphocytes was conducted by flow cytometry. PLHIV had increased levels of total cholesterol, LDL, triglycerides, ALT, urea and creatinine after 24 months of ART use (p < 0.05). In the assessment of the nutritional status, PLHIV had increased measures of Triciptal Skinfold, body mass index and arm circumference after the use of ART (p < 0.05). The viral load levels decreased and the CD4 levels increased after 24 months of ART use (p < 0.05). The change in the nutritional status in PLHIV on antiretroviral therapy seems to be a slow process, occurring in the long term, therefore, there is the need for a constant evaluation of these people to identify patients who need a nutritional intervention.
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Affiliation(s)
- Ranilda Gama de Souza
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
- Graduate Program in Biology of Infectious and Parasitic Agents, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Sandra Souza Lima
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Andresa Corrêa Pinto
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Jacqueline Silva Souza
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Tuane Carolina Ferreira Moura
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Ednelza da Silva Graça Amoras
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Luiz Fernando Almeida Machado
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - João Farias Guerreiro
- Human and Medical Genetics Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Maria Alice Freitas Queiroz
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
- Correspondence:
| | - Ricardo Ishak
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará (UFPA), Belém 66075-110, Brazil
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Valderrama-Beltrán S, Martínez-Vernaza S, Figueredo M, Martínez E, Blair KJ, Cuervo-Rojas J, Arévalo L, De La Hoz A, Quiroga C, Mueses H, Sussmann O, Mantilla M, Ramírez C, Gonzalez C, Montero-Riascos L, Botero M, Alzate-Ángel J, García-Garzón M, Franco J, Lenis W, Galindo-Orrego X, Stand J, Fonseca N, Alzamora D, Ramos O, Tobon W, Ruiz J, León S, Rojas-Rojas M, Urrego-Reyes J, Beltrán-Rodríguez C, Rosselli D, Rodriguez-Lugo DA, Villamil-Castañeda LP, Álvarez-Moreno C. Cardiovascular risk factors and comorbidities in people living with HIV: A cross-sectional multicenter study from Colombia comorbidities in a Colombian PLWHIV population. Int J STD AIDS 2022; 33:641-651. [PMID: 35502981 DOI: 10.1177/09564624221089456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. METHODS This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. RESULTS A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively. CONCLUSIONS In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.
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Affiliation(s)
- Sandra Valderrama-Beltrán
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Samuel Martínez-Vernaza
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - María Figueredo
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ernesto Martínez
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, 28006Universidad Del Valle, Cali, Colombia
| | - Kevin J Blair
- Department of Surgery, David Geffen School of Medicine, 12222University of California, Los Angeles, CA, USA.,Division of Infectious Diseases, Department of Medicine, South American Program in HIV Prevention Research (SAPHIR), UCLA, Los Angeles, CA, USA
| | - Juliana Cuervo-Rojas
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Arévalo
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia
| | - Alejandro De La Hoz
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Camilo Quiroga
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Héctor Mueses
- HIV Clinic, 456131Corporación de Lucha Contra El Sida, Cali, Colombia
| | - Otto Sussmann
- HIV Clinic, Infectoclínicos, Bogotá, Colombia.,HIV Clinic, Asistencia Científica de Alta Complejidad, Bogotá, Colombia
| | - Mónica Mantilla
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia.,HIV Clinic, SANAS IPS, Bogotá, Colombia
| | | | | | - Leonardo Montero-Riascos
- Division of Infectious Diseases, School of Medicine, 67637Universidad Libre, Cali, Colombia.,HIV Clinic, Todomed Cali, Cali, Colombia
| | | | | | | | | | | | | | - Javier Stand
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia
| | - Norberto Fonseca
- HIV Clinic, Asistencia Científica de Alta Complejidad, Bogotá, Colombia
| | | | - Olga Ramos
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia
| | - Wilmar Tobon
- HIV Clinic, Centro de Expertos para Atención Integral, Cepain, Colombia
| | - Jaime Ruiz
- Research Department, MSD Colombia, Bogotá, Colombia
| | | | | | | | | | - Diego Rosselli
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diego-Andres Rodriguez-Lugo
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lina Paola Villamil-Castañeda
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Research Group on Infectious Diseases, Hospital Universitario San Ignacio, 27964Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Álvarez-Moreno
- Vicepresidente Científico, Clínica Colsanitas, Bogotá, Colombia.,Division of Infectious Diseases, Facultad de Medicina, 28021Universidad Nacional de Colombia, Bogotá, Colombia
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Camps-Vilaró A, Pérez-Fernández S, Subirana I, Teira R, Estrada V, Domingo P, Dégano IR, Marrugat J. Standardized Comparison of Cardiovascular Risk Factors Prevalence in Spanish Women and Men Living with HIV and in the General Population. J Pers Med 2021; 11:jpm11111085. [PMID: 34834438 PMCID: PMC8621654 DOI: 10.3390/jpm11111085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
People living with HIV (PLWH) have an increased risk of cardiovascular (CV) disease, likely due to a higher prevalence of CV risk factors. We compared the age-standardized prevalence and management of CV risk factors in PLWH to that of the general population in Spain. Blood pressure, lipid, glucose, and anthropometric profiles were cross-sectionally compared along with the treatment of hypertension, dyslipidemia, and diabetes in a general population cohort and a PLWH cohort. Prevalence rates were standardized by the direct method by 10-year age groups in European standard populations and stratified by gender. We included 47,593 individuals aged 35 to 74 years, 28,360 from the general population cohort and 19,233 from the PLWH cohort. Compared to the general population, PLWH had a higher concentration of triglycerides (>35 mg/dL in women and >26 mg/dL in men) and a higher prevalence of smoking (>23% and >17%) and diabetes (>9.9% and >8.5%). The prevalence of treated diabetes, hypertension, and dyslipidemia were up to three-fold lower in both women and men living with HIV. There was a significant difference in PLWH compared to the general population in the lipid, glucose, and anthropometric profile. In addition, PLWH were less often treated for diagnosed diabetes, hypertension, and dyslipidemia.
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Affiliation(s)
- Anna Camps-Vilaró
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Silvia Pérez-Fernández
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Isaac Subirana
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Ramon Teira
- Infectious Diseases Unit, Hospital Sierrallana, 39300 Torrelavega, Spain;
| | - Vicente Estrada
- Infectious Diseases Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Irene R. Dégano
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
- Correspondence: (I.R.D.); (J.M.); Tel.: +34-9-3316-0714 (I.R.D.); +34-9-3316-0733 (J.M.); Fax: +34-9-3316-0796 (I.R.D. & J.M.)
| | - Jaume Marrugat
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park (PRBB), Dr. Aiguader 88, 08003 Barcelona, Spain; (A.C.-V.); (S.P.-F.); (I.S.)
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: (I.R.D.); (J.M.); Tel.: +34-9-3316-0714 (I.R.D.); +34-9-3316-0733 (J.M.); Fax: +34-9-3316-0796 (I.R.D. & J.M.)
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Grand M, Bia D, Diaz A. Cardiovascular Risk Assessment in People Living With HIV: A Systematic Review and Meta-Analysis of Real-Life Data. Curr HIV Res 2021; 18:5-18. [PMID: 31830884 DOI: 10.2174/1570162x17666191212091618] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND People living with HIV (PLWHIV) have a 2-fold higher risk of having a cardiovascular event than HIV-negative individuals. OBJECTIVE The objective of this article is to estimate the pooled proportion of moderate-high cardiovascular risk in PLWHIV obtained through different scores. In addition, this study also aims to establish the prevalence of dyslipidemia, smoking habits, diabetes and high blood pressure in the included studies. METHODS A bibliographic search was conducted in MEDLINE for studies on cardiovascular risk assessment in PLWHVI that took place during the period of inception to July 2018. The eligibility criteria for inclusion were: cross-sectional or longitudinal studies on HIV-positive adults in which the prevalence of moderate-high cardiovascular risk (or data to calculate it) was reported, and included at least one of the following cardiovascular risk scores: Framingham, ASCVD, D:A:D, Progetto Cuore, PROCAM, SCORE, Regicor, and World Health Organization scores. RESULTS Bibliographic search identified 278 studies. Finally, thirty-nine peer-reviewed publications were identified for a collective total of 13698 subjects. The pooled prevalence of moderate-high cardiovascular risk in PLWHIV obtained with nine different scores through random-effect modeling was 20.41% (95% CI: 16.77-24.31). The most prevalent concomitant cardiovascular risk factor was dyslipidemia (39.5%), smoking (33.0 %), high blood pressure (19.8%) and diabetes (7.24%). CONCLUSION Data obtained in this systematic review indicate that more than 1 in every five subjects with HIV have a moderate-high cardiovascular risk. In consequence, the burden of cardiovascular disease in PLWHIV represents a public health problem. There is an urgent need to develop strategies to prevent and detect cardiovascular risk effectively in PLWHIV.
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Affiliation(s)
- Marina Grand
- Instituto de Investigacion en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Pringles 4375, Olavarría (7400), Argentina
| | - Daniel Bia
- Departamento de Fisiologia, Facultad de Medicina, Universidad de la Republica, Centro Universitario de Investigacion, Innovacion y Diagnostico Arterial (CUiiDARTE), Universidad de la Republica General Flores 2125, PC 11800 Montevideo, Uruguay
| | - Alejandro Diaz
- Instituto de Investigacion en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Pringles 4375, Olavarría (7400), Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET, Centro Científico Tecnológico Tandil) 4 de abril 618, Tandil (7000), Argentina
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Grand M, Diaz A, Bia D. [Cardiovascular risk calculators for people living with human immunodeficiency virus]. HIPERTENSION Y RIESGO VASCULAR 2020; 37:181-193. [PMID: 32709573 DOI: 10.1016/j.hipert.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
The increasing access and efficacy of antiretroviral therapy has allowed people living with human immunodeficiency virus to achieve a life expectancy similar to that of the general population. However, this goal may be affected by the increased risk of cardiovascular disease in this group. This risk is multifactorial, involving the high prevalence of traditional risk factors, the development of a pro-inflammatory state related to chronic infection, and the use of antiretroviral drugs with an adverse metabolic profile. In daily practice, in order to estimate this risk and guide medical decision-making, different calculators are available. These are based on data from population cohorts, many of them from human immunodeficiency virusnegative subjects. The main aim of this review is to describe the epidemiology of cardiovascular disease in people living with human immunodeficiency virus, the available risk calculators and their use.
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Affiliation(s)
- M Grand
- Instituto de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Olavarría, Argentina.
| | - A Diaz
- Instituto de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Olavarría, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET, Centro Científico Tecnológico Tandil). Instituto de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - D Bia
- Departamento de Fisiologia, Facultad de Medicina, Universidad de la Republica, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República General Flores, Montevideo, Uruguay
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6
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Risk of cardiovascular disease in patients with HIV infection undergoing antiretroviral therapy. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Estrada V, Domingo P, Suarez-Lozano I, Gutiérrez F, Knobel H, Palacios R, Antela A, Blanco JR, Refoyo E. Risk of cardiovascular disease in patients with HIV infection undergoing antiretroviral therapy. Rev Clin Esp 2019; 220:149-154. [PMID: 31690452 DOI: 10.1016/j.rce.2019.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The increased survival of patients with HIV infection thanks to antiretroviral therapy (ART) is accompanied by a higher rate of cardiovascular disease (CVD). We analysed the prevalence of the cardiovascular risk factors (CRFs) and estimated the risk of CVD in a cohort of patients with HIV in Spain. METHODS We conducted a cross-sectional, observational study of CRFs in the Spanish VACH cohort of patients with HIV who undergo ART. RESULTS The study assessed 15,559 patients with HIV (76% men; mean age, 46 years). Some 3.7% had experienced at least 1 CVD event. The prevalence of CRFs was high (hyperlipidaemia, 64%; tobacco use, 47%; arterial hypertension, 22%; and diabetes, 16%). According to the Framingham scale, 10.9% of the patients presented a high CVD risk, and 28.8% presented a moderate risk. Of the patients with a high CVD risk, 49% took protease inhibitors and 43% took abacavir. Fifty-three percent of the patients diagnosed with arterial hypertension took antihypertensive drugs, and 2.6% of the patients with diabetes took antidiabetic agents. CONCLUSIONS Classical CRFs are common in patients with HIV undergoing ART in Spain, and a large proportion of them have a moderate-high risk of CVD. Therefore, controlling the modifiable CRFs in patients with HIV should be improved, and the use of drugs with a better cardiovascular risk profile should be assessed.
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Affiliation(s)
- V Estrada
- Hospital Clínico San Carlos-IdiSSC, Universidad Complutense de Madrid, Madrid, España.
| | - P Domingo
- Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - F Gutiérrez
- Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, España
| | - H Knobel
- Hospital del Mar, Barcelona, España
| | - R Palacios
- Hospital Universitario Virgen de la Victoria, Málaga, España
| | - A Antela
- Hospital Clínico Universitario, Santiago de Compostela, España
| | - J R Blanco
- Hospital San Pedro-CIBIR, Logroño, España
| | - E Refoyo
- Hospital Universitario La Paz, Madrid, España
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Muller EV, Gimeno SGA. Risk factors for cardiovascular disease in HIV/AIDS patients treated with highly active antiretroviral therapy (HAART) in the central-southern region of the state of Paraná - Brazil. CIENCIA & SAUDE COLETIVA 2019; 24:1903-1914. [PMID: 31166523 DOI: 10.1590/1413-81232018245.16682017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/30/2017] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to describe metabolic changes in HIV/AIDS patients according to the treatment regimen. It was a retrospective cohort conducted from 2002 to 2014. Researchers surveyed clinical variables and treatment regimen of 538 individuals. They used measures of central tendency and marginal logistic regression to determine the influence of the treatment regimen on clinical variables over time; survival was estimated using Kaplan-Meier curves. 56.2% of patients were male, 82.2% white, 33.8% had 4 to 7 years of study, 49.2% were married, 98.5% had sexual transmission, and 89.0% were heterosexuals. During the study period, 24.4% had hypertension, 18.2% changed cholesterol, 39.7% low HDL, 51.3% high triglycerides and 33.3% hyperglycemia. Treatment regimens with nucleotide reverse transcriptase inhibitors associated with protease inhibitors, and the association of different classes of antiretrovirals have been associated with greater lipid changes. Higher metabolic changes were observed in patients with longer treatment time. It is concluded that preventive measures, as well as early treatment, can contribute to minimize the risks of developing cardiovascular diseases.
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Affiliation(s)
- Erildo Vicente Muller
- Universidade Estadual de Ponta Grossa. Av. General Carlos Cavalcanti 4.748, Uvaranas. 84030-900 Ponta Grossa PR Brasil.
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Valanikas E, Dinas K, Tziomalos K. Cancer prevention in patients with human immunodeficiency virus infection. World J Clin Oncol 2018; 9:71-73. [PMID: 30254961 PMCID: PMC6153129 DOI: 10.5306/wjco.v9.i5.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/16/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
Cancer is a leading cause of death in patients with human immunodeficiency virus (HIV) infection. With the advent of antiretroviral treatment, the risk of AIDS-defining cancers declined but the ageing of this population resulted in the emergence of other common cancers, particularly lung and hepatocellular cancer. Accordingly, screening programs similar to the general population should be implemented in patients with HIV infection. Vaccination against common oncogenic viruses is also essential. However, rates of cancer screening and vaccination against HPV and HBV are considerably low in this population, highlighting a pressing need to educate patients and healthcare professionals about the importance of cancer preventive measures in these vulnerable patients.
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Affiliation(s)
- Evripidis Valanikas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki 54642, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
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The HIV patient profile in 2013 and 2003: Results from the Greek AMACS cohort. PLoS One 2018; 13:e0203601. [PMID: 30208097 PMCID: PMC6135491 DOI: 10.1371/journal.pone.0203601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/23/2018] [Indexed: 01/10/2023] Open
Abstract
Combined Antiretroviral therapy (cART) has improved life-expectancy of people living with HIV (PLHIV) but as they age, prevalence of chronic non-AIDS related comorbidities may increase. We study the evolution of HIV-disease markers and comorbidities’ prevalence in PLHIV in Greece. Two cross-sectional analyses (2003 and 2013) on data from the AMACS cohort were performed. Comparisons were based on population average models and were repeated for subjects under follow-up at both 2003 and 2013. 2,403 PLHIV were identified in 2003 and 4,910 in 2013 (1,730 contributing for both cross-sections). Individuals in 2013 were on average older, diagnosed/treated for HIV for longer, more likely to be on cART, virologically suppressed, and with higher CD4 counts. Chronic kidney disease, dyslipidemia and hypertension prevalence increased over time. There was an increase in prescription of lipid-lowering treatment (3.5% in 2003 vs. 7.7% 2013, p<0.001). Among 220 and 879 individuals eligible for Framingham 10-year Event Risk calculation, the proportion of patients in the high-risk group (>20%) increased from 18.2% to 22.2% (p = 0.002). Increase in the prevalence of comorbidities was more pronounced in the subset of patients who were followed in both 2003 and 2013. The increased availability and uptake of cART led to significant improvements in the immuno-virological status of PLHIV in Greece, but they aged alongside an increase in prevalence of non-AIDS related comorbidities. These results highlight the need for appropriate monitoring, optimal cART selection and long-term management and prevention strategies for such comorbidities.
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Morillo-Verdugo R, Robustillo-Cortés MDLA, Martín-Conde MT, Callejón-Callejón G, Cid-Silva P, Moriel-Sánchez C, Tortajada-Goitia B, Almeida-González CV. Effect of a Structured Pharmaceutical Care Intervention Versus Usual Care on Cardiovascular Risk in HIV Patients on Antiretroviral Therapy: INFAMERICA Study. Ann Pharmacother 2018; 52:1098-1108. [PMID: 29808711 DOI: 10.1177/1060028018778045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND HIV+ patients have increased their life expectancy with a parallel increase in age-associated comorbidities. OBJECTIVE To determine the effectiveness of an intensive pharmaceutical care follow-up program in comparison to a traditional model among HIV-infected patients with moderate/high cardiovascular risk. METHOD This was a multicenter, prospective, randomized study of a structured health intervention conducted between January-2014 and June-2015 with 12 months of follow-up at outpatient pharmacy services. The selected patients were randomized to a control group (usual care) or intervention group (intensive pharmaceutical care). The interventional program included follow-up of all medication taken by the patient to detect and work toward the achievement of pharmacotherapeutic objectives related to cardiovascular risk and making recommendations for improving diet, exercising, and smoking cessation. Individual motivational interview and periodic contact by text messages about health promotion were used. The primary end point was the percentage of patients who had reduced the cardiovascular risk index, according to the Framingham-score. RESULTS A total of 53 patients were included. As regards the main variable, 20.7% of patients reduced their Framingham-score from high/very high to moderate/low cardiovascular risk versus 12.5% in the control group ( P=0.016). In the intervention group, the number of patients with controlled blood pressure increased by 32.1% ( P=0.012); 37.9% of patients overall stopped smoking ( P=0.001), and concomitant medication adherence increased by 39.4% at the 48-week follow-up ( P=0.002). Conclusion and Relevance: Tailored pharmaceutical care based on risk stratification, motivational interviewing, and new technologies might lead to improved health outcomes in HIV+ patients at greater cardiovascular risk.
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Abstract
PURPOSE OF REVIEW This review describes what is known concerning the burden of hypertension among people living with HIV (PLHIV), and also addresses relevant topics with respect to its risk factors and clinical management. RECENT FINDINGS Hypertension is highly prevalent in HIV-positive populations, and may be more common than in HIV-negative populations. Risk factors contributing to the development of hypertension in PLHIV include demographic factors, genetic predisposition, lifestyle, comorbidities such as obesity, antiretroviral therapy-related changes in body composition, and potentially also immunodeficiency, immune activation and inflammation, as well as effects from antiretroviral therapy itself. Clinical management of hypertension in PLHIV requires awareness for drug-drug interactions between antiretroviral drugs and antihypertensive drugs. Awareness, treatment, and control of hypertension in PLHIV is currently suboptimal and should be improved. SUMMARY The burden of hypertension among PLHIV is high and its pathophysiology most likely multifactorial. Elucidating the exact pathophysiology of hypertension in PLHIV is vital as this may provide new targets to impact and improve clinical management. In the meantime, efforts should be made to improve hypertension management as per existing clinical guidelines in order to safeguard cardiovascular health and quality of life in PLHIV.
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Masiá M, Padilla S, García JA, Bernardino JI, Campins AA, Asensi V, Gutiérrez F. Decreasing rates of acute myocardial infarction in people living with HIV: a nationwide cohort study in Spain, 2004-2015. HIV Med 2018; 19:491-496. [PMID: 29683252 DOI: 10.1111/hiv.12616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Contemporary data from country-wide cohorts are needed to reveal trends in the occurrence of acute myocardial infarction (AMI) in people living with HIV (PLWH). We analysed time trends in the standardized incidence rate (sIR) of AMI in PLWH in Spain from 2004 to 2015, and compared them with trends in the general population. METHODS A longitudinal study in a nationwide contemporary multicentre HIV-infected cohort was carried out. Data on all incident AMI events were collected, and age- and sex-standardized IRs calculated. To analyse the IR of AMI in the general population, the national rates of hospital discharges for AMI per 100 000 inhabitants stratified for age and sex from 2004 to 2015 were obtained using the morbidity report data from the National Statistics Institute. A Poisson regression model was fitted to assess the effect of covariates of interest on AMI occurrence. RESULTS The sIRs of AMI in 2004-2015 were 237.92 [95% confidence interval (CI) 225.95-249.90] and 66.75 (95% CI: 23.49-110.01) per 100 000 patient-years in male and female PLWH, respectively. There was a decrease in the sIR of AMI in male PLWH from 279.02 (95% CI: 265.46-292.59) per 100 000 person-years in 2004-2009 to 222.13 (95% CI: 210.83-233.42) per 100 000 person-years in 2010-2015. Compared with the general population, the sIR ratio was 1.41 (95% CI: 1.26-1.55) in 2004-2009, and 1.28 (95% CI: 1.15-1.43) in 2010-2014. AMI occurrence was associated with older age (P < 0.066 for each 10-year age stratum ≥ 35-years compared with the 25-34 year stratum), higher plasma HIV RNA (P < 0.001), lower CD4 count (P < 0.04 for CD4 strata > 350 cells/μL compared with the 0-100 cells/μL stratum), and the period 2004-2009 (P < 0.001). CONCLUSIONS There has been a decreasing incidence of AMI in PLWH in Spain, associated with improving immune and virological status, but the incidence of AMI has remained higher than in the general population.
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Affiliation(s)
- M Masiá
- Infectious Diseases Unit, Elche University General Hospital, University Miguel Hernández, Alicante, Spain
| | - S Padilla
- Infectious Diseases Unit, Elche University General Hospital, University Miguel Hernández, Alicante, Spain
| | - J A García
- Statistics, Operational Research Center, University Miguel Hernández, Elche, Alicante, Spain
| | - J I Bernardino
- Infectious Diseases Unit, La Paz-Carlos III-Cantoblanco Hospital, Madrid, Spain
| | - A A Campins
- Infectious Diseases Unit, Son Espases University Hospital, Palma de Mallorca, Spain
| | - V Asensi
- Infectious Diseases Unit, Asturias Central University Hospital, Oviedo, Spain
| | - F Gutiérrez
- Infectious Diseases Unit, Elche University General Hospital, University Miguel Hernández, Alicante, Spain
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Levy ME, Greenberg AE, Hart R, Powers Happ L, Hadigan C, Castel A. High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC. HIV Med 2017; 18:724-735. [PMID: 28503912 DOI: 10.1111/hiv.12516] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidaemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates. METHODS Utilizing an electronic medical record (EMR) database from the DC Cohort study - a multicentre prospective cohort study of HIV-infected outpatients - we assessed the period prevalence of metabolic comorbidities between 2011 and 2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results. RESULTS Of 7018 adult patients (median age 50 years; 77% black), 50% [95% confidence interval (CI) 49-51] had hypertension, 13% (95% CI: 12-14) had diabetes, 48% (95% CI: 47-49) had dyslipidaemia, and 35% (95% CI: 34-36) had obesity. Hypertension was more prevalent among black patients, diabetes and obesity were more prevalent among female and black patients, dyslipidaemia was more prevalent among male and white patients, and comorbidities were more prevalent among older patients (all P < 0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immunovirological parameters were associated with metabolic comorbidities. CONCLUSIONS These findings underscore the pervasive burden of metabolic comorbidities among HIV-infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population.
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Affiliation(s)
- M E Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - A E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - R Hart
- Research Department, Cerner Corporation, Kansas City, MO, USA
| | - L Powers Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - C Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - A Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
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Weinberger AH, Smith PH, Funk AP, Rabin S, Shuter J. Sex Differences in Tobacco Use Among Persons Living With HIV/AIDS: A Systematic Review and Meta-Analysis. J Acquir Immune Defic Syndr 2017; 74:439-453. [PMID: 28002182 PMCID: PMC5321840 DOI: 10.1097/qai.0000000000001279] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Persons living with HIV/AIDS (PLWH) smoke at higher rates than other adults and experience HIV-related and non-HIV-related adverse smoking consequences. This study conducted a systematic review to synthesize current knowledge about sex differences in smoking behaviors among PLWH. METHODS Over 3000 abstracts from MEDLINE were reviewed and 79 publications met all the review inclusion criteria (ie, reported data on smoking behaviors for PLWH by sex). Sufficient data were available to conduct a meta-analysis for one smoking variable: current smoking prevalence. RESULTS Across studies (n = 51), the meta-analytic prevalence of current smoking among female PLWH was 36.3% (95% confidence interval [CI]: 28.0% to 45.4%) and male PLWH was 50.3% (95% CI: 44.4% to 56.2%; meta-analytic odds ratio = 1.78, 95% CI: 1.29 to 2.45). When analyses were repeated just on the US studies (n = 23), the prevalence of current smoking was not significantly different for female PLWH (55.1%, 95% CI: 47.6% to 62.5%) compared with male PLWH (55.5%, 95% CI: 48.2% to 62.5%; meta-analytic odds ratio = 1.04, 95% CI: 0.86 to 1.26). Few studies reported data by sex for other smoking variables (eg, quit attempts, noncigarette tobacco product use) and results for many variables were mixed. DISCUSSION Unlike the general US population, there was no difference in smoking prevalence for female versus male PLWH (both >50%) indicating that HIV infection status was associated with a greater relative increase in smoking for women than men. More research is needed in all areas of smoking behavior of PLWH to understand similarities and differences by sex to provide the best interventions to reduce the high smoking prevalence for all sexes.
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Affiliation(s)
- Andrea H Weinberger
- *Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY; †Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY; ‡Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY; §Department of Psychology, Hofstra University, Hempstead, NY; ‖Stern College for Women, Yeshiva University, New York, NY; and ¶AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
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Domingues EAM, Ferrit-Martín M, Calleja-Hernández MÁ. Impact of pharmaceutical care on cardiovascular risk among older HIV patients on antiretroviral therapy. Int J Clin Pharm 2016; 39:52-60. [PMID: 27864732 DOI: 10.1007/s11096-016-0387-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/12/2016] [Indexed: 01/05/2023]
Abstract
Background Advances in the treatment of HIV infection have enabled better control of the disease, allowing patients to enjoy a longer life expectancy. However, the ageing of patients leads to an increased prevalence of cardiovascular disease. Various studies have found that pharmaceutical care results in better control of cardiovascular risk factors. Objective To measure the impact of pharmaceutical care on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy. Setting Outpatient pharmacy service of a tertiary hospital, Spain. Methods A pre/post-intervention quasi-experimental clinical study was conducted in which health education and pharmacist interventions to reduce cardiovascular risk factors were carried out in a single patient cohort using the Dader method of pharmacotherapy, with a 12-month follow-up period per patient. Patients included were older than 50 years, with moderate/elevated cardiovascular risk. Data were obtained from patient clinical histories, dispensing records and patient interviews, and were subjected to statistical analysis. Main outcome measure Cardiovascular risk estimated by SCORE and REGICOR equations. Results Forty-two patients completed the study. Of these, 93 % were men, with an average age of 57 years and 15 years since diagnosis of HIV. A reduction was observed in the mean values (baseline vs. 12 months) of the following cardiovascular risk factors: systolic blood pressure (P = 0.009), diastolic blood pressure (P = 0.010), total cholesterol (P = 0.006), low-density lipoprotein cholesterol (LDL-c; P = 0.039), triglycerides (P = 0.010) and total cholesterol/high-density lipoprotein cholesterol (HDL-c; P < 0.001). An increase in HDL-c (P = 0.037) was also observed. The average cardiovascular risk estimated by the SCORE instrument was reduced from 7.6 % at the beginning of the study to 6.4 % after 12 months (P = 0.039). The risk estimate according to REGICOR also decreased (P = 0.002). Over the 12-month period, 6.3 ± 3.4 interventions were carried out per patient. Quantitative ineffectiveness was the most prevalent negative outcome associated with medication throughout the study, and noncompliance was the most frequent cause. Interventions on health education were the most common, followed by interventions on improving adherence. Conclusion Pharmaceutical care, delivered as a combination of health education and pharmacotherapy follow-up to outpatients at a tertiary hospital, had a positive impact on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy.
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Affiliation(s)
- Elza Aparecida Machado Domingues
- Federal University of Mato Grosso do Sul, Avenida Senador Filinto Muller, s/n, Campo Grande, MS, CEP 79080-190, Brazil. .,Doctoral Programme in Clinical Medicine and Public Health, Granada University, Granada, Spain.
| | - Mónica Ferrit-Martín
- Pharmacy Clinical Management Department, Virgen de las Nieves University Hospital, Granada University Hospital Complex, Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacy Clinical Management Department, Virgen de las Nieves University Hospital, Granada University Hospital Complex, Granada, Spain
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Cuende JI, Saltijeral A, Estrada V, Pérez De Isla L. Vascular age calculation and equivalent risk factors in HIV-infected patients obtained from the D:A:D risk equation. Eur J Prev Cardiol 2016; 23:1903-1908. [PMID: 27486159 DOI: 10.1177/2047487316663546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/20/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular age is a concept that represents the hypothetical age of the cardiovascular system and might be an alternative way of expressing the cardiovascular risk of a patient. The Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) developed a cardiovascular risk equation from a population of HIV-infected patients, incorporating exposure to individual antiretroviral therapy drugs and traditional classic cardiovascular risk factors. OBJECTIVES The aim of this study was to determine the vascular age calculated from the D:A:D equation, for HIV infected patients. METHODS Vascular age was calculated according to its definition by using the D:A:D equation. The Poisson regression model used in the D:A:D equation is an exponential model to calculate the vascular age to match the exponent of the equation with the factors of a patient with the exponent of a subject with controlled risk factors. RESULTS We obtained an equation that allows calculating the vascular age of a patient considering cardiovascular risk factors listed in the same D:A:D equation. From the equation, we have built a table for easy calculation of the vascular age and a table of cardiovascular risk equivalents. CONCLUSIONS Vascular age is a new concept derived from Framingham risk tables that can be calculated with other risk scales, such as D:A:D for HIV patients. The calculation of vascular age in HIV patients could be a useful tool for communicating cardiovascular risk and to improve the control of modifiable risk factors.
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Affiliation(s)
- Jose I Cuende
- Internal Medicine Department, Complejo Asistencial Universitario de Palencia, Spain
| | | | - Vicente Estrada
- Infectious Diseases Unit, Hospital Clínico San Carlos, Madrid, Spain
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