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Akhigbe RE, Akhigbe TM, Oyedokun PA, Famurewa AC. Molecular mechanisms underpinning the protection against antiretroviral drug-induced sperm-endocrine aberrations and testicular toxicity: A review. Reprod Toxicol 2024; 128:108629. [PMID: 38825169 DOI: 10.1016/j.reprotox.2024.108629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/04/2024]
Abstract
The introduction of highly active antiretroviral therapy (HAART) has revolutionized the treatment of HIV/AIDS worldwide. The HAART approach is the combination of two or more antiretroviral drugs of different classes and are responsible for patient's survival and declining death rates from HIV/AIDS and AIDS-related events. However, the severe and persistent reproductive side effect toxicity of HAART regimens is of great concern to patients within the reproductive age. Till date, the underlying pathophysiology of the HAART-induced reproductive toxicity remains unraveled. Nevertheless, preclinical studies show that oxidative stress and inflammation may be involved in HAART-induced sperm-endocrine deficit and reproductive aberrations. Studies are emerging demonstrating the efficacy of plant-based and non-plant products against the molecular alterations and testicular toxicity of HAART. The testicular mechanisms of mitigation by these products are associated with enhancement of testicular steroidogenesis, spermatogenesis, inhibition of oxidative stress and inflammation. This review presents the toxic effects of HAART on spermatogenesis, reproductive hormones and testis integrity. It also provides insights on the molecular mechanisms underlying the mitigation of HAART testicular toxicity by plant-based and non-plant agents. However, effect of repurposing clinical drugs to combat HAART toxicity is unknown, and more mechanistic studies are evidently needed. Altogether, plant-based and non-plant products are potential agents for prevention of rampant endocrine dysfunction and testicular toxicity of HAART.
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Affiliation(s)
- Roland E Akhigbe
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria; Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
| | - Tunmise M Akhigbe
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria; Breeding and Genetics Unit, Department of Agronomy, Osun State University, Ejigbo Campus, Osun State, Nigeria
| | - Precious A Oyedokun
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria; Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
| | - Ademola C Famurewa
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, College of Medical Sciences, Alex Ekwueme Federal University, Ndufu-Alike Ikwo, Ebonyi State, Nigeria.
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Jemal M. A review of dolutegravir-associated weight gain and secondary metabolic comorbidities. SAGE Open Med 2024; 12:20503121241260613. [PMID: 38881592 PMCID: PMC11179510 DOI: 10.1177/20503121241260613] [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: 12/15/2023] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
Dolutegravir is an integrase inhibitor and is recommended by the World Health Organization as the preferred first-line and second-line human immunodeficiency virus treatment in all populations. Excessive weight gain associated with dolutegravir-based regimens is an emerging issue; however, the long-term metabolic consequences of this effect have not been fully understood. Growing evidence shows that this leads to a higher incidence of hyperglycemia, hypertension, and metabolic syndrome, along with elevated cardiovascular risk. Dolutegravir-based regimens, also associated with greater adipocyte differentiation and greater expression of markers associated with lipid storage, continue to be a problem among patients living with human immunodeficiency virus. The mechanisms by which certain antiretroviral therapy agents differentially contribute to weight gain remain unknown. Some clinical investigators speculate that dolutegravir could interfere with central nervous system appetite regulation (melanocortin-4 receptor) and insulin signaling, or may have better penetration of adipose tissue where they could exert a direct impact on adipose tissue adipogenesis, fibrosis, and insulin resistance. This review summarizes our current understanding of weight gain and fat changes associated with dolutegravir and its possible secondary metabolic comorbidities.
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Affiliation(s)
- Mohammed Jemal
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Amhara, Ethiopia
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dos Santos AP, da Silva LSL, Navarro AM, Cordeiro JFC, Marchiori GF, Abdalla PP, Tasinafo Júnior MF, Venturini ACR, Gomide EBG, Brilhadori J, Correia IM, Benedetti C, Mota J, Bohn L, Machado DRL. Forecasting and validating fat mass ratio models through anthropometric measurements and health-related factors among people with HIV: a cross-sectional investigation. ANNALS OF TRANSLATIONAL MEDICINE 2024; 12:44. [PMID: 38911564 PMCID: PMC11193570 DOI: 10.21037/atm-23-1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/28/2024] [Indexed: 06/25/2024]
Abstract
Background There is a limited research on predictive models of fat mass ratio (FMR) in people living with human immunodeficiency virus (HIV) (PWH). This study aimed to develop models considering anthropometric and health-related factors to predict and validate FMR in PWH regardless of sex. Methods One hundred and six Brazilian PWH (46.4±9.8 years) were evaluated for body composition using dual-energy X-ray absorptiometry (DXA), body circumference (BC), and skinfold thicknesses (SKs). FMR predictive models were developed using stepwise linear regression, and their agreement with DXA was assessed using Bland-Altman plots. Cross-validation was performed using the predicted residual error sum of squares (PRESS) method. Results Six FMR estimation models were developed for PWH, with adjusted R2 ranging from 0.43 to 0.72, standard error of the estimate (SEE) from 0.16% to 0.22%, and 95% confidence interval (CI) from 1.03 to 1.15. Model 6, including thigh SK, waist BC, therapy duration, subscapular SK, education years, and abdominal SK, exhibited the highest determination power (R2 adjusted 0.72, SEE 0.16%, and 95% CI: 1.06-1.15). The agreement between DXA-based FMR and predictive models showed minimal bias (-0.03 to +0.04) and narrower limits of agreement, particularly for the top-performing model (-0.33 to +0.30). Model 6 exhibited a high adjusted Q2PRESS (0.70) and low SPRESS (0.17). Conclusions Our predictive models advance the study of body composition in PWH by consolidating the use of anthropometry for diagnosing and monitoring lipodystrophy regardless of sex.
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Affiliation(s)
- André Pereira dos Santos
- Faculty of Sport of the University of Porto, Porto, Portugal
- College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Human Exposome and Infectious Diseases Network (HEID), University of São Paulo, Ribeirão Preto, Brazil
| | - Leonardo Santos Lopes da Silva
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | - Pedro Pugliesi Abdalla
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Márcio Fernando Tasinafo Júnior
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Cláudia Rossini Venturini
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Euripedes Barsanulfo Gonçalves Gomide
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Claretiano - University Center, Batatais, São Paulo, Brazil
| | - Joana Brilhadori
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Igor Massari Correia
- College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Caio Benedetti
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Jorge Mota
- Research Center in Physical Activity, Health and Leisure (CIAFEL) and Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
| | - Lucimere Bohn
- Research Center in Physical Activity, Health and Leisure (CIAFEL) and Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
- Research Center in Sport, Physical Education, and Exercise and Health (CIDEFES), Lusófona University, Porto, Portugal
| | - Dalmo Roberto Lopes Machado
- College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Research Center in Physical Activity, Health and Leisure (CIAFEL) and Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
- School of Education and Communication (ESEC), University of Algarve, Penha Campus, Faro, Portugal
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González-Domenech CM, Plaza-Andrades IJ, Garrido-Sanchez L, Queipo-Ortuño MI. Synergic effect of metabolic syndrome and lipodystrophy on oxidative stress and inflammation process in treated HIV-patients. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:310-316. [PMID: 35680349 DOI: 10.1016/j.eimce.2020.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/23/2020] [Indexed: 06/15/2023]
Abstract
The aim of this study was to assess the effect of lipodystrophy (LD) associated to metabolic syndrome (MS) on oxidative stress and inflammation in a cohort of 243 HIV-infected patients with MS, all of them under three different antiretroviral regimens. We collected immunovirological, biochemical and metabolic data, as well as anthropometric measurements. In addition, cardiovascular risk was also assessed by means of Atherogenic Index of Plasma (API) and Framingham Risk Score. The MS-LD patient set was characterized by a lower initial lymphocyte CD4 count and CD4/CD8 ratio and a higher initial viral load than the group without LD. We also found worse lipidic and glycaemic profiles (with lower HDL-cholesterol and higher triglyceride and glucose levels) in the MS-LD group. BMI, systolic blood pressure and Framingham score were significantly increased compared to MS-Non LD. In addition, patients with MS and LD had significantly higher levels of carbonylated proteins, lipid peroxidation, IL-6 and IL-8, as well as a significant decrease in the levels of leptin, adiponectin and antioxidant activities of catalase, super oxide dismutase and glutathione associated enzymes. In MS-LD HIV-1 patients, a significant negative correlation was found between Framingham Risk Score and the antioxidant biomarkers, however a positive association was found between API and protein-C reactive and carbonylated proteins. Segregating by ART, the above-mentioned conditions were worse within the MS-LD group whose treatment contained protease inhibitors, such as lopinavir. In conclusion, HIV-1 infected patients treated for at least six months, especially with regimens including PIs, showed a worsening of inflammatory process and oxidative stress.
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Affiliation(s)
| | - Isaac J Plaza-Andrades
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), UMA, Málaga, Spain
| | - Lourdes Garrido-Sanchez
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), UMA, Málaga, Spain.
| | - María Isabel Queipo-Ortuño
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA)-CIMES-UMA, Málaga, Spain
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Olund Villumsen S, Benfeitas R, Knudsen AD, Gelpi M, Høgh J, Thomsen MT, Murray D, Ullum H, Neogi U, Nielsen SD. Integrative Lipidomics and Metabolomics for System-Level Understanding of the Metabolic Syndrome in Long-Term Treated HIV-Infected Individuals. Front Immunol 2022; 12:742736. [PMID: 35095835 PMCID: PMC8791652 DOI: 10.3389/fimmu.2021.742736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
People living with HIV (PLWH) require life-long anti-retroviral treatment and often present with comorbidities such as metabolic syndrome (MetS). Systematic lipidomic characterization and its association with the metabolism are currently missing. We included 100 PLWH with MetS and 100 without MetS from the Copenhagen Comorbidity in HIV Infection (COCOMO) cohort to examine whether and how lipidome profiles are associated with MetS in PLWH. We combined several standard biostatistical, machine learning, and network analysis techniques to investigate the lipidome systematically and comprehensively and its association with clinical parameters. Additionally, we generated weighted lipid-metabolite networks to understand the relationship between lipidomic profiles with those metabolites associated with MetS in PLWH. The lipidomic dataset consisted of 917 lipid species including 602 glycerolipids, 228 glycerophospholipids, 61 sphingolipids, and 26 steroids. With a consensus approach using four different statistical and machine learning methods, we observed 13 differentially abundant lipids between PLWH without MetS and PLWH with MetS, which mainly belongs to diacylglyceride (DAG, n = 2) and triacylglyceride (TAG, n = 11). The comprehensive network integration of the lipidomics and metabolomics data suggested interactions between specific glycerolipids' structural composition patterns and key metabolites involved in glutamate metabolism. Further integration of the clinical data with metabolomics and lipidomics resulted in the association of visceral adipose tissue (VAT) and exposure to earlier generations of antiretroviral therapy (ART). Our integrative omics data indicated disruption of glutamate and fatty acid metabolism, suggesting their involvement in the pathogenesis of PLWH with MetS. Alterations in the lipid homeostasis and glutaminolysis need clinical interventions to prevent accelerated aging in PLWH with MetS.
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Affiliation(s)
- Sofie Olund Villumsen
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Rui Benfeitas
- National Bioinformatics Infrastructure Sweden (NBIS), Science for Life Laboratory, Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden
| | - Andreas Dehlbæk Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marco Gelpi
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Julie Høgh
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Magda Teresa Thomsen
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Daniel Murray
- Personalized Medicine of Infectious Complications in Immune Deficiency (PERSIMUNE), Rigshospitalet, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ujjwal Neogi
- The Systems Virology Lab, Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, ANA Futura, Stockholm, Sweden
- Manipal Institute of Virology (MIV), Manipal Academy of Higher Education, Manipal, India
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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González-Domenech CM, Plaza-Andrades IJ, Garrido-Sanchez L, Queipo-Ortuño MI. Synergic effect of metabolic syndrome and lipodystrophy on oxidative stress and inflammation process in treated HIV-patients. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30423-7. [PMID: 33494978 DOI: 10.1016/j.eimc.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/03/2022]
Abstract
The aim of this study was to assess the effect of lipodystrophy (LD) associated to metabolic syndrome (MS) on oxidative stress and inflammation in a cohort of 243 HIV-infected patients with MS, all of them under three different antiretroviral regimens. We collected immunovirological, biochemical and metabolic data, as well as anthropometric measurements. In addition, cardiovascular risk was also assessed by means of Atherogenic Index of Plasma (API) and Framingham Risk Score. The MS-LD patient set was characterized by a lower initial lymphocyte CD4 count and CD4/CD8 ratio and a higher initial viral load than the group without LD. We also found worse lipidic and glycaemic profiles (with lower HDL-cholesterol and higher triglyceride and glucose levels) in the MS-LD group. BMI, systolic blood pressure and Framingham score were significantly increased compared to MS-Non LD. In addition, patients with MS and LD had significantly higher levels of carbonylated proteins, lipid peroxidation, IL-6 and IL-8, as well as a significant decrease in the levels of leptin, adiponectin and antioxidant activities of catalase, super oxide dismutase and glutathione associated enzymes. In MS-LD HIV-1 patients, a significant negative correlation was found between Framingham Risk Score and the antioxidant biomarkers, however a positive association was found between API and protein-C reactive and carbonylated proteins. Segregating by ART, the above-mentioned conditions were worse within the MS-LD group whose treatment contained protease inhibitors, such as lopinavir. In conclusion, HIV-1 infected patients treated for at least six months, especially with regimens including PIs, showed a worsening of inflammatory process and oxidative stress.
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Affiliation(s)
| | - Isaac J Plaza-Andrades
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), UMA, Málaga, Spain
| | - Lourdes Garrido-Sanchez
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), UMA, Málaga, Spain.
| | - María Isabel Queipo-Ortuño
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA)-CIMES-UMA, Málaga, Spain
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Vargas-Pacherrez D, Cotrim HP, Pires L, Cunha V, Coelho V, Brites C, Daltro C. Metabolic Syndrome in HIV-patients in Antiretroviral Therapy. Curr HIV Res 2020; 18:388-395. [PMID: 32516101 DOI: 10.2174/1570162x18666200609115615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The global prevalence of metabolic syndrome (MS) among people living with HIV/AIDS varies from 20% to 33%. OBJECTIVE to estimate the prevalence of metabolic syndrome and associated factors in a group of HIV-infected patients on antiretroviral therapy. METHODS This is a cross-sectional study with HIV-infected patients from a reference center in Bahia, Brazil. We evaluated clinical, socio-demographic and anthropometric data. MS was defined according to the guidelines of International Diabetes Federation. RESULTS We evaluated 152 patients with mean age of 47.3±11.6 years, 59.2% male. The main comorbidities detected were diabetes (3.3%) hypertriglyceridemia (9.3%) and metabolic syndrome (MS,38.2%). Patients with MS were predominantly women (55.2% vs 31.9%; p=0.005), older [52.1 (10.4) vs 44.3 (11.3); p<0.001], and had overweight (74.1% vs 23.4%; p<0.001). After multivariate analysis MS remained associated with age (OR = 1.076; 95% CI: 1.030 - 1.125), female sex (OR = 2.452; 95% CI: 1.114 - 5.374) and family history of hypertension (OR = 3.678; 95% CI: 1.431 - 9.395). CONCLUSION Almost half of the HIV-infected patients in Bahia presents with MS which seems to be driven by classical risk factors.
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Affiliation(s)
- Daniel Vargas-Pacherrez
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,Communicable Diseases and Environmental - Pan American Health Organization, Altamira - Caracas 1060, Venezuela
| | - Helma P Cotrim
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Leonardo Pires
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Vitor Cunha
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Vitor Coelho
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Carlos Brites
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,CoBraH Study Group - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Carla Daltro
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,Escola de Nutrição - Universidade Federal da Bahia (UFBA), Bahia, Brazil
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Taramasso L, Bonfanti P, Ricci E, Orofino G, Squillace N, Menzaghi B, De Socio GV, Madeddu G, Pellicanò GF, Pagnucco L, Celesia BM, Calza L, Conti F, Martinelli CV, Valsecchi L, Cascio A, Bolla C, Maggi P, Vichi F, Dentone C, Angioni G, Mastroianni A, Falasca K, Cenderello G, Di Biagio A. Factors Associated With Weight Gain in People Treated With Dolutegravir. Open Forum Infect Dis 2020; 7:ofaa195. [PMID: 32577427 PMCID: PMC7295329 DOI: 10.1093/ofid/ofaa195] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background An unexpected excess in weight gain has recently been reported in the course of dolutegravir (DTG) treatment. The aim of the present study was to investigate whether weight gain differs among different DTG-containing regimens. Methods Adult naïve and experienced people with HIV (PWH) initiating DTG-based antiretroviral therapy (ART) between July 2014 and December 2019 in the Surveillance Cohort Long-Term Toxicity Antiretrovirals (SCOLTA) prospective cohort were included. We used an adjusted general linear model to compare weight change among backbone groups and a Cox proportional hazard regression model to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for weight increases >10% from baseline. Results A total of 713 participants, 25.3% women and 91% Caucasian, were included. Of these, 195 (27.4%) started DTG as their first ART regimen, whereas 518 (72.6%) were ART-experienced. DTG was associated with abacavir/lamivudine in 326 participants, tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in 148, boosted protease inhibitors in 60, rilpivirine in 45, lamivudine in 75, and tenofovir alafenamide (TAF)/FTC in 59. At 6 and 12 months, weight gain was highest among PWH on TDF/FTC+DTG and TAF/FTC+DTG. Baseline CD4 <200 cells/mm3 (HR, 1.84; 95% CI, 1.15 to 2.96), being ART-naïve (HR, 2.24; 95% CI, 1.24 to 4.18), and treatment with TDF/FTC+DTG (HR, 1.92; 95% CI, 1.23 to 2.98) or TAF/FTC+DTG (HR, 3.80; 95% CI, 1.75 to 8.23) were associated with weight gain >10% from baseline. Higher weight (HR, 0.97 by 1 kg; 95% CI, 0.96 to 0.99) and female gender (HR, 0.54; 95% CI, 0.33 to 0.88) were protective against weight gain. Conclusions Naïve PWH with lower CD4 counts and those on TAF/FTC or TDF/FTC backbones were at higher risk of weight increase in the course of DTG-based ART.
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Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Bonfanti
- Infectious Disease Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Elena Ricci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A," Amedeo di Savoia Hospital, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Giuseppe Vittorio De Socio
- Unit of Infectious Diseases, Department of Medicine 2, Azienda Ospedaliera di Perugia, Santa Maria Hospital, Perugia, Italy
| | - Giordano Madeddu
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Francesco Pellicanò
- Department of Human Pathology of the Adult and the Developmental Age "G. Barresi," Unit of Infectious Diseases, University of Messina, Messina, Italy
| | - Layla Pagnucco
- Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Benedetto Maurizio Celesia
- Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Federico Conti
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | | | - Laura Valsecchi
- Infectious Disease Unit (I Divisione), ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Cesare Bolla
- Infectious Diseases Unit, S.Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Chiara Dentone
- Infectious Disease Unit, Sanremo Hospital, Sanremo, Italy
| | | | - Antonio Mastroianni
- Unit of Infectious and Tropical Diseases, St. Annunziata Hospital, Cosenza, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University "G. d"Annunzio' Chieti-Pescara, Chieti, Italy
| | - Giovanni Cenderello
- Infectious Disease Unit, Sanremo Hospital, Sanremo, Italy.,Department of Infectious Diseases, Galliera Hospital, Genova, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
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9
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Zhao D, Ding Y, Lin H, Chen X, Shen W, Gao M, Wei Q, Zhou S, Liu X, He N. Mitochondrial Haplogroups N9 and G Are Associated with Metabolic Syndrome Among Human Immunodeficiency Virus-Infected Patients in China. AIDS Res Hum Retroviruses 2019; 35:536-543. [PMID: 30950284 DOI: 10.1089/aid.2018.0151] [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] [Indexed: 01/15/2023] Open
Abstract
Increasing evidence shows that mitochondrial DNA (mtDNA) variations have an important effect on metabolic disorders, but such studies have not been conducted in HIV-infected patients in Asia. We investigated the distribution of mtDNA haplogroups and their correlation with metabolic disorders in HIV-infected patients. A cross-sectional survey was performed among 296 HIV patients older than the age of 40 years in a rural prefecture, Eastern China. The entire mtDNA sequence was amplified by polymerase chain reaction using four overlapping pairs of primers that have been standardly used. In this sample, mtDNA haplogroups B, D, M7, and F were the most dominant haplogroups. The overall prevalence of metabolic syndrome (MetS) was 36.1%, and was highest (77.8%) among those with haplogroup G and lowest (21.4%) among those with haplogroup M8. In multivariable analysis, haplogroups G and N9 were significantly associated with the presence of MetS [adjusted odds ratio (aOR) = 13.5, 95% confidence interval (CI): 1.9-94.7; aOR = 8.1, 95% CI: 1.8-36.1; respectively]. Moreover, patients with haplogroup G had increased odds of elevated glycated hemoglobin (HbA1c) (aOR = 10.1, 95% CI: 1.4-71.1), patients with haplogroup N9 had increased odds of elevated triglycerides (aOR = 13.5, 95% CI: 2.4-76.8). No significant association between mtDNA haplogroups and other MetS components was observed. Our data demonstrate the association between mtDNA haplogroups and MetS in HIV-infected patients. The Asian-specific mtDNA haplogroups G and N9 may confer higher risk for the development of MetS in HIV-infected patients, which requires further longitudinal investigation.
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Affiliation(s)
- Dan Zhao
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, China
| | - Yingying Ding
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Haijiang Lin
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Taizhou City Center for Disease Control and Prevention, Taizhou, China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention, Taizhou, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Taizhou, China
| | - Meiyang Gao
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Qian Wei
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Sujuan Zhou
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xing Liu
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Na He
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, China
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10
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Liu Y, Foreman SC, Joseph GB, Neumann J, Tien PC, Li X, Lane NE, Nevitt MC, McCulloch CE, Link TM. Is treated HIV infection associated with knee cartilage degeneration and structural changes? A longitudinal study using data from the osteoarthritis initiative. BMC Musculoskelet Disord 2019; 20:190. [PMID: 31054571 PMCID: PMC6500016 DOI: 10.1186/s12891-019-2573-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/15/2019] [Indexed: 12/28/2022] Open
Abstract
Background Metabolic disorders presenting in HIV-infected patients on antiretroviral therapy (ART) may increase the risk of osteoarthritis. However, structural changes of the knee in HIV infected subjects are understudied. The aim of this study is to investigate knee cartilage degeneration and knee structural changes over 8 years in subjects with and without HIV infection determined based on the use of ART. Methods We studied 10 participants from the Osteoarthritis Initiative who received ART at baseline and 20 controls without ART, frequency matched for age, sex, race, baseline body mass index (BMI) and Kellgren & Lawrence grade. Knee abnormalities were assessed using the whole-organ magnetic resonance imaging score (WORMS) and cartilage T2 including laminar and texture analyses were analyzed using a multislice-multiecho spin-echo sequence. Signal abnormalities of the infrapatellar fat pad (IPFP) and suprapatellar fat pad (SPFP) were assessed separately using a semi-quantitative scoring system. Linear regression models were used in the cross-sectional analysis to compare the differences between ART/HIV subjects and controls in T2 (regular and laminar T2 values, texture parameters) and morphologic parameters (subscores of WORMS, scores for signal alterations of IPFP and SPFP). Mixed effects models were used in the longitudinal analysis to compare the rate of change in T2 and morphological parameters between groups over 8 years. Results At baseline, individuals on ART had significantly greater size of IPFP signal abnormalities (P = 0.008), higher signal intensities of SPFP (P = 0.015), higher effusion scores (P = 0.009), and lower subchondral cysts sum scores (P = 0.003) compared to the controls. No significant differences were found between the groups in T2-based cartilage parameters and WORMS scores for cartilage, meniscus, bone marrow edema patterns and ligaments (P > 0.05). Longitudinally, the HIV cohort had significantly higher global knee T2 entropy values (P = 0.047), more severe effusion (P = 0.001) but less severe subchondral cysts (P = 0.002) on average over 8 years. Conclusions Knees of individuals with HIV on ART had a more heterogeneous cartilage matrix, more severe synovitis and abnormalities of the IPFP and SPFP, which may increase the risk of incident knee osteoarthritis. Electronic supplementary material The online version of this article (10.1186/s12891-019-2573-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yao Liu
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA.,Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sarah C Foreman
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Gabby B Joseph
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Jan Neumann
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Phyllis C Tien
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, CA, USA.,Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nancy E Lane
- Department of Internal Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Thomas M Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA.
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11
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Todowede OO, Mianda SZ, Sartorius B. Prevalence of metabolic syndrome among HIV-positive and HIV-negative populations in sub-Saharan Africa-a systematic review and meta-analysis. Syst Rev 2019; 8:4. [PMID: 30606249 PMCID: PMC6317235 DOI: 10.1186/s13643-018-0927-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a constellation of conditions that increase the risk of cardiovascular diseases. It is an emerging concern in sub-Saharan African (SSA) countries, particularly because of an increasingly aging population and lifestyle changes. There is an increased risk of MetS and its components among people living with Human immune deficiency syndrome (HIV) individuals; however, the prevalence of metabolic syndrome in the SSA population and its differential contribution by HIV status is not yet established. This systematic review and meta-analysis were conducted to estimate the pooled prevalence of metabolic syndrome in people living with HIV and uninfected populations, its variation by sub-components. METHODS We performed a comprehensive search on major databases-MEDLINE (PubMed), EBSCOhost, and Cochrane Database of Systematic Reviews and Web of sciences for original epidemiological research articles that compared proportions of the MetS and its subcomponents between people living with HIV and uninfected patients and published between January 1990-December 2017. The inclusion criteria were adults aged ≥ 18 years, with confirmed HIV status. We assessed the risk of bias using a prevalence studies tool, and random effect meta-analyses were used to compute the pooled overall prevalence. RESULTS A total of four cross-sectional studies comprising 496 HIV uninfected and 731 infected participants were included in the meta-analysis. The overall prevalence of MetS among people living with HIV was 21.5% (95% CI 15.09-26.86) versus uninfected 12.0% (95% CI 5.00-21.00%), with substantial heterogeneity. The reported relative risk estimate for MetS among the two groups was twofold (RR 1.83, 95% CI 0.98-3.41), with an estimated predictive interval of 0.15 to 22.43 and P = 0.055 higher for the infected population. Hypertension was the most prevalent MetS sub-components, with diverse proportions of people living with HIV (5.2-50.0%) and uninfected (10.0-59.0%) populations. CONCLUSIONS The high range of MetS prevalence in the HIV-infected population compared to the uninfected population highlights the possible presence of HIV related drivers of MetS. Also, the reported high rate of MetS, irrespective of HIV status, indicates a major metabolic disorder epidemic that requires urgent prevention and management programs in SSA. Similarly, in the era of universal test and treat strategy among people living with HIV cohorts, routine check-up of MetS sub-components is required in HIV management as biomarkers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016045727.
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Affiliation(s)
- Olamide O Todowede
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
| | - Solange Z Mianda
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Benn Sartorius
- Department of 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
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12
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Abrahams Z, Maartens G, Levitt N, Dave J. Anthropometric definitions for antiretroviral-associated lipodystrophy derived from a longitudinal South African cohort with serial dual-energy X-ray absorptiometry measurements. Int J STD AIDS 2018; 29:1194-1203. [PMID: 29945538 DOI: 10.1177/0956462418778649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of lipodystrophy is associated with the long-term use of antiretroviral therapy (ART). We assessed agreement between patient-reported lipodystrophy and body composition measures using dual-energy X-ray absorptiometry (DXA) and developed objective measures to define lipoatrophy and lipohypertrophy in black South Africans. One hundred and eighty-seven ART-naïve HIV-infected adults were enrolled in a 24-month longitudinal study. Self-reported information on regional fat loss and fat gain, anthropometry, and DXA measures were collected at baseline, three, six, 12, 18, and 24 months after starting ART. Receiver operating characteristic curves were used to describe the performance of anthropometric variables using change in limb and trunk fat measured by DXA, as the reference standard. The proportion of men and women who developed lipoatrophy and lipohypertrophy increased over the 24-month period, with lipoatrophy occurring more frequently in men (21% versus 10%). In women, lipoatrophy was best determined by thigh skinfold thickness (80.3% correctly classified) and mid-arm circumference (77.6% correctly classified). None of the anthropometric measures performed well for defining lipoatrophy in men. Anthropometric measures performed well for defining lipoatrophy in women, but not lipohypertrophy.
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Affiliation(s)
- Zulfa Abrahams
- 1 Department of Medicine, Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- 2 Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Naomi Levitt
- 1 Department of Medicine, Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa
| | - Joel Dave
- 1 Department of Medicine, Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa
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13
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Beires MT, Silva-Pinto A, Santos AC, Madureira AJ, Pereira J, Carvalho D, Sarmento A, Freitas P. Visceral adipose tissue and carotid intima-media thickness in HIV-infected patients undergoing cART: a prospective cohort study. BMC Infect Dis 2018; 18:32. [PMID: 29325542 PMCID: PMC5765644 DOI: 10.1186/s12879-017-2884-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/05/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Combined antiretroviral therapy (cART) in HIV-infected patients has been associated with lipodystrophy, metabolic abnormalities, and an increased risk of cardiovascular disease. Ultrasound measures of carotid artery intima-media thickness (cIMT) have been used as a valid measure of subclinical atherosclerosis and as a tool to predict the risk of cardiovascular events. Our aim was to evaluate the progression of cIMT in HIV-infected patients subjected to cART, with and without lipodystrophy, over a one-year period. METHODS We performed a one-year prospective cohort study to compare changes in cIMT, metabolic and inflammation markers in HIV-infected patients undergoing cART. Body composition was assessed by dual-energy X-ray absorptiometry (DXA) and abdominal computed tomography (CT). Levels of blood pressure, lipids and inflammatory markers were evaluated, as well as ultrasound measures of cIMT. Lipodystrophy defined by Fat Mass Ratio (L-FMR) is measured as the ratio of the percentage of trunk fat mass to the percentage of lower limb fat mass by DXA. Categorical variables were compared, using the chi-square or Fisher's exact test. Wilcoxon ranks tests and the McNemar chi-square tests were used to compare results of selected variables, from the first to the second year of evaluation. Means of cIMT, adjusted for age, glucose, triglycerides levels, systolic blood pressure (SBP), and waist to hip ratio were calculated, using generalised linear models for repeated measures. RESULTS L-FMR was present in 44.3% of patients, and the mean of cIMT increased significantly in this group [0.82 (0.26) vs 0.92 (0.33); p = 0.037], as well as in patients without lipodystrophy [0.73 (0.20) vs 0.84 (0.30); p = 0.012]. In the overall sample, the progression of cIMT was statistically significant after the adjustment for age, glucose, triglycerides, and SBP, but the significance of the progression ceased after the adjustment for waist/hip ratio [0.770 (0.737-0.803) vs 0.874 (0.815-0.933); p = 0.514]. CONCLUSIONS Carotid IMT progressed significantly in both groups of this HIV-infected cohort, however no association between the progression of cIMT and the presence of lipodystrophy defined by FMR was found. Visceral adipose tissue had an impact on the increment of cIMT, both in patients with, and without lipodystrophy defined by FMR.
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Affiliation(s)
- Maria Teresa Beires
- Faculty of Medicine, University of Porto. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - André Silva-Pinto
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
- Renal, Urological and Infectious Diseases Department, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - António José Madureira
- Radiology Department, Hospital de São João and University of Porto Medical School, Porto, Portugal
| | - Jorge Pereira
- Nuclear Medicine Department, Hospital de São João, Porto, Portugal
| | - Davide Carvalho
- Endocrinology Department, Hospital de São João and University of Porto Medical School, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
- Renal, Urological and Infectious Diseases Department, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Paula Freitas
- Endocrinology Department, Hospital de São João and University of Porto Medical School, Porto, Portugal
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14
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Neves JS, Guerreiro V, Carvalho D, Serrão R, Sarmento A, Freitas P. Metabolically Healthy or Metabolically Unhealthy Obese HIV-Infected Patients: Mostly a Matter of Age? Front Endocrinol (Lausanne) 2018; 9:681. [PMID: 30505292 PMCID: PMC6250744 DOI: 10.3389/fendo.2018.00681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/30/2018] [Indexed: 12/27/2022] Open
Abstract
Background: Life expectancy of HIV-infected patients has increased with antiretroviral treatment (ART). Chronic diseases associated with aging, including metabolic and cardiovascular diseases are becoming more prevalent in this population. We aimed to evaluate the association of obesity and aging with cardiometabolic comorbidities and metabolic health status among patients with HIV infection. Methods: We evaluated 580 HIV-1 infected patients (71.7% male, mean age of 47.7 ± 11.5 years). We analyzed the association of age and obesity (defined by and by central obesity) with gender, duration of HIV infection, and ART, anthropometric parameters, cardiometabolic comorbidities, Framingham risk score (FRS), blood pressure, lipid profile, uric acid, liver biochemical tests, and glycemic profile. Furthermore, we analyzed the above-mentioned associations according to the category and central obesity into the metabolically healthy (MH) and unhealthy (MUH) categories. To evaluate the association of anthropometric parameters with cardiometabolic comorbidities, we performed unadjusted and adjusted logistic regression models. Results: The prevalence of excessive weight and cardiometabolic comorbidities increased with age. Patients with normal weight were younger and there was a higher proportion of female patients in the obesity group. The prevalence of hypertension and metabolic syndrome were higher among patients who were overweight or with obesity. The FRS was higher among patients with obesity. The proportion of MUH patients was higher among patients with excessive weight and central obesity. MUH patients had more cardiometabolic comorbidities and a higher FRS. In the normal weight group, MUH patients were older, and in the obesity group they were more likely to be male. The anthropometric parameter most associated with metabolic syndrome was waist circumference and that most associated with hypertension was waist-to-height ratio. The anthropometric parameter most associated with diabetes and FRS was waist-to-hip ratio. Conclusion: Patients with HIV present a high prevalence of obesity and related comorbidities. Ageing significantly contributes to metabolic dysfunction in this population. The proportion of MUH patients is higher among groups with excessive weight and central obesity, with those patients presenting a higher cardiovascular risk. Our results highlight the importance of evaluating and addressing obesity in patients with HIV, as well as metabolic comorbidities and cardiovascular risk.
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Affiliation(s)
- João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- *Correspondence: João Sérgio Neves
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Rosário Serrão
- Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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15
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Grenha I, Oliveira J, Lau E, Santos AC, Sarmento A, Pereira J, Carvalho D, Freitas P. HIV-Infected Patients With and Without Lipodystrophy Under Combined Antiretroviral Therapy: Evaluation of Body Composition. J Clin Densitom 2018; 21:75-82. [PMID: 28034590 DOI: 10.1016/j.jocd.2016.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/23/2016] [Accepted: 07/27/2016] [Indexed: 11/21/2022]
Abstract
In HIV-infected patients, combined antiretroviral therapy (cART) is associated to adipose tissue redistribution known as lipodystrophy and associated cardiometabolic risk. This study aimed to evaluate the evolution of body composition in HIV-infected patients, with and without lipodystrophy, over 2 yr. We evaluated anthropometric parameters and body composition by whole-body dual-energy X-ray absorptiometry in 144 HIV-infected patients on cART. We defined lipodystrophy by fat mass ratio. Lipodystrophy was present in 45.77% of the patients. These patients presented higher HIV infection duration, cART duration, and CD4+ cell count, with no differences regarding gender, age, body mass index, and viral load. Patients with lipodystrophy showed an increase in total fat mass (9.9%) and upper-limbs fat mass (17.6%), with a decrease in total, trunk, and lower-limbs fat-free mass (2.2%; 2.2%, and 3.9%, respectively), over 2 yr. In patients without lipodystrophy, the trunk fat-free mass decreased 1.9% over time, and no changes were observed in the other studied parameters. In patients with lipodystrophy, there was predominantly a central fat mass gain, with no changes in lower limbs, suggesting that peripheral adipocytes lose their regenerative capacity.
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Affiliation(s)
- Inês Grenha
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Faculty of Medicine, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
| | - Joana Oliveira
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Faculty of Medicine, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Eva Lau
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Faculty of Medicine, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Ana Cristina Santos
- Clinical Epidemiology, Predictive Medicine and Public Health Department, Faculty of Medicine, University of Porto, Porto, Portugal; EPIUNIT-Institute of Public Health of University of Porto, Porto, Portugal
| | - António Sarmento
- Infectious Disease Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jorge Pereira
- Nuclear Medicine Department, Centro Hospitalar São João, Porto, Portugal
| | - Davide Carvalho
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Faculty of Medicine, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Paula Freitas
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Faculty of Medicine, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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16
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Abstract
The metabolic syndrome-otherwise called syndrome X, insulin resistance syndrome, Reaven syndrome, and "the deadly quartet"-is the name given to the aggregate of clinical conditions comprising central and abdominal obesity, systemic hypertension, insulin resistance (or type 2 diabetes mellitus), and atherogenic dyslipidemia. It is a prothrombotic and proinflammatory state characterized by increased inflammatory cytokine activity. In addition to inflammatory dermatoses such as psoriasis, lichen planus, and hidradenitis suppurativa, metabolic syndrome is also commonly associated with accelerated atherosclerotic cardiovascular disease, hyperuricemia/gout, chronic kidney disease, and obstructive sleep apnea. Current therapeutic options for metabolic syndrome are limited to individual treatments for hypertension, hyperglycemia, and hypertriglyceridemia, as well as dietary control measures and regular exercise.
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Affiliation(s)
- Emma McCracken
- Diabetes and Endocrinology, Department of Medicine, South West Acute Hospital, Enniskillen, County Fermanagh, UK
| | - Monica Monaghan
- Cardiology, Department of Medicine, South West Acute Hospital, Enniskillen, County Fermanagh, UK
| | - Shiva Sreenivasan
- Acute and General Medicine, Department of Medicine, South West Acute Hospital, Enniskillen, County Fermanagh, UK; School of Medicine, Dentistry, and Biomedical Sciences, Queen's University, Belfast, UK.
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17
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Akl LD, Valadares ALR, Moraes MJD, Pinto-Neto AM, Lagrutta B, Costa-Paiva L. Metabolic syndrome in HIV-infected middle-aged women on antiretroviral therapy: prevalence and associated factors. Braz J Infect Dis 2017; 21:263-269. [PMID: 28284656 PMCID: PMC9427828 DOI: 10.1016/j.bjid.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/23/2016] [Accepted: 02/21/2017] [Indexed: 01/06/2023] Open
Abstract
Objectives To determine the prevalence of metabolic syndrome (MetS) and its associated factors in a group of HIV-infected middle-aged women. Methods Cross-sectional study including 273 HIV-infected climacteric women of 40–60 years of age under care in two HIV outpatient reference centers in Brazil. Metabolic syndrome diagnosis was based on 2006 International Diabetes Federation criteria. Sociodemographic, clinical and behavioral factors were evaluated as well as HIV infection-related parameters. Results Mean age was 47.7 years; 59.1% of women were premenopausal, 91% were on antiretroviral therapy. Current CD4 count was >500 cells/mm3 in 61.7%, current viral load undetectable in 76.9% of women, and a quarter had previous diagnosis of aids. The prevalence of metabolic syndrome in the subgroup of menopausal women was 46.9%. Univariate analysis showed an association between metabolic syndrome and age ≥50 years (p = 0.002), schooling <8 years (p = 0.003), post-menopause (p < 0.001), body mass index (BMI) >25 kg/m2 (p < 0.001), and FSH ≥40 mIU/mL (p = 0.002). In the multivariate analysis only increased BMI (PR = 1.09; 95% CI: 1.05–1.13; p < 0.001) and FSH levels ≥40 mIU/mL (PR = 1.66; 95% CI: 1.14–2.40; p = 0.008) maintained statistical significance. There was no association between PI use or any other factor related to HIV-infection and MetS in any of the analyses performed. Conclusion High BMI and FSH levels compatible with menopause were the only factors associated with MetS in these middle aged HIV-infected women. In the context of well-controlled, early treated HIV infection, traditional rather than HIV-related factors were associated with MetS.
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Affiliation(s)
- Lívia D Akl
- Hospital Eduardo de Menezes (HEM), Belo Horizonte, MG, Brazil
| | - Ana L R Valadares
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil; Universidade José do Rosário Vellano (Unifenas), Belo Horizonte, MG, Brazil.
| | | | | | - Bianca Lagrutta
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Srdic D, Khawla AM, Soldatovic I, Nikolic J, Jevtovic D, Nair D, Dragovic G. Correlation of Leptin, Adiponectin, and Resistin Levels in Different Types of Lipodystrophy in HIV/AIDS Patients. Metab Syndr Relat Disord 2017; 15:153-159. [PMID: 28339344 DOI: 10.1089/met.2016.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Leptin, adiponectin, and resistin may play an important role in the development of lipodystrophy (LD) in HIV/AIDS patients. The aim of this study was to correlate levels of leptin, adiponectin, and resistin between HIV/AIDS patients with LD and without lipodystrophy (non-LD), as well as between subgroups of LD [lipoatrophy (LA), lipohypertrophy (LH), and mixed fat redistribution (MFR)] and non-LD patients. METHODS Cross-sectional study of 66 HIV/AIDS patients. Serum levels of leptin, adiponectin, and resistin were measured. The associations between adipocytokine levels and metabolic variables were estimated by Spearman correlation. Analysis of covariance with bootstrapping method was used to examine the relationship between adiponectin and leptin and lipodystrophy categories. RESULTS The LD was observed in 29 (44%) patients, while 15 (52%) of them had LA, 4 (14%) had LH, and 10 (34%) patients had MFR. No significant differences regarding leptin, adiponectin, and resistin levels, between LD and non-LD patients, were observed. LH patients had significantly higher levels of leptin and adiponectin in comparison with non-LD patients (P = 0.039, P = 0.011, respectively). Within the LD group, LA patients had significantly lower levels of leptin (LA vs. LH, P = 0.020; LA vs. MFR, P = 0.027), while LH patients had significantly higher levels of adiponectin (LH vs. LA, P = 0.027; LH vs. MFR, P = 0.028). Correlation of adiponectin with LD remains significant in the LH subgroup after adjustment for age, body mass index, cystatin-C, plasminogen activator inhibitor-1 (PAI-1), and interferon gamma (IFN-γ) (P = 0.001). CONCLUSIONS Adiponectin and leptin levels differ significantly between LH patients and non-LD patients, as well as between the LD subgroups. Adiponectin may be a more useful marker of LD in HIV/AIDS patients.
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Affiliation(s)
- Danica Srdic
- 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Al Musalhi Khawla
- 2 Department of Clinical Biochemistry, Royal Free Hospital, University College London , London, United Kingdom
| | - Ivan Soldatovic
- 3 Institute for Biomedical Statistics, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Jelena Nikolic
- 4 Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Djordje Jevtovic
- 4 Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Devaki Nair
- 2 Department of Clinical Biochemistry, Royal Free Hospital, University College London , London, United Kingdom
| | - Gordana Dragovic
- 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade , Belgrade, Serbia
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Resveratrol Co-Treatment Attenuates the Effects of HIV Protease Inhibitors on Rat Body Weight and Enhances Cardiac Mitochondrial Respiration. PLoS One 2017; 12:e0170344. [PMID: 28107484 PMCID: PMC5249196 DOI: 10.1371/journal.pone.0170344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022] Open
Abstract
Since the early 1990s human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) emerged as a global health pandemic, with sub-Saharan Africa the hardest hit. While the successful roll-out of antiretroviral (ARV) therapy provided significant relief to HIV-positive individuals, such treatment can also elicit damaging side-effects. Here especially HIV protease inhibitors (PIs) are implicated in the onset of cardio-metabolic complications such as type-2 diabetes and coronary heart disease. As there is a paucity of data regarding suitable co-treatments within this context, this preclinical study investigated whether resveratrol (RSV), aspirin (ASP) or vitamin C (VitC) co-treatment is able to blunt side-effects in a rat model of chronic PI exposure (Lopinavir/Ritonavir treatment for 4 months). Body weights and weight gain, blood metabolite levels (total cholesterol, HDL, LDL, triglycerides), echocardiography and cardiac mitochondrial respiration were assessed in PI-treated rats ± various co-treatments. Our data reveal that PI treatment significantly lowered body weight and cardiac respiratory function while no significant changes were found for heart function and blood metabolite levels. Moreover, all co-treatments ameliorated the PI-induced decrease in body weight after 4 months of PI treatment, while RSV co-treatment enhanced cardiac mitochondrial respiratory capacity in PI-treated rats. This pilot study therefore provides novel hypotheses regarding RSV co-treatment that should be further assessed in greater detail.
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Naidu S, Ponnampalvanar S, Kamaruzzaman SB, Kamarulzaman A. Prevalence of Metabolic Syndrome Among People Living with HIV in Developing Countries: A Systematic Review. AIDS Patient Care STDS 2017; 31:1-13. [PMID: 28051897 DOI: 10.1089/apc.2016.0140] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Metabolic syndrome (MS) is a group of components associated with cardiovascular disease and type 2 diabetes mellitus. The prevalence of MS in the HIV population is increasing in epidemic proportions globally. However, the magnitude and characteristics of MS are not fully elucidated in developing countries. The aim of this systematic review was to assess the prevalence of MS and its components among people living with HIV (PLWH) in developing countries. Searches were carried out in MEDLINE, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, other web sources, and by hand search. Articles were restricted to English language studies reporting on the prevalence of MS among PLWH in developing countries. Eighteen articles were included in the review. The studies were divided into Africa, South America, and Asia regions. The most frequent criterion used in the review was the National Cholesterol Education Program: Adult Treatment Program III 2001 definition. The prevalence of MS among PLWH ranged from 8.4% to 47% across the developing regions and comparable to the overall prevalence across the developed regions (7.8-52.2%). The mean prevalence was 30.5%, 21.5%, and 21.4% in Africa, Asia, and South America, respectively. The most frequent component observed was low high-density lipoprotein cholesterol (50.1%). This systematic review provides an essential overview on the distribution of MS in the HIV population across the developing regions. As these prevalences were comparably high in the developed regions, this review highlights the need for more robust research in developing countries.
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Affiliation(s)
- Sivaraj Naidu
- Center of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sasheela Ponnampalvanar
- Center of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Division of Geriatric, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Center of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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21
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Martin-Iguacel R, Negredo E, Peck R, Friis-Møller N. Hypertension Is a Key Feature of the Metabolic Syndrome in Subjects Aging with HIV. Curr Hypertens Rep 2016; 18:46. [PMID: 27131801 PMCID: PMC5546311 DOI: 10.1007/s11906-016-0656-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With widespread and effective antiretroviral therapy, the life expectancy in the HIV population has dramatically improved over the last two decades. Consequently, as patients are aging with HIV, other age-related comorbidities, such as metabolic disturbances and cardiovascular disease (CVD), have emerged as important causes of morbidity and mortality. An overrepresentation of traditional cardiovascular risk factors (RF), toxicities associated with long exposure to antiretroviral therapy, together with residual chronic inflammation and immune activation associated with HIV infection are thought to predispose to these metabolic complications and to the excess risk of CVD observed in the HIV population. The metabolic syndrome (MS) represents a clustering of RF for CVD that includes abdominal obesity, hypertension, dyslipidemia and insulin resistance. Hypertension is a prevalent feature of the MS in HIV, in particular in the aging population, and constitutes an important RF for CVD. Physicians should screen their patients for metabolic and cardiovascular risk at the regular visits to reduce MS and the associated CVD risk among people aging with HIV, since many of RF are under-diagnosed and under-treated conditions. Interventions to reduce these RF can include lifestyle changes and pharmacological interventions such as antihypertensive and lipid-lowering therapy, and treatment of glucose metabolism disturbances. Changes in antiretroviral therapy to more metabolic neutral antiretroviral drugs may also be considered.
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Affiliation(s)
- Raquel Martin-Iguacel
- Infectious Diseases Department, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark.
| | - Eugènia Negredo
- "Lluita contra la SIDA" Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - Robert Peck
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Nina Friis-Møller
- Infectious Diseases Department, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark
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22
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Nguyen KA, Peer N, Mills EJ, Kengne AP. A Meta-Analysis of the Metabolic Syndrome Prevalence in the Global HIV-Infected Population. PLoS One 2016; 11:e0150970. [PMID: 27008536 PMCID: PMC4805252 DOI: 10.1371/journal.pone.0150970] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/22/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cardio-metabolic risk factors are of increasing concern in HIV-infected individuals, particularly with the advent of antiretroviral therapy (ART) and the subsequent rise in longevity. However, the prevalence of cardio-metabolic abnormalities in this population and the differential contribution, if any, of HIV specific factors to their distribution, are poorly understood. Therefore, we conducted a systematic review and meta-analysis to estimate the global prevalence of metabolic syndrome (MS) in HIV-infected populations, its variation by the different diagnostic criteria, severity of HIV infection, ART used and other major predictive characteristics. METHODS We performed a comprehensive search on major databases for original research articles published between 1998 and 2015. The pooled overall prevalence as well as by specific groups and subgroups were computed using random effects models. RESULTS A total of 65 studies across five continents comprising 55094 HIV-infected participants aged 17-73 years (median age 41 years) were included in the final meta-analysis. The overall prevalence of MS according to the following criteria were: ATPIII-2001:16.7% (95%CI: 14.6-18.8), IDF-2005: 18% (95%CI: 14.0-22.4), ATPIII-2004-2005: 24.6% (95%CI: 20.6-28.8), Modified ATPIII-2005: 27.9% (95%CI: 6.7-56.5), JIS-2009: 29.6% (95%CI: 22.9-36.8), and EGIR: 31.3% (95%CI: 26.8-36.0). By some MS criteria, the prevalence was significantly higher in women than in men (IDF-2005: 23.2% vs. 13.4, p = 0.030), in ART compared to non-ART users (ATPIII-2001: 18.4% vs. 11.8%, p = 0.001), and varied significantly by participant age, duration of HIV diagnosis, severity of infection, non-nucleoside reverse transcriptase inhibitors (NNRTIs) use and date of study publication. Across criteria, there were significant differences in MS prevalence by sub-groups such as in men, the Americas, older publications, regional studies, younger adults, smokers, ART-naïve participants, NNRTIs users, participants with shorter duration of diagnosed infection and across the spectrum of HIV severity. Substantial heterogeneities across and within criteria were not fully explained by major study characteristics, while evidence of publication bias was marginal. CONCLUSIONS The similar range of MS prevalence in the HIV-infected and general populations highlights the common drivers of this condition. Thus, cardio-metabolic assessments need to be routinely included in the holistic management of the HIV-infected individual. Management strategies recommended for MS in the general population will likely provide similar benefits in the HIV-infected.
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Affiliation(s)
- Kim A Nguyen
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Medeiros DCD, Galvão HA, Melo JPD, Medeiros RCDSCD, Silva TALD, Medeiros JAD, Silva CGS, Sousa ECD, Dantas PMS. SOMATÓTIPO E IMAGEM CORPORAL EM PESSOAS VIVENDO COM HIV/AIDS. REV BRAS MED ESPORTE 2016. [DOI: 10.1590/1517-869220162201137961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Introdução: A terapia antirretroviral de alta atividade (HAART) está associada ao surgimento de diversos efeitos adversos na população com HIV/Aids, dentre as quais, a lipodistrofia. Caracterizada pela reorganização anormal de gordura pelo corpo, é um dos efeitos mais relevantes, envolvendo riscos cardiometabólicos e prejuízos na imagem corporal. Objetivo: Analisar a somatotipia e a imagem corporal em pessoas vivendo com HIV/AIDS. Métodos: A amostra foi composta por cinco mulheres (47,8 ± 6,53 anos) em uso da HAART e fisicamente ativas. Foi realizada uma intervenção com o treinamento concorrente e aconselhamento dietético e avaliou-se a conformação corporal pelo somatótipo e a imagem corporal pela escala de silhuetas. Resultados: Não houve diferença na classificação do somatótipo, entretanto, os resultados apontaram diferença significativa para a análise da distância de dispersão entre somatótipos (DDS) na 1ª semana (DDS = 2,63) e 16ª semana de intervenção (DDS = 2,96), quando avaliado pelas médias; e quando avaliado individualmente, verificou-se diferença significativa tanto na DDS quanto na distância espacial entre somatótipos (DES) nos casos 1, na 8ª semana (DDS = 3,20 e DES = 1,01) e 16.a semana (DDS = 2,73); e caso 3, na 1ª semana (DDS = 9,25 e DES = 1,44) e 16ª semana (DDS = 8,06 e DES = 1,37). Quanto à imagem corporal, observou-se a aproximação da imagem atual à imagem ideal (imagem atual inicial = 6; imagem atual final = 5; e imagem ideal inicial e final = 3). Conclusão: O programa de treinamento concorrente associado à orientação nutricional produziu resultados positivos tanto no somatótipo quanto na percepção da imagem corporal das participantes, comprovando sua eficácia no controle da lipodistrofia e na satisfação da imagem corporal do grupo avaliado.
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Guira O, Tiéno H, Diendéré AE, Sagna Y, Diallo I, Yaméogo B, Zoungrana L, Yaméogo TM, Bognounou R, Drabo JY. Features of Metabolic Syndrome and Its Associated Factors during Highly Active Antiretroviral Therapy in Ouagadougou (Burkina Faso). J Int Assoc Provid AIDS Care 2015; 15:159-63. [PMID: 26307211 DOI: 10.1177/2325957415601503] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To study the features of metabolic syndrome (MS) and its associated factors during highly active antiretroviral therapy (HAART), in Ouagadougou. METHODS It was a cross-sectional study from March to November 2011 in Yalgado Ouédraogo hospital. A nonprobability sample of adults receiving antiretroviral drugs for at least 6 months was studied. Pregnancy, ascites, or abdominal mass were noninclusion criteria. Metabolic syndrome met the criteria of International Diabetes Federation 2005. RESULTS The authors studied 300 patients. Metabolic syndrome was diagnosed in 54 (18%) patients: mean age 44.8 ± 7.4 years, sex ratio 0.17, and mean duration of HAART 71 ± 30.9 months. The current anomaly of MS was low high-density lipoprotein (HDL)-cholesterol in 37 patients (68.5%), and the common profile of MS was high waist circumference + low HDL-cholesterol + abnormal blood pressure (29.6%). Associated factors were protease inhibitor regimens (P = .000), female gender (P = .004), age > 42 years (P = .001), and lipodystrophy (P = .01). CONCLUSION Cardiovascular risks should be regarded during the care of HIV-infected patients.
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Affiliation(s)
- Oumar Guira
- Unité de formation et de recherche en sciences de la santé, Université de Ouagadougou, Ouagadougou, Burkina Faso Service de médecine interne, Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Hervé Tiéno
- Unité de formation et de recherche en sciences de la santé, Université de Ouagadougou, Ouagadougou, Burkina Faso Service de médecine interne, Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Arnaud Eric Diendéré
- Service de médecine interne, Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Yempabou Sagna
- Service de médecine interne, Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Ismael Diallo
- Unité de formation et de recherche en sciences de la santé, Université de Ouagadougou, Ouagadougou, Burkina Faso Service de médecine interne, Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Bertille Yaméogo
- Service de médecine interne, Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Lassané Zoungrana
- Service de médecine interne, Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | | | - Réné Bognounou
- Service de médecine interne, Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Joseph Youssouf Drabo
- Unité de formation et de recherche en sciences de la santé, Université de Ouagadougou, Ouagadougou, Burkina Faso Service de médecine interne, Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Belo S, Santos AC, Madureira A, Pereira J, Sarmento A, Carvalho D, Freitas P. IL-4 and IL-6 levels and adipose tissue distribution in HIV-1 patients under antiretroviral therapy. J Endocrinol Invest 2015; 38:779-84. [PMID: 25722225 DOI: 10.1007/s40618-015-0256-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 02/06/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Combined antiretroviral therapy (cART) for the treatment of HIV-1 infection has been associated with complications, including lipodystrophy. Several interleukins have been implicated in the pathology and physiology of lipodystrophy. The present study aimed to compare the levels of IL-4 and IL-6 in HIV-1 patients under cART with and without, clinically and fat mass ratio defined, lipodystrophy and in four different groups of fat distribution: (1) no lipodystrophy; (2) isolated central fat accumulation; (3) isolated lipoatrophy and (4) mixed forms of lipodystrophy. METHODS In the present cross-sectional study we evaluated IL-4 and IL-6 levels, insulin resistance and insulin sensitivity indexes in 86 HIV-infected adults under cART. RESULTS No significant differences in IL-4 and IL-6 levels between the four groups of body composition were observed. Patients with HOMA-IR >4 presented higher levels of IL-6 and lower levels of IL-4, although without statistical significance. No correlation between IL-6, or IL-4, HOMA-IR and quantitative body fat mass distribution was found. CONCLUSION Although there was a tendency for patients with isolated lipoatrophy and isolated fat accumulation to present higher IL-6 levels, these differences were not statistically significant. No differences were found relating IL-4 levels.
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Affiliation(s)
- S Belo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, 4200, Portugal.
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
| | - A C Santos
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
| | - A Madureira
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- Department of Radiology, Centro Hospitalar de São João, Porto, Portugal.
| | - J Pereira
- Department of Nuclear Medicine, Centro Hospitalar de São João, Porto, Portugal.
| | - A Sarmento
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- Department of Infectious Diseases, Centro Hospitalar de São João, Porto, Portugal.
| | - D Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, 4200, Portugal.
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
| | - P Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, 4200, Portugal.
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
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Drelichowska J, Kwiatkowska W, Knysz B, Witkiewicz W. Metabolic syndrome in HIV-positive patients. HIV & AIDS REVIEW 2015. [DOI: 10.1016/j.hivar.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ramírez-Marrero FA, Santana-Bagur JL, Joyner MJ, Rodríguez-Zayas J, Frontera W. Metabolic syndrome in relation to cardiorespiratory fitness, active and sedentary behavior in HIV+ Hispanics with and without lipodystrophy. PUERTO RICO HEALTH SCIENCES JOURNAL 2014; 33:163-169. [PMID: 25563033 PMCID: PMC4329015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Hispanics in Puerto Rico (PR) have a high prevalence of metabolic syndrome (met-syn), partially explained by low physical activity (PA) and possibly low cardiorespiratory fitness (VO2peak). Met-syn is also associated with lipodystrophy in HIV infected (HIV+) adults taking antiretroviral therapies. However, associations between met-syn, VO2peak, PA, sedentary behavior and lipodystrophy among HIV+ Hispanics have not been adequately reported. We tested the following hypotheses: 1) HIV+ Hispanics with lipodystrophy (HIV-Lipo) would have a higher prevalence of met-syn, lower VO2peak and PA, and higher sedentary behavior compared with those without lipodystrophy (HIV-no-Lipo) and without HIV infection (Non-HIV); and 2) met-syn would be inversely associated with VO2peak and PA, and directly associated with sedentary behavior. METHODS Ninety Hispanic adults (32 HIV-Lipo, 28 HIV-no-Lipo, 30 Non-HIV) completed measurements of VO2,peak, anthropometry, PA and sedentary behavior with accelerometry, blood pressure, fasting glucose, insulin, and lipids. ANOVA and chi-square tests were used to detect differences between groups, and regression analyses to test associations between variables. RESULTS More HIV-Lipo (69%) had met-syn compared with HIV-no-Lipo (39%) and Non-HIV (37%) (P = 0.002). Sedentary behavior and PA were not different, but VO2peak differed between all groups: lowest in HIV-Lipo and highest in non-HIV. PA and sedentary behavior were not associated with met-syn, but PA was directly associated with VO2peak (R2 = 0.26, p < 0.01). Also, a lower odds ratio for met-syn was observed with higher VO2peak (0.87; 95% CI: 0.83-0.95). CONCLUSION Met-syn is related to lipodystrophy in HIV+ Hispanics in PR, and high VO2peak may protect against met-syn in this population.
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Abstract
HIV infection and its treatment have been associated with adipose tissue changes and disorders of glucose and lipid metabolism. The proportion of HIV-infected adults over the age of 50 is also growing placing HIV-infected adults at particular risk for metabolic perturbations and cardiovascular disease. The metabolic syndrome in HIV-infected adults has been increasingly studied but whether HIV is associated with greater risk remains unclear, likely because of the interplay of host, viral and antiretroviral factors that are associated with the components of the metabolic syndrome. The relationship between HIV and diabetes mellitus (DM) risk has also been debated. While the Framingham Risk Score is a well-accepted measure of 10-year cardiovascular risk in the general population, it may not accurately predict risk in the HIV setting due to HIV-related factors such as inflammation that are not accounted for. We summarize the recent literature on metabolic syndrome, DM, and cardiovascular risk in HIV-infected adults.
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Affiliation(s)
- Linda Nix
- Department of Clinical Pharmacy, University of California, San Francisco, Northern California Institute for Research and Education, San Francisco, UCSF Box 1352, 405 Irving Street, Room 101, San Francisco, CA 94122
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco, Medical Service, Department of Veterans Affairs Medical Center, San Francisco, 4150 Clement Street, 111W, San Francisco, CA 94121, , p: 415-221-4810 f: 415-379-5523
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Abrahams Z, Dave JA, Maartens G, Lesosky M, Levitt NS. The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings. AIDS Res Ther 2014; 11:26. [PMID: 25143778 PMCID: PMC4138415 DOI: 10.1186/1742-6405-11-26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Lipohypertrophy does not appear to be an adverse ART reaction while lipoatrophy is clearly associated with the use of stavudine (d4T) and zidovudine (AZT). In low and middle income countries d4T has only recently been phased out and AZT is still widely being used. Several case definitions have been developed to diagnose lipodystrophy, but none of them are generalizable to sub-Saharan Africa where black women have less visceral adipose tissue and more subcutaneous adipose tissue than white women. We aimed to develop a simple, objective measure to define lipoatrophy and lipohypertrophy by comparing patient report to anthropometric and dual-energy X-ray absorptiometry (DXA) -derived variables. Methods DXA and anthropometric measures were obtained in a cross sectional sample of black HIV-infected South African men (n = 116) and women (n = 434) on ART. Self-reported information on fat gain or fat loss was collected using a standard questionnaire. Receiver operating characteristic (ROC) curves were used to describe the performance of anthropometric and DXA-derived variables using patient reported lipoatrophy and lipohypertrophy as the reference standard. Results Lipoatrophy and lipohypertrophy were more common in women (25% and 33% respectively) than in men (10% and 13% respectively). There were insufficient numbers of men with DXA scans for meaningful analysis. The best predictors of lipoatrophy in women were the anthropometric variables tricep (AUC = 0.725) and thigh skinfold (AUC =0.720) thicknesses; and the DXA-derived variables percentage lower limb fat (AUC = 0.705) and percentage lower limb fat/height (AUC = 0.713). The best predictors of lipohypertrophy in women were the anthropometric variable waist/hip ratio (AUC = 0.645) and the DXA-derived variable percentage trunk fat/percentage limb fat (AUC = 0.647). Conclusions We were able to develop simple, anthropometric measures for defining lipoatrophy and lipohypertrophy, using a sample of black HIV-infected South African women with DXA scans. This is of particular relevance in resource limited settings, where health professionals need simple and inexpensive methods of diagnosing patients with lipoatrophy and lipohypertrophy.
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Freitas P, Carvalho D, Santos AC, Madureira AJ, Martinez E, Pereira J, Sarmento A, Medina JL. Carotid intima media thickness is associated with body fat abnormalities in HIV-infected patients. BMC Infect Dis 2014; 14:348. [PMID: 24958511 PMCID: PMC4087129 DOI: 10.1186/1471-2334-14-348] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 06/13/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV-infected patients may be at increased risk of cardiovascular (CV) events, and lipodystrophy is generally associated with proatherogenic metabolic disturbances. Carotid intima-media thickness (cIMT) has been used as a surrogate marker for atherosclerosis and it has been shown to be an independent risk factor for CV disease. Our objective was to evaluate cIMT in HIV-infected patients on combined anti-retroviral therapy (cART) with and without lipodystrophy defined by fat mass ratio (L-FMR), and to determine the association of lipodystrophy and visceral obesity [(visceral (VAT), subcutaneous adipose tissue (SAT) volume and VAT/SAT ratio, objectively evaluated by CT scan] with cIMT. METHODS Cross-sectional study of 199 HIV-infected patients. Body composition by DXA and abdominal CT, lipids, blood pressure, inflammatory markers, and cIMT by ultrasonography were performed. L-FMR was defined as the ratio of the percentage of trunk fat mass to the percentage of lower limb fat mass by DXA. Categorical variables were compared using the chi-square or Fisher's exact test. Spearman correlation coefficients were estimated to study the association between cIMT and clinical and metabolic characteristics. Means of cIMT, adjusted for age, were calculated, using generalized linear models. RESULTS L-FMR was present in 41.2% of patients and cIMT was higher in these patients [0.81 (0.24) vs. 0.76 (0.25); p=0.037)]. Lipodystrophic patients had higher VAT and VAT/SAT ratio and lower SAT. cIMT was associated with lipodystrophy evaluated by FMR, trunk fat, total abdominal fat, VAT and VAT/SAT ratio. No association was observed between cIMT and leg fat mass. Using generalized linear models, cIMT means were adjusted for age and no significant differences remained after this adjustment. The adjusted mean of cIMT was 0.787 (95%CI: 0.751-0.823) in patients without lipodystrophy, and 0.775 (95%CI: 0.732-0.817) in those with lipodystrophy (p=0.671). CONCLUSIONS HIV-infected patients on cART with lipodystrophy defined by FMR, had a significantly higher cIMT. Carotid IMT was also associated with classical cardiovascular risk factors. In these patients, visceral adipose tissue had a significant impact on cIMT, although age was the strongest associated factor.
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Affiliation(s)
- Paula Freitas
- Endocrinology Department, Hospital de São João and University of Porto Medical School, Alameda Hernâni Monteiro, Porto 4200, Portugal
| | - Davide Carvalho
- Endocrinology Department, Hospital de São João and University of Porto Medical School, Alameda Hernâni Monteiro, Porto 4200, Portugal
| | - Ana Cristina Santos
- Hygiene and Epidemiology Department, University of Porto Medical School, Porto, Portugal
- University of Porto Institute of Public Health, Porto, Portugal
| | - António José Madureira
- Radiology Department, Hospital de São João and University of Porto Medical School, Porto, Portugal
| | - Esteban Martinez
- Department of Infectious Diseases, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Jorge Pereira
- Nuclear Medicine Department, Hospital de São João l, Porto, Portugal
| | - António Sarmento
- Infectious Disease Department, Hospital de São João and University of Porto Medical School, Porto, Portugal
| | - José Luís Medina
- Endocrinology Department, Hospital de São João and University of Porto Medical School, Alameda Hernâni Monteiro, Porto 4200, Portugal
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Freitas P, Carvalho D, Santos AC, Madureira AJ, Martinez E, Pereira J, Sarmento A, Medina JL. Adipokines, hormones related to body composition, and insulin resistance in HIV fat redistribution syndrome. BMC Infect Dis 2014; 14:347. [PMID: 24958357 PMCID: PMC4079215 DOI: 10.1186/1471-2334-14-347] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 06/13/2014] [Indexed: 01/11/2023] Open
Abstract
Background Lipodystrophies are characterized by adipose tissue redistribution, insulin resistance (IR) and metabolic complications. Adipokines and hormones related to body composition may play an important role linking these alterations. Our aim was to evaluate adipocyte-derived hormones (adiponectin, leptin, resistin, TNF-α, PAI-1) and ghrelin plasma levels and their relationship with IR in HIV-infected patients according to the presence of lipodystrophy and fat redistribution. Methods Anthropometric and metabolic parameters, HOMA-IR, body composition by DXA and CT, and adipokines were evaluated in 217 HIV-infected patients on cART and 74 controls. Fat mass ratio defined lipodystrophy (L-FMR) was defined as the ratio of the percentage of the trunk fat mass to the percentage of the lower limb fat mass by DXA. Patient’s fat redistribution was classified into 4 different groups according the presence or absence of either clinical lipoatrophy or abdominal prominence: no lipodystrophy, isolated central fat accumulation (ICFA), isolated lipoatrophy and mixed forms (MXF). The associations between adipokines levels and anthropometric, metabolic and body composition were estimated by Spearman correlation. Results Leptin levels were lower in patients with FMR-L and isolated lipoatrophy, and higher in those with ICFA and MXF. Positive correlations were found between leptin and body fat (total, trunk, leg, arm fat evaluated by DXA, and total, visceral (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio evaluated by CT) regardless of FMR-L, and with HOMA-IR only in patients with FMR-L. Adiponectin correlated negatively with VAT, and its mean levels were lower in patients with ICFA and higher in those with no lipodystrophy. Resistin was not correlated with adipose tissue but positively correlated with HOMA-IR in FMR-L patients. PAI-1 levels were higher in MXF-patients and their levels were positively correlated with VAT in those with FMR-L. Ghrelin was higher in HIV-infected patients than controls despite BMI-matching. Conclusion The overall body fat reduction in HIV lipoatrophy was associated with low leptin plasma levels, and visceral fat accumulation was mainly associated with decreased plasma levels of adiponectin.
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Affiliation(s)
- Paula Freitas
- Endocrinology Department, Hospital de São João and University of Porto Medical School, Alameda Hernâni Monteiro, 4200 Porto, Portugal.
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Abstract
Metabolic syndrome is not a disease per se, but is a term that highlights traits that may have an increased risk of disease, approximately 2-fold for cardiovascular disease and 5-fold or more for type 2 diabetes mellitus. Obesity and insulin resistance are believed to be at the core of most cases of metabolic syndrome, although further research is required to truly understand the pathophysiology behind the syndrome and the gene-environment interactions that increase susceptibility. The mainstay of treatment remains lifestyle changes with exercise and diet to induce weight loss and pharmacologic intervention to treat atherogenic dyslipidemia, hypertension, and hyperglycemia.
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Affiliation(s)
- Susan L Samson
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, ABBR R615, Houston, TX 77030, USA
| | - Alan J Garber
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, BCM 620, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, BCM 620, Houston, TX 77030, USA; Department of Biochemistry and Molecular Biology, Baylor College of Medicine, One Baylor Plaza, BCM 620, Houston, TX 77030, USA.
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Lemogoum D, Ngatchou W, Borne PVD, Ndobo V, Leeman M, Yagnigni E, Tiogou E, Nga E, Kouanfack C, Bortel LV, Degaute JP, Hermans MP. Cardiometabolic Phenotype and Arterial Stiffness in HIV-Positive Black African Patients. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojpm.2014.44024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ngatchou W, Lemogoum D, Ndobo P, Yagnigni E, Tiogou E, Nga E, Kouanfack C, van de Borne P, Hermans MP. Increased burden and severity of metabolic syndrome and arterial stiffness in treatment-naïve HIV+ patients from Cameroon. Vasc Health Risk Manag 2013; 9:509-16. [PMID: 24043942 PMCID: PMC3772749 DOI: 10.2147/vhrm.s42350] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) and its therapy are associated with increased aortic stiffness and metabolic syndrome (MetS) phenotype in Caucasian patients. We hypothesized that, independently of antiretroviral therapy, HIV infection in native black African patients is associated with increased burden of cardiometabolic risk factors that may accelerate arterial structural damage and translate into increased aortic stiffness. PATIENTS AND METHODS Ninety-six apparently healthy Cameroonian subjects (controls) were compared to 108 untreated Cameroonian HIV+ patients (HIV-UT) of similar age. In each participant, pulse wave velocity (Complior), aortic augmentation index (SphygmoCor), brachial blood pressure (Omron 705 IT), fasting plasma glucose (FPG), and lipids were recorded, as well as the prevalence and severity of MetS, based on the American Heart Association/National Heart, Lung, and Blood Institute score ≥3/5. RESULTS Prevalence of impaired fasting glucose (FPG 100-125 mg · dL⁻¹) and of diabetes (FPG > 125 mg · dL⁻¹) was higher in HIV-UT than in controls (47% versus 27%, and 26% versus 1%, respectively; both P < 0.01). Fasting triglycerides and the atherogenic dyslipidemia ratio were significantly higher in HIV-UT than in controls. Hypertension prevalence was high and comparable in both groups (41% versus 44%, respectively; not significant). HIV-UT patients exhibited a twice-higher prevalence of MetS than controls (47% versus 21%; P = 0.02). Age- and sex-adjusted pulse wave velocity was higher in HIV-UT than in controls (7.5 ± 2.2 m/s versus 6.9 ± 1.7 m/s, respectively; P = 0.02), whereas aortic augmentation index was significantly lower (6% ± 4% versus 8% ± 7%, respectively; P = 0.01). CONCLUSION Similar to Caucasian populations, native Cameroonian HIV-UT patients showed a higher prevalence of MetS and its phenotype, associated with increased aortic stiffness, an early marker of atherosclerosis.
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Affiliation(s)
- William Ngatchou
- Hypertension Clinic, Erasme University Hospital, Brussels, Belgium
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Jarrett OD, Wanke CA, Ruthazer R, Bica I, Isaac R, Knox TA. Metabolic syndrome predicts all-cause mortality in persons with human immunodeficiency virus. AIDS Patient Care STDS 2013; 27:266-71. [PMID: 23651103 DOI: 10.1089/apc.2012.0402] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We examined the association between metabolic syndrome (MS) and its individual defining criteria on all-cause mortality in human immunodeficiency virus (HIV)-infected persons. We used data from 567 HIV-infected participants of the Nutrition for Healthy Living study with study visits between 9/1/2000 and 1/31/2004 and determined mortality through 12/31/2006. MS was defined using modified National Cholesterol Education Program guidelines. Cox proportional hazards for all-cause mortality were estimated for baseline MS status and for its individual defining criteria. There were 83 deaths with median follow-up of 63 months. Baseline characteristics associated with increased risk of mortality were: older age in years (univariate hazard ratio [HR] 1.04, p<0.01), current smoking (HR 1.99, p=0.02), current heroin use (HR 1.97, p=0.02), living in poverty (HR 2.0, p<0.01), higher mean HIV viral load (HR 1.81, p<0.01), and having a BMI <18 (HR 5.84, p<0.01). For MS and its criteria, only low HDL was associated with increased risk of mortality on univariate analysis (HR 1.84, p=0.01). However, metabolic syndrome (adjusted HR 2.31, p=0.02) and high triglycerides (adjusted HR 3.97, p<0.01) were significantly associated with mortality beyond 36 months follow-up. MS, low HDL, and high triglycerides are associated with an increased risk of mortality in HIV-infected individuals.
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Affiliation(s)
- Olamide D. Jarrett
- Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois
| | - Christine A. Wanke
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Nutrition/Infection Unit, Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Robin Ruthazer
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Ioana Bica
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Rita Isaac
- RUHSA Department, Christian Medical College, Vellore, India
| | - Tamsin A. Knox
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Nutrition/Infection Unit, Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts
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Freitas P, Carvalho D, Santos AC, Mesquita J, Matos MJ, Madureira AJ, Martinez E, Sarmento A, Medina JL. Lipodystrophy defined by Fat Mass Ratio in HIV-infected patients is associated with a high prevalence of glucose disturbances and insulin resistance. BMC Infect Dis 2012; 12:180. [PMID: 22866963 PMCID: PMC3495654 DOI: 10.1186/1471-2334-12-180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 07/13/2012] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Combined antiretroviral therapy (cART) in the treatment of HIV-1 infection has been associated with complications, including lipodystrophy, hyperlipidaemia, insulin resistance (IR) and diabetes. AIMS To compare the prevalence of glucose homeostasis disturbances and IR in HIV patients on cART according to the presence of lipodystrophy (defined clinically and by Fat Mass Ratio) and different patterns of fat distribution and to establish their associations. DESIGN Cross-sectional cohort study. METHODS We evaluated body composition and IR and insulin sensitivity indexes in 345 HIV-infected adults. RESULTS Patients with clinical lipodystrophy (CL) had higher plasma glucose levels than patients without CL, without significant differences in plasma insulin levels, A1c, HOMA-IR, HOMA-B, QUICKI, or MATSUDA index. Patients with lipodystrophy defined by FMR had higher plasma glucose and insulin levels, A1c, HOMA-IR, QUICKI and MATSUDA than patients without lipodystrophy, without differences in HOMA-B. Higher insulin resistance (HOMA-IR ≥ 4) was present in patients with FMR-defined lipodystrophy. Patients with FMR-defined lipodystrophy had a higher prevalence of IFG, IGT and DM than patients without lipodystrophy. Significant associations between HOMA-IR and total, central and central/peripheral fat evaluated by CT at abdominal level were found and no association between HOMA-IR and peripheral fat. Association between HOMA-IR and total and trunk fat but no association with leg and arm fat (evaluated by DXA) was found. CONCLUSIONS IR and glucose disturbances were significantly increased in patients with FMR-defined lipodystrophy. FMR lipodystrophy definition seems to be a more sensitive determinant of insulin resistance and glucose disturbances than clinical definition.
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Affiliation(s)
- Paula Freitas
- Department of Endocrinology, Hospital de São João, University of Porto Medical School, Alameda Hernâni Monteiro, 4200, Porto, Portugal, Portugal.
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Freitas P, Carvalho D, Santos AC, Madureira AJ, Xerinda S, Martinez E, Pereira J, Sarmento A, Medina JL. Central/Peripheral Fat Mass Ratio Is Associated With Increased Risk of Hypertension in HIV-Infected Patients. J Clin Hypertens (Greenwich) 2012; 14:593-600. [DOI: 10.1111/j.1751-7176.2012.00671.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Knudsen A, Kristoffersen US, Kjær A, Lebech AM. Cardiovascular disease in patients with HIV. Future Virol 2012. [DOI: 10.2217/fvl.12.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The introduction of combination antiretroviral therapy (cART) has substantially decreased mortality among the HIV-infected population. In this setting, cardiovascular disease (CVD) has become a leading cause of morbidity and mortality. Compared with the general population, higher rates of myocardial infarction as well as a high prevalence of subclinical coronary atherosclerosis have been found in the HIV-infected population. It has been suggested that in HIV-infected patients, the atherosclerotic burden is not based solely on traditional cardiovascular risk factors. The interplay of other mechanisms such as chronic inflammation, effects of cART or immune activation after initiation of cART may predispose to accelerated and increased risk of CVD. Effective treatment are available today to reduce CVD in at-risk patients, and therefore early detection of subclinical coronary atherosclerosis is important. However, the mechanisms behind the development of CVD in HIV-infected patients may limit the usefulness of the traditional noninvasive screening tools for CVD used in the general population. This review will focus on the different plausible mechanisms behind the increased risk of CVD and the noninvasive methods by which atherosclerosis may be assessed in the HIV-infected population.
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Affiliation(s)
- Andreas Knudsen
- Department of Infectious Diseases, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet University Hospital & Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Sloth Kristoffersen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet University Hospital & Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet University Hospital & Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
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