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Mojahedi A. Evaluating the use of antiviral drugs in HIV patients with cardiovascular diseases and how to reduce the incidence of cardiac events in these patients. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2024; 14:70-80. [PMID: 38764550 PMCID: PMC11101959 DOI: 10.62347/obxq4787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/27/2024] [Indexed: 05/21/2024]
Abstract
Globally, the incidence of newly diagnosed human immunodeficiency virus (HIV) infections is concerning. Despite enhancing the quality of life for this patient population, antiretroviral therapy (ART) is linked to an increased risk of cardiovascular disease (CVD). In people living with HIV (PLWH) undergoing ART, recent research has demonstrated that the use of statins and aspirin (ASA) can reduce the incidence or progression of CVD. However, research has demonstrated that interactions may occur when these medications are used concurrently in the treatment regimen of PLWH. Therefore, we conclude this systematic review to evaluate the use of ART in HIV individuals with CVD and also the effect of adding ASA and statins to ART for reducing the cardiac adverse events.
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Affiliation(s)
- Azad Mojahedi
- Department of Internal Medicine, Stony Brook University Hospital Stony Brook, New York, The United States
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Wu PY, Sun HY, Huang YS, Liu WD, Lin KY, Luo YZ, Chang HY, Chen LY, Chen YT, Hung CC. Under-utilization of statins among people with HIV who were aged 40 years or older. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:200-203. [PMID: 38233294 DOI: 10.1016/j.jmii.2024.01.003] [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: 09/04/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
From June 2022 to April 2023, 1629 HIV-positive participants were assessed for the risk of atherosclerotic cardiovascular disease (ASCVD). The 10-year ASCVD risk of <5 %, 5 % to <7.5 %, ≥7.5 % to <20 % and ≥20 % were 59.9 %, 14.4 %, 20.7 % and 5.0 %, respectively; 440 (27.0 %) participants met the criteria for statin therapy, but only 171 (38.8 %) were prescribed statins.
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Affiliation(s)
- Pei-Ying Wu
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Kuan-Yin Lin
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Zhen Luo
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsi-Yen Chang
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Ya Chen
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ting Chen
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.
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Cárdenas JDG, Oliveira VHF, Borsari AL, Marinello PC, Longenecker CT, Deminice R. Statin protects men but not women with HIV against loss of muscle mass, strength, and physical function: a pilot study. Sci Rep 2023; 13:4693. [PMID: 36949103 PMCID: PMC10033712 DOI: 10.1038/s41598-023-31643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/15/2023] [Indexed: 03/24/2023] Open
Abstract
Statins are cholesterol-lowering drugs commonly used among people with HIV, associated with an increased risk of myopathies. Considering that cardiovascular disease, statin therapy, and sarcopenia are independently prevalent in people with HIV, clarity on the potential benefits or harms of statin therapy on muscle health is useful to provide insight into ways to maximize skeletal muscle health and minimize CVD risk in this population. We aimed to study the effects of statin therapy on strength, muscle mass, and physical function parameters in people with HIV. This was a pilot cross-sectional study. People with HIV on continuous statin therapy (n = 52) were paired 1:1 according to age (people with HIV 53.9 ± 8.2 and people with HIV on statins 53.9 ± 8.4 years), sex, body mass index (Body mass index, people with HIV 28.6 ± 5.3 and people with HIV on statins 28.8 ± 6.3 kg/m2), and race with people with HIV not using statin (n = 52). Participants were evaluated for muscle strength (i.e. handgrip strength), lean and fat body mass (using bioelectric impedance analysis), and physical function (i.e. Short Physical Performance Battery-SPPB). Isokinetic strength and appendicular lean mass (using dual-energy X-ray absorptiometry), more accurate strength and body composition measures, were determined in 38% of the participants. Overall, statin usage does not exacerbated loss of muscle strength (32.2 ± 11.5 vs. 30.3 ± 9.6 kg, p > 0.05) muscle mass (7.6 ± 1.8 vs. 7.7 ± 1.1 kg/m2, p > 0.05), and impaired physical performance (10.1 ± 1.8 vs. 9.7 ± 2.1 points, p > 0.05) of PLWH. When analyzed by sex, men living with HIV on statins usage presented higher appendicular muscle mass (28.4 ± 3.1 vs. 26.2 ± 4.9 kg, p < 0.05) handgrip strength (42.1 ± 8.8 vs. 37.1 ± 8.3 kg, p < 0.05) and physical function through SPPB score (10.9 ± 1.3 vs. 9.5 ± 2.1, p < 0.05) than men living with HIV not on statins treatment. The same protection was not observed in women. This data was demonstrated when muscle mass and strength were determined clinically (i.e. handgrip strength and electrical impedance) and when more precise laboratory measurements of muscle mass and strength were conducted (i.e. isokinetic strength and DXA scans). Statin does not exacerbate muscle wasting, strength loss, or muscle dysfunction among people with HIV. Indeed, statins may protect men, but not woman with HIV against HIV and antiretroviral therapy-induced loss of muscle mass and strength.
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Affiliation(s)
- José David G Cárdenas
- Health Sciences Graduate Studies, State University of Londrina, Londrina, Paraná, Brazil
| | - Vitor H F Oliveira
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, Washington, USA
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
| | - Ana L Borsari
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
| | - Poliana C Marinello
- Biological Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Chris T Longenecker
- Department of Cardiology and Global Health, University of Washington, Seattle, Washington, USA
| | - Rafael Deminice
- Health Sciences Graduate Studies, State University of Londrina, Londrina, Paraná, Brazil.
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil.
- Department of Physical Education, Faculty of Physical Education and Sport, State University of Londrina, Rodovia Celso Garcia Cid, Pr 445 km 380, Campus Universitário, Londrina, PR, Brazil.
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Vigny NN, Bonsu KO, Kadirvelu A. Effectiveness and safety of statins on outcomes in patients with HIV infection: a systematic review and meta-analysis. Sci Rep 2022; 12:18121. [PMID: 36302940 PMCID: PMC9613890 DOI: 10.1038/s41598-022-23102-2] [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: 06/29/2022] [Accepted: 10/25/2022] [Indexed: 12/30/2022] Open
Abstract
Statins are hypolipidaemic in human immunodeficiency virus (HIV) positive individuals. However, their effect on all-cause mortality and rate of discontinuation is unclear. We conducted a systematic review to evaluate the impact of statins on all-cause mortality, discontinuation rates, and risk of adverse effects among HIV patients on highly active antiretroviral therapy (HAART). We searched four electronic databases from inception until October 2021 for trials and cohort studies evaluating the effects of statin treatment versus placebo in HIV patients. Forty-seven studies involving 91,594 patients were included. Statins were associated with significantly lower risk of discontinuation (RR, 0.701; 95% CI 0.508-0.967; p = 0.031). The risk of all-cause mortality (RR, 0.994; 95% CI 0.561-1.588; p = 0.827), any adverse effects (RR, 0.780; 95% CI 0.564-1.077; p = 0.131) and, diabetes mellitus (RR, 0.272; 95% CI 0.031-2.393; p = 0.241) with statin treatment were lower but not statistically significant compared to placebo/control. Statin treatment was associated with a trend of higher but statistically insignificant risk of myalgia (RR, 1.341; 95% CI 0.770-2.333; p = 0.299), elevated creatine kinase (RR, 1.101; 95% CI 0.457-2.651; p = 0.830) and liver enzyme activities (RR, 1.709; 95% CI 0.605-4.831; p = 0.312). Clinicians should consider the nocebo effect in the effective management of PLWH on statins, who present with common adverse effects such as myalgia and, elevated levels of creatine kinase and liver enzymes.
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Affiliation(s)
- Njeodo Njongang Vigny
- grid.29273.3d0000 0001 2288 3199Department of Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea, Cameroon ,grid.442717.3Department of Medical Laboratory Science, School of Engineering and Applied Sciences, Institut Universitaire de La Côte, Douala, Cameroon
| | - Kwadwo Osei Bonsu
- grid.25055.370000 0000 9130 6822School of Pharmacy, Memorial University of Newfoundland and Labrador, St. John’s, NL Canada
| | - Amudha Kadirvelu
- grid.440425.30000 0004 1798 0746Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
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Abdelghafar A, Mohyeldin M, Haroon OS, Mohamed FO, Alfardous Alazm M. Role of Statin in Reducing Cardiovascular Diseases in Human Immunodeficiency Virus (HIV) Patients: A Systematic Review. Cureus 2022; 14:e30549. [DOI: 10.7759/cureus.30549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
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Variation in statin prescription among veterans with HIV and known atherosclerotic cardiovascular disease. Am Heart J 2022; 249:12-22. [PMID: 35318028 PMCID: PMC9976623 DOI: 10.1016/j.ahj.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND People with HIV have increased atherosclerotic cardiovascular disease (ASCVD) risk, worse outcomes following incident ASCVD, and experience gaps in cardiovascular care, highlighting the need to improve delivery of preventive therapies in this population. OBJECTIVE Assess patient-level correlates and inter-facility variations in statin prescription among Veterans with HIV and known ASCVD. METHODS We studied Veterans with HIV and existing ASCVD, ie, coronary artery disease (CAD), ischemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD), who received care across 130 VA medical centers for the years 2018-2019. We assessed correlates of statin prescription using two-level hierarchical multivariable logistic regression. Median odds ratios (MORs) were used to quantify inter-facility variation in statin prescription. RESULTS Nine thousand six hundred eight Veterans with HIV and known ASCVD (mean age 64.3 ± 8.9 years, 97% male, 48% Black) were included. Only 68% of the participants were prescribed any-statin. Substantially higher statin prescription was observed for those with diabetes (adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI], 2.0-2.6), history of coronary revascularization (OR = 4.0, CI, 3.2-5.0), and receiving antiretroviral therapy (OR = 3.0, CI, 2.7-3.4). Blacks (OR = 0.7, CI, 0.6-0.9), those with non-coronary ASCVD, ie, ICVD and/or PAD only, (OR 0.53, 95% CI: 0.48-0.57), and those with history of illicit substance use (OR=0.7, CI, 0.6-0.9) were less likely to be prescribed statins. There was significant variation in statin prescription across VA facilities (10th, 90th centile: 55%, 78%), with an estimated 20% higher likelihood of difference in statin prescription practice for two clinically similar individuals treated at two comparable facilities (adjusted MOR = 1.21, CI, 1.18-1.24), and a greater variation observed for Blacks or those with non-coronary ASCVD or history of illicit drug use. CONCLUSION In an analysis of large-scale VA data, we found suboptimal statin prescription and significant interfacility variation in statin prescription among Veterans with HIV and known ASCVD, particularly among Blacks and those with a history of non-coronary ASCVD.
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Glicklich D, Nog R. HIV in kidney transplantation. Curr Opin Organ Transplant 2022; 27:64-69. [PMID: 34890378 DOI: 10.1097/mot.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to describe recent developments in renal transplantation for HIV-positive recipients, especially the HIV Organ Policy Equity (HOPE) trial results. RECENT FINDINGS HOPE trial data show that HIV-positive D+/R+ results are excellent and similar to D-/R+ in patients controlled on antiretroviral therapy (ART). Patients coinfected with hepatitis C or B virus now have effective treatment available. As pretransplant evaluation and post-transplant management is more complex in HIV-positive individuals early referral is important and coordination of evaluation and care with an infectious disease specialist is critical. HIV coordinated care services should be involved for best outcomes. HIV-positive renal transplant recipients have an increased risk of rejection and evidence suggests that standard lymphocyte depletion induction and maintenance immunosuppression be employed. Cardiovascular risk reduction and surveillance and attention to metabolic bone disease are important for HIV-positive renal transplant recipients. SUMMARY HIV-positive to HIV-positive renal transplantation has been established as well tolerated and successful. Further efforts are needed to expand access to transplantation in this population. VIDEO ABSTRACT http://links.lww.com/MOT/A29.
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Affiliation(s)
- Daniel Glicklich
- Westchester Medical Center, New York Medical College, Westchester, New York, USA
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Li Y, Wang Z, Xia H, Zhang J. Influence of Statin Therapy on the Incidence of Cardiovascular Events, Cancer, and All-Cause Mortality in People Living With HIV: A Meta-Analysis. Front Med (Lausanne) 2021; 8:769740. [PMID: 34820402 PMCID: PMC8606632 DOI: 10.3389/fmed.2021.769740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Possible influences of statin therapy on the risk of cardiovascular events, cancer, and all-cause mortality in people living with HIV (PLWH) remain unclear. We performed a meta-analysis to systematically evaluate the efficacy of statin in PLWH. Methods: Relevant cohort studies were retrieved via a search of the Medline, the Embase, and the Web of Science databases until June 14, 2021. The data were combined with a random-effects model by incorporating the between-study heterogeneity. Results: A total of 12 multivariate cohort studies with 162,252 participants were eligible for the meta-analysis and 36,253 (22.3%) of them were statin users. Pooled results showed that statin use was independently related to a reduced mortality risk in PLWH [adjusted risk ratio (RR): 0.56, 95% CI: 0.44 to 0.72, p < 0.001, I2 = 41%]. In addition, results of the meta-analysis showed that statin use was not significantly associated with a reduced risk of cardiovascular events in PLWH compared to the statin non-users (RR: 1.14, 95% CI: 0.80 to 1.63, p = 0.48, I2 = 42%). However, statin use was significantly related to a reduced risk of cancer in PLWH (RR: 0.73, 95% CI: 0.58 to 0.93, p = 0.009, I2 = 49%). Sensitivity analyses by excluding one study at a time showed consistent results. No significant publication biases were observed. Conclusion: Statin use is associated with reduced all-cause mortality in PLWH. In addition, statin use is related to a reduced risk of cancer, although the risk of cardiovascular events seems not significantly affected.
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Affiliation(s)
- Yanping Li
- School of Chemistry, Biology and Environment, Institute of Biology and Environmental Engineering, Yuxi Normal University, Yuxi, China
| | - Zhandi Wang
- School of Chemistry, Biology and Environment, Institute of Biology and Environmental Engineering, Yuxi Normal University, Yuxi, China
| | - Haimei Xia
- Center of Chinese Medicine, Yunnan Institute of Traditional Chinese Medicine, Kunming, China
| | - Ju Zhang
- Center of Chinese Medicine, Yunnan Institute of Traditional Chinese Medicine, Kunming, China
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Ngo MD, Bartlett S, Ronacher K. Diabetes-Associated Susceptibility to Tuberculosis: Contribution of Hyperglycemia vs. Dyslipidemia. Microorganisms 2021; 9:2282. [PMID: 34835407 PMCID: PMC8620310 DOI: 10.3390/microorganisms9112282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022] Open
Abstract
Diabetes is a major risk factor for tuberculosis (TB). Diabetes increases the risk of the progression from latent tuberculosis infection (LTBI) to active pulmonary TB and TB patients with diabetes are at greater risk of more severe disease and adverse TB treatment outcomes compared to TB patients without co-morbidities. Diabetes is a complex disease, characterised not only by hyperglycemia but also by various forms of dyslipidemia. However, the relative contribution of these underlying metabolic factors to increased susceptibility to TB are poorly understood. This review summarises our current knowledge on the epidemiology and clinical manifestation of TB and diabetes comorbidity. We subsequently dissect the relative contributions of body mass index, hyperglycemia, elevated cholesterol and triglycerides on TB disease severity and treatment outcomes. Lastly, we discuss the impact of selected glucose and cholesterol-lowering treatments frequently used in the management of diabetes on TB treatment outcomes.
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Affiliation(s)
- Minh Dao Ngo
- Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, QLD 4102, Australia; (M.D.N.); (S.B.)
| | - Stacey Bartlett
- Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, QLD 4102, Australia; (M.D.N.); (S.B.)
| | - Katharina Ronacher
- Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, QLD 4102, Australia; (M.D.N.); (S.B.)
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
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de Pádua Borges R, Degobi NAH, Bertoluci MC. Choosing statins: a review to guide clinical practice. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:639-653. [PMID: 33166435 PMCID: PMC10528630 DOI: 10.20945/2359-3997000000306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022]
Abstract
Statins are among the most widely prescribed medicines in the world and have proved their value in reducing cardiovascular events and mortality. Many patients report adverse effects that lead to interruption of treatment. This review aims to individualize statin treatment, considering efficacy for reducing cardiovascular risk and safety, in the setting of specific diseases, to minimize the side effects and improve compliance. We gathered evidence that may help clinicians to choose specific statins in different clinical situations, such as the risk of new diabetes, chronic kidney disease, liver disease, human immunodeficiency virus infection, organ transplant, heart failure and elderly people. Efficacy of statins is well established in a large number of clinical conditions. Therefore, main objective is to revise statin in specific clinical settings, based on pharmacokinetics, safety, drug metabolism and interactions to provide the best choice in different clinical scenarios.
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Affiliation(s)
- Roberta de Pádua Borges
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Nathália Abi Habib Degobi
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Marcello Casaccia Bertoluci
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil,
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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Ober AJ, Takada S, Zajdman D, Todd I, Horwich T, Anderson A, Wali S, Ladapo JA. Factors affecting statin uptake among people living with HIV: primary care provider perspectives. BMC FAMILY PRACTICE 2021; 22:215. [PMID: 34717560 PMCID: PMC8556944 DOI: 10.1186/s12875-021-01563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major cause of morbidity and mortality among people living with HIV (PLWH), but statin therapy, safe and effective for PLWH, is under-prescribed. This study examined clinic leadership and provider perceptions of factors associated with statin prescribing for PLWH receiving care in eight community health clinics across Los Angeles, California. METHODS We conducted semi-structured telephone interviews with clinic leadership and providers across community health clinics participating in a larger study (INSPIRE) aimed at improving statin prescribing through education and feedback. Clinics included federally qualified health centers (N = 5), community clinics (N = 1) and county-run ambulatory care clinics (N = 2). Leadership and providers enrolled in INSPIRE (N = 39) were invited to participate in an interview. We used the Consolidated Framework for Implementation Research (CFIR) to structure our interview guide and analysis. We used standard qualitative content analysis methods to identify themes within CFIR categories; we also assessed current CVD risk assessment and statin-prescribing practices. RESULTS Participants were clinic leaders (n = 6), primary care physicians with and without an HIV specialization (N = 6, N = 6, respectively), infectious diseases specialists (N = 12), nurse practitioners, physician assistants and registered nurses (N = 7). Ninety-five percent of providers from INSPIRE participated in an interview. We found that CVD risk assessment for PLWH is standard practice but that there is variation in risk assessment practices and that providers are unsure whether or how to adjust the risk threshold to account for HIV. Time, clinic and patient priorities impede ability to conduct CVD risk assessment with PLWH. CONCLUSIONS Providers desire more data and standard practice guidance on prescribing statins for PLWH, including estimates of the effect of HIV on CVD, how to adjust the CVD risk threshold to account for HIV, which statins are best for people on antiretroviral therapy and on shared decision-making around prescribing statins to PLWH. While CVD risk assessment and statin prescribing fits within the mission and workflow of primary care, clinics may need to emphasize CVD risk assessment and statins as priorities in order to improve uptake.
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Affiliation(s)
| | - Sae Takada
- RAND Corporation, Santa Monica, CA, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Ivy Todd
- RAND Corporation, Santa Monica, CA, USA
| | - Tamara Horwich
- Division of Cardiology, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Abraelle Anderson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Soma Wali
- Olive View - UCLA Medical Center, Sylmar, CA, USA
| | - Joseph A Ladapo
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
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Giacomelli A, Conti F, Pezzati L, Oreni L, Ridolfo AL, Morena V, Bonazzetti C, Pagani G, Formenti T, Galli M, Rusconi S. Impact of switching to TAF/FTC/RPV, TAF/FTC/EVG/cobi and ABC/3TC/DTG on cardiovascular risk and lipid profile in people living with HIV: a retrospective cohort study. BMC Infect Dis 2021; 21:595. [PMID: 34157984 PMCID: PMC8220746 DOI: 10.1186/s12879-021-06304-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to assess the overall cardiovascular and metabolic effect of the switch to three different single tablet regimens (STRs) [tenofovir alafenamide/emtricitabine/rilpivirine (TAF/FTC/RPV), TAF/FTC/elvitegravir/cobi (TAF/FTC/EVG/cobi) and ABC/lamivudine/dolutegravir (ABC/3TC/DTG)] in a cohort of people living with HIV/AIDS (PLWH) under effective ART. METHODS All PLWH aged above 18 years on antiretroviral treatment with an HIV-RNA < 50 cp/mL at the time of the switch to TAF/FTC/RPV, TAF/FTC/EVG/cobi and ABC/3TC/DTG were retrospectively included in the analysis. Framingham risk score modification after 12 months from the switch such as lipid profile and body weight modification were assessed. The change from baseline to 12 months in mean cardiovascular risk and body weight in each of the STR's group were assessed by means of Wilcoxon signed-rank test whereas a mixed regression model was used to assess variation in lipid levels. RESULTS Five-hundred and sixty PLWH were switched to an STR regimen of whom 170 (30.4%) to TAF/FTC/EVG/cobi, 191 (34.1%) to TAF/FTC/RPV and 199 (35.5%) to ABC/3TC/DTG. No difference in the Framingham cardiovascular risk score was observed after 12 months from the switch in each of the STR's groups. No significant overtime variation in mean total cholesterol levels from baseline to 12 months was observed for PLWH switched to ABC/3TC/DTG [200 (SD 38) mg/dl vs 201 (SD 35) mg/dl; p = 0.610] whereas a significant increment was observed in PLWH switched to TAF/FTC/EVG/cobi [192 (SD 34) mg/dl vs 208 (SD 40) mg/dl; p < 0.0001] and TAF/FTC/RPV [187 (SD 34) mg/dl vs 195 (SD 35) mg/dl; p = 0.027]. In addition, a significant variation in the mean body weight from baseline to 12 months was observed in PLWH switched to TAF/FTC/EVG/cobi [72.2 (SD 13.5) kilograms vs 74.6 (SD 14.3) kilograms; p < 0.0001] and TAF/FTC/RPV [73.4 (SD 11.6) kilograms vs 75.6 (SD 11.8) kilograms; p < 0.0001] whereas no difference was observed in those switched to ABC/3TC/DTG [71.5 (SD 12.8) kilograms vs 72.1 (SD 12.6) kilograms; p = 0.478]. CONCLUSION No difference in the cardiovascular risk after 1 year from the switch to these STRs were observed. PLWH switched to TAF/FTC/EVG/cobi and TAF/FTC/RPV showed an increase in total cholesterol levels and body weight 12 months after the switch.
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MESH Headings
- Adult
- Anti-HIV Agents/metabolism
- Anti-HIV Agents/therapeutic use
- Body Weight/drug effects
- Cohort Studies
- Dideoxynucleosides/metabolism
- Dideoxynucleosides/therapeutic use
- Drug Combinations
- Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination/metabolism
- Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination/therapeutic use
- Emtricitabine, Rilpivirine, Tenofovir Drug Combination/metabolism
- Emtricitabine, Rilpivirine, Tenofovir Drug Combination/therapeutic use
- Female
- HIV Infections/drug therapy
- Heart Disease Risk Factors
- Heterocyclic Compounds, 3-Ring/metabolism
- Heterocyclic Compounds, 3-Ring/therapeutic use
- Humans
- Italy/epidemiology
- Lamivudine/metabolism
- Lamivudine/therapeutic use
- Lipid Metabolism/drug effects
- Lipids/blood
- Male
- Middle Aged
- Oxazines/metabolism
- Oxazines/therapeutic use
- Piperazines/metabolism
- Piperazines/therapeutic use
- Pyridones/metabolism
- Pyridones/therapeutic use
- Retrospective Studies
- Tablets/therapeutic use
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Affiliation(s)
- Andrea Giacomelli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
- III Infectious Diseases Unit, Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Luigi Sacco Hospital, Legnano (MI), Italy
| | - Federico Conti
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
- III Infectious Diseases Unit, Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Luigi Sacco Hospital, Legnano (MI), Italy
| | - Laura Pezzati
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
- III Infectious Diseases Unit, Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Luigi Sacco Hospital, Legnano (MI), Italy
| | - Letizia Oreni
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Anna Lisa Ridolfo
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
- III Infectious Diseases Unit, Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Luigi Sacco Hospital, Legnano (MI), Italy
| | - Valentina Morena
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
- III Infectious Diseases Unit, Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Luigi Sacco Hospital, Legnano (MI), Italy
| | - Cecilia Bonazzetti
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
- III Infectious Diseases Unit, Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Luigi Sacco Hospital, Legnano (MI), Italy
| | - Gabriele Pagani
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
- III Infectious Diseases Unit, Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Luigi Sacco Hospital, Legnano (MI), Italy
- Infectious Diseases Unit, Legnano General Hospital, ASST Ovest Milanese, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Tiziana Formenti
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Massimo Galli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
- III Infectious Diseases Unit, Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Luigi Sacco Hospital, Legnano (MI), Italy
| | - Stefano Rusconi
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy.
- III Infectious Diseases Unit, Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Luigi Sacco Hospital, Legnano (MI), Italy.
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13
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Abdo M, Langan SJ, MaWhinney S, Sun J, Lake JE, Palella FJ, Kingsley L, Brown TT, Erlandson KM. Effect of Statin Therapy on Age-Associated Changes in Physical Function Among Men With and Without HIV in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr 2021; 86:455-462. [PMID: 33230030 PMCID: PMC8193908 DOI: 10.1097/qai.0000000000002579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The longer-term risks of statins on physical function among people with HIV are unclear. METHODS Longitudinal analysis of Multicenter AIDS Cohort Study men between 40 and 75 years of age with ≥2 measures of gait speed or grip strength. Generalized estimating equations with interaction terms between (1) statin use and age and (2) HIV serostatus, age, and statin use were considered to evaluate associations between statin use and physical function. Models were adjusted for demographics and cardiovascular risk factors. RESULTS Among 2021 men (1048 with HIV), baseline median age was 52 (interquartile range 46-58) years; 636 were consistent, 398 intermittent, and 987 never statin users. There was a significant interaction between age, statin, and HIV serostatus for gait speed. Among people with HIV, for every 5-year age increase, gait speed (m/s) decline was marginally greater among consistent versus never statin users {-0.008 [95% confidence interval (CI) -0.017 to -0.00007]; P = 0.048}, with more notable differences between intermittent and never users [-0.017 (95% CI -0.027 to -0.008); P < 0.001]. Similar results were observed among men without HIV. Significant differences in grip strength (kg) decline were seen between intermittent and never users [-0.53 (95% CI -0.98 to -0.07); P = 0.024] and differences between consistent and never users [-0.28 (95% CI -0.63 to 0.06); P = 0.11] were not statistically significant. CONCLUSIONS Among men with and without HIV, intermittent statin users had more pronounced declines in physical function compared with consistent and never users. Consistent statin use does not seem to have a major impact on physical function in men with or without HIV.
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Affiliation(s)
- Mona Abdo
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | | | - Samantha MaWhinney
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Jing Sun
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jordan E Lake
- University of Texas Health Science Center at Houston, Houston, TX
| | | | | | | | - Kristine M Erlandson
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
- Division of Infectious Diseases, School of Medicine, University of Colorado-Anschutz Medical Center, Aurora, CO
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14
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Courlet P, Guidi M, Alves Saldanha S, Stader F, Traytel A, Cavassini M, Stoeckle M, Buclin T, Marzolini C, Decosterd LA, Csajka C. Pharmacokinetic/Pharmacodynamic Modelling to Describe the Cholesterol Lowering Effect of Rosuvastatin in People Living with HIV. Clin Pharmacokinet 2021; 60:379-390. [PMID: 33124006 PMCID: PMC7932937 DOI: 10.1007/s40262-020-00946-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Rosuvastatin is a lipid-lowering agent widely prescribed in people living with HIV, which is actively transported into the liver, making it a potential victim of drug-drug interactions with antiretroviral agents. OBJECTIVES The aims of this study were to characterise the pharmacokinetic profile of rosuvastatin and to describe the relationship between rosuvastatin concentrations and non-high-density lipoprotein (HDL)-cholesterol levels in people living with HIV. METHODS A population pharmacokinetic model (NONMEM) was developed to quantify the influence of demographics, clinical characteristics and comedications on rosuvastatin pharmacokinetics. This model was combined with an indirect effect model to describe non-HDL-cholesterol measurements. RESULTS A two-compartment model with sequential zero- and first-order absorption best fitted the 154 rosuvastatin concentrations provided by 65 people living with HIV. None of the tested covariates significantly influenced rosuvastatin pharmacokinetics. A total of 403 non-HDL cholesterol values were available for pharmacokinetic-pharmacodynamic modelling. Baseline non-HDL cholesterol decreased by 14% and increased by 12% with etravirine and antiretroviral drugs with a known impact on the lipid profile (i.e. protease inhibitors, efavirenz, cobicistat), respectively. The baseline value was surprisingly 43% lower in people living with HIV aged 80 years compared with those aged 40 years. Simulations based on the covariate-free model predicted that, under standard rosuvastatin dosages of 5 mg and 20 mg once daily, 31% and 64% of people living with HIV would achieve non-HDL-cholesterol targets, respectively. CONCLUSIONS The high between-subject variability that characterises both rosuvastatin pharmacokinetic and pharmacodynamic profiles remained unexplained after the inclusion of usual covariates. Considering its limited potential for drug-drug interactions with antiretroviral agents and its potent lipid-lowering effect, rosuvastatin prescription appears safe and effective in people living with HIV with hypercholesterolaemia. CLINICAL TRIAL REGISTRATION NO NCT03515772.
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Affiliation(s)
- Perrine Courlet
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Monia Guidi
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005, 1011, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Susana Alves Saldanha
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Felix Stader
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Traytel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Thierry Buclin
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Laurent A Decosterd
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chantal Csajka
- Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005, 1011, Lausanne, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
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15
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Drechsler H, Ayers C, Cutrell J, Arasaratnam R, Bedimo R. Consistent use of lipid lowering therapy in HIV infection is associated with low mortality. BMC Infect Dis 2021; 21:150. [PMID: 33546621 PMCID: PMC7866454 DOI: 10.1186/s12879-021-05787-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In people living with HIV (PLWH), statins may be disproportionately effective but remain underutilized. A large prospective trial in patients with low to moderate cardiovascular (ASCVD) risk will reveal whether they should be considered in all PLWH. But its effect size may not apply to real-world PLWH with higher ASCVD and mortality risk. Also, the clinical role of non-statin lipid-lowering therapy (LLT) and LLT adherence in this population is unknown. METHODS Comparative multi-level marginal structural model for all-cause mortality examining four time-updated exposure levels to LLT, antihypertensives, and aspirin in a virtual cohort of older PLWH. Incident coronary, cerebrovascular, and overall ASCVD events, serious infections, and new cancer diagnoses served as explanatory outcomes. RESULTS In 23,276 HIV-infected US-veterans who were followed for a median of 5.2 years after virologic suppression overall mortality was 33/1000 patient years: > 3 times higher than in the US population. Use of antihypertensives or aspirin was associated with increased mortality. Past LLT use (> 1 year ago) had no effect on mortality. LLT exposure in the past year was associated with a reduced hazard ratio (HR) of death: 0.59, 95% confidence interval (CI) 0.51-0.69, p < 0.0001 for statin containing LLT and 0.71 (CI: 0.54-0.93), p = 0.03 for statin-free LLT. For consistent LLT use (> 11/12 past months) the HR of death was 0.48 (CI: 0.35-0.66) for statin-only LLT, 0.34 (CI: 0.23-0.52) for combination LLT, and 0.27 (CI: 0.15-0.48) for statin-free LLT (p < 0.0001 for all). The ASCVD risk in these patients was reduced in similar fashion. Use of statin containing LLT was also associated with reduced infection and cancer risk. Multiple contrasting subgroup analyses yielded comparable results. Confounding is unlikely to be a major contributor to our findings. CONCLUSIONS In PLWH, ongoing LLT use may lead to substantially lower mortality, but consistent long-term adherence may be required to reduce ASCVD risk. Consistent non-statin LLT may be highly effective and should be studied prospectively.
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Affiliation(s)
- Henning Drechsler
- VA North Texas Health Care System, Dallas, TX, USA.
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA.
| | - Colby Ayers
- VA North Texas Health Care System, Dallas, TX, USA
| | | | - Reuben Arasaratnam
- VA North Texas Health Care System, Dallas, TX, USA
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA
| | - Roger Bedimo
- VA North Texas Health Care System, Dallas, TX, USA
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA
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16
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Crockett KB, Wen Y, Overton ET, Jackson EA, Rosenson RS, Muntner P, Colantonio LD. One-year statin persistence and adherence in adults with HIV in the United States. J Clin Lipidol 2021; 15:181-191. [PMID: 33341376 PMCID: PMC7887025 DOI: 10.1016/j.jacl.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/16/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Statin persistence and adherence are low among US adults. Most individuals with HIV in the US have high adherence to antiretroviral therapy (ART), but less is known about their statin persistence and adherence. OBJECTIVES We analyzed persistence and adherence to statin therapy among adults with and without HIV. METHODS We analyzed claims data from adults in the MarketScan database who initiated statin therapy between 2007 and 2016. People with HIV (n = 5619) were frequency matched 1-to-4 to those without HIV (n = 22,476) based on age, sex, and calendar year of statin initiation. Statin persistence was defined by having dispensed statin medication during the last 90 days of the 365 days following initiation. High statin adherence was defined as a proportion of days covered (PDC) ≥0.80 during the 365 days following initiation. Among people with HIV, the PDC for each ART was calculated. RESULTS The mean age of the study population was 51 years and 85.8% were men. Statin persistence was higher among adults with versus without HIV (72.8% versus 65.2%, multivariable-adjusted prevalence ratio 1.13, 95%CI 1.11-1.15). Among those who were persistent, a higher proportion of people with versus without HIV had high statin adherence (69.6% versus 59.9%, multivariable-adjusted prevalence ratio 1.16, 95%CI 1.13-1.19). Among people with HIV and high ART adherence (minimum PDC ≥0.90), 34.6% had a PDC for statin therapy <0.80. CONCLUSION Adults with HIV were more persistent and adherent to statin medications versus those without HIV. However, a high proportion of adults with HIV had low statin adherence.
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Affiliation(s)
- Kaylee B Crockett
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Ying Wen
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edgar T Overton
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Jackson
- Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lisandro D Colantonio
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Xie W, Huang H, Xiao S, Yang X, Zhang Z. Effect of statin use on cardiovascular events and all-cause mortality in immune-mediated inflammatory diseases: A systematic review and meta-analysis involving 148,722 participants. Pharmacol Res 2020; 160:105057. [DOI: 10.1016/j.phrs.2020.105057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023]
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Implementation of Cholesterol-Lowering Therapy to Reduce Cardiovascular Risk in Persons Living with HIV. Cardiovasc Drugs Ther 2020; 36:173-186. [PMID: 32979175 DOI: 10.1007/s10557-020-07085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
The widespread availability of highly effective antiretroviral therapies has reduced mortality from opportunistic infections in persons living with HIV (PLHIV), resulting in an increase in atherosclerotic cardiovascular disease (ASCVD) and other chronic illnesses (Samji et al. 2013). Although there has been a decline in morbidity and mortality from ASCVD in the past several decades, contemporary studies continue to report higher rates of cardiovascular events (Rosenson et al. 2020). HIV has been identified as a risk enhancer for ASCVD by multiple professional guideline writing committees (Grundy Scott et al. 2019, Mach et al. 2020); however, the utilization of cholesterol-lowering therapies in PLHIV remains low (Rosenson et al. 2018). Moreover, the use of statin therapy in PLHIV is complicated by drug-drug interactions that may either elevate or lower the blood statin concentrations resulting in increased toxicity or reduced efficacy respectively. Other comorbidities commonly associated with HIV present other challenges for the use of cholesterol-lowering therapies. This review will summarize the data on lipoprotein-associated ASCVD risk in PLHIV and discuss the challenges with effective treatment. Finally, we present a clinical algorithm to optimize cardiovascular risk reduction in this high-risk population.
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19
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Dai L, Liu A, Zhang H, Wu H, Zhang T, Su B, Shao Y, Li J, Ye J, Scott SR, Mahajan SD, Schwartz SA, Yu H, Sun L. Impact of Lopinavir/Ritonavir and Efavirenz-Based Antiretroviral Therapy on the Lipid Profile of Chinese HIV/AIDS Treatment-Naïve Patients in Beijing: A Retrospective Study. Curr HIV Res 2020; 17:324-334. [PMID: 31654514 DOI: 10.2174/1570162x17666191025115508] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) is associated with lipid abnormalities that contribute to increased risk of cardiovascular (CV) events among patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Although disorders of lipid metabolism associated with ART have been described before in developed countries, data on lipid profile disorders associated with ART use in China are limited. This study aimed to examine the changes in lipid profile among patients with HIV/AIDS who initiated lopinavir/ritonavir LPV/r or efavirenz (EFV)-based antiretroviral treatment regimens, which continue to be widely used China and other developing countries. METHODS This is a retrospective, matched case-control study of HIV-positive patients initiating either LPV/r or EFV regimens at the Beijing You'an Hospital, Capital Medical University between July 2012 and January 2017. Generalized estimating equations were used to compare the differences in total cholesterol [TC], triglycerides [TG], low-density lipoprotein-cholesterol [LDL-C], and highdensity lipoprotein-cholesterol [HDL-C] at baseline and up to 24-months after ART initiation between the two treatment arms. RESULTS Baseline characteristics, including age, sex, CD4 cell count, viral load, and serum lipids, which were comparable between the two groups. The LPV/r-based regimen group had increased TC, TG, HDL-C, and LDL-C after 24-months of treatment. In the EFV-regimen group, TC, HDL-C, and LDL-C were increased compared to baseline, while the TC/HDL-C ratio decreased, and TG did not change significantly. After 24-months of treatment, the percentage of patients with dyslipidemia in the LPV/r group was much higher than in the EFV group (84.0% vs. 52.6%, P<0.001), and 17(10%) patients on LPV/r-based regimens had severe dyslipidemia. Patients on LPV/r-based regimens were at increased odds of hypercholesterolemia (odds ratio [OR]=1.709, P=0.038), hypertriglyceridemia (OR=4.315, P<0.001), and high TC/HDL-C ratio (OR=1.951, P=0.003). However, no significant difference was found in HDL-C (OR=1.246, P=0.186) or LDL-C (OR=1.253, P=0.410) between the treatment groups. CONCLUSION Both LPV/r or EFV treatment regimens impacted patients' lipid profiles. Compared to EFV-based regimens, patients on LPV/r-based regimens had increased odds of dyslipidemia, such as hypercholesterolemia, hypertriglyceridemia, or high TC/HDL-C ratio; however, there was no obvious effect on LDL-C, which is more relevant to the development of the cardiovascular disease.
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Affiliation(s)
- Lili Dai
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - An Liu
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Hongwei Zhang
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Hao Wu
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Tong Zhang
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Bin Su
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Ying Shao
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Jianwei Li
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Jiangzhu Ye
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Sarah Robbins Scott
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Supriya D Mahajan
- Department of Medicine, Division of Allergy, Immunology & Rheumatology, University at Buffalo, Clinical & Translational Research Center, Buffalo, NY 14203, United States
| | - Stanley A Schwartz
- Department of Medicine, Division of Allergy, Immunology & Rheumatology, University at Buffalo, Clinical & Translational Research Center, Buffalo, NY 14203, United States
| | - Hongwei Yu
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Lijun Sun
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
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Abstract
Individuals with HIV are at increased risk for ESKD. Kidney transplantation is the best treatment for ESKD in the HIV+ population. Despite reduced access to transplantation, patients who are HIV+ have excellent outcomes and clearly benefit from receiving one. Common post-transplant complications and management concerns, including the optimal antiretroviral regimen, immunosuppression protocols, infectious prophylaxis, hepatitis C coinfection, metabolic complications, and malignancy are all discussed.
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Affiliation(s)
- Deirdre Sawinski
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Zanetti HR, Gonçalves A, Teixeira Paranhos Lopes L, Mendes EL, Roever L, Silva-Vergara ML, Neves FF, Resende ES. Effects of Exercise Training and Statin Use in People Living with Human Immunodeficiency Virus with Dyslipidemia. Med Sci Sports Exerc 2020; 52:16-24. [PMID: 31834252 DOI: 10.1249/mss.0000000000002120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the effects of the combination of exercise training (ET) and statins in people living with human immunodeficiency virus. METHODS This was a randomized, double-blind, placebo-controlled clinical trial. Eighty-three people living with human immunodeficiency virus were assigned to either placebo (PL), statins (STA), PL + ET (PLET) or STA + ET (STAET) groups. Volunteers assigned to STA and STAET groups were administered 10 mg of rosuvastatin, whereas the PL and PLET groups were administered a placebo. The PLET and STAET groups performed ET three times a week. Before and after the 12-wk follow-up, the volunteers underwent to anthropometric assessment and blood collection to evaluate lipid profile, cardiovascular markers, inflammatory profile; a Doppler ultrasound examination, muscle strength (MS) and cardiorespiratory fitness (CF) tests were performed. RESULTS There was a decrease in total cholesterol, triglycerides, low-density lipoprotein, C-reactive protein, fibrinogen, interleukin (IL)-1β and right carotid intima-media thickness in the STA, PLET, and STAET groups compared with PL group (P < 0.001). Furthermore, there was a decrease in total cholesterol, triglycerides, low-density lipoprotein, IL-1β, IL-6, and IL-8 levels and in left and right carotid intima-media thickness and an increase in HDL-c levels in the STAET groups compared with the STA (P ≤ 0.001) and PLET groups (P ≤ 0.001). There was an increase in IL-10 levels, peak-systolic velocity, end-diastolic velocity, wall shear rate in the PLET and STAET groups compared with the PL (P ≤ 0.001) and STA groups (P ≤ 0.001). The PLET and STAET groups reduced body fat mass, body fat percentage and increased lean body mass, MS and CF compared with PL (P ≤ 0.001) and STA (P ≤ 0.001) groups. CONCLUSIONS The combination of ET and statins is useful to enhance lipid and inflammatory profiles, reduce cardiovascular disease markers, and improve Doppler ultrasound findings, MS and CF in people living with HIV.
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Affiliation(s)
| | | | | | - Edmar Lacerda Mendes
- Institute of Health Sciences, Department of Sport Sciences, Federal University of Triângulo Mineiro, Uberaba/MG, BRAZIL
| | - Leonardo Roever
- Postgraduate Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, Uberlândia/MG, BRAZIL
| | - Mário Leon Silva-Vergara
- Institute of Health Sciences, Department of Medical Clinics, Clinics Hospital, Federal University of Triângulo Mineiro, Uberaba/MG, BRAZIL
| | - Fernando Freitas Neves
- Institute of Health Sciences, Department of Medical Clinics, Clinics Hospital, Federal University of Triângulo Mineiro, Uberaba/MG, BRAZIL
| | - Elmiro Santos Resende
- Postgraduate Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, Uberlândia/MG, BRAZIL
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Gamble-George JC, Longenecker CT, Webel AR, Au DH, Brown AF, Bosworth H, Crothers K, Cunningham WE, Fiscella KA, Hamilton AB, Helfrich CD, Ladapo JA, Luque A, Tobin JN, Wyatt GE. ImPlementation REsearCh to DEvelop Interventions for People Living with HIV (the PRECluDE consortium): Combatting chronic disease comorbidities in HIV populations through implementation research. Prog Cardiovasc Dis 2020; 63:79-91. [PMID: 32199901 PMCID: PMC7237329 DOI: 10.1016/j.pcad.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 02/08/2023]
Abstract
Antiretroviral therapy (ART) prevented premature mortality and improved the quality of life among people living with the human immunodeficiency virus (PLWH), such that now more than half of PLWH in the United States are 50 years of age and older. Increased longevity among PLWH has resulted in a significant rise in chronic, comorbid diseases. However, the implementation of guideline-based interventions for preventing, treating, and managing such age-related, chronic conditions among the HIV population is lacking. The PRECluDE consortium supported by the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute catalyzes implementation research on proven-effective interventions for co-occurring heart, lung, blood, and sleep diseases and conditions among PLWH. These collaborative research studies use novel implementation frameworks with HIV, mental health, cardiovascular, and pulmonary care to advance comprehensive HIV and chronic disease healthcare in a variety of settings and among diverse populations.
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Affiliation(s)
- Joyonna Carrie Gamble-George
- Health Scientist Administrator and AAAS Science and Technology Policy Fellow, Implementation Science Branch (ISB), Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), U.S. Department of Health and Human Services, Bethesda, MD 20892, United States of America; Office of Science Policy (OSP), Office of the Director (OD), National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD 20892, United States of America.
| | - Christopher T Longenecker
- Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States of America
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - David H Au
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA 98195, United States of America; Seattle-Denver Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, United States of America
| | - Arleen F Brown
- Department of Medicine, Division of General Internal Medicine and Health Services Research (GIM and HSR), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, United States of America; GIM and HSR, Olive View-UCLA Medical Center Sylmar, Los Angeles, CA 90095, United States of America; Community Engagement and Research Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA 90095, United States of America
| | - Hayden Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, NC 27701, United States of America; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701, United States of America
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA 98195, United States of America; Pulmonary and Critical Care Section, VA Puget Sound Health Care System, Seattle, WA 98108, United States of America
| | - William E Cunningham
- Department of Medicine, GIM and HSR, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, United States of America; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, United States of America
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Center for Communication and Disparities Research, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Greater Rochester Practice-Based Research Network, Clinical and Translational Science Institute (CTSI), University of Rochester Medical Center, Rochester, NY 14642, United States of America
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States of America; VA Health Services Research and Development (HSR&D) Service, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, North Hills, CA 91343, United States of America
| | - Christian D Helfrich
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA 98101, United States of America; Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration (VA) Puget Sound Health Care System, Seattle, WA 98108, United States of America
| | - Joseph A Ladapo
- Department of Medicine, GIM and HSR, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, United States of America; Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY 10016, United States of America
| | - Amneris Luque
- HIV Clinical Services, Parkland Health and Hospital System, Dallas, TX 75235, United States of America; Department of Internal Medicine, University of Texas (UT) Southwestern Medical Center, Dallas, TX 75390, United States of America
| | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY 10018; Community-Engaged Research, The Rockefeller University Center for Clinical and Translational Science, New York, NY 10065, United States of America
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States of America; Sexual Health Programs, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States of America; The Center for Culture, Trauma, and Mental Health Disparities, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, United States of America; University of Cape Town, Rondebosch, Cape Town 7701, South Africa
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23
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Suzuki K, Oikawa T, Nochioka K, Miura M, Kasahara S, Sato M, Aoyanagi H, Shiroto T, Takahashi J, Miyata S, Sakata Y, Shimokawa H. Elevated Serum Non-HDL (High-Density Lipoprotein) Cholesterol and Triglyceride Levels as Residual Risks for Myocardial Infarction Recurrence Under Statin Treatment. Arterioscler Thromb Vasc Biol 2020; 39:934-944. [PMID: 30866657 DOI: 10.1161/atvbaha.119.312336] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective- Secondary prevention for recurrent myocardial infarction (MI) is one of the most important therapeutic goals in patients with old MI (OMI). Although statins are widely used for this purpose, there remains considerable residual risk even after LDL (low-density lipoprotein cholesterol) is well controlled by statins. Approach and Results- We examined clinical impacts of nHDL (nonhigh-density lipoprotein cholesterol) and its major components triglyceride and LDL as residual risks for acute MI recurrence, using the database of our CHART (Chronic Heart Failure Analysis and Registry in the Tohoku District)-2 Study, the largest-scale cohort study of cardiovascular patients in Japan. We enrolled 1843 consecutive old MI patients treated with statins (mean age 67.3 years, male 19.2%) in the CHART-2 Study. The incidence of recurrent acute MI during the median 8.6-year follow-up was compared among the groups divided by the levels of nHDL (<100, 100-129, and ≥130 mg/dL), LDL (<70, 70-99, and ≥100 mg/dL), triglyceride (<84, 84-149, and ≥150 mg/dL), and combination of LDL and triglyceride. Kaplan-Meier curves and multiple Cox proportional hazards models showed that higher levels of nHDL, but not LDL or triglyceride alone, were associated with higher incidence of recurrent acute MI. Furthermore, higher triglyceride levels were associated with higher incidence of recurrent MI in patients with LDL <100 mg/dL but not in those with LDL ≥100 mg/dL. Conclusions- These results indicate that management of residual risks for acute MI recurrence should include nHDL management considering both LDL and triglyceride in old MI patients under statin treatment. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00418041.
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Affiliation(s)
- Kota Suzuki
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuya Oikawa
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Big Data Medicine Center, Tohoku University, Sendai, Japan (K.N., Y.S., H.S.)
| | - Masanobu Miura
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shintaro Kasahara
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Sato
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hajime Aoyanagi
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Evidence-based Cardiovascular Medicine (S.M., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Big Data Medicine Center, Tohoku University, Sendai, Japan (K.N., Y.S., H.S.)
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine (K.S., T.O., K.N., M.M., S.K., M.S., H.A., T.S., J.T., Y.S., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Evidence-based Cardiovascular Medicine (S.M., H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan.,Big Data Medicine Center, Tohoku University, Sendai, Japan (K.N., Y.S., H.S.)
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24
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Duan H, Liu T, Zhang X, Yu A, Cao Y. Statin use and risk of tuberculosis: a systemic review of observational studies. Int J Infect Dis 2020; 93:168-174. [PMID: 31982626 DOI: 10.1016/j.ijid.2020.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/11/2020] [Accepted: 01/18/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Statin intake may be linked with a lower risk of several infectious diseases, including tuberculosis, which is an important cause of mortality worldwide. The aim of this study was to investigate the definite impacts of statins on the risk of tuberculosis (TB) in diabetic patients and in the general population. METHODS Four databases were thoroughly searched from inception up to July 2019. Articles in any language were included if they assessed and clarified statin intake, presented the risk of TB in diabetes mellitus (DM) patients or the general population, and reported odds ratios (ORs), relative risks (RRs), or hazard ratios (HRs) or contained data for relevant calculation. RRs with 95% confidence intervals (CIs) were pooled using random-effects models regardless of heterogeneity quantified by Cochran's Q and I2 statistics. RESULTS Six articles reporting observational studies involving 2 073 968 patients were included. Four reported cohort studies, one a nested case-control study, and one was an abstract. Statin use significantly reduced the risk of TB in DM patients by 22% (pooled RR 0.78, 95% CI 0.63-0.95), with severe heterogeneity (I2 = 76.1%). Statin intake also significantly decreased the risk of TB in the general population by 40% (pooled RR 0.60, 95% CI 0.50-0.71), with severe heterogeneity (I2 = 57.7%). CONCLUSIONS Statin use is related to a considerably lower risk of TB in both DM patients and the general population. However, these conclusions should be interpreted with caution given the possible remaining confounding, and call for large-size and multicenter randomized controlled studies in the future.
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Affiliation(s)
- Haizhen Duan
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, PR China; Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, PR China
| | - Tongying Liu
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, PR China
| | - Xiaojun Zhang
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, PR China
| | - Anyong Yu
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, PR China
| | - Yu Cao
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, PR China.
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25
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Thompson-Paul AM, Palella FJ, Rayeed N, Ritchey MD, Lichtenstein KA, Patel D, Yang Q, Gillespie C, Loustalot F, Patel P, Buchacz K. Excess heart age in adult outpatients in routine HIV care. AIDS 2019; 33:1935-1942. [PMID: 31274539 PMCID: PMC8428771 DOI: 10.1097/qad.0000000000002304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is a common cause of morbidity and mortality among persons living with HIV (PLWH). We used individual cardiovascular risk factor profiles to estimate heart age for PLWH in medical care in the United States. DESIGN Cross-sectional analyses of HIV Outpatient Study (HOPS) data METHODS:: Included in this analysis were participants aged 30-74 years, without prior CVD, with at least two HOPS clinic visits during 2010-2017, at least 1-year of follow-up, and available covariate data. We calculated age and race/ethnicity-adjusted heart age and excess heart age (chronological age - heart age), using a Framingham risk score-based model. RESULTS We analyzed data from 2467 men and 619 women (mean chronologic age 49.3 and 49.1 years, and 23.6% and 54.6% Non-Hispanic/Latino black, respectively). Adjusted excess heart age was 11.5 years (95% confidence interval, 11.1-12.0) among men and 13.1 years (12.0-14.1) among women. Excess heart age was seen among all age groups beginning with persons aged 30-39 years [men, 7.8 (6.9-8.8); women, 7.7 (4.9-10.4)], with the highest excess heart age among participants aged 50-59 years [men, 13.7 years (13.0-14.4); women, 16.4 years (14.8-18.0)]. More than 50% of participants had an excess heart age of at least 10 years. CONCLUSIONS Excess heart age is common among PLWH, begins in early adulthood, and impacts both women and men. Among PLWH, CVD risk factors should be addressed early and proactively. Routine use of the heart age calculator may help optimize CVD risk stratification and facilitate interventions for aging PLWH.
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Affiliation(s)
- Angela M. Thompson-Paul
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Matthew D. Ritchey
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Deesha Patel
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, & TB Prevention, Centers for Disease Control and Prevention, Atlanta
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pragna Patel
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, & TB Prevention, Centers for Disease Control and Prevention, Atlanta
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26
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Ruiz-Rebollo ML, Muñoz-Moreno MF, Mayo-Iscar A, Udaondo-Cascante MA, Nistal RB. Statin intake can decrease acute pancreatitis severit. Pancreatology 2019; 19:807-812. [PMID: 31378582 DOI: 10.1016/j.pan.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Acute Pancreatitis (AP) is one of the leading gastrointestinal conditions requiring hospitalization. It has been suggested that statins could exert a protective role in the natural history of AP; however, their influence is not entirely clear. Our objective was to investigate the relationship between statin intake and AP. METHODS Retrospective analysis of a prospective registry of patients diagnosed with AP. Statin intake on admission as well as clinical, analytical, demographic and radiological data were recorded. OUTCOME PARAMETERS Severity of AP, SIRS development, organ failure, local complications, intensive care admission, collection drainage, hospital length of admission, and death. Univariate and multivariate analyses as well as a propensity score logistic regression were conducted. RESULTS From March 2014-October 2018 we studied 356 patients. 101 patients (28%) were taking statins. 55 (15%) suffered from moderate/severe pancreatitis. Multivariate analysis showed a 50% less risk of suffering from moderate/severe AP (OR 0.50 95% CI 0.22-1.0, p 0.50) and 33% less risk of developing local complications (OR 0.33 95%CI 0.15-0.80, p 0.014) among statin consumers, with a tendency towards less SIRS. Propensity score analysis confirmed that patients on statins suffering from AP had a lower risk to have a moderate/severe episode (OR 0.409 95%CI 0.192-0.872, p 0.031), to develop local complications (OR 0.47 95%CI 0.20-1.06, p 0.11) and SIRS (OR 0.516 95% CI 0.28-0.93, p 0.041). CONCLUSIONS Patients taking statins who suffer from an episode of AP are more likely to follow a mild course and have a lower risk of developing local complications and SIRS.
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Affiliation(s)
| | | | - Agustín Mayo-Iscar
- Statistics Department, School of Medicine, University of Valladolid, Valladolid, Spain
| | | | - Reyes Busta Nistal
- Hepato-Gastroenterology Department, Hospital Clínico Universitario, Valladolid, Spain
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27
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Sarfo FS, Nichols M, Agyei B, Singh A, Ennin E, Nyantakyi AD, Asibey SO, Tagge R, Gebregziabher M, Jenkins C, Ovbiagele B. Burden of subclinical carotid atherosclerosis and vascular risk factors among people living with HIV in Ghana. J Neurol Sci 2018; 397:103-111. [PMID: 30599299 DOI: 10.1016/j.jns.2018.12.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The burden of cardiovascular disease (CVD) among people living with HIV (PLWH) in sub-Saharan Africa is projected to rise due to a rapid epidemiological transition and improved treatment of HIV infection on the sub-continent. OBJECTIVE The Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy (EVERLAST) Study sought to assess the extent of subclinical atherosclerosis and characterize the nature of CVD risk factors among HIV patients on Antiretroviral therapy (ART) in Ghana. METHODS We conducted a cross-sectional study involving HIV patients on antiretroviral therapy (n = 250) in comparison with HIV positive ART naïve (n = 201), and HIV uninfected controls (n = 250). We assessed prevalence of hypertension, dyslipidemia, diabetes mellitus, central obesity, and carotid atherosclerosis using B-mode carotid Doppler ultrasonography. We assessed factors associated with subclinical atherosclerosis defined by a carotid intimal media thickness (CIMT) cut-off of ≥0.78 mm among PLWH using a logistic regression model. RESULTS Mean age of PLWH on combination ART (cART) was 45.7 ± 8.6 years, 42.9 ± 8.8 years among PLWH not on cART, and 44.9 ± 9.5 years among HIV negative controls of which 81.2%, 81.6% and 81.1% respectively were females. Prevalence of subclinical atherosclerosis at the common carotid artery in the three groups was 67.6%, 66.7% and 62.4%, p = 0.43. Among PLWH, raised serum total cholesterol (OR 1.16, 95% CI: 1.00-1.35) and triglycerides (OR 1.32, 95% CI: 1.01-1.73) were significantly associated with subclinical atherosclerosis. Prevalence of vascular risk factors among PLWH on cART, PLWH cART naïve, and HIV negative controls respectively were as follows: dyslipidemia- 79.5%, 83.1%, and 73.5%, p = 0.04; hypertension- 40.2%, 23.4%, and 44.9%, p < 0.0001; central obesity-61.8%, 66.7%, and 78.2%, p < 0.0001; diabetes mellitus-6.8%, 5.5% and 4.9%, p = 0.53. CONCLUSION Overall while there is a high baseline prevalence of CVD risk factors in the Ghanaian population, serum lipid derangements appear to be more prevalent among HIV infected patients, and are linked to sub-clinical atherosclerosis. Future studies need to confirm these findings, explore the underlying pathophysiology, and optimize treatment strategies to avert untoward CVD outcomes.
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Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | - Benedict Agyei
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Arti Singh
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | | | | | - Raelle Tagge
- Medical University of South Carolina, Charleston, USA
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28
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Waters DD, Hsue PY. Lipid Abnormalities in Persons Living With HIV Infection. Can J Cardiol 2018; 35:249-259. [PMID: 30704819 DOI: 10.1016/j.cjca.2018.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/16/2023] Open
Abstract
Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug-drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.
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Affiliation(s)
- David D Waters
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA
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