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Kigongo VJ, Nankabirwa JI, Kitutu FE, Ssenyonga R, Mutebi RK, Kazibwe A, Kiguba R, Kambugu AD, Castelnuovo B. Dyslipidemia among adult people living with HIV on dolutegravir - based antiretroviral therapy at a private tertiary hospital in Kampala, Uganda: burden and determinants. BMC Infect Dis 2024; 24:53. [PMID: 38183002 PMCID: PMC10770888 DOI: 10.1186/s12879-023-08892-8] [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: 09/06/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Understanding the burden of dyslipidemia and its associated factors among adult people living with HIV on dolutegravir (DTG) based anti-retroviral therapy (ART) is critical to provide clinical guidance and risk reduction strategies in our setting. METHODS We conducted a cross-sectional study on adult people living with HIV on DTG based ART between July and August 2022 at Mengo Hospital, a private not for profit missionary hospital owned by the Church of Uganda. Dyslipidemia was defined as: Total cholesterol (TC) ≥ 5.2 mmol/l, or high-density lipoprotein (HDL) < 1 mmol/l for men and < 1.3 mmol/l for women, or triglycerides (TG) ≥ 1.7 mmol/l, and low-density lipoprotein (LDL) ≥ 3.4 mmol/l. A participant was considered to have dyslipidemia if they had any of the lipid profile parameters in the above ranges. Socio-demographic information, clinical data and behavioral characteristics were collected. Fasting lipid profile and fasting blood glucose levels were also measured. Bivariate and multivariate analyses were done using a generalized linear model regression of the Poisson family with a log link (modified Poisson) using robust standard errors since the prevalence of dyslipidemia was more than 10%. Adjusted prevalence ratios (PR) were reported with their 95% confidence intervals (CI). A p-value of less than 0.05 was considered statistically significant. RESULTS A total of 341 participants were included. The prevalence of dyslipidemia was 78.0%, (95%CI:73.3-82.1). The highest prevalence was for low HDL (72.1%, 95%CI 67.1-76.7) followed by high TG (20.2%, 95%CI: 16.3-24.9), high TC (12.0%, 95%CI: 9.0-15.9) and high LDL (6.5%, 95%CI: 4.3-9.6). Female sex (aPR:1.55, 95%CI: 1.32-1.84, p < 0.001) and previous use of protease inhibitor (PI) based ART regimen (aPR:1.26, 95%CI: 1.04-1.53, p = 0.018) were significantly associated with dyslipidemia. CONCLUSION We demonstrate that the prevalence of dyslipidemia is very high as it was present in more than three quarters of the study participants. Female sex and previous use of PI based ART regimen were significantly associated with dyslipidemia. Management of dyslipidemia should be integrated in the HIV treatment package and we recommend further inquiry into the temporal relationship between dyslipidemia and DTG among ART patients, if any.
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Affiliation(s)
- Vianney John Kigongo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
- The AIDS Support Organisation (TASO), Kampala, Uganda.
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew D Kambugu
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
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Fernandes SR, Leite AR, Lino R, Guimarães AR, Pineiro C, Serrão R, Freitas P. The impact of integrase inhibitors on steatosis and fibrosis biomarkers in persons with HIV naïve to antiretroviral therapy. BMC Infect Dis 2023; 23:553. [PMID: 37620821 PMCID: PMC10464196 DOI: 10.1186/s12879-023-08530-3] [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: 05/29/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Non-alcoholic Fatty Liver Disease (NAFLD) has a high prevalence among persons with HIV infection. Since Integrase Strand Transfer Inhibitors (INSTIs) are used worldwide and have been associated with weight gain, we must determine their effect in the development of NAFLD and Non-alcoholic Steatohepatitis (NASH) in these patients. The aim of this study was to explore the impact of INSTIs on variation of liver steatosis and fibrosis in the ART-naïve person with HIV, using Hepatic Steatosis Index (HSI), Fibrosis-4 Index (FIB-4), BARD score and NAFLD Fibrosis Score (NFS). METHODS We performed a monocentric, retrospective cohort study in ART-naïve persons with HIV that initiated INSTI based regimens between December 2019 and January 2022. Data was collected at baseline, 6 and 12 months after initiation. Demographic, clinical and laboratory characteristics, hepatic steatosis, and fibrosis scores were compared between baseline and last visit at 12 months. Linear regression models were performed to analyse the associations between analytical data at baseline and hepatic scores variation during the 12 months of treatment. Models were performed unadjusted and adjusted for age and sex. RESULTS 99 patients were included in our study. 82% were male and median age was 36 years. We observed a significant increase in body mass index (BMI), HDL, platelet count, albumin, and creatinine and a significant decrease in AST levels. HSI showed no statistically significant differences during follow-up (p = 0.114). We observed a significant decrease in FIB-4 (p = 0.007) and NFS (p = 0.002). BARD score showed a significant increase (p = 0.006). The linear regression model demonstrated a significant negative association between baseline HIV RNA and FIB-4 change (β= -0.08, 95% CI [-0.16 to -0.00], p = 0.045), suggesting that higher HIV RNA loads at baseline were associated with a greater decrease in FIB-4. CONCLUSION INSTIs seem to have no impact on hepatic steatosis, even though they were associated with a significant increase in BMI. This might be explained by the direct effect of a dolutegravir-containing regimen and/or by the "return-to-health effect" observed with ART initiation. Furthermore, INSTIs were associated with a reduction in risk of liver fibrosis in ART-naïve persons with HIV, possibly due to their effect on viral suppression.
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Affiliation(s)
| | - Ana Rita Leite
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário São João, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rita Lino
- Departamento de Doenças Infeciosas do Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Carmela Pineiro
- Departamento de Doenças Infeciosas do Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rosário Serrão
- Departamento de Doenças Infeciosas do Centro Hospitalar Universitário São João, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário São João, Faculdade de Medicina, Investigação e Inovação em Saúde (i3s), Universidade do Porto, Porto, Portugal
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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Francisco C, Gonzales E, Yu MG, Salvaña EM, Abad C, Reganit PF, Maningat P, Sison O, Alejandria M. Metabolic Profile of People Living with HIV in a Treatment Hub in Manila, Philippines: A Pre- and Post-Antiretroviral Analysis. J ASEAN Fed Endocr Soc 2022; 37:53-61. [PMID: 35800599 PMCID: PMC9242666 DOI: 10.15605/jafes.037.01.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/26/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives People living with HIV (PLHIV) are susceptible to develop dyslipidemia and hyperglycemia. This study aims to determine the prevalence of these metabolic derangements among Filipino PLHIV. Methodology We reviewed 635 medical records in a treatment hub in Manila, Philippines from January 2004 to July 2016. Logistic regression analysis was done to determine factors associated with dyslipidemia and hyperglycemia pre- and post-ART. Results Among 635 PLHIV, 97.3% were males with mean age of 30 years and median CD4 count of 207 cells/mm3. Pre-ART, prevalence of dyslipidemia was 65.4% and hyperglycemia was 10.4%. Risk factors for dyslipidemia include hyperglycemia (AOR 3.8, p 0.001) and >320 days delay in ART initiation from HIV confirmation (AOR 1.5, p 0.032), while dyslipidemia was associated with hyperglycemia (AOR 3.1, p 0.001). Post-ART, prevalence of dyslipidemia was 48.6% and hyperglycemia was 15.6%. Risk factors for post-ART dyslipidemia include being WHO stage 4 (AOR 2.1, p 0.021), hyperglycemia (AOR 16.1, p<0.001), >36 months ART duration (AOR 8.7, p<0.001) and efavirenz-based ART (AOR 2.8, p<0.001). Low CD4 count post-ART had a negative correlation with dyslipidemia (AOR 0.5, p 0.005). Post-ART hyperglycemia was associated with age >30 years (AOR 2.1, p 0.004), being overweight (AOR 1.8, p 0.023), dyslipidemia (AOR 17.8, p<0.001) and zidovudine-based ART (AOR 1.4, p 0.051). Conclusion Dyslipidemia and hyperglycemia prevalence was high in Filipino PLHIV. Traditional, HIV and treatment related factors contributed to its development. Intensive monitoring and initiation of appropriate treatment is recommended.
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Affiliation(s)
- Christian Francisco
- Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines Manila
- Division of Infectious Diseases, Department of Medicine, University of the Philippines-Philippine General Hospital
| | - Eddieson Gonzales
- Division of Cardiovascular Medicine, Department of Medicine, University of the Philippines-Philippine General Hospital
| | - Marc Gregory Yu
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital
| | - Edsel Maurice Salvaña
- Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines Manila
- Division of Infectious Diseases, Department of Medicine, University of the Philippines-Philippine General Hospital
| | - Cybele Abad
- Division of Infectious Diseases, Department of Medicine, University of the Philippines-Philippine General Hospital
| | - Paul Ferdinand Reganit
- Division of Cardiovascular Medicine, Department of Medicine, University of the Philippines-Philippine General Hospital
| | - Patricia Maningat
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital
| | - Olivia Sison
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila
| | - Marissa Alejandria
- Division of Infectious Diseases, Department of Medicine, University of the Philippines-Philippine General Hospital
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila
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Su X, Zhang G, Cheng Y, Wang B. New insights into the emerging effects of inflammatory response on HDL particles structure and function. Mol Biol Rep 2021; 48:5723-5733. [PMID: 34319542 DOI: 10.1007/s11033-021-06553-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022]
Abstract
According to the increasing results, it has been well-demonstrated that the chronic inflammatory response, including systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel disease are associated with an increased risk of atherosclerotic cardiovascular disease. The mechanism whereby inflammatory response up-regulates the risk of cardio-metabolic disorder disease is multifactorial; furthermore, the alterations in high density lipoprotein (HDL) structure and function which occur under the inflammatory response could play an important modulatory function. On the other hand, the serum concentrations of HDL cholesterol (HDL-C) have been shown to be reduced significantly under inflammatory status with remarked alterations in HDL particles. Nevertheless, the potential mechanism whereby the inflammatory response reduces serum HDL-C levels is not simply defined but reduces apolipoprotein A1 production. The alterations in HDL structure mediated by the inflammatory response has been also confirmed to decrease the ability of HDL particle to play an important role in reverse cholesterol transport and protect the LDL particles from oxidation. Recently, it has been shown that under the inflammatory condition, diverse alterations in HDL structure could be observed which lead to changes in HDL function. In the current review, the emerging effects of inflammatory response on HDL particles structure and function are well-summarized to elucidate the potential mechanism whereby different inflammatory status modulates the pathogenic development of dyslipidemia.
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Affiliation(s)
- Xin Su
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China
| | - Guoming Zhang
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China
| | - Ye Cheng
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China.
| | - Bin Wang
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China.
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Greiner R, Nyrienda M, Rodgers L, Asiki G, Banda L, Shields B, Hattersley A, Crampin A, Newton R, Jones A. Associations between low HDL, sex and cardiovascular risk markers are substantially different in sub-Saharan Africa and the UK: analysis of four population studies. BMJ Glob Health 2021; 6:e005222. [PMID: 34016577 PMCID: PMC8141440 DOI: 10.1136/bmjgh-2021-005222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/11/2021] [Accepted: 05/05/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Low high-density lipoprotein (HDL) is widely used as a marker of cardiovascular disease risk, although this relationship is not causal and is likely mediated through associations with other risk factors. Low HDL is extremely common in sub-Saharan African populations, and this has often been interpreted to indicate that these populations will have increased cardiovascular risk. We aimed to determine whether the association between HDL and other cardiovascular risk factors differed between populations in sub-Saharan Africa and the UK. METHODS We compared data from adults living in Uganda and Malawi (n=26 216) and in the UK (n=8747). We examined unadjusted and adjusted levels of HDL and applied the WHO recommended cut-offs for prevalence estimates. We used spline and linear regression to assess the relationship between HDL and other cardiovascular risk factors. RESULTS HDL was substantially lower in the African than in the European studies (geometric mean 0.9-1.2 mmol/L vs 1.3-1.8 mmol/L), with African prevalence of low HDL as high as 77%. Total cholesterol was also substantially lower (geometric mean 3.3-3.9 mmol/L vs 4.6-5.4 mmol/L). In comparison with European studies the relationship between HDL and adiposity (body mass index, waist to hip ratio) was greatly attenuated in African studies and the relationship with non-HDL cholesterol reversed: in African studies low HDL was associated with lower non-HDL cholesterol. The association between sex and HDL was also different; using the WHO sex-specific definitions, low HDL was substantially more common among women (69%-77%) than men (41%-59%) in Uganda/Malawi. CONCLUSION The relationship between HDL and sex, adiposity and non-HDL cholesterol in sub-Saharan Africa is different from European populations. In sub-Saharan Africans low HDL is a marker of low overall cholesterol and sex differences are markedly attenuated. Therefore low HDL in isolation is unlikely to indicate raised cardiovascular risk and the WHO sex-based cut-offs are inappropriate.
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Affiliation(s)
- Rosamund Greiner
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | | | - Lauren Rodgers
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Louis Banda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Beverly Shields
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Andrew Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Angus Jones
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
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Jakhar S, Sakamuri R, Vu D, Dighe P, Stromberg LR, Lilley L, Hengartner N, Swanson BI, Moreau E, Dorman SE, Mukundan H. Interaction of amphiphilic lipoarabinomannan with host carrier lipoproteins in tuberculosis patients: Implications for blood-based diagnostics. PLoS One 2021; 16:e0243337. [PMID: 33826643 PMCID: PMC8026062 DOI: 10.1371/journal.pone.0243337] [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] [Received: 11/13/2020] [Accepted: 03/01/2021] [Indexed: 11/18/2022] Open
Abstract
Lipoarabinomannan (LAM), an amphiphilic lipoglycan of the Mycobacterium tuberculosis cell wall, is a diagnostic target for tuberculosis. Previous work from our laboratory and others suggests that LAM is associated with host serum lipoproteins, which may in turn have implications for diagnostic assays. Our team has developed two serum assays for amphiphile detection: lipoprotein capture and membrane insertion. The lipoprotein capture assay relies on capture of the host lipoproteins, exploiting the biological association of host lipoprotein with microbial amphiphilic biomarkers to "concentrate" LAM. In contrast, the membrane insertion assay is independent of the association between pathogen amphiphiles and host lipoprotein association, and directly captures LAM based on its thermodynamic propensity for association with a supported lipid membrane, which forms the functional surface of an optical biosensor. In this manuscript, we explored the use of these assays for the detection of LAM in sera from adults whose tuberculosis status had been well-characterized using conventional microbiological tests, and endemic controls. Using the lipoprotein capture assay, LAM signal/noise ratios were >1.0 in 29/35 (83%) individuals with culture-confirmed active tuberculosis, 8/13 (62%) individuals with tuberculosis symptoms, but no positive culture for M. tuberculosis, and 0/6 (0%) symptom-free endemic controls. To evaluate serum LAM levels without bias associated with potential differences in circulating host lipoprotein concentrations between individuals, we subsequently processed available samples to liberate LAM from associated host lipoprotein assemblies followed by direct detection of the pathogen biomarker using the membrane insertion approach. Using the membrane insertion assay, signal/noise for detection of serum LAM was greater than that observed using the lipoprotein capture method for culture-confirmed TB patients (6/6), yet remained negative for controls (2/2). Taken together, these results suggest that detection of serum LAM is a promising TB diagnostic approach, but that further work is required to optimize assay performance and to decipher the implications of LAM/host lipoprotein associations for diagnostic assay performance and TB pathogenesis.
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Affiliation(s)
- Shailja Jakhar
- Physical Chemistry and Applied Spectroscopy, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Ramamurthy Sakamuri
- Physical Chemistry and Applied Spectroscopy, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Dung Vu
- Physical Chemistry and Applied Spectroscopy, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
- Actinide Analytical chemistry, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Priya Dighe
- Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Loreen R. Stromberg
- Physical Chemistry and Applied Spectroscopy, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Laura Lilley
- Physical Chemistry and Applied Spectroscopy, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Nicolas Hengartner
- Theoretical Biology and Biophysics, Theory Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Basil I. Swanson
- Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Emmanuel Moreau
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Susan E. Dorman
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Harshini Mukundan
- Physical Chemistry and Applied Spectroscopy, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
- * E-mail:
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Tilahun H, Masyuko SJ, Mogaka JN, Temu T, Kinuthia J, Osoti AO, Nakanjako D, Farquhar C, Page ST. Prevalence and correlates of dyslipidemia in HIV positive and negative adults in Western Kenya: A cross-sectional study. Medicine (Baltimore) 2021; 100:e24800. [PMID: 33725834 PMCID: PMC7969311 DOI: 10.1097/md.0000000000024800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/01/2021] [Accepted: 01/28/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT There is increasing morbidity and mortality from cardiovascular diseases (CVD) in sub-Saharan Africa (SSA). Dyslipidemia is a well-known CVD risk factor which has been associated with human immunodeficiency virus (HIV) infection and its treatment in high-income countries. Studies in SSA that have examined the relationship between HIV and dyslipidemia have reported mixed results. In this study, we sought to determine the prevalence of dyslipidemia in HIV positive and negative adults (>=30 years old) and evaluate for association in Western Kenya with a higher prevalence expected among HIV positive individuals.HIV positive adults receiving antiretroviral therapy (ART) and HIV negative individuals seeking HIV testing and counseling services were recruited into a cross-sectional study. Demographic and behavioral data and fasting blood samples were collected. Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Associations between baseline demographic and clinical variables and dyslipidemia were analyzed using logistic regression.A total of 598 participants, 300 HIV positive and 298 HIV negative adults were enrolled. Dyslipidemia data was available for 564 (94%) participants. In total, 267 (47%) had dyslipidemia. This was not significantly different between HIV positive and HIV negative individuals (46% vs 49%, P = .4). In a multivariate analysis including both HIV positive and negative individuals, adults 50 to 59 years of age had a 2-fold increased risk of dyslipidemia (Odds ratio [OR] 2.1, 95% confidence interval (1.2-3.5) when compared to 30 to 39-years-old participants. Abdominal obesity (OR 2.5), being overweight (OR 1.9), and low fruit and vegetable intake (OR 2.2) were significantly associated with dyslipidemia. Among HIV positive participants, time since HIV diagnosis, ART duration, use of (PI) protease inhibitor-based ART, viral load suppression, current cluster of differentiation (CD4) count and nadir CD4 did not have significant associations with dyslipidemia.The prevalence of dyslipidemia is high in Western Kenya, with nearly half of all participants with lipid abnormalities. Dyslipidemia was not significantly associated with HIV status, or with HIV-specific factors. Older age, being overweight, abdominal obesity, and low fruit and vegetable intake were associated with dyslipidemia and may be targets for public health interventions to lower the prevalence of dyslipidemia and CVD risk in sub-Saharan Africa.
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Affiliation(s)
| | - Sarah J. Masyuko
- Department of Global Health, University of Washington, Seattle, WA
- Ministry of Health
| | | | - Tecla Temu
- Department of Global Health, University of Washington, Seattle, WA
| | - John Kinuthia
- Kenyatta National Hospital
- University of Nairobi, Nairobi, Kenya
| | - Alfred O. Osoti
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Carey Farquhar
- Departments of Global Health, Medicine and Epidemiology, University of Washington
| | - Stephanie T. Page
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA
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Hamooya BM, Musonda P, Mutale W, Masenga SK, Halwiindi H, Mutengo KH, Chiyeñu KOR, Chongwe G, Koethe JR, Lipworth L, Heimburger DC. Prevalence of low high-density lipoprotein among young adults receiving antiretroviral therapy in Zambia: An opportunity to consider non-communicable diseases in resource-limited settings. PLoS One 2021; 16:e0247004. [PMID: 33592027 PMCID: PMC7886128 DOI: 10.1371/journal.pone.0247004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/29/2021] [Indexed: 01/13/2023] Open
Abstract
Background With the introduction of effective antiretroviral therapy (ART), people living with HIV (PLWH) are surviving longer and are at risk for developing metabolic abnormalities that contribute to cardiovascular disease (CVD). In Sub-Saharan Africa (SSA), there is a paucity of epidemiological data on lipid profiles among young adults receiving ART. This study aimed to estimate the prevalence of low high-density lipoprotein cholesterol (HDL-c), a cardioprotective lipid class, and whether it differed by age among adults on ART in Livingstone, Zambia. Methods From April to December 2019, we conducted a cross-sectional study of 597 PLWH [n = 58 aged 18–24 years (young adults); n = 539 aged ≥25 years (adults)] on ART for ≥6 months. Data collected included demographic and lifestyle information, anthropometrics, viral load (VL), CD4 count, blood pressure, lipid profiles and fasting/random blood glucose. Clinical measures were defined as: low HDL-c [<1.0 mmol/L for men, <1.3 for women], increased waist circumference (WC) [≥94 cm for men, ≥80 cm for women], high triglycerides (TG) [≥1.7 mmol/l], and virological failure (VF) [VL ≥1000 copies/μl]. We used logistic regression to examine the association between age and low HDL-c after adjusting for multiple variables. Results Among the young adults, 60% (35/58) were women, median (25th, 75th percentile) age 21 years (18, 23), and median time on ART 116 months (60, 144). Among adults, 63% (342/539) were women, median age 46 years (40, 53) and median time on ART 108 months (60, 144). Young adults had a lower CD4 count compared to adults (median, 492 vs. 568 cells/μL, p = 0.010) and higher prevalence of VF (29% vs. 17%, p = 0.016). In young adults, prevalence of low HDL-c was significantly higher than in adults (63 vs. 38%, p<0.001). A high proportion of young adults (75%) and adults (58%) with low HDL-c were on dolutegravir (DTG)-based ART regimens. After adjusting for sex, duration on ART, WC, body mass index, ART regimen, VF, CD4 count, low density lipoprotein cholesterol, blood pressure and smoking, young adults were significantly more likely than adults to have low HDL-c (odds ratio 2.93; 95% confidence interval 1.46–5.86). Conclusion Low HDL-c is highly prevalent among young adult with HIV in SSA independent of other risk factors for metabolic derangements. Lipid abnormalities among young PLWH may contribute to the early development of cardiovascular diseases in this population. This highlights the need to consider low HDL-c in the quest to reduce CVD risk among young adults on ART in SSA.
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Affiliation(s)
- Benson M. Hamooya
- University of Zambia School of Public Health, Lusaka, Zambia
- Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
- Vanderbilt Institute for Global Health, Nashville, TN, United States of America
- * E-mail:
| | - Patrick Musonda
- University of Zambia School of Public Health, Lusaka, Zambia
| | - Wilbroad Mutale
- University of Zambia School of Public Health, Lusaka, Zambia
| | - Sepiso K. Masenga
- Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
- Department of Biomedical Sciences, University of Zambia School of Health Sciences, Lusaka, Zambia
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | | | - Katongo H. Mutengo
- Livingstone Central Hospital, Livingstone, Zambia
- Ministry of Health, Lusaka, Zambia
| | - Kaseya O. R. Chiyeñu
- Livingstone Central Hospital, Livingstone, Zambia
- Ministry of Health, Lusaka, Zambia
| | - Gershom Chongwe
- University of Zambia School of Public Health, Lusaka, Zambia
| | - John R. Koethe
- Vanderbilt Institute for Global Health, Nashville, TN, United States of America
- Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Loren Lipworth
- Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Douglas C. Heimburger
- Vanderbilt Institute for Global Health, Nashville, TN, United States of America
- Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
- University of Zambia School of Medicine, Lusaka, Zambia
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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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Seedat F, Raal F, Martinson N, Variava E. LIPID AND LIPOPROTEIN LEVELS IN HIV-INFECTED ADULTS WITH SEPSIS COMPARED TO HEALTHY HIV- INFECTED CONTROLS. Afr J Infect Dis 2020; 14:1-9. [PMID: 33884344 PMCID: PMC8047293 DOI: 10.21010/ajid.v14i2.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background: In acute sepsis, reduced lipid and lipoprotein levels occur in HIV negative patients, in particular, low high-density lipoprotein cholesterol (HDL–c) levels are inversely correlated with sepsis severity and increased mortality. However, due to the limited data describing lipid and lipoprotein levels in septic HIV–infected individuals we aimed to investigate the changes in this subgroup. Materials and Methods: A prospective cross–sectional observational study of HIV–infected patients comparing admitted HIV – infected patients with sepsis to healthy controls from the antiretroviral therapy (ART) clinic. Non fasting - lipograms, ART use, diagnosis of tuberculosis (TB), markers of infection, renal function and mortality outcome to 3 months post discharge were reviewed. Results: Total cholesterol (TC), low–density lipoprotein (LDL–c) and HDL-c were all significantly lower in the sepsis group (p < 0.001). HDL–c was significantly associated with a higher white cell count (p = 0.018), higher C– reactive protein (p = 0.036) and low serum albumin (p < 0.001). In those with active TB (55%) HDL–c was reduced even further (0.55 vs. 0.72mmol/L, p = 0.013). Acute kidney injury (p = 0.560) and mortality at discharge (p = 0.097) or 3 months follow up (p = 0.953) was not associated with reduced HDL–c. Conclusion: Septic HIV–infected patients had significantly reduced lipid and lipoprotein levels at admission. Of note however, a low HDL–c was associated with markers of infection and reductions in HDL–c was more marked in those with active TB.
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Affiliation(s)
- Faheem Seedat
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | - Frederick Raal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | - Neil Martinson
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, North West Province Department of Health, University of the Witwatersrand, South Africa
| | - Ebrahim Variava
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, North West Province Department of Health, University of the Witwatersrand, South Africa.,Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa
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Kemal A, Teshome MS, Ahmed M, Molla M, Malik T, Mohammed J, Abate KH. Dyslipidemia and Associated Factors Among Adult Patients on Antiretroviral Therapy in Armed Force Comprehensive and Specialized Hospital, Addis Ababa, Ethiopia. HIV AIDS (Auckl) 2020; 12:221-231. [PMID: 32753977 PMCID: PMC7342468 DOI: 10.2147/hiv.s252391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/12/2020] [Indexed: 12/25/2022] Open
Abstract
Background The development of antiretroviral drugs and subsequent access to combined antiretroviral therapy contributed to the decline in morbidity and mortality rates associated with acquired immune deficiency syndrome, resulting in an increased life expectancy and improved quality of life for people living with human immunodeficiency virus. However, a cluster of metabolic derangements such as dyslipidemia is increasing, especially for those on antiretroviral therapy. Limited studies were done on the prevalence of dyslipidemia and its associated factors among adult patients on antiretroviral therapy in Ethiopia which demand the conduct of the present investigation entitled on the prevalence of dyslipidemia and its associated factors among adult patients on antiretroviral therapy in Armed Force Comprehensive and Specialized Hospital Addis Ababa, Ethiopia, 2018. Methods Institution-based cross-sectional study design was employed between March and April 2018. Systematic sampling method was used to select 353 study participants. Pretested stepwise approach of the World Health Organization questionnaire (WHO Stepwise), document review, anthropometric measurements, and laboratory analysis were used to collect data on different variables under the study. Collected data were entered in Epidata version 3 and analyzed by SPSS version 21. Results The prevalence of dyslipidemia among study participants was 74.8%. Female participants were twice and half at risk of developing dyslipidemia compared to males (AOR= 2.38; 95% CI: 1.15, 3.66). Similarly, compared to those attended college level of education, not attended formal education (AOR=0.19; 95% CI: 0.05, 0.66), and having primary/secondary educational level (AOR= 0.33; 95% CI: 0.16, 0.66) showed lower odds to develop dyslipidemia. Furthermore, WHO clinical stage II (AOR= 0.35; 95% CI: 0.14,0.92), stage III (AOR=0.25; 95% CI:0.10,0.64), duration on ART (AOR= 1.01; 95% CI: 1.001,1.02), and BMI (AOR =1.13; 95% CI: 1.06,1.23) were significantly associated with dyslipidemia. Conclusion There exists a high prevalence of dyslipidemia among study participants. Sex, educational status, WHO clinical stage, duration on ART, and BMI were significantly associated factors for dyslipidemia. Intervention strategies including the identified factors are demanded in the setting.
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Affiliation(s)
- Adnan Kemal
- Department of Public Health, College of Health Science, Defense University, Addis Ababa, Ethiopia
| | | | - Mohammed Ahmed
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Meseret Molla
- Department of Public Health, College of Health Science, Defense University, Addis Ababa, Ethiopia
| | - Tabarak Malik
- Department of Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jemmal Mohammed
- Department of Ophthalmology, Jimma University, Jimma, Ethiopia
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Dyslipidemia among rural and urban HIV patients in south-east Malawi. PLoS One 2018; 13:e0197728. [PMID: 29782548 PMCID: PMC5962094 DOI: 10.1371/journal.pone.0197728] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/08/2018] [Indexed: 12/17/2022] Open
Abstract
Background While dyslipidemia importantly contributes to increased cardiovascular disease risk among patients on antiretroviral therapy (ART), data on lipid patterns among African adults on ART are limited. We describe the prevalence of lipid abnormalities and associated factors in two HIV clinics in Malawi. Methods We conducted a cross-sectional study in 2014 and enrolled adult patients at a rural and an urban HIV clinic in Zomba district, Malawi. We recorded patient characteristics, CVD risk factors and anthropometric measurements, using the WHO STEPS validated instrument. Non-fasting samples were taken for determination of total cholesterol (TC), triglyceride (TG) and HDL-cholesterol (HDL-c) levels. Logistic regression analysis was used to determine factors associated with elevated TC and elevated TC/HDL-c ratio. Results 554 patients were enrolled, 50% at the rural HIV clinic, 72.7% were female, the median (IQR) age was 42 years (36–50); 97.3% were on ART, 84.4% on tenofovir/lamivudine/efavirenz, 17.5% were overweight/obese and 27.8%% had elevated waist/hip ratio. 15.5% had elevated TC, 15.9% reduced HDL-c, 28.7% had elevated TG and 3.8% had elevated TC/HDL-c ratio. Lipid abnormalities were similar in rural and urban patients. Women had significantly higher burden of elevated TC and TG whereas men had higher prevalence of reduced HDL-c. Waist-to-hip ratio was independently associated with elevated TC (aOR = 1.90; 95% CI: 1.17–3.10, p = 0.01) and elevated TC/HDL-c ratio (aOR = 3.50; 95% CI: 1.38–8.85, p = 0.008). Increasing age was independently associated with elevated TC level (aOR = 1.54, 95% CI 0.51–4.59 for age 31–45; aOR = 3.69, 95% CI 1.24–10.95 for age >45 years vs. ≤30 years; p-trend <0.01). Conclusions We found a moderate burden of dyslipidemia among Malawian adults on ART, which was similar in rural and urban patients but differed significantly between men and women. High waist-hip ratio predicted elevated TC and elevated TC/HDL-c ratio and may be a practical tool for CVD risk indication in resource limited settings.
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