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Quinlan CM, Avorn J, Kesselheim AS, Singer DE, Zhang Y, Cervone A, Lin KJ. Comparative Bleeding Risk in Older Patients With HIV and Atrial Fibrillation Receiving Oral Anticoagulants. JAMA Intern Med 2025:2830181. [PMID: 39992678 PMCID: PMC11851300 DOI: 10.1001/jamainternmed.2024.8335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 12/20/2024] [Indexed: 02/26/2025]
Abstract
Importance People living with HIV and atrial fibrillation (AF) often receive anticoagulation that may interact with their antiretroviral therapy (ART). No studies exist comparing the safety of oral anticoagulants in this population. Objective To compare the bleeding risks among warfarin, rivaroxaban, and apixaban users in a national US cohort with AF and HIV. Design, Setting, and Participants A new-user, active-comparator, propensity score overlap-weighted cohort study using the target trial emulation framework including Medicare claims database data (January 1, 2013, to December 31, 2020) was carried out. The analysis was conducted from July 2023 to April 2024. Exposure New initiators of warfarin vs apixaban, rivaroxaban vs apixaban, and rivaroxaban vs warfarin aged 50 years or older with nonvalvular AF and HIV. Main Outcomes and Measures The primary outcome was hospitalization for major bleeding. Secondary outcomes included hospitalization for gastrointestinal bleeding, ischemic stroke, and all-cause mortality. Results Overall, 2683 individuals (mean [SD] age, 66.22 [8.97] years; 580 female individuals [21.6%]) in the warfarin vs apixaban cohort, 2176 (mean [SD] age, 66.61 [8.87] years; 455 female individuals [20.9%]) in the rivaroxaban vs apixaban cohort, and 1787 (mean age, 65.47 years; 377 female individuals [21.1%]) in the rivaroxaban vs warfarin cohort. After propensity score overlap weighting, warfarin initiation was associated with a higher rate of major bleeding than initiation of apixaban (hazard ratio [HR], 2.60; 95% CI, 1.51-4.49), including major gastrointestinal bleeding (HR, 2.99; 95% CI, 1.52-5.90). This association was intensified in the 71% of patients taking concurrent ART (major bleeding, HR, 6.68; 95% CI, 2.78-16.02; gastrointestinal bleeding, HR, 5.28; 95% CI, 2.08-13.42). Rivaroxaban vs apixaban was also associated with a higher rate of major bleeding (HR, 2.15; 95% CI, 1.18-3.94) and gastrointestinal bleeding (HR, 3.38; 95% CI, 1.57-7.25), with a stronger association in those using ART (major bleeding, HR, 4.83; 95% CI, 2.11-11.08; gastrointestinal bleeding, HR, 4.76; 95% CI, 1.78-12.70). Estimates were similar when comparing rivaroxaban with warfarin. No significant difference was observed in the rate of ischemic stroke or mortality among the 3 oral anticoagulants. Conclusions and Relevance This study found that in patients with HIV and AF, especially those treated with ART, warfarin and rivaroxaban were associated with higher rates of major bleeding compared with apixaban, suggesting a superior safety profile for apixaban in this high-risk population.
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Affiliation(s)
| | - Jerry Avorn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aaron S. Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel E. Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yichi Zhang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alex Cervone
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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2
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Elvstam O, Ryom L, Neesgaard B, Tau L, Günthard HF, Zangerle R, Vehreschild JJ, Wit F, Sönnerborg A, Kovari H, Abutidze A, Petoumenos K, Jaschinski N, Hosein S, Bogner J, Grabmeier-Pfistershammer K, Garges H, Rooney J, Young L, Law M, Kirk O. Viremia Does Not Independently Predict Cardiovascular Disease in People With HIV: A RESPOND Cohort Study. Open Forum Infect Dis 2025; 12:ofaf016. [PMID: 39896984 PMCID: PMC11786055 DOI: 10.1093/ofid/ofaf016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 01/09/2025] [Indexed: 02/04/2025] Open
Abstract
Background HIV viremia has been considered a cardiovascular disease (CVD) risk factor, but many studies have had insufficient data on potential confounders. We explored the association between viremia and CVD after adjusting for established risk factors and analyzed whether consideration of viremia would improve CVD prediction. Methods Adults from RESPOND were followed from the first date with available data until the first of rigorously defined CVD, loss to follow-up, death, or administrative censoring. We first analyzed the associations between 6 measures of viremia (time-updated, before antiretroviral therapy [ART], viremia category, and measures of cumulative viremia) and CVD after adjusting for the variables in the D:A:D CVD score (age, sex/gender, smoking, family history, diabetes, recent abacavir, CD4 count, blood pressure, cholesterol, high-density lipoprotein, cumulative use of stavudine, didanosine, indinavir, lopinavir, and darunavir). We subsequently compared predictive performance with and without viremia in 5-fold internal cross-validation. Results A total of 547 events were observed in 17 497 persons (median follow-up, 6.8 years). Although some viremia variables were associated with CVD in univariable analyses, there were no statistically significant associations after adjusting for potential confounders, neither for measures of current viral load, pre-ART viral load, highest viremia category during ART, nor cumulative viremia (modeled both as total cumulative viremia, cumulative viremia during ART, and recent cumulative viremia). Consistently, none of the viremia variables improved prediction capacity. Conclusions In this large international cohort, HIV viremia was not associated with CVD when adjusting for established risk factors. Our results did not show viremia to be predictive of CVD among people with HIV.
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Affiliation(s)
- Olof Elvstam
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Växjö Central Hospital, Växjö, Sweden
| | - Lene Ryom
- CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases 144, Hvidovre University Hospital, Copenhagen, Denmark
| | - Bastian Neesgaard
- CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Luba Tau
- Tel Aviv Sourasky Medical Center, Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Robert Zangerle
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, University Hospital, Innsbruck, Austria
| | - Jörg Janne Vehreschild
- Institute for Digital Medicine and Clinical Data Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Anders Sönnerborg
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Helen Kovari
- Center for Infectious Diseases, Klinik im Park, Zürich, Switzerland
| | - Akaki Abutidze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Kathy Petoumenos
- The Australian HIV Observational Database (AHOD), The Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Nadine Jaschinski
- CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Hosein
- European AIDS Treatment Group (EATG), Brussels, Belgium
| | - Johannes Bogner
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | | | - Harmony Garges
- ViiV Healthcare, Research Triangle Park, Durham, North Carolina, USA
| | - Jim Rooney
- Gilead Science, Foster City, California, USA
| | - Lital Young
- Merck Sharp & Dohme, Rahway, New Jersey, USA
| | - Matthew Law
- Biostatistics and Databases Program, Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Ole Kirk
- CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Kobe EA, Thakkar A, Matai S, Akkaya E, Pagidipati NJ, McGarrah RW, Bloomfield GS, Shah NP. Optimizing cardiometabolic risk in people living with human immunodeficiency virus: A deep dive into an important risk enhancer. Am J Prev Cardiol 2024; 20:100888. [PMID: 39552706 PMCID: PMC11566711 DOI: 10.1016/j.ajpc.2024.100888] [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: 07/04/2024] [Revised: 10/13/2024] [Accepted: 10/27/2024] [Indexed: 11/19/2024] Open
Abstract
Effective antiretroviral therapy (ART) is now nearly ubiquitous. However, the survival benefits conferred with ART contribute to an aging human immunodeficiency virus (HIV) population and increased risk of chronic diseases, like atherosclerotic cardiovascular disease (ASCVD). Furthermore, HIV is a known risk enhancer of ASCVD and acknowledged as such in the current 2018 AHA/ACC Blood Cholesterol guidelines [1]. This makes cardiovascular risk factor identification and modification among people living with HIV (PLWH) of increasing importance to prevent cardiovascular events. In this review, we aim to summarize the epidemiology and pathogenesis of how HIV is linked to atherogenesis and to discuss cardiometabolic risk factor modification specific to PLWH, covering obesity, hypertension, insulin resistance, metabolic dysfunction-associated steatotic liver disease, and dyslipidemia.
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Affiliation(s)
- Elizabeth A. Kobe
- Duke University Hospitals, 2301 Erwin Road, Suite 7400, Cubicle 13, Durham, NC 27710, USA
| | - Aarti Thakkar
- Duke University Hospitals, 2301 Erwin Road, Suite 7400, Cubicle 13, Durham, NC 27710, USA
| | - Sarina Matai
- Raleigh Charter High School, 1307 Glenwood Ave, Raleigh, NC 27605, USA
| | - Esra Akkaya
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710, USA
- Duke Molecular Physiology Institute, 300 N Duke St, Durham, NC 27701, USA
| | - Neha J. Pagidipati
- Duke University Hospitals, 2301 Erwin Road, Suite 7400, Cubicle 13, Durham, NC 27710, USA
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710, USA
- Duke Clinical Research Institute, 300 W Morgan St, Durham, NC 27701, USA
| | - Robert W. McGarrah
- Duke University Hospitals, 2301 Erwin Road, Suite 7400, Cubicle 13, Durham, NC 27710, USA
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710, USA
- Duke Molecular Physiology Institute, 300 N Duke St, Durham, NC 27701, USA
| | - Gerald S. Bloomfield
- Duke University Hospitals, 2301 Erwin Road, Suite 7400, Cubicle 13, Durham, NC 27710, USA
- Duke Clinical Research Institute, 300 W Morgan St, Durham, NC 27701, USA
- Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Nishant P. Shah
- Duke University Hospitals, 2301 Erwin Road, Suite 7400, Cubicle 13, Durham, NC 27710, USA
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710, USA
- Duke Clinical Research Institute, 300 W Morgan St, Durham, NC 27701, USA
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Rerkasem A, Chotirosniramit N, Tangmunkongvorakul A, Aurpibul L, Sripan P, Parklak W, Thaichana P, Srithanaviboonchai K, Rerkasem K. Impact of arterial stiffness on health-related quality of life in older Thai adults with treated HIV infection: a multicenter cohort study. Qual Life Res 2024; 33:3245-3257. [PMID: 39400692 DOI: 10.1007/s11136-024-03796-9] [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] [Accepted: 09/24/2024] [Indexed: 10/15/2024]
Abstract
PURPOSE Despite advancements in antiretroviral therapy (ART) that extend life expectancy, older adults with HIV (OAHIV) face elevated cardiovascular disease risks. This study examines the impact of arterial stiffness on health-related quality of life (HRQoL) among OAHIV in rural Northern Thailand. METHODS We conducted a 5-year prospective cohort study from 2015, including 338 OAHIV aged ≥ 50 without prior cardiovascular disease who received ART in 12 community hospitals in Chiang Mai. Arterial stiffness was assessed using Cardio-Ankle Vascular Index (CAVI), with values ≥ 8 indicating significant stiffness. HRQoL was measured using the MOS-HIV Health Survey at baseline, one year, and five years. Analysis adjusted for HIV/AIDS severity, cardiovascular comorbidities, and socioeconomic factors. RESULTS Elevated CAVI (≥ 8) was associated with lower HRQoL scores. The elevated CAVI group showed lower physical health summary scores (average difference:- 2.2 points, 95%CI: - 3.5 to - 0.9) and mental health summary scores (average difference: - 1.2 points, 95%CI: - 2.2 to - 0.3) compared to the normal CAVI group (CAVI < 8). CONCLUSION Findings highlight the importance of routine screening for arterial stiffness and support the implementation of comprehensive care strategies that incorporate cardiovascular risk management. Such approaches could guide public health interventions and clinical practices to enhance the overall health and well-being of OAHIV, potentially through targeted cardiovascular risk reduction programs and personalized care plans. However, the study's regional focus in rural Northern Thailand and participant attrition over the five-year period limit the generalizability of the findings. Future research in diverse settings with larger sample sizes is needed to confirm these results.
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Affiliation(s)
- Amaraporn Rerkasem
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nuntisa Chotirosniramit
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Arunrat Tangmunkongvorakul
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Patumrat Sripan
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Wason Parklak
- Environmental - Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Pak Thaichana
- Environmental - Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand.
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Kittipan Rerkasem
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand.
- Environmental - Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Kaur G, Sohanur Rahman M, Shaikh S, Panda K, Chinnapaiyan S, Santiago Estevez M, Xia L, Unwalla H, Rahman I. Emerging roles of senolytics/senomorphics in HIV-related co-morbidities. Biochem Pharmacol 2024; 228:116179. [PMID: 38556028 PMCID: PMC11410549 DOI: 10.1016/j.bcp.2024.116179] [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: 12/21/2023] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024]
Abstract
Human immunodeficiency virus (HIV) is known to cause cellular senescence and inflammation among infected individuals. While the traditional antiretroviral therapies (ART) have allowed the once fatal infection to be managed effectively, the quality of life of HIV patients on prolonged ART use is still inferior. Most of these individuals suffer from life-threatening comorbidities like chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension (PAH), and diabetes, to name a few. Interestingly, cellular senescence is known to play a critical role in the pathophysiology of these comorbidities as well. It is therefore important to understand the role of cellular senescence in the disease progression and co-morbidity development in HIV-infected individuals. In this respect, use of senolytic/senomorphic drugs as combination therapy with ART would be beneficial for HIV patients. This review provides a critical analysis of the current literature to determine the potential and efficacy of using senolytics/senotherapeutics in managing HIV infection, latency, and associated co-morbidities in humans. The various classes of senolytics have been studied in detail to focus on their potential to combat against HIV infections and associated pathologies with advancing age.
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Affiliation(s)
- Gagandeep Kaur
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Md Sohanur Rahman
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Sadiya Shaikh
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Kingshuk Panda
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Srinivasan Chinnapaiyan
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Maria Santiago Estevez
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Li Xia
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hoshang Unwalla
- Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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Quinlan CM. When the epidemic ends, our work begins: The pharmacoepidemiology of HIV primary care. J Am Geriatr Soc 2024; 72:2620-2622. [PMID: 38465775 DOI: 10.1111/jgs.18873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
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Sung ML, Eden SK, Becker WC, Crystal S, Duncan MS, Gordon KS, Kerns RD, Kundu S, Freiberg M, So-Armah KA, Edelman EJ. The Association of Prescribed Opioids and Incident Cardiovascular Disease. THE JOURNAL OF PAIN 2024; 25:104436. [PMID: 38029949 PMCID: PMC11058015 DOI: 10.1016/j.jpain.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
Opioid prescribing remains common despite known overdose-related harms. Less is known about links to nonoverdose morbidity. We determined the association between prescribed opioid receipt with incident cardiovascular disease (CVD) using data from the Veterans Aging Cohort Study, a national prospective cohort of Veterans with/without Human Immunodeficiency Virus (HIV) receiving Veterans Health Administration care. Selected participants had no/minimal prior exposure to prescription opioids, no opioid use disorder, and no severe illness 1 year after the study start date (baseline period). We ascertained prescription opioid exposure over 3 years after the baseline period using outpatient pharmacy fill/refill data. Incident CVD ascertainment began at the end of the prescribed opioid exposure ascertainment period until the first incident CVD event, death, or September 30, 2015. We used adjusted Cox proportional hazards regression models with matching weights using propensity scores for opioid receipt to estimate CVD risk. Among 49,077 patients, 30% received opioids; the median age was 49 years, 97% were male, 49% were Black, and 47% were currently smoking. Prevalence of hypertension, diabetes, current smoking, alcohol and cocaine use disorder, and depression was higher in patients receiving opioids versus those not but were well-balanced by matching weights. Unadjusted CVD incidence rates per 1,000-person-years were higher among those receiving opioids versus those not: 17.4 (95% confidence interval [CI], 16.5-18.3) versus 14.7 (95% CI, 14.2-15.3). In adjusted analyses, those receiving opioids versus those not had an increased hazard of incident CVD (adjusted hazard ratio 1.16 [95% CI, 1.08-1.24]). Prescribed opioids were associated with increased CVD incidence, making opioids a potential modifiable CVD risk factor. PERSPECTIVE: In a propensity score weighted analysis of Veterans Administration data, prescribed opioids compared to no opioids were associated with an increased hazard of incident CVD. Higher opioid doses compared with lower doses were associated with increased hazard of incident CVD. Opioids are a potentially modifiable CVD risk factor.
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Affiliation(s)
- Minhee L Sung
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Svetlana K Eden
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William C Becker
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, New Jersey
| | - Meredith S Duncan
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - Kirsha S Gordon
- Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, Connecticut
| | - Suman Kundu
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - E Jennifer Edelman
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
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Moawad MHED, Mohamed Shalaby MM, Hamouda E, Mahfouz A, Mouffokes A, Hamouda H, Abbas A, Abdelgawad HAH. Risk of Stroke Among HIV Patients: A Systematic Review and Meta-analysis of Global Studies and Associated Comorbidities. J Acquir Immune Defic Syndr 2024; 95:399-410. [PMID: 38489489 DOI: 10.1097/qai.0000000000003382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/20/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Despite advancements in the management of HIV infection, the factors contributing to stroke development among HIV-positive individuals remain unclear. This systematic review and meta-analysis aim to identify and evaluate the relative risk factors associated with stroke susceptibility in the HIV population. METHODS A comprehensive search was conducted in PubMed, Scopus, and Web of Science databases to identify studies investigating the risk of stroke development in HIV patients and assessing the role of different risk factors, including hypertension, diabetes, dyslipidemia, smoking, sex, and race. The quality assessment of case-control studies was conducted using the Newcastle-Ottawa Scale, whereas cohort studies were assessed using the National Institute of Health tool. Meta-analyses were performed using a random-effects model to determine pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS A total of 18 observational studies involving 116,184 HIV-positive and 3,184,245 HIV-negative patients were included. HIV-positive patients exhibited a significantly higher risk of stroke compared with HIV-negative patients [OR (95% CI): 1.31 (1.20 to 1.44)]. Subgroup analyses revealed increased risks for both ischemic stroke [OR (95% CI): 1.32 (1.19 to 1.46)] and hemorrhagic stroke [OR (95% CI): 1.31 (1.09 to 1.56)]. Pooled adjusted HRs showed a significant association between stroke and HIV positivity (HR: 1.37, 95% CI: 1.22 to 1.54). Among HIV-positive patients with stroke, hypertension [OR (95% CI): 3.5 (1.42 to 8.65)], diabetes [OR (95% CI): 5 (2.12 to 11.95)], hyperlipidemia, smoking, male gender, and black race were associated with an increased risk. DISCUSSION Our study revealed a significant increased risk of stroke development among people with HIV. A multitude of factors, encompassing sociodemographic characteristics, racial background, underlying health conditions, and personal behaviors, significantly elevate the risk of stroke in individuals living with HIV. The use of observational studies introduces inherent limitations, and further investigations are necessary to explore the underlying mechanisms of stroke in people with HIV for potential treatment strategies. CONCLUSION HIV patients face a higher risk of stroke development, either ischemic and hemorrhagic strokes. Hypertension, diabetes, hyperlipidemia, smoking, male gender, and black race were identified as significant risk factors. Early identification and management of these risk factors are crucial in reducing stroke incidence among patients living with HIV.
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Affiliation(s)
- Mostafa Hossam El Din Moawad
- Faculty of Pharmacy Clinical Department Alexandria University, Alexandria, Egypt
- Faculty of Medicine Suez Canal University, Ismailia, Egypt
| | | | - Esraa Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amany Mahfouz
- Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Adel Mouffokes
- Faculty of Medicine, University of Oran 1 Ahmed Ben Bella, Oran, Algeria
| | - Heba Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Abdallah Abbas
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt; and
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Yang Q, Zaongo SD, Zhu L, Yan J, Yang J, Ouyang J. The Potential of Clostridium butyricum to Preserve Gut Health, and to Mitigate Non-AIDS Comorbidities in People Living with HIV. Probiotics Antimicrob Proteins 2024:10.1007/s12602-024-10227-1. [PMID: 38336953 DOI: 10.1007/s12602-024-10227-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
A dramatic reduction in mortality among people living with HIV (PLWH) has been achieved during the modern antiretroviral therapy (ART) era. However, ART does not restore gut barrier function even after long-term viral suppression, allowing microbial products to enter the systemic blood circulation and induce chronic immune activation. In PLWH, a chronic state of systemic inflammation exists and persists, which increases the risk of development of inflammation-associated non-AIDS comorbidities such as metabolic disorders, cardiovascular diseases, and cancer. Clostridium butyricum is a human butyrate-producing symbiont present in the gut microbiome. Convergent evidence has demonstrated favorable effects of C. butyricum for gastrointestinal health, including maintenance of the structural and functional integrity of the gut barrier, inhibition of pathogenic bacteria within the intestine, and reduction of microbial translocation. Moreover, C. butyricum supplementation has been observed to have a positive effect on various inflammation-related diseases such as diabetes, ulcerative colitis, and cancer, which are also recognized as non-AIDS comorbidities associated with epithelial gut damage. There is currently scant published research in the literature, focusing on the influence of C. butyricum in the gut of PLWH. In this hypothesis review, we speculate the use of C. butyricum as a probiotic oral supplementation may well emerge as a potential future synergistic adjunctive strategy in PLWH, in tandem with ART, to restore and consolidate intestinal barrier integrity, repair the leaky gut, prevent microbial translocation from the gut, and reduce both gut and systemic inflammation, with the ultimate objective of decreasing the risk for development of non-AIDS comorbidities in PLWH.
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Affiliation(s)
- Qiyu Yang
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Silvere D Zaongo
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Lijiao Zhu
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Jiangyu Yan
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Jiadan Yang
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Jing Ouyang
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China.
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10
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Molefe-Baikai OJ, Kebotsamang K, Modisawakgomo P, Tlhakanelo JT, Motlhatlhedi K, Moshomo T, Youssouf NF, Masupe T, Gaolathe T, Tapela N, Lockman S, Mosepele M. Self-reported cardiovascular disease risk factor screening among people living with HIV vs. members of the general population in Botswana: a community-based study. BMC Public Health 2024; 24:198. [PMID: 38229024 PMCID: PMC10792864 DOI: 10.1186/s12889-024-17651-6] [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: 06/28/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Morbidity and mortality due to cardiovascular diseases (CVDs) are high and increasing in low- and middle-income countries. People living with HIV (PLWH) are more likely to experience CVD than members of the general population. Therefore, we aimed to assess whether PLWH were more likely to have previously been screened for cardiovascular disease risk factors (CVDRFs) than people without HIV. METHODS A population-based, cross-sectional study was conducted among individuals aged 16 to 68 years across 22 communities in Botswana from February to August 2017 as part of a larger community-based cluster randomized HIV treatment-as-prevention trial. Participants were asked if they had been screened for and counselled on cardiovascular disease risk factors (history of hypertension or blood pressure check, blood glucose and cholesterol measurements, weight check and weight control, tobacco smoking and cessation, alcohol use and physical activity) in the preceding 3 years. HIV testing was offered to those with an unknown HIV status. Multiple logistic regression analysis controlling for age and sex was used to assess the relationship between CVDRF screening and HIV status. RESULTS Of the 3981 participants enrolled, 2547 (64%) were female, and 1196 (30%) were PLWH (93% already on antiretroviral therapy [ART]). PLWH were more likely to report previous screening for diabetes (25% vs. 19%, p < 0.001), elevated cholesterol (17% vs. 12%, p < 0.001) and to have had their weight checked (76% vs. 55%, p < 0.001) than HIV-uninfected participants. PLWH were also more likely to have received counselling on salt intake (42% vs. 33%, p < 0.001), smoking cessation (66% vs. 46%, p < 0.001), weight control (38% vs. 29%, p < 0.001), physical activity (46% vs. 34%, p < 0.001) and alcohol consumption (35% vs. 23%, p < 0.001) than their HIV-uninfected counterparts. Overall, PLWH were more likely to have received screening for and/or counselling on CVDRFs (adjusted odds ratio 1.84, 95% CI: 1.46-2.32, p < 0.001). CONCLUSION PLWH were almost two times more likely to have been previously screened for CVDRFs than those without HIV, indicating a need for universal scale-up of integrated management and prevention of CVDs in the HIV-uninfected population.
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Affiliation(s)
- Onkabetse Julia Molefe-Baikai
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana.
| | - Kago Kebotsamang
- Faculty of Social Sciences, Department of Statistics, University of Botswana, Gaborone, Botswana
| | | | - John Thato Tlhakanelo
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Keneilwe Motlhatlhedi
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Thato Moshomo
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
| | - Nabila Farah Youssouf
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- London School of Hygiene and Tropical Medicine, London, UK
| | - Tiny Masupe
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Tendani Gaolathe
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- International Consortium for Health Outcomes Measurement, Boston, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA
| | - Mosepele Mosepele
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
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11
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Fan Y, Song Z, Zhang M. Emerging frontiers of artificial intelligence and machine learning in ischemic stroke: a comprehensive investigation of state-of-the-art methodologies, clinical applications, and unraveling challenges. EPMA J 2023; 14:645-661. [PMID: 38094579 PMCID: PMC10713915 DOI: 10.1007/s13167-023-00343-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/14/2023] [Indexed: 12/05/2024]
Abstract
At present, stroke remains the second highest cause of death globally and a leading cause of disability. From 1990 to 2019, the absolute number of strokes worldwide increased by 70.0%, and the prevalence of stroke increased by 85.0%, causing millions of deaths and disability. Ischemic stroke accounts for the majority of strokes, which is caused by arterial occlusion. Effective primary prevention strategies, early diagnosis, and timely interventions such as rapid reperfusion are in urgent implementation to control ischemic stroke. Otherwise, the stroke burden will probably continue to grow across the world as a result of population aging and an ongoing high prevalence of risk factors. To help with the diagnosis and management of ischemic stroke, newer techniques such as artificial intelligence (AI) are highly anticipated and may bring a new revolution. AI is a recent fast-growing research area which aims to mimic cognitive processes through a number of techniques such as machine learning (ML) methods of random forest learning (RFL) and convolutional neural networks (CNNs). With the help of AI, several momentous milestones have already been attained across diverse dimensions of ischemic stroke. In the context of predictive, preventive, and personalized medicine (PPPM/3PM), we aim to transform stroke care from a reactive to a proactive and individualized paradigm. In this way, AI demonstrates strong clinical utility across all three levels of prevention in ischemic stroke. In this paper, we synoptically illustrated the history and current situation of AI and ML. Then, we summarized their clinical applications and efficacy in the management of stroke. We finally provided an outlook on how AI approaches might contribute to enhancing favorable outcomes after stroke and proposed our suggestions on developing AI-based PPPM strategies. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00343-3.
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Affiliation(s)
- Yishu Fan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders,Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan China
| | - Zhenshan Song
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008 China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008 China
- National Clinical Research Center for Geriatric Disorders,Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan China
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12
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Ng RQM, Yip KF, Teh YE. An overview of neurocognitive impairment in older people living with HIV. PROCEEDINGS OF SINGAPORE HEALTHCARE 2023. [DOI: 10.1177/20101058231160605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Background With improved survival among People Living with HIV (PLHIV), many are confronted with age associated comorbidities and geriatric syndromes. Neurocognitive impairment is one of the three most frequent conditions that affects quality of life of PLHIV despite achieving viral suppression. Healthcare providers face challenges in early identification of neurocognitive impairment, performing comprehensive assessment and managing older PLHIV. Objectives This paper aims to review available evidence regarding aetiology and management of older PLHIV who develop neurocognitive impairment, suggest improvements on current management and postulate future study direction. Methods A PubMed search for original articles and Clinical Guidelines was conducted from September 2021 to August 2022 using a combination of keywords related to neurocognitive impairment in PLHIV. The citations from all selected articles were reviewed for additional studies. Results Older PLHIV tend to be frailer than their uninfected counterparts, are plagued with multi-morbidity and are at increased risk of cognitive impairment. The aetiologies for neurocognitive impairment are multifactorial, multi-dimensional and complex. The management of neurocognitive impairment in older PLHIV involves identifying and optimizing predisposing factors, physical function, social and psychological health with appropriate care navigation. Conclusion Identification and management of neurocognitive impairment in older PLHIV through interdisciplinary collaboration among stakeholders is important. This exemplifies an integrated model of care for older PLHIV and promotes the notion of living well beyond viral suppression.
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Affiliation(s)
- Rachel QM Ng
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
| | - KF Yip
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
| | - YE Teh
- Department of Infectious Disease, Singapore General Hospital, Singapore, Singapore
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13
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Rahim FO, Sakita FM, Coaxum L, Maro AV, Ford JS, Hatter K, Gedion K, Ezad SM, Galson SW, Bloomfield GS, Limkakeng AT, Kessy MS, Mmbaga B, Hertz JT. Longitudinal ECG changes among adults with HIV in Tanzania: A prospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002525. [PMID: 37878582 PMCID: PMC10599566 DOI: 10.1371/journal.pgph.0002525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023]
Abstract
The prevalence of cardiovascular disease (CVD) is rising among people with HIV (PWH) in sub-Saharan Africa (SSA). Despite the utility of the electrocardiogram (ECG) in screening for CVD, there is limited data regarding longitudinal ECG changes among PWH in SSA. In this study, we aimed to describe ECG changes over a 6-month period in a cohort of PWH in northern Tanzania. Between September 2020 and March 2021, adult PWH were recruited from Majengo HIV Care and Treatment Clinic (MCTC) in Moshi, Tanzania. Trained research assistants surveyed participants and obtained a baseline ECG. Participants then returned to MCTC for a 6-month follow-up, where another ECG was obtained. Two independent physician adjudicators interpreted baseline and follow-up ECGs for rhythm, left ventricular hypertrophy (LVH), bundle branch blocks, ST-segment changes, and T-wave inversion, using standardized criteria. New ECG abnormalities were defined as those that were absent in a patient's baseline ECG but present in their 6-month follow-up ECG. Of 500 enrolled participants, 476 (95.2%) completed follow-up. The mean (± SD) age of participants was 45.7 (± 11.0) years, 351 (73.7%) were female, and 495 (99.8%) were taking antiretroviral therapy. At baseline, 248 (52.1%) participants had one or more ECG abnormalities, the most common of which were LVH (n = 108, 22.7%) and T-wave inversion (n = 89, 18.7%). At six months, 112 (23.5%) participants developed new ECG abnormalities, including 40 (8.0%) cases of new T-wave inversion, 22 (4.6%) cases of new LVH, 12 (2.5%) cases of new ST elevation, and 11 (2.3%) cases of new prolonged QTc. Therefore, new ECG changes were common over a relatively short 6-month period, which suggests that subclinical CVD may develop rapidly in PWH in Tanzania. These data highlight the need for additional studies on CVD in PWH in SSA and the importance of routine CVD screening in this high-risk population.
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Affiliation(s)
- Faraan O. Rahim
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Francis M. Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Lauren Coaxum
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | | | - James S. Ford
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Kate Hatter
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kalipa Gedion
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Saad M. Ezad
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, United Kingdom
| | - Sophie W. Galson
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Gerald S. Bloomfield
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Alexander T. Limkakeng
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | | | - Blandina Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Julian T. Hertz
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
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14
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Ku HC, Wu YL, Yip HT, Hsieh CY, Li CY, Ou HT, Chen YC, Ko NY. Herpes zoster associated with stroke incidence in people living with human immunodeficiency virus: a nested case-control study. BMC Infect Dis 2023; 23:636. [PMID: 37770849 PMCID: PMC10536781 DOI: 10.1186/s12879-023-08628-8] [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: 04/25/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The incidence of stroke is increasing among younger people with human immunodeficiency virus (HIV). The burden of stroke has shifted toward the young people living with HIV, particularly in low- and middle-income countries. People infected with herpes zoster (HZ) were more likely to suffer stroke than the general population. However, the association of HZ infection with the incidence of stroke among patients with HIV remains unclear. METHODS A nested case-control study was conducted with patients with HIV registered in the Taiwan National Health Insurance Research Database in 2000-2017. A total of 509 stroke cases were 1:10 matched to 5090 non-stroke controls on age, sex, and date of first stroke diagnosis. Logistic regression models were used to estimate the odds ratio and 95% confidence intervals (CI) of stroke incidence. RESULTS The odds ratio of stroke was significantly higher in the HIV-infected population with HZ (adjusted odds ratio [AOR]: 1.85, 95% CI: 1.42-2.41). A significantly increased AOR of stroke was associated with hypertension (AOR: 3.53, 95% CI: 2.86-4.34), heart disease (AOR: 2.32, 95% CI: 1.54-3.48), chronic kidney disease (AOR: 1.82, 95% CI: 1.16-2.85), hepatitis C virus infection (AOR: 1.49, 95% CI: 1.22-1.83), hyperlipidemia (OR: 1.41, 95% CI: 1.12-1.78), and treatment with protease inhibitors (AOR: 1.33, 95% CI: 1.05-1.69). CONCLUSIONS Our findings suggest that HZ concurrent with HIV may increase the risk of stroke. The incidence rates of stroke were independent of common risk factors, suggesting strategies for early prevention of HZ infection among people living with HIV.
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Affiliation(s)
- Han-Chang Ku
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Branch, Chiayi, Taiwan
| | - Yi-Lin Wu
- Department of Nursing, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Hei-Tung Yip
- Clinical Trial Research Center (CTC), China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Yang Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 7010, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 7010, Taiwan.
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15
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Yang Y, Yao X, Liu Y, Zhao J, Sun P, Zhang Y, Li K, Chen Y, Zheng J, Deng L, Fan S, Ma X, Guo S, Shuai P, Wan Z. Global and Regional Estimate of HIV-Associated Stroke Burden: A Meta-Analysis and Population Attributable Modeling Study. Stroke 2023; 54:2390-2400. [PMID: 37477007 DOI: 10.1161/strokeaha.123.043410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND This study aimed to determine the correlation between human-immunodeficiency-virus (HIV) infection and stroke, as well as to estimate the global, regional, and national burden of HIV-associated stroke. METHODS A registered meta-analysis was performed by searching PubMed, Embase, and Web of Science for relevant literature up to October 31, 2022. The pooled relative risk of stroke in HIV-infected people was calculated using a random-effects model. HIV prevalence and disability-adjusted life years (DALYs) datasets were obtained from the Joint United Nations Program on HIV and AIDS, and the Global Health Data Exchange, respectively. The population attributable fraction was estimated and delivered to calculate the HIV-associated DALYs of stroke from 1990 to 2019, at the global, regional, and national levels. Pearson correlation analysis were conducted to assess the correlation between the age-standardized rate or estimated annual percentage changes and the sociodemographic index. RESULTS Out of 10 080 identified studies, 11 were included in this meta-analysis. Compared with individuals without HIV-infection, the pooled relative risk of stroke in HIV-infected individuals was 1.40 (95% CI, 1.18-1.65). From 1990 to 2019, the global population attributable fraction of HIV-associated stroke increased almost 3-fold, while the HIV-associated DALYs increased from 18 595 (95% CI, 7485-31 196) in 1990 to 60 684 (95% CI, 24 281-101 894) in 2019. Meanwhile, HIV-associated DALYs varied by region, with Eastern and Southern Africa having the highest value of 126 160 in 2019. Moreover, countries with middle social development index were shouldering the highest increase trend of the HIV-associated DALYs age-standardized rates. CONCLUSIONS HIV-infected individuals face a significantly higher risk of stroke, and the global burden of HIV-associated stroke has increased over the past 3 decades, showing regional variations. Eastern and Southern Africa bear the highest burden, while Eastern Europe and Central Asia have seen significant growth. Health care providers, researchers, and decision-makers should give increased attention to stroke prevention and management in HIV-endemic areas. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: CRD42022367450.
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Affiliation(s)
- Yumei Yang
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Xiaoqin Yao
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Yuping Liu
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
| | - Jianhui Zhao
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Ping Sun
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
| | - Yixuan Zhang
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Kangning Li
- Department of School of Public Health, and Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China (J. Zhao, Y.Z., K.L.)
| | - Yan Chen
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- School of Public Health, Southwest Medical University, Luzhou, China (Y.C., S.F.)
| | - Jinxin Zheng
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, China (J. Zheng)
| | - Ling Deng
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China (Y.C., S.F.)
| | - Xiaoxiang Ma
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Shujin Guo
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Ping Shuai
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
| | - Zhengwei Wan
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Y.Y., X.Y., Y.L., P. Sun, Y.C., L.D., X.M., S.G., P. Shuai, Z.W.)
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China (Y.L., P. Sun, Z.W.)
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16
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Singh MV, Uddin MN, Singh VB, Peterson AN, Murray KD, Zhuang Y, Tyrell A, Wang L, Tivarus ME, Zhong J, Qiu X, Schifitto G. Initiation of combined antiretroviral therapy confers suboptimal beneficial effects on neurovascular function in people with HIV. Front Neurol 2023; 14:1240300. [PMID: 37719766 PMCID: PMC10500594 DOI: 10.3389/fneur.2023.1240300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Due to advances in combined anti-retroviral treatment (cART), there is an increased burden of age-related cerebrovascular disease (CBVD), in people living with HIV (PWH). The underlying CNS injury can be assessed by measuring cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). Methods 35 treatment-naïve PWH and 53 HIV negative controls (HC) were enrolled in this study. Study participants underwent T1-weighted anatomical, pseudo-continuous arterial spin labeling, and resting-state functional MRI to obtain measures of CBF and CVR prior to starting cART treatment and at two-time points (12 weeks and 2 years) post-cART initiation. Controls were scanned at the baseline and 2-year visits. We also measured plasma levels of microparticles of endothelial and glial origin and well-known endothelial inflammation markers, ICAM-1 and VCAM-1, to assess HIV-associated endothelial inflammation and the interaction of these peripheral markers with brain neurovascular function. Results HIV infection was found to be associated with reduced CVR and increased levels of endothelial and glial microparticles (MPs) prior to initiation of cART. Further, CVR correlated negatively with peripheral MP levels in PWH. Discussion Our results suggest that while cART treatment has a beneficial effect on the neurovascular function after initiation, these benefits are suboptimal over time.
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Affiliation(s)
- Meera V. Singh
- Department of Neurology, University of Rochester, Rochester, NY, United States
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, United States
| | - Md Nasir Uddin
- Department of Neurology, University of Rochester, Rochester, NY, United States
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Vir B. Singh
- Albany College of Pharmacy and Health Sciences, Albany, NY, United States
| | | | - Kyle D. Murray
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, United States
| | - Yuchuan Zhuang
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States
| | - Alicia Tyrell
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, United States
| | - Lu Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Madalina E. Tivarus
- Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester, Rochester, NY, United States
| | - Jianhui Zhong
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
- Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester, Rochester, NY, United States
| | - Xing Qiu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester, Rochester, NY, United States
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States
- Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
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Martín-Iguacel R, Vazquez-Friol MC, Burgos J, Bruguera A, Reyes-Urueña J, Moreno-Fornés S, Aceitón J, Díaz Y, Domingo P, Saumoy M, Knobel H, Dalmau D, Borjabad B, Johansen IS, Miro JM, Casabona J, Llibre JM. Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study. Front Med (Lausanne) 2023; 10:1182359. [PMID: 37415770 PMCID: PMC10321350 DOI: 10.3389/fmed.2023.1182359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 07/08/2023] Open
Abstract
Objectives People with HIV (PWH) have a higher cardiovascular risk than the general population. It remains unclear, however, whether the risk of cardiovascular disease (CVD) is higher in late HIV presenters (LP; CD4 ≤ 350 cells/μL at HIV diagnosis) compared to PWH diagnosed early. We aimed to assess the rates of incident cardiovascular events (CVEs) following ART initiation among LP compared to non-LP. Methods From the prospective, multicentre PISCIS cohort, we included all adult people with HIV (PWH) initiating antiretroviral therapy (ART) between 2005 and 2019 without prior CVE. Additional data were extracted from public health registries. The primary outcome was the incidence of first CVE (ischemic heart disease, congestive heart failure, cerebrovascular, or peripheral vascular disease). The secondary outcome was all-cause mortality after the first CVE. We used Poisson regression. Results We included 3,317 PWH [26 589.1 person/years (PY)]: 1761 LP and 1556 non-LP. Overall, 163 (4.9%) experienced a CVE [IR 6.1/1000PY (95%CI: 5.3-7.1)]: 105 (6.0%) LP vs. 58 (3.7%) non-LP. No differences were observed in the multivariate analysis adjusting for age, transmission mode, comorbidities, and calendar time, regardless of CD4 at ART initiation [aIRR 0.92 (0.62-1.36) and 0.84 (0.56-1.26) in LP with CD4 count <200 and 200- ≤ 350 cells/μL, respectively, compared to non-LP]. Overall mortality was 8.5% in LP versus 2.3% in non-LP (p < 0.001). Mortality after the CVE was 31/163 (19.0%), with no differences between groups [aMRR 1.24 (0.45-3.44)]. Women vs. MSM and individuals with chronic lung and liver disease experienced particularly high mortality after the CVE [aMRR 5.89 (1.35-25.60), 5.06 (1.61-15.91), and 3.49 (1.08-11.26), respectively]. Sensitivity analyses including only PWH surviving the first 2 years yielded similar results. Conclusion CVD remains a common cause of morbidity and mortality among PWH. LP without prior CVD did not exhibit an increased long-term risk of CVE compared with non-LP. Identifying traditional cardiovascular risk factors is essential for CVD risk reduction in this population.
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Affiliation(s)
- Raquel Martín-Iguacel
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | - Joaquin Burgos
- Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Andreu Bruguera
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juliana Reyes-Urueña
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Sergio Moreno-Fornés
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Aceitón
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Yesika Díaz
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Pere Domingo
- Infectious Diseases Unit, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Saumoy
- Department of Internal Medicine and Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Hernando Knobel
- Department of Infectious Diseases, Hospital del Mar- Parc de Salut MAR, Barcelona, Spain
| | - David Dalmau
- Department of Internal Medicine, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Beatriz Borjabad
- Department of Internal Medicine, Consorci Sanitari Integral, Hospitalet del Llobregat, Barcelona, Spain
| | | | - Jose M. Miro
- Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
- Fundació Institut D'investigació en Ciències de la Salut Germans Trias I Pujol (IGTP), Badalona, Spain
| | - Josep M. Llibre
- Infectious Diseases Department, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Fight Infections Foundation, Barcelona, Spain
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18
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Murphy J, AlJaroudi WA, Hage FG. Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2022: positron emission tomography, computed tomography, and magnetic resonance. J Nucl Cardiol 2023; 30:941-954. [PMID: 37204688 DOI: 10.1007/s12350-023-03283-7] [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: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023]
Abstract
In 2022, the Journal of Nuclear Cardiology® published many excellent original research articles and editorials focusing on imaging in patients with cardiovascular disease. In this review of 2022, we summarize a selection of articles to provide a concise recap of major advancements in the field. In the first part of this 2-part series, we addressed publications pertaining to single-photon emission computed tomography. In this second part, we focus on positron emission tomography, cardiac computed tomography, and cardiac magnetic resonance. We specifically review advances in imaging of non-ischemic cardiomyopathy, cardio-oncology, infectious disease cardiac manifestations, atrial fibrillation, detection and prognostication of atherosclerosis, and technical improvements in the field. We hope that this review will be useful to readers as a reminder to articles they have seen during the year as well as ones they have missed.
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Affiliation(s)
- John Murphy
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Augusta University, Augusta, GA, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, GSB 446, 1900 University BLVD, Birmingham, AL, 35294, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Akgün KM, Krishnan S, Tate J, Bryant K, Pisani M, Re VL, Rentsch CT, Crothers K, Gordon K, Justice AC. Delirium among people aging with and without HIV: Role of alcohol and Neurocognitively active medications. J Am Geriatr Soc 2023; 71:1861-1872. [PMID: 36786300 PMCID: PMC10258127 DOI: 10.1111/jgs.18265] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/29/2022] [Accepted: 01/15/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND People aging with and without HIV (PWH and PWoH) want to avoid neurocognitive dysfunction, especially delirium. Continued use of alcohol in conjunction with neurocognitively active medications (NCAMs) may be a largely underappreciated cause, especially for PWH who experience polypharmacy a decade earlier than PWoH. We compare absolute and relative risk of delirium among PWH and PWoH by age, level of alcohol use, and exposure to NCAMs. METHODS Using the VACS cohort, we compare absolute and relative risk of inpatient delirium among PWH and PWoH by age, level of alcohol use, and exposure to NCAMs between 2007 and 2019. We matched each case based on age, race/ethnicity, sex, HIV, baseline year, and observation time with up to 5 controls. The case/control date was defined as date of admission for cases and the date corresponding to the same length of time on study for controls. Level of alcohol use was defined using Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Medication exposure was measured from 45 to 3 days prior to index date; medications were classified as anticholinergic NCAM, non-anticholinergic NCAM, or non NCAM and counts generated. We used logistic regression to determine odds ratios (ORs) for delirium associated with medication counts stratified by HIV status and adjusted for demographics, severity of illness, and related diagnoses. RESULTS PWH experienced a higher incidence of delirium (5.6, [95% CI 5.3-5.9/1000 PY]) than PWoH (5.0, [95% CI 4.8-5.1/1000 PY]). In multivariable analysis, anticholinergic and non-anticholinergic NCAM counts and level of alcohol use demonstrated strong independent dose-response associations with delirium. CONCLUSIONS Decreasing alcohol use and limiting the use of neurocognitively active medications may help decrease excess rates of delirium, especially among PWH.
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Affiliation(s)
- Kathleen M. Akgün
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Janet Tate
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | | | - Vincent Lo Re
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christopher T. Rentsch
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Kristina Crothers
- VA Puget Sound Health Care System Seattle Division, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Kirsha Gordon
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Amy C. Justice
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
- Yale University School of Public Health, New Haven, CT, USA
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20
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Chow FC, Zhao F, He Y, Song X, Zhang J, Ao D, Wu Y, Hou B, Sorond FA, Ances BM, Letendre S, Heaton RK, Shi C, Feng F, Zhu Y, Wang H, Li T. Brief Report: Sex Differences in the Association Between Cerebrovascular Function and Cognitive Health in People Living With HIV in Urban China. J Acquir Immune Defic Syndr 2023; 92:217-222. [PMID: 36318881 PMCID: PMC11806922 DOI: 10.1097/qai.0000000000003127] [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: 06/08/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiometabolic and cerebrovascular disease are strong independent contributors to cognitive impairment in people living with HIV. Data suggest that cardiovascular risk may play a greater role in cognitive health in women than in men with HIV. METHODS We performed a cross-sectional study of 104 participants with virologically suppressed HIV from 2 clinics in urban China. Participants underwent neuropsychological testing from which we calculated T scores globally and in 5 cognitive domains. We assessed cerebral vasoreactivity of the middle cerebral arteries in response to breath holding. We constructed linear regression models to determine associations between cerebrovascular and cognitive function overall and stratified by sex. RESULTS Women were younger than men (48 versus 51 years, P = 0.053), had fewer years of education (9 years versus 12 years, P = 0.004), and fewer cardiometabolic risk factors (0 versus 1 factor, P = 0.008). In a model with all participants, cerebrovascular function was significantly associated with global cognition (2.74 higher T score per 1-point higher cerebral vasoreactivity [SE 1.30], P = 0.037). Cerebrovascular function remained significantly associated with global cognition among women (4.15 higher T score [SE 1.78], P = 0.028) but not men (1.70 higher T score [SE 1.74], P = 0.33). The relationships between cerebrovascular function and specific cognitive domains followed a similar pattern, with significant associations present among women but not men. CONCLUSIONS Women with well-controlled HIV may be more vulnerable to the effect of cerebrovascular injury on cognitive health than men. Studies evaluating strategies to protect against cognitive impairment in people living with HIV should include adequate representation of women and stratification of analyses by sex.
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Affiliation(s)
- Felicia C. Chow
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA
| | - Fang Zhao
- Department of Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
| | - Yun He
- Department of Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
| | - Xiaojing Song
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangxia Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Donghui Ao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuchen Wu
- Department of Hematology, Tiantan Hospital, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Beau M. Ances
- Department of Neurology and Hope Center for Neurological Disorders, Washington University, St. Louis, MO
| | - Scott Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Robert K. Heaton
- HIV Neurobehavioral Research Program, Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Chuan Shi
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanling Wang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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Chou YS, Wang CC, Hsu LF, Chuang PH, Cheng CF, Li NH, Chen CC, Chen CL, Lai YJ, Yen YF. Gonadotropin-releasing hormone agonist treatment and ischemic heart disease among female patients with breast cancer: A cohort study. Cancer Med 2023; 12:5536-5544. [PMID: 36305849 PMCID: PMC10028063 DOI: 10.1002/cam4.5390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/01/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The risk of ischemic heart disease (IHD) due to the impact of gonadotropin-releasing hormone (GnRH) agonists among female patients with breast cancer remains a controversy. METHODS Information from the Registry for Catastrophic Illness, the National Health Insurance Research Database (NHIRD), and the Death Registry Database in Taiwan were analyzed. Female patients with breast cancer were selected from the Registry for Catastrophic Illness from January 1, 2000, to December 31, 2018. All the breast cancer patients were followed until new-onset IHD diagnosis, death, or December 31, 2018. A Kaplan-Meier survival curve was drawn to show the difference between patients treated with and without GnRH agonists. The Cox regression analysis was used to investigate the effects of GnRH agonists and the incidence of IHD. RESULTS A total of 172,850 female patients with breast cancer were recognized with a mean age of 52.6 years. Among them, 6071(3.5%) had received GnRH agonist therapy. Kaplan-Meier survival curves showed a significant difference between patients with and without GnRH therapy (log-rank p < 0.0001). Patients who received GnRH therapy had a significantly decreased risk of developing IHD than those without GnRH therapy (HR = 0.18; 95% CI = 0.14-0.23). After adjusting for age, treatment, and comorbidity, patients who received GnRH therapy still had a significantly lower risk of developing IHD (AHR = 0.5, 95% CI = 0.39-0.64). CONCLUSION The study showed that the use of GnRH agonists for breast cancer treatment was significantly associated with a reduced risk of IHD. Further research is required to investigate the possible protective effect of GnRH on IHD.
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Affiliation(s)
- Yi-Sheng Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Hematology and Oncology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Chun-Chieh Wang
- Division of Chest Medicine, Department of Internal Medicine, Puli branch of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Fei Hsu
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Chi-Feng Cheng
- Department of Hematology and Oncology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Nai-Hsin Li
- Department of General Surgery, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chien-Liang Chen
- Department of Economics, National Chi Nan University, Nantou, Taiwan
| | - Yun-Ju Lai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Yung-Feng Yen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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22
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Human Immunodeficiency Virus. Neuroimaging Clin N Am 2023; 33:147-165. [DOI: 10.1016/j.nic.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Polanka BM, Gupta SK, So-Armah KA, Freiberg MS, Zapolski TCB, Hirsh AT, Stewart JC. Examining Depression as a Risk Factor for Cardiovascular Disease in People with HIV: A Systematic Review. Ann Behav Med 2023; 57:1-25. [PMID: 35481701 PMCID: PMC9773373 DOI: 10.1093/abm/kaab119] [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] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND People with human immunodeficiency virus (HIV) have an increased risk of cardiovascular disease (CVD) not fully accounted for by traditional or HIV-specific risk factors. Successful management of HIV does not eliminate this excess risk. Thus, there is a need to identify novel risk factors for CVD among people with HIV (PWH). PURPOSE Our objective was to systematically review the literature on one such candidate CVD risk factor in PWH-depression. METHODS A systematic literature search of PubMed, PsycINFO, EMBASE, Web of Science, and CINAHL was performed to identify published English-language studies examining associations of depression with clinical CVD, subclinical CVD, and biological mechanisms (immune activation, systemic inflammation, altered coagulation) among PWH between the earliest date and June 22, 2021. RESULTS Thirty-five articles were included. For clinical CVD (k = 8), findings suggests that depression is consistently associated with an increased risk of incident CVD. For subclinical CVD (k = 5), one longitudinal analysis reported a positive association, and four cross-sectional analyses reported null associations. For immune activation (k = 13), systemic inflammation (k = 17), and altered coagulation (k = 5), findings were mixed, and there was considerable heterogeneity in sample characteristics and methodological quality across studies. CONCLUSIONS Depression may be an independent risk factor for CVD among PWH. Additional research is needed to confirm depression's association with clinical CVD and to determine whether depression is consistently and meaningfully associated with subclinical CVD and biological mechanisms of CVD in HIV. We propose a research agenda for this emerging area.
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Affiliation(s)
- Brittanny M Polanka
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Samir K Gupta
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kaku A So-Armah
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Matthew S Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Haji M, Lopes VV, Ge A, Halladay C, Soares C, Shah NR, Longenecker CT, Lally M, Bloomfield GS, Shireman TI, Ross D, Sullivan JL, Rudolph JL, Wu WC, Erqou S. Two decade trends in cardiovascular disease outcomes and cardiovascular risk factors among US veterans living with HIV. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 15:200151. [PMID: 36573195 PMCID: PMC9789359 DOI: 10.1016/j.ijcrp.2022.200151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 12/30/2022]
Abstract
Coomprhensive data on temporal trends in cardiovascular disease (CVD) risk factors and outcomes in people living with HIV are limited. Using retrospective data on 50,284 US Veterans living with HIV (VLWH) who received care in the VA from 2001 to 2019, we calculated the prevalence and incidence estimates of CVD risk factors and outcomes, as well as the average annual percent changes (AAPC) in the estimates. The mean age of the Veterans increased from 47.8 (9.1) years to 58.0 (12.4) years during the study period. The population remained predominantly (>95%) male and majority Black (∼50%). The prevalence of the CVD outcomes increased progressively over the study period: coronary artery disease (3.9%-18.7%), peripheral artery disease (2.3%, 10.3%), ischemic cerebrovascular disease (1.1%-9.9%), and heart failure (2.4%-10.5%). There was a progressive increase in risk factor burden, except for smoking which declined after 2015. The AAPC in prevalence was statistically significant for the CVD outcomes and risk factors. When adjusted for age, the predicted prevalence of CVD risk factors and outcomes showed comparable (but attenuated) trends. There was generally a comparable (but attenuated) trend in incidence of CVD outcomes, procedures, and risk factors over the study period. The use of statins increased from 10.6% (2001) to 40.8% (2019). Antiretroviral therapy usage increased from 77.7% (2001) to 85.0% (2019). In conclusion, in a retrospective analysis of large-scale VA data we found the burden and incidence of several CVD risk factors and outcomes have increased among VLWH over the past 20 years.
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Affiliation(s)
- Mohammed Haji
- Department of Medicine, Brown University, Providence, RI, USA
| | - Vrishali V. Lopes
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, RI, USA
| | - Augustus Ge
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, RI, USA
| | - Christopher Halladay
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, RI, USA
| | - Cullen Soares
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nishant R. Shah
- Department of Medicine, Brown University, Providence, RI, USA
- Department of Medicine, Providence VA Medical Center, Providence, RI, USA
- Brown University School of Public Health, Brown University, Providence, RI, USA
| | | | - Michelle Lally
- Department of Medicine, Brown University, Providence, RI, USA
- Department of Medicine, Providence VA Medical Center, Providence, RI, USA
| | - Gerald S. Bloomfield
- Duke Clinical Research Institute, Duke Global Health Institute and Department of Medicine, Duke University, Durham, NC, USA
| | - Theresa I. Shireman
- Brown University School of Public Health, Brown University, Providence, RI, USA
| | - David Ross
- Office of Specialty Care Service, US Department of Veterans Affairs, USA
- Infectious Disease Section, Washington, DC Department of Veterans Affairs Medical Center, USA
| | - Jennifer L. Sullivan
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Providence VA Medical Center, Providence, RI, USA
- Brown University School of Public Health, Brown University, Providence, RI, USA
| | - James L. Rudolph
- Department of Medicine, Brown University, Providence, RI, USA
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Providence VA Medical Center, Providence, RI, USA
- Brown University School of Public Health, Brown University, Providence, RI, USA
| | - Wen-Chih Wu
- Department of Medicine, Brown University, Providence, RI, USA
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Providence VA Medical Center, Providence, RI, USA
- Brown University School of Public Health, Brown University, Providence, RI, USA
| | - Sebhat Erqou
- Department of Medicine, Brown University, Providence, RI, USA
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Providence VA Medical Center, Providence, RI, USA
- Corresponding author. Division of Cardiology, Providence VA Medical Center, Providence, RI, USA.
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Aragon KG, Ray G, Conklin J, Stever E, Marquez C, Magallanes A, Anderson J, Jakeman B. Underprescribing of statin therapy in people with HIV at risk for atherosclerotic cardiovascular disease. Am J Health Syst Pharm 2022; 79:2026-2031. [PMID: 35976174 DOI: 10.1093/ajhp/zxac224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE People with HIV (PWH) are at increased risk for developing atherosclerotic cardiovascular disease (ASCVD). The primary objective of this study was to evaluate adherence to guideline recommendations on statin use in PWH for both primary and secondary ASCVD prevention in a single healthcare institution. METHODS A retrospective chart review was performed to evaluate statin use for cardiovascular risk reduction in PWH 40 to 75 years of age at an HIV clinic over a 1-year evaluation period. The study included patients who met one of the 4 criteria for statin therapy defined in the "ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults." Patient demographics were collected and a 10-year ASCVD risk score was calculated. RESULTS A total of 432 PWH were evaluated for statin therapy; 205 patients (47.5%) met criteria for statin therapy. The majority of patients were male, the average age was 58 years, and the average time since HIV diagnosis was 19 years. The mean ASCVD risk score was 14.2%. Only 79 patients (38.5%) who met criteria were prescribed statin therapy, and only 45 (56.9%) were prescribed statin therapy of appropriate intensity. Use of ART pharmacokinetic enhancer was low and did not affect statin prescribing. Multivariable analysis found that age, diabetes, clinical ASCVD, and an appointment with a pharmacist clinician prescriber predicted statin utilization. A high ASCVD risk score (>20%) did not predict statin treatment. CONCLUSION Statin prescribing is low in PWH, who are at increased risk for ASCVD. Future research in PWH should focus on improving ASCVD risk assessment and exploring causes for statin underprescribing.
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Affiliation(s)
- Kelsea Gallegos Aragon
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, and University of New Mexico Truman Health Services, Albuquerque, NM, USA
| | - Gretchen Ray
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Jessica Conklin
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, University of New Mexico Truman Health Services, Albuquerque, NM, and Department of Pharmacy, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Erin Stever
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Carlos Marquez
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Adan Magallanes
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Joe Anderson
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Bernadette Jakeman
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, and University of New Mexico Truman Health Services, Albuquerque, NM, USA
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Taglieri N, Bonfiglioli R, Bon I, Malosso P, Corovic A, Bruno M, Le E, Granozzi B, Palmerini T, Ghetti G, Tamburello M, Bruno AG, Saia F, Tarkin JM, Rudd JHF, Calza L, Fanti S, Re MC, Galié N. Pattern of arterial inflammation and inflammatory markers in people living with HIV compared with uninfected people. J Nucl Cardiol 2022; 29:1566-1575. [PMID: 33569752 PMCID: PMC9345795 DOI: 10.1007/s12350-020-02522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/25/2020] [Indexed: 11/03/2022]
Abstract
STUDY DESIGN To compare arterial inflammation (AI) between people living with HIV (PLWH) and uninfected people as assessed by 18F-Fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET). METHODS We prospectively enrolled 20 PLWH and 20 uninfected people with no known cardiovascular disease and at least 3 traditional cardiovascular risk factors. All patients underwent 18F-FDG-PET/computed tomography (CT) of the thorax and neck. Biomarkers linked to inflammation and atherosclerosis were also determined. The primary outcome was AI in ascending aorta (AA) measured as mean maximum target-to-background ratio (TBRmax). The independent relationships between HIV status and both TBRmax and biomarkers were evaluated by multivariable linear regression adjusted for body mass index, creatinine, statin therapy, and atherosclerotic cardiovascular 10-year estimated risk (ASCVD). RESULTS Unadjusted mean TBRmax in AA was slightly higher but not statistically different (P = .18) in PLWH (2.07; IQR 1.97, 2.32]) than uninfected people (2.01; IQR 1.85, 2.16]). On multivariable analysis, PLWH had an independent risk of increased mean log-TBRmax in AA (coef = 0.12; 95%CI 0.01,0.22; P = .032). HIV infection was independently associated with higher values of interleukin-10 (coef = 0.83; 95%CI 0.34, 1.32; P = .001), interferon-γ (coef. = 0.90; 95%CI 0.32, 1.47; P = .003), and vascular cell adhesion molecule-1 (VCAM-1) (coef. = 0.75; 95%CI: 0.42, 1.08, P < .001). CONCLUSIONS In patients with high cardiovascular risk, HIV status was an independent predictor of increased TBRmax in AA. PLWH also had an increased independent risk of IFN-γ, IL-10, and VCAM-1 levels.
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Affiliation(s)
- Nevio Taglieri
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Rachele Bonfiglioli
- Division of Nuclear Medicine, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Isabella Bon
- Division of Microbiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Pietro Malosso
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Andrej Corovic
- Division of Cardiovascular Medicine, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Matteo Bruno
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Elizabeth Le
- Division of Cardiovascular Medicine, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Bianca Granozzi
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Gabriele Ghetti
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Martina Tamburello
- Division of Microbiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Antonio Giulio Bruno
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Francesco Saia
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Division of Nuclear Medicine, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Maria Carla Re
- Division of Microbiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Nazzareno Galié
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
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Wagner TH, Schoemaker L, Gehlert E, Nelson RE, Murphy K, Martini S, Graham GD, Govindarajan P, Williams LS. One-Year Costs Associated With the Veterans Affairs National TeleStroke Program. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:937-943. [PMID: 35346590 DOI: 10.1016/j.jval.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Access to timely care is important for patients with stroke, where rapid diagnosis and treatment affect functional status, disability, and mortality. Telestroke programs connect stroke specialists with emergency department staff at facilities without on-site stroke expertise. The objective of this study was to examine healthcare costs for patients with stroke who sought care before and after implementation of the US Department of Veterans Affairs National TeleStroke Program (NTSP). METHODS We identified 471 patients who had a stroke and sought care at a telestroke site and compared them to 529 patients with stroke who received stroke care at the same sites before telestroke implementation. We examined patient costs for 12 months before and after stroke, using a linear model with a patient-level fixed effect. RESULTS NTSP was associated with significantly higher rates of patients receiving guideline concordant care. Compared with control patients, those treated by NTSP were 14.3 percentage points more likely to receive tissue plasminogen activator and 4.3 percentage points more likely to receive a thrombectomy (all P < .0001). NTSP was associated with $4821 increased costs for patients with stroke in the first 30 days after the program (2019 dollars). There were no observed savings over 12 months, and the added costs of care were attributable to higher rates of guideline concordant care. CONCLUSIONS Telestroke programs are unlikely to yield short-term savings because optimal stroke care is expensive. Healthcare organizations should expect increases in healthcare costs for patients treated for stroke in the first year after implementing a telestroke program.
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Affiliation(s)
- Todd H Wagner
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA; Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Surgery, Stanford University, Stanford, CA, USA.
| | - Lena Schoemaker
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Elizabeth Gehlert
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Richard E Nelson
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Sharyl Martini
- VA National TeleStroke Program and VA Office of Specialty Care Services, Washington, DC, USA; Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Glenn D Graham
- VA National TeleStroke Program and VA Office of Specialty Care Services, Washington, DC, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Linda S Williams
- VA HSR&D EXTEND QUERI and the Center for Health Information and Communication, Indianapolis VA Medical Center, Indianapolis, IN, USA; Department of Neurology, Indiana University, Indianapolis, IN, USA; Regenstrief Institute, Inc, Indianapolis, IN, USA
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28
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Gooden TE, Gardner M, Wang J, Jolly K, Lane DA, Benjamin LA, Mwandumba HC, Kandoole V, Lwanga IB, Taylor S, Manaseki-Holland S, Lip GYH, Nirantharakumar K, Thomas GN. Incidence of Cardiometabolic Diseases in People With and Without Human Immunodeficiency Virus in the United Kingdom: A Population-Based Matched Cohort Study. J Infect Dis 2022; 225:1348-1356. [PMID: 34417792 PMCID: PMC9016421 DOI: 10.1093/infdis/jiab420] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/19/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Evidence on the risk of cardiovascular disease (CVD) and CVD risk factors in people with human immunodeficiency virus (PWH) is limited. We aimed to identify the risk of composite CVD, individual CVD events, and common risk factors. METHODS This was a nationwide, population-based, cohort study comparing adult (≥18 years old) PWH with people without human immunodeficiency virus (HIV) matched on age, sex, ethnicity, and location. The primary outcome was composite CVD comprising stroke, myocardial infarction, peripheral vascular disease, ischemic heart disease, and heart failure. The secondary outcomes were individual CVD events, hypertension, diabetes, chronic kidney disease (CKD), and all-cause mortality. Cox proportional hazard regression models were used to examine the risk of each outcome. RESULTS We identified 9233 PWH and matched them with 35 721 HIV-negative individuals. An increased risk was found for composite CVD (adjusted hazard ratio [aHR], 1.50; 95% confidence interval [CI], 1.28-1.77), stroke (aHR, 1.42; 95% CI, 1.08-1.86), ischemic heart disease (aHR, 1.55; 95% CI, 1.24-1.94), hypertension (aHR, 1.37; 95% CI, 1.23-1.53), type 2 diabetes (aHR, 1.28; 95% CI, 1.09-1.50), CKD (aHR, 2.42; 95% CI, 1.98-2.94), and all-cause mortality (aHR, 2.84; 95% CI, 2.48-3.25). CONCLUSIONS PWH have a heightened risk for CVD and common CVD risk factors, reinforcing the importance for regular screening for such conditions.
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Affiliation(s)
- Tiffany E Gooden
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Mike Gardner
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jingya Wang
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kate Jolly
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Deirdre A Lane
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Laura A Benjamin
- Laboratory of Molecular and Cell Biology, University College London, London, United Kingdom
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London, United Kingdom
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Henry C Mwandumba
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Vanessa Kandoole
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- College of Medicine, University of Malawi, Blantyre, Malawi
- Bristol Heart Institute, University Hospitals Bristol and Western NHS Foundation Trust, Bristol, United Kingdom
| | - Isaac B Lwanga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen Taylor
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Department of Infection and Immunology, University Hospitals Birmingham, Birmingham, United Kingdom
| | | | - Gregory Y H Lip
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | | | - G Neil Thomas
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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29
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Eilam A, Samogalsky V, Elbirt D, Gilad R. Incidence of acute ischemic cerebrovascular events in a cohort of HIV-infected patients. Acta Neurol Belg 2022; 122:417-422. [PMID: 34114141 DOI: 10.1007/s13760-021-01705-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/09/2021] [Indexed: 12/26/2022]
Abstract
The prevalence of vascular diseases in HIV (human immunodeficiency virus)-infected individuals has been comprehensively investigated. However, their incidence of ischemic cerebrovascular events has not been thoroughly examined. Our aim was to examine the rate of ischemic stroke or TIA (transient ischemic attack) in a defined HIV population and to find the risk factors that are characteristic in this population. A case-controlled retrospective cohort study of HIV patients followed up at Kaplan Medical Center between 2009 and 2017 was performed. The study included 300 patients who had been compared to a matched age and gender group. The data were collected by reviewing patients' files and imaging studies. The first goal was to compare the incidence of ischemic cerebrovascular events in both groups. Secondary endpoints were to characterize the types of cerebrovascular events and risk factors in the study group versus the general population. There were more ischemic stroke cases in the study group vs. the control group. After adjusting for vascular risk factors in a multivariate analysis, the odds ratio for a cerebrovascular accident in the HIV patient group was 2.29 (p = 0.057). Notably, in the comparative group, the vascular risk factors' rate (hyperlipidemia, IHD and smoking) was higher than in the HIV group. In this study, ischemic cerebrovascular events were more common in HIV-infected patients than in the control group, in spite of the fact that they had fewer vascular risk factors.
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Affiliation(s)
- Anda Eilam
- Neurology Department, Kaplan Medical Center, Rechovot, Israel. .,Hadassah Medical School, The Hebrew University, Jerusalem, Israel. .,Kaplan Medical Center, 1 Pasternak road, 7661041, Rechovot, Israel.
| | - Volodymyr Samogalsky
- Neurology Department, Kaplan Medical Center, Rechovot, Israel.,Kaplan Medical Center, 1 Pasternak road, 7661041, Rechovot, Israel
| | - Daniel Elbirt
- "Neve Or", Immunology Department, Kaplan Medical Center, Rechovot, Israel.,Kaplan Medical Center, 1 Pasternak road, 7661041, Rechovot, Israel
| | - Ronit Gilad
- Neurology Department, Kaplan Medical Center, Rechovot, Israel.,Hadassah Medical School, The Hebrew University, Jerusalem, Israel.,Kaplan Medical Center, 1 Pasternak road, 7661041, Rechovot, Israel
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30
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Kovacs L, Kress TC, Belin de Chantemèle EJ. HIV, Combination Antiretroviral Therapy, and Vascular Diseases in Men and Women. JACC Basic Transl Sci 2022; 7:410-421. [PMID: 35540101 PMCID: PMC9079796 DOI: 10.1016/j.jacbts.2021.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
Thanks to the advent of combination antiretroviral therapy (cART), people living with human immunodeficiency virus (HIV) (PLWH) experienced a marked increase in life expectancy but are now at higher risk for cardiovascular disease (CVD), the current leading cause of death in PLWH on cART. Although HIV preponderantly affects men over women, manifestations of HIV-related CVD differ by sex with women experiencing greater risks than men. Despite extensive investigation, the etiopathology of CVD, notably the respective contribution of viral infection and cART, remain ill-defined. However, both viral infection and cART have been reported to contribute to endothelial dysfunction, the precursor and major cause of atherosclerosis-associated CVD, through mechanisms involving endothelial cell activation, inflammation, and oxidative stress, all leading to reduced nitric oxide bioavailability. Therefore, preserving endothelial function in PLWH on cART should be a main target to reduce CVD morbidity and mortality, notably in females.
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Key Words
- CVD, cardiovascular disease
- FMD, flow-mediated dilatation
- HF, heart failure
- HIV
- HIV, human immunodeficiency virus
- MI, myocardial infarction
- NO, nitric oxide
- PAD, peripheral artery disease
- PH, pulmonary hypertension
- PLWH, people living with HIV
- cART, combination antiretroviral therapy
- cIMT, carotid intima-media thickness
- combination antiretroviral therapy
- endothelial dysfunction
- sex differences
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Affiliation(s)
- Laszlo Kovacs
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Taylor C Kress
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta Georgia, USA
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31
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Gutierrez J. The persistent disparity in brain health among aging people with HIV. AIDS 2022; 36:475-477. [PMID: 35084385 PMCID: PMC8827616 DOI: 10.1097/qad.0000000000003148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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32
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Lomakina V, Sozio SJ, Tekle J. Use of Apixaban in Atrial Fibrillation With Ritonavir-Boosted Antiretroviral Therapy: A Case Report. J Pharm Pract 2022; 36:728-732. [PMID: 35138967 DOI: 10.1177/08971900221074938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Direct oral anticoagulants (DOACs) pose a challenge when given with potent CYP3A4 and P-gp inhibitors, such as the commonly prescribed pharmacokinetic booster ritonavir. As per the manufacturer, apixaban offers a dose reduction when administered concurrently with ritonavir; thus, we explore the clinical indication and safety of apixaban when given with ritonavir-boosted highly active antiretroviral therapy (HAART) in an HIV patient. SUMMARY We describe a 73-year-old male with extensive cardiac history, including a past medical history of resolved left ventricular thrombus, newly diagnosed non-valvular atrial fibrillation treated with warfarin, and HIV infection treated with ritonavir-boosted HAART. The patient presented to the emergency department with bleeding from multiple sites, necessitating the use of vitamin K. Consequently, his hospital course was complicated by episodes of minor bleeding and labile INR. Due to the complicated nature of his condition and the potential for drug-drug interactions (DDIs), he was transitioned from warfarin to apixaban. Since there is little readily available data to support the use of rivaroxaban and dabigatran with ritonavir, our patient was safely started on dose-reduced apixaban for stroke prophylaxis in atrial fibrillation due to the predictable nature of apixaban pharmacokinetics and proven superiority regarding adverse effects, as compared to other DOACs. CONCLUSION Dose-reduced apixaban is a safe and viable choice in patients with atrial fibrillation warranting stroke prophylaxis while concurrently receiving ritonavir-boosted HAART.
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Affiliation(s)
- Veronica Lomakina
- Department of Pharmacy, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Stephen J Sozio
- 43987Rowan University School of Osteopathic Medicine, Stratford, NJ USA
| | - Jowana Tekle
- Department of Pharmacy, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
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Nhean S, Tseng A, Back D. The intersection of drug interactions and adverse reactions in contemporary antiretroviral therapy. Curr Opin HIV AIDS 2021; 16:292-302. [PMID: 34459470 DOI: 10.1097/coh.0000000000000701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Advances in antiretroviral therapy (ART) have transformed HIV infection into a chronic and manageable condition. The introduction of potent and more tolerable antiretrovirals (ARVs) with favorable pharmacokinetic profiles has changed the prevalence and nature of drug-drug interactions (DDIs). Here, we review the relevance of DDIs in the era of contemporary ART. RECENT FINDINGS Management of DDIs remains an important challenge with modern ART, primarily due to increased polypharmacy in older persons living with HIV. Significant DDIs exist between boosted ARVs or older nonnucleoside reverse transcriptase inhibitors and comedications for chronic comorbidities (e.g., anticoagulants, antiplatelets, statins) or complex conditions (e.g., anticancer agents, immunosuppressants). Newer ARVs such as unboosted integrase inhibitors, doravirine, and fostemsavir have reduced DDI potential, but there are clinically relevant DDIs that warrant consideration. Potential consequences of DDIs include increased toxicity and/or reduced efficacy of ARVs and/or comedications. Management approaches include switching to an ARV with less DDI potential, changing comedications, or altering medication dosage or dosing frequency. Deprescribing strategies can reduce DDIs and polypharmacy, improve adherence, minimize unnecessary adverse effects, and prevent medication-related errors. SUMMARY Management of DDIs requires close interdisciplinary collaboration from multiple healthcare disciplines (medicine, nursing, pharmacy) across a spectrum of care (community, outpatient, inpatient).
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Affiliation(s)
- Salin Nhean
- Correct Rx Pharmacy Services, Hanover, Maryland, USA
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - David Back
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
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Freiberg MS, Duncan MS, Alcorn C, Chang CH, Kundu S, Mumpuni A, Smith EK, Loch S, Bedigian A, Vittinghoff E, So‐Armah K, Hsue PY, Justice AC, Tseng ZH. HIV Infection and the Risk of World Health Organization-Defined Sudden Cardiac Death. J Am Heart Assoc 2021; 10:e021268. [PMID: 34493058 PMCID: PMC8649505 DOI: 10.1161/jaha.121.021268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 12/04/2022]
Abstract
Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)-defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow-up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04-1.25), adjusting for possible confounders. In analyses with time-varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm3 (HR, 1.57; 95% CI, 1.28-1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46-1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm3 (HR, 1.03; 95% CI, 0.90-1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87-1.09) were not at increased SCD risk. Conclusions HIV infection is associated with increased risk of WHO-defined SCD among those with elevated HIV viral load or low CD4 cell counts.
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Affiliation(s)
- Matthew S. Freiberg
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Geriatric Research Education and Clinical Centers (GRECC)Veterans Affairs Tennessee Valley Healthcare SystemNashvilleTN
- Department of MedicineVanderbilt University Medical CenterNashvilleTN
- Yale School of Public HealthNew HavenCT
| | - Meredith S. Duncan
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Department of BiostatisticsUniversity of KentuckyLexingtonKY
| | - Charles Alcorn
- Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPA
| | - Chung‐Chou H. Chang
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Suman Kundu
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
| | - Asri Mumpuni
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Vanderbilt Institute for Clinical and Translational ResearchVanderbilt University Medical CenterNashvilleTN
| | - Emily K. Smith
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
| | - Sarah Loch
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Vanderbilt Center for Child Health PolicyVanderbilt University Medical CenterNashvilleTN
| | | | - Eric Vittinghoff
- Department of Epidemiology and BiostatisticsUniversity of California at San FranciscoCA
| | - Kaku So‐Armah
- Division of General Internal MedicineBoston UniversityBostonMA
| | - Priscilla Y. Hsue
- Division of CardiologyUniversity of California San FranciscoSan FranciscoCA
| | - Amy C. Justice
- Veterans Affairs Connecticut Health Care SystemWest Haven Veterans Administration Medical CenterWest HavenCT
- Department of MedicineYale School of MedicineNew HavenCT
| | - Zian H. Tseng
- Cardiac Electrophysiology Section, Division of CardiologyUniversity of California San FranciscoSan FranciscoCA
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35
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Chichetto NE, Kundu S, Freiberg MS, Koethe JR, Butt AA, Crystal S, So-Armah KA, Cook RL, Braithwaite RS, Justice AC, Fiellin DA, Khan M, Bryant KJ, Gaither JR, Barve SS, Crothers K, Bedimo RJ, Warner A, Tindle HA. Association of Syndemic Unhealthy Alcohol Use, Smoking, and Depressive Symptoms on Incident Cardiovascular Disease among Veterans With and Without HIV-Infection. AIDS Behav 2021; 25:2852-2862. [PMID: 34101074 PMCID: PMC8376776 DOI: 10.1007/s10461-021-03327-4] [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] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
Unhealthy alcohol use, smoking, and depressive symptoms are risk factors for cardiovascular disease (CVD). Little is known about their co-occurrence - termed a syndemic, defined as the synergistic effect of two or more conditions-on CVD risk in people with HIV (PWH). We used data from 5621 CVD-free participants (51% PWH) in the Veteran's Aging Cohort Study-8, a prospective, observational study of veterans followed from 2002 to 2014 to assess the association between this syndemic and incident CVD by HIV status. Diagnostic codes identified cases of CVD (acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary revascularization). Validated measures of alcohol use, smoking, and depressive symptoms were used. Baseline number of syndemic conditions was categorized (0, 1, ≥ 2 conditions). Multivariable Cox Proportional Hazards regressions estimated risk of the syndemic (≥ 2 conditions) on incident CVD by HIV-status. There were 1149 cases of incident CVD (52% PWH) during the follow-up (median 10.1 years). Of the total sample, 64% met our syndemic definition. The syndemic was associated with greater risk for incident CVD among PWH (Hazard Ratio [HR] 1.87 [1.47-2.38], p < 0.001) and HIV-negative veterans (HR 1.70 [1.35-2.13], p < 0.001), compared to HIV-negative with zero conditions. Among those with the syndemic, CVD risk was not statistically significantly higher among PWH vs. HIV-negative (HR 1.10 [0.89, 1.37], p = .38). Given the high prevalence of this syndemic combined with excess risk of CVD, these findings support linked-screening and treatment efforts.
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Affiliation(s)
- Natalie E Chichetto
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA.
| | - Suman Kundu
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, Weill-Cornell Medical College, Doha, USA
- Hamad Medical Corporation, Doha, Qatar
| | - Stephen Crystal
- Health Care Policy, and Aging Research and School of Social Work, Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Amy C Justice
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, New Haven, CT, USA
| | - David A Fiellin
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Maria Khan
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Julie R Gaither
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Shirish S Barve
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Roger J Bedimo
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alberta Warner
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CT, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
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36
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Bellinati PQ, Alfieri DF, Flauzino T, Junior PFG, Rossi DJ, Breganó JW, Simão ANC, de Almeida ERD, Lozovoy MAB, Reiche EMV. Association of Lower Adiponectin Plasma Levels, Increased Age and Smoking with Subclinical Atherosclerosis in Patients with HIV-1 Infection. Curr HIV Res 2021; 18:292-306. [PMID: 32516102 DOI: 10.2174/1570162x18666200609114741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association between subclinical atherosclerosis and traditional cardiovascular disease (CVD) risk factors, inflammatory and metabolic biomarkers has been demonstrated around the world and specifically Brazilian human immunodeficiency virus type 1 (HIV-1)- infected individuals. However, the association between subclinical atherosclerosis and these aforementioned factors combined with anti-inflammatory biomarkers has not been examined in these populations. OBJECTIVES To evaluate the association of the carotid intima-media thickness (cIMT) with CVD risk factors, inflammatory, metabolic and HIV-1 infection markers combined with adiponectin and interleukin (IL)-10 as anti-inflammatory variables. METHODS In this case-control study, 49 HIV-1-infected patients on combined antiretroviral therapy (cART) and 85 controls were compared for traditional CVD risk factors, inflammatory, metabolic, and anti-inflammatory variables. Further, we compared HIV-1-infected patients according to their cIMT (as continuous and categorized <0.9 or ≥0.9 mm variable) visualized by carotid ultrasonography doppler (USGD). RESULTS Twenty-four (48.9%) HIV-1-infected patients showed cIMT ≥0.9 mm. The patients had higher levels of C reactive protein on high sensitivity assay (hsCRP), tumor necrosis factor α, IL-6, IL-10, triglycerides, and insulin, and lower levels of adiponectin, total cholesterol and low-density lipoprotein cholesterol than controls (all p<0.05). Low levels of adiponectin were negatively associated with cIMT ≥0.9 mm (p=0.019), and explained 18.7% of the cIMT variance. Age (p=0.033) and current smoking (p=0.028) were positively associated with cIMT values, while adiponectin levels (p=0.008) were negatively associated with cIMT values; together, these three variables explained 27.3% of cIMT variance. CONCLUSION Low adiponectin was associated with higher cIMT in HIV-1-infected patients on cART. Low adiponectin levels in combination with age and smoking could explain, in part, the increased subclinical atherosclerosis observed in these patients. Adiponectin may be a good candidate for predicting subclinical atherosclerosis in the management of HIV-1-infected patients in public health care, especially where USGD is not available.
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Affiliation(s)
| | - Daniela Frizon Alfieri
- Department of Pharmaceutical Sciences, Health Sciences Center, Londrina State University, Londrina, Paraná, Brazil
| | - Tamires Flauzino
- Laboratory of Research in Applied Immunology, Health Sciences Center, Londrina State University, Londrina, Paraná, Brazil
| | | | - Diogo Jorge Rossi
- Infectious Diseases Unity, University Hospital, Londrina State University, Londrina, Paraná, Brazil
| | - José Wander Breganó
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, Londrina State University, Londrina, Paraná, Brazil
| | - Andrea Name Colado Simão
- Laboratory of Research in Applied Immunology, Health Sciences Center, Londrina State University, Londrina, Paraná, Brazil
| | | | | | - Edna Maria Vissoci Reiche
- Laboratory of Research in Applied Immunology, Health Sciences Center, Londrina State University, Londrina, Paraná, Brazil
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Sico JJ, Kundu S, So-Armah K, Gupta SK, Chang CCH, Butt AA, Gibert CL, Marconi VC, Crystal S, Tindle HA, Freiberg MS, Stewart JC. Depression as a Risk Factor for Incident Ischemic Stroke Among HIV-Positive Veterans in the Veterans Aging Cohort Study. J Am Heart Assoc 2021; 10:e017637. [PMID: 34169726 PMCID: PMC8403311 DOI: 10.1161/jaha.119.017637] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background HIV infection and depression are each associated with increased ischemic stroke risk. Whether depression is a risk factor for stroke within the HIV population is unknown. Methods and Results We analyzed data on 106 333 (33 528 HIV‐positive; 72 805 HIV‐negative) people who were free of baseline cardiovascular disease from an observational cohort of HIV‐positive people and matched uninfected veterans in care from April 1, 2003 through December 31, 2014. International Classification of Diseases, Ninth Revision (ICD‐9) codes from medical records were used to determine baseline depression and incident stroke. Depression occurred in 19.5% of HIV‐positive people. After a median of 9.2 years of follow‐up, stroke rates were highest among people with both HIV and depression and lowest among those with neither condition. In Cox proportional hazard models, depression was associated with an increased risk of stroke for HIV‐positive people after adjusting for sociodemographic characteristics and cerebrovascular risk factors (hazard ratio [HR], 1.18; 95% CI: 1.03–1.34; 0.014). The depression‐stroke relationship was attenuated by alcohol use disorders, cocaine use, and baseline antidepressant use, and unaffected by combined antiretroviral therapy use or individual antiretroviral agents. A numerically higher HR of depression on stroke was found among those younger than 60 years. Conclusions Depression is associated with an increased risk of stroke among HIV‐positive people after adjusting for sociodemographic characteristics, traditional cerebrovascular risk factors, and HIV‐specific factors. Alcohol use disorders, cocaine use, and baseline antidepressant use accounted for some of the observed stroke risk. Depression may be a novel, independent risk factor for ischemic stroke in HIV, particularly among younger people.
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Affiliation(s)
- Jason J Sico
- Neurology Service VA Connecticut Healthcare System West Haven CT.,Department of Neurology Yale School of Medicine New Haven CT.,Center for NeuroEpidemiological and Clinical Neurological Research Yale School of Medicine New Haven CT.,Department of Internal Medicine Yale School of Medicine New Haven CT.,Clinical Epidemiology Research Center (CERC) VA Connecticut Healthcare System West Haven CT.,Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center VA Connecticut Healthcare System West Haven CT.,Vanderbilt Center for Clinical Cardiovascular Outcomes Research and Trials Evaluation (V-CREATE) Vanderbilt University School of Medicine Nashville TN
| | - Suman Kundu
- Vanderbilt Center for Clinical Cardiovascular Outcomes Research and Trials Evaluation (V-CREATE) Vanderbilt University School of Medicine Nashville TN.,Tennessee Valley Geriatrics Research Education and Clinical Centers (GRECC) VA Tennessee Valley Healthcare System Nashville TN
| | | | - Samir K Gupta
- Department of Medicine Indiana University School of Medicine Indianapolis IN
| | | | - Adeel A Butt
- VA Pittsburgh Healthcare System Pittsburgh PA.,Weill Cornell Medical College New York NY.,Weill Cornell Medical College Doha Qatar.,Hamad Medical Corporation Doha Qatar
| | - Cynthia L Gibert
- Washington DC Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences Washington DC
| | - Vincent C Marconi
- Emory University School of Medicine and Rollins School of Public Health Emory Center for AIDS Research, and the Atlanta VA Medical Center Atlanta GA
| | - Stephen Crystal
- Center for Health Services Research Institute for Health Rutgers University New Brunswick NJ
| | - Hilary A Tindle
- Tennessee Valley Geriatrics Research Education and Clinical Centers (GRECC) VA Tennessee Valley Healthcare System Nashville TN.,Vanderbilt University Medical Center Nashville TN
| | - Matthew S Freiberg
- Vanderbilt Center for Clinical Cardiovascular Outcomes Research and Trials Evaluation (V-CREATE) Vanderbilt University School of Medicine Nashville TN.,Tennessee Valley Geriatrics Research Education and Clinical Centers (GRECC) VA Tennessee Valley Healthcare System Nashville TN
| | - Jesse C Stewart
- Department of Psychology Indianapolis University-Purdue University Indianapolis (IUPUI) Indianapolis IN
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38
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Spagnolo-Allende A, Gutierrez J. Role of Brain Arterial Remodeling in HIV-Associated Cerebrovascular Outcomes. Front Neurol 2021; 12:593605. [PMID: 34239489 PMCID: PMC8258100 DOI: 10.3389/fneur.2021.593605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 05/07/2021] [Indexed: 01/11/2023] Open
Abstract
As the life expectancy of people living with HIV (PLWH) on combination antiretroviral therapy (cART) increases, so does morbidity from cerebrovascular disease and neurocognitive disorders. Brain arterial remodeling stands out as a novel investigational target to understand the role of HIV in cerebrovascular and neurocognitive outcomes. We therefore conducted a review of publications in PubMed, EMBASE, Web of Science and Wiley Online Library, from inception to April 2021. We included search terms such as HIV, cART, brain, neuroimmunity, arterial remodeling, cerebrovascular disease, and neurocognitive disorders. The literature shows that, in the post-cART era, PLWH continue to experience an increased risk of stroke and neurocognitive disorders (albeit milder forms) compared to uninfected populations. PLWH who are immunosuppressed have a higher proportion of hemorrhagic strokes and strokes caused by opportunistic infection and HIV vasculopathy, while PLWH on long-term cART have higher rates of ischemic strokes, compared to HIV-seronegative controls. Brain large artery atherosclerosis in PLWH is associated with lower CD4 nadir and higher CD4 count during the stroke event. HIV vasculopathy, a form of non-atherosclerotic outward remodeling, on the other hand, is associated with protracted immunosuppression. HIV vasculopathy was also linked to a thinner media layer and increased adventitial macrophages, suggestive of non-atherosclerotic degeneration of the brain arterial wall in the setting of chronic central nervous system inflammation. Cerebrovascular architecture seems to be differentially affected by HIV infection in successfully treated versus immunosuppressed PLWH. Brain large artery atherosclerosis is prevalent even with long-term immune reconstitution post-cART. HIV-associated changes in brain arterial walls may also relate to higher rates of HIV-associated neurocognitive disorders, although milder forms are more prevalent in the post-cART era. The underlying mechanisms of HIV-associated pathological arterial remodeling remain poorly understood, but a role has been proposed for chronic HIV-associated inflammation with increased burden on the vasculature. Neuroimaging may come to play a role in assessing brain arterial remodeling and stratifying cerebrovascular risk, but the data remains inconclusive. An improved understanding of the different phenotypes of brain arterial remodeling associated with HIV may reveal opportunities to reduce rates of cerebrovascular disease in the aging population of PLWH on cART.
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Affiliation(s)
| | - Jose Gutierrez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
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39
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Tan BK, Chalouni M, Ceron DS, Cinaud A, Esterle L, Loko MA, Katlama C, Poizot-Martin I, Neau D, Chas J, Morlat P, Rosenthal E, Lacombe K, Naqvi A, Barange K, Bouchaud O, Gervais A, Lascoux-Combe C, Garipuy D, Alric L, Goujard C, Miailhes P, Aumaitre H, Duvivier C, Simon A, Lopez-Zaragoza JL, Zucman D, Raffi F, Lazaro E, Rey D, Piroth L, Boué F, Gilbert C, Bani-Sadr F, Dabis F, Sogni' P, Wittkop L, Boccara F. Atherosclerotic Cardiovascular Events in Patients Infected With Human Immunodeficiency Virus and Hepatitis C Virus. Clin Infect Dis 2021; 72:e215-e223. [PMID: 32686834 DOI: 10.1093/cid/ciaa1014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND An increased risk of cardiovascular disease (CVD) was reported in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), without identifying factors associated with atherosclerotic CVD (ASCVD) events. METHODS HIV-HCV coinfected patients were enrolled in the Agence Nationale de Recherches sur le Sida et les hépatites virales (ANRS) CO13 HEPAVIH nationwide cohort. Primary outcome was total ASCVD events. Secondary outcomes were coronary and/or cerebral ASCVD events, and peripheral artery disease (PAD) ASCVD events. Incidences were estimated using the Aalen-Johansen method. Factors associated with ASCVD were identified using cause-specific Cox proportional hazards models. RESULTS At baseline, median age of the study population (N = 1213) was 45.4 (interquartile range [IQR] 42.1-49.0) years and 70.3% were men. After a median follow-up of 5.1 (IQR 3.9-7.0) years, the incidence was 6.98 (95% confidence interval [CI], 5.19-9.38) per 1000 person-years for total ASCVD events, 4.01 (2.78-6.00) for coronary and/or cerebral events, and 3.17 (2.05-4.92) for PAD ASCVD events. Aging (hazard ratio [HR] 1.06; 95% CI, 1.01-1.12), prior CVD (HR 8.48; 95% CI, 3.14-22.91), high total cholesterol (HR 1.43; 95% CI, 1.11-1.83), high-density lipoprotein cholesterol (HR 0.22; 95% CI, 0.08-0.63), statin use (HR 3.31; 95% CI, 1.31-8.38), and high alcohol intake (HR 3.18; 95% CI, 1.35-7.52) were independently associated with total ASCVD events, whereas undetectable baseline viral load (HR 0.41, 95% CI, 0.18-0.96) was associated with coronary and/or cerebral events. CONCLUSIONS HIV-HCV coinfected patients experienced a high incidence of ASCVD events. Some traditional cardiovascular risk factors were the main determinants of ASCVD. Controlling cholesterol abnormalities and maintaining undetectable HIV RNA are essential to control cardiovascular risk.
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Affiliation(s)
- Boun Kim Tan
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Department of Internal Medicine, Hôpital Cochin, Paris, France.,Unité des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France
| | - Mathieu Chalouni
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Dominique Salmon Ceron
- Unité des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France
| | - Alexandre Cinaud
- Université Paris Descartes, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hypertension and Cardiovascular Prevention Unit, Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital, Paris, France
| | - Laure Esterle
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Marc Arthur Loko
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Christine Katlama
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Service des Maladies Infectieuses et Tropicales, Paris, France.,Inserm Institut Pierre Louis Epidémiologie et Santé Publique, UPMC, Sorbonne Université, Paris, France
| | - Isabelle Poizot-Martin
- Assistance Publique des Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France.,Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Didier Neau
- Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
| | - Julie Chas
- France Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Philippe Morlat
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne, Hôpital Saint-André, Bordeaux, France
| | - Eric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne et Cancérologie, Hôpital l'Archet, Nice, France.,Université de Nice-Sophia Antipolis, Nice, France
| | - Karine Lacombe
- Inserm Institut Pierre Louis Epidémiologie et Santé Publique, UPMC, Sorbonne Université, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Alissa Naqvi
- Centre Hospitalier Universitaire de Nice, Service d'Infectiologie, Hôpital l'Archet, Nice, France
| | - Karl Barange
- Centre Hospitalier Universitaire de Toulouse, Service d'Hépatologie, Hôpital Purpan, Toulouse, France
| | - Olivier Bouchaud
- Assistance Publique des Hôpitaux de Paris, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France.,Université Sorbonne Paris Nord, Bobigny, France
| | - Anne Gervais
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Caroline Lascoux-Combe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Daniel Garipuy
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Services des Maladies Infectieuses et Tropicales, Toulouse, France
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Service de Médecine Interne-Pôle Digestif, Toulouse, France.,Université Toulouse III, UMR 152, IRD, Toulouse, France
| | - Cécile Goujard
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, Parris, France.,Université Paris-Saclay, Le Kremlin-Bicêtre, Parris, France
| | - Patrick Miailhes
- Centre Hospitalier Universitaire de Lyon, Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Lyon, France
| | - Hugues Aumaitre
- Centre Hospitalier de Perpignan, Service des Maladies Infectieuses et Tropicales, Perpignan, France
| | - Claudine Duvivier
- Assistance Publique des Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Anne Simon
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Jose-Luis Lopez-Zaragoza
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service d'Immunologie Clinique et de Maladies Infectieuses, Créteil, France
| | | | - François Raffi
- Centre Hospitalier Universitaire de Nantes, Department of Infectious Diseases, Nantes, France.,Université de Nantes, CIC 1413, INSERM, Nantes, France
| | - Estibaliz Lazaro
- Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, hôpital Haut-Lévèque, Service de Médecine Interne et Maladies Infectieuses, Pessac, France
| | - David Rey
- Centre Hospitalier Universitaire de Strasbourg, Le Trait d'Union, HIV Infection Care Center, Strasbourg, France
| | - Lionel Piroth
- Centre Hospitalier Universitaire de Dijon, Département d'Infectiologie, Dijon, France.,Université de Bourgogne, Dijon, France
| | - François Boué
- Université Paris-Saclay, Le Kremlin-Bicêtre, Parris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Antoine Béclère, Service de Médecine Interne et d'Immunologie clinique, Clamart, France
| | - Camille Gilbert
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Firouzé Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Unité des Maladies Infectieuses et Tropicales, Hôpital Robert Debré, Reims, France.,Université Reims Champagne Ardenne, EA-4684/SFR CAP-SANTE, Reims, France
| | - François Dabis
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Philippe Sogni'
- Université Paris Descartes, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service d'Hépatologie, Paris, France.,Inserm U-1223, Institut Pasteur, Paris, France
| | - Linda Wittkop
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Franck Boccara
- Assistance Publique des Hôpitaux de Paris, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Paris University, Paris, France.,National Institute of Health and Medical Research, INSERM, UMR_S 938, UPMC, Paris, France
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40
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Harding BN, Avoundjian T, Heckbert SR, Whitney BM, Nance RM, Ruderman SA, Kalani R, Tirschwell DL, Ho EL, Becker KJ, Zunt J, Chow F, Huffer A, Mathews WC, Eron J, Moore RD, Marra CM, Burkholder G, Saag MS, Kitahata MM, Crane HM, Delaney JC. HIV Viremia and Risk of Stroke Among People Living with HIV Who Are Using Antiretroviral Therapy. Epidemiology 2021; 32:457-464. [PMID: 33591056 PMCID: PMC8012252 DOI: 10.1097/ede.0000000000001331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rates of stroke are higher in people living with HIV compared with age-matched uninfected individuals. Causes of elevated stroke risk, including the role of viremia, are poorly defined. METHODS Between 1 January 2006 and 31 December 2014, we identified incident strokes among people living with HIV on antiretroviral therapy at five sites across the United States. We considered three parameterizations of viral load (VL) including (1) baseline (most recent VL before study entry), (2) time-updated, and (3) cumulative VL (copy-days/mL of virus). We used Cox proportional hazards models to estimate hazard ratios (HRs) for stroke risk comparing the 75th percentile ("high VL") to the 25th percentile ("low VL") of baseline and time-updated VL. We used marginal structural Cox models, with most models adjusted for traditional stroke risk factors, to estimate HRs for stroke associated with cumulative VL. RESULTS Among 15,974 people living with HIV, 139 experienced a stroke (113 ischemic; 18 hemorrhagic; eight were unknown type) over a median follow-up of 4.2 years. Median baseline VL was 38 copies/mL (interquartile interval: 24, 3,420). High baseline VL was associated with increased risk of both ischemic (HR: 1.3; 95% CI = 0.96-1.7) and hemorrhagic stroke (HR: 3.1; 95% CI = 1.6-5.9). In time-updated models, high VL was also associated with an increased risk of any stroke (HR: 1.8; 95% CI = 1.4-2.3). We observed no association between cumulative VL and stroke risk. CONCLUSIONS Our findings are consistent with the hypothesis that elevated HIV VL may increase stroke risk, regardless of previous VL levels.
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Affiliation(s)
| | | | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Rizwan Kalani
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Emily L Ho
- Department of Medicine, University of Washington, Seattle, WA
| | - Kyra J Becker
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph Zunt
- Department of Medicine, University of Washington, Seattle, WA
| | - Felicia Chow
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Andrew Huffer
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Joseph Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | | | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph C Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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41
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Review of the neurological aspects of HIV infection. J Neurol Sci 2021; 425:117453. [PMID: 33895464 DOI: 10.1016/j.jns.2021.117453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
There are almost 40 million people in the world who live with the human immunodeficiency virus (HIV). The neurological manifestations associated with HIV contribute to significant morbidity and mortality despite the advances made with anti-retroviral therapy (ART). This review presents an approach to classification of neurological disorders in HIV, differentiating diseases due to the virus itself and those due to opportunistic infection. The effects of antiretroviral therapy are also discussed. The emphasis is on the developing world where advanced complications of HIV itself and infections such as tuberculosis (TB), toxoplasmosis and cryptococcal meningitis remain prevalent.
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42
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Crane HM, Nance RM, Avoundjian T, Harding BN, Whitney BM, Chow FC, Becker KJ, Marra CM, Zunt JR, Ho EL, Kalani R, Huffer A, Burkholder GA, Willig AL, Moore RD, Mathews WC, Eron JJ, Napravnik S, Lober WB, Barnes GS, McReynolds J, Feinstein MJ, Heckbert SR, Saag MS, Kitahata MM, Delaney JA, Tirschwell DL. Types of Stroke Among People Living With HIV in the United States. J Acquir Immune Defic Syndr 2021; 86:568-578. [PMID: 33661824 PMCID: PMC9680532 DOI: 10.1097/qai.0000000000002598] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most studies of stroke in people living with HIV (PLWH) do not use verified stroke diagnoses, are small, and/or do not differentiate stroke types and subtypes. SETTING CNICS, a U.S. multisite clinical cohort of PLWH in care. METHODS We implemented a centralized adjudication stroke protocol to identify stroke type, subtype, and precipitating conditions identified as direct causes including infection and illicit drug use in a large diverse HIV cohort. RESULTS Among 26,514 PLWH, there were 401 strokes, 75% of which were ischemic. Precipitating factors such as sepsis or same-day cocaine use were identified in 40% of ischemic strokes. Those with precipitating factors were younger, had more severe HIV disease, and fewer traditional stroke risk factors such as diabetes and hypertension. Ischemic stroke subtypes included cardioembolic (20%), large vessel atherosclerosis (13%), and small vessel (24%) ischemic strokes. Individuals with small vessel strokes were older, were more likely to have a higher current CD4 cell count than those with cardioembolic strokes and had the highest mean blood pressure of the ischemic stroke subtypes. CONCLUSION Ischemic stroke, particularly small vessel and cardioembolic subtypes, were the most common strokes among PLWH. Traditional and HIV-related risk factors differed by stroke type/subtype. Precipitating factors including infections and drug use were common. These results suggest that there may be different biological phenomena occurring among PLWH and that understanding HIV-related and traditional risk factors and in particular precipitating factors for each type/subtype may be key to understanding, and therefore preventing, strokes among PLWH.
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Affiliation(s)
| | | | | | | | | | | | | | - Christina M. Marra
- Neurology, University of Washington, Seattle, USA
- Medicine, University of Washington, Seattle, USA
| | - Joseph R. Zunt
- Neurology, University of Washington, Seattle, USA
- Medicine, University of Washington, Seattle, USA
- Epidemiology, University of Washington, Seattle, USA
| | - Emily L. Ho
- Neurology, University of Washington, Seattle, USA
- Swedish Neuroscience Institute, Seattle, USA
| | | | | | | | | | | | | | | | | | - William B. Lober
- Clinical Informatics Research Group, University of Washington, Seattle, USA
| | - Greg S. Barnes
- Clinical Informatics Research Group, University of Washington, Seattle, USA
| | - Justin McReynolds
- Clinical Informatics Research Group, University of Washington, Seattle, USA
| | | | | | | | | | - Joseph A.C. Delaney
- Epidemiology, University of Washington, Seattle, USA
- University of Manitoba, Manitoba, Canada
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43
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Leone MJ, Sun H, Boutros CL, Liu L, Ye E, Sullivan L, Thomas RJ, Robbins GK, Mukerji SS, Westover MB. HIV Increases Sleep-based Brain Age Despite Antiretroviral Therapy. Sleep 2021; 44:6204183. [PMID: 33783511 DOI: 10.1093/sleep/zsab058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/06/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Age-related comorbidities and immune activation raise concern for advanced brain aging in people living with HIV (PLWH). The brain age index (BAI) is a machine learning model that quantifies deviations in brain activity during sleep relative to healthy individuals of the same age. High BAI was previously found to be associated with neurological, psychiatric, cardiometabolic diseases, and reduced life expectancy among people without HIV. Here, we estimated the effect of HIV infection on BAI by comparing PLWH and HIV-controls. METHODS Clinical data and sleep EEGs from 43 PLWH on antiretroviral therapy (HIV+) and 3,155 controls (HIV-) were collected from Massachusetts General Hospital. The effect of HIV infection on BAI, and on individual EEG features, was estimated using causal inference. RESULTS The average effect of HIV on BAI was estimated to be +3.35 years (p < 0.01, 95% CI = [0.67, 5.92]) using doubly robust estimation. Compared to HIV- controls, HIV+ participants exhibited a reduction in delta band power during deep sleep and rapid eye movement sleep. CONCLUSION We provide causal evidence that HIV contributes to advanced brain aging reflected in sleep EEG. A better understanding is greatly needed of potential therapeutic targets to mitigate the effect of HIV on brain health, potentially including sleep disorders and cardiovascular disease.
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Affiliation(s)
| | - Haoqi Sun
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Lin Liu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Elissa Ye
- Massachusetts General Hospital, Boston, MA, USA
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Abstract
Care of patients with human immunodeficiency virus (HIV) infection in the intensive care unit (ICU) has changed dramatically since the infection was first recognized in the United States in 1981. The purpose of this review is to describe the current important aspects of care of patients with HIV infection in the ICU, with a primary focus on the United States and developed countries. The epidemiology and initial approach to diagnosis and treatment of HIV (including the newest antiretroviral guidelines), common syndromes and their management in the ICU, and typical comorbidities and opportunistic infections of patients with HIV infection are discussed.
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45
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Boettiger DC, Kerr S, Chattranukulchai P, Siwamogsatham S, Avihingsanon A. Maintenance of statin therapy among people living with HIV. AIDS 2021; 35:567-574. [PMID: 33252492 DOI: 10.1097/qad.0000000000002769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Statins play a critical role in reducing the elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLHIV). However, maintaining statin therapy is difficult and may be impeded further in PLHIV due to the risk of antiretroviral therapy (ART)/statin interactions. We estimated rates of statin discontinuation and reinitiation, and the percentage of days covered by statin use among PLHIV on ART, and investigated factors associated with these outcomes. DESIGN Observational cohort study. METHODS Clinical data from individuals attending the HIV-NAT Centre in Bangkok, Thailand between 2001 and 2020 were analyzed using Kaplan-Meier curves, competing-risk regression, and generalized estimating equations. Discontinuation was defined as statin cessation lasting 90 days. RESULTS Data on 318 PLHIV were included. After 1, 3, and 5 years, 22.3, 50.8, and 61.1% had discontinued statin use, respectively. Among those who discontinued (n = 178), 52.0% reinitiated statin use within 5 years. Factors associated with statin discontinuation were low education level, fewer concomitant medications, and lack of ASCVD. Factors associated with statin reinitiation were older age, diabetes, and high levels of LDL cholesterol. The adjusted mean percentage of days covered by a statin was 86.7, 61.1, and 58.1% in the 6 months prior to 1, 3, and 5 years of follow-up, respectively. CONCLUSION Maintenance of statin therapy is poor among PLHIV on ART but is not associated with using contraindicated antiretroviral/statin combinations. A better understanding of statin use in PLHIV will aid clinicians treating individuals and policy makers designing interventions for population-level ASCVD risk reduction.
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Affiliation(s)
- David C Boettiger
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA
- Faculty of Medicine, Biostatistics Excellence Centre, Chulalongkorn University, King Chulalongkorn Memorial Hospital
| | - Stephen Kerr
- Faculty of Medicine, Biostatistics Excellence Centre, Chulalongkorn University, King Chulalongkorn Memorial Hospital
- HIV-NAT Research Collaboration/Thai Red Cross AIDS Research Centre
| | | | | | - Anchalee Avihingsanon
- HIV-NAT Research Collaboration/Thai Red Cross AIDS Research Centre
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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46
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Römer C. Viruses and Endogenous Retroviruses as Roots for Neuroinflammation and Neurodegenerative Diseases. Front Neurosci 2021; 15:648629. [PMID: 33776642 PMCID: PMC7994506 DOI: 10.3389/fnins.2021.648629] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022] Open
Abstract
Many neurodegenerative diseases are associated with chronic inflammation in the brain and periphery giving rise to a continuous imbalance of immune processes. Next to inflammation markers, activation of transposable elements, including long intrespersed nuclear elements (LINE) elements and endogenous retroviruses (ERVs), has been identified during neurodegenerative disease progression and even correlated with the clinical severity of the disease. ERVs are remnants of viral infections in the human genome acquired during evolution. Upon activation, they produce transcripts and the phylogenetically youngest ones are still able to produce viral-like particles. In addition, ERVs can bind transcription factors and modulate immune response. Being between own and foreign, ERVs are reviewed in the context of viral infections of the central nervous system, in aging and neurodegenerative diseases. Moreover, this review tests the hypothesis that viral infection may be a trigger at the onset of neuroinflammation and that ERVs sustain the inflammatory imbalance by summarizing existing data of neurodegenerative diseases associated with viruses and/or ERVs.
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Affiliation(s)
- Christine Römer
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, The Berlin Institute for Medical Systems Biology, Berlin, Germany
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47
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Boettiger DC, Newall AT, Phillips A, Bendavid E, Law MG, Ryom L, Reiss P, Mocroft A, Bonnet F, Weber R, El‐Sadr W, d’Arminio Monforte A, de Wit S, Pradier C, Hatleberg CI, Lundgren J, Sabin C, Kahn JG, Kazi DS. Cost-effectiveness of statins for primary prevention of atherosclerotic cardiovascular disease among people living with HIV in the United States. J Int AIDS Soc 2021; 24:e25690. [PMID: 33749164 PMCID: PMC7982504 DOI: 10.1002/jia2.25690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Expanding statin use may help to alleviate the excess burden of atherosclerotic cardiovascular disease in people living with HIV (PLHIV). Pravastatin and pitavastatin are preferred agents due to their lack of substantial interaction with antiretroviral therapy. We aimed to evaluate the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of atherosclerotic cardiovascular disease among PLHIV in the United States. METHODS We developed a microsimulation model that randomly selected (with replacement) individuals from the Data-collection on Adverse Effects of Anti-HIV Drugs study with follow-up between 2013 and 2016. Our study population was PLHIV aged 40 to 75 years, stable on antiretroviral therapy, and not currently using lipid-lowering therapy. Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles and discounted at 3% per year. We assumed a willingness-to-pay threshold of $100,000/QALY gained. The interventions assessed were as follows: (1) treating no one with statins; (2) treating everyone with generic pravastatin 40 mg/day (drug cost $236/year) and (3) treating everyone with branded pitavastatin 4 mg/day (drug cost $2,828/year). The model simulated each individual's probability of experiencing atherosclerotic cardiovascular disease over 20 years. RESULTS Persons receiving pravastatin accrued 0.024 additional QALYs compared with those not receiving a statin, at an incremental cost of $1338, giving an incremental cost-effectiveness ratio of $56,000/QALY gained. Individuals receiving pitavastatin accumulated 0.013 additional QALYs compared with those using pravastatin, at an additional cost of $18,251, giving an incremental cost-effectiveness ratio of $1,444,000/QALY gained. These findings were most sensitive to the pill burden associated with daily statin administration, statin costs, statin efficacy and baseline atherosclerotic cardiovascular disease risk. In probabilistic sensitivity analysis, no statin was optimal in 5.2% of simulations, pravastatin was optimal in 94.8% of simulations and pitavastatin was never optimal. CONCLUSIONS Pravastatin was projected to be cost-effective compared with no statin. With substantial price reduction, pitavastatin may be cost-effective compared with pravastatin. These findings bode well for the expanded use of statins among PLHIV in the United States. To gain greater confidence in our conclusions it is important to generate strong, HIV-specific estimates on the efficacy of statins and the quality-of-life burden associated with taking an additional daily pill.
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Affiliation(s)
- David C Boettiger
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
- Kirby InstituteUNSW SydneySydneyNSWAustralia
| | - Anthony T Newall
- The School of Public Health and Community MedicineUNSW SydneySydneyNSWAustralia
| | - Andrew Phillips
- Institute for Global HealthUniversity College LondonLondonUK
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes ResearchStanford UniversityStanfordCAUSA
| | | | - Lene Ryom
- RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Peter Reiss
- Amsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- HIV Monitoring FoundationAmsterdamThe Netherlands
| | - Amanda Mocroft
- Institute for Global HealthUniversity College LondonLondonUK
| | | | - Rainer Weber
- University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Wafaa El‐Sadr
- ICAP‐Columbia University and Harlem HospitalNew YorkNYUSA
| | | | - Stephane de Wit
- Saint Pierre University HospitalUniversité Libre de BruxellesBrusselsBelgium
| | | | | | - Jens Lundgren
- RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Caroline Sabin
- Institute for Global HealthUniversity College LondonLondonUK
| | - James G Kahn
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Dhruv S Kazi
- Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolHarvard UniversityBostonMAUSA
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48
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Ekun OA, Fasela EO, Oladele DA, Liboro GO, Raheem TY. Risks of cardio-vascular diseases among highly active antiretroviral therapy (HAART) treated HIV seropositive volunteers at a treatment centre in Lagos, Nigeria. Pan Afr Med J 2021; 38:206. [PMID: 33995812 PMCID: PMC8106780 DOI: 10.11604/pamj.2021.38.206.26791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/01/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION highly active antiretroviral therapy (HAART) has led to a decline in HIV-induced morbidity and mortality in recent years. However, it has been opined that this has led to elevated risks of cardiovascular diseases (CVDs). This study assessed the risks of CVDs among HAART experienced individuals living with HIV. METHODS a cross sectional study involving 196 adults consisting of 118 HAART experienced and 78 HAART naïve was conducted. Anthropometric and blood pressure measurements were recorded for all participants. Blood samples obtained from the volunteers were used to determine glucose, creatinine, HIV viral load, CD4 count and lipid profile using standard methods. Lipid ratios, atherogenic indices and QRISK3 risk score were calculated. RESULTS the median CD4 lymphocyte, mean body mass index (BMI) and HDL-c in HAART experienced participants were higher (P<0.05) than HAART naive individuals. The QRISK3 risk score and creatinine were higher (p<0.05) among HAART experienced group. In HAART experienced group, the risk of hypertension, increased low-density lipoprotein (LDL-c), atherogenic index of plasma (AIP) and QRISK3 were 3.7, 2.0, 2.38 and 3.85 times (p<0.05) higher respectively than in HAART naive. Atherogenic coefficient (AC) increase was more prevalent among male (p<0.05) participants. Risk of chronic renal disease (eGFR), hypertension and CVD (as measured by QRISK3) was higher (p<0.05) among the female and older participants respectively. CONCLUSION the risk of CVDs and renal disease appeared to be higher among HAART experienced volunteers and older (>45 years) volunteers. The risk of renal disease appeared higher in females.
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Affiliation(s)
- Oloruntoba Ayodele Ekun
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Idi-araba, Lagos State, Nigeria
| | - Emmanuel Olusesan Fasela
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Idi-araba, Lagos State, Nigeria
- Clinical Diagnostic Laboratory, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - David Ayoola Oladele
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Gideon Odemakpore Liboro
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Idi-araba, Lagos State, Nigeria
- Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Toyosi Yekeen Raheem
- Clinical Diagnostic Laboratory, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
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49
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Chow FC, Ma Y, Manion M, Rupert A, Lambert-Messerlian G, Bushnell CD, Cedars MI, Sereti I, Sorond FA, Hsue PY, Tien PC. Factors associated with worse cerebrovascular function in aging women with and at risk for HIV. AIDS 2021; 35:257-266. [PMID: 33229895 PMCID: PMC7789911 DOI: 10.1097/qad.0000000000002755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Women may be disproportionately impacted by the negative effect of HIV on cerebrovascular risk. We examined the association of HIV, sex, menopause, and immune activation with cerebrovascular function among women with HIV (WWH) and at risk for HIV from the Women's Interagency HIV Study and men with HIV. DESIGN Cross-sectional. METHODS Participants were aged at least 40 years with coronary heart disease or at least one cardiometabolic risk factor. All persons with HIV were on antiretroviral therapy with undetectable viral load. Cerebral vasoreactivity was assessed by the transcranial Doppler breath-holding test, with lower vasoreactivity corresponding to worse cerebrovascular function. Menopausal status was determined by anti-Müllerian hormone level. We used mixed effects linear regression to identify factors associated with cerebral vasoreactivity. RESULTS Mean cerebral vasoreactivity was similar in WWH (n = 33) and women at risk for HIV (n = 16). A trend toward higher cerebral vasoreactivity in WWH compared with men with HIV (n = 37) was no longer present after excluding women on estrogen replacement therapy (n = 3). In women, menopausal status was not significantly associated with cerebral vasoreactivity. WWH with higher cardiovascular risk (-0.14 for each additional cardiometabolic risk factor, P = 0.038), sCD163 (-0.20 per doubling, P = 0.033), and proportion of CD4+CX3CR1+ T cells (-0.14 per doubling, P = 0.028) had lower cerebral vasoreactivity. CONCLUSION Among older women at high cardiovascular risk, women with virologically suppressed HIV and women at risk for HIV had similar cerebrovascular function. Our findings, which must be interpreted in the context of the small sample, highlight the contribution of traditional cardiometabolic risk factors and immune activation to cerebrovascular risk in WWH.
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Affiliation(s)
- Felicia C. Chow
- Weill Institute for Neurosciences, Department of Neurology, and Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA
| | - Yifei Ma
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Maura Manion
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Adam Rupert
- AIDS Monitoring Laboratory, Frederick National Laboratory for Cancer Research
| | - Geralyn Lambert-Messerlian
- Departments of Pathology and Laboratory Medicine and Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC
| | - Marcelle I. Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | | - Priscilla Y. Hsue
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA
| | - Phyllis C. Tien
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California, USA
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50
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Daramola O, Ali H, Mckenzie CA, Smith C, Benjamin LA, Solomon T. Pre-clinical atherosclerosis is found at post-mortem, in the brains of men with HIV. J Neurovirol 2021; 27:80-85. [PMID: 33405199 PMCID: PMC7921050 DOI: 10.1007/s13365-020-00917-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 07/24/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022]
Abstract
The aim of this study is to ascertain the burden of pre-clinical atherosclerotic changes in the brains of young adult males with HIV and explore the impact of anti-retroviral therapy (ART). The study design is case-control, cross-sectional. Histological sections from HIV-positive post-mortem brain samples, with no associated opportunistic infection, from the MRC Edinburgh brain bank were evaluated. These were age and sex matched with HIV-negative controls. Immunohistochemical stains were performed to evaluate characteristics of atherosclerosis. The pathological changes were graded blinded to the HIV status and a second histopathologist reassessed 15%. Univariable models were used for statistical analyses; p ≤ 0.05 was considered significant. Nineteen HIV-positive post-mortem cases fulfilled our inclusion criteria. Nineteen HIV-negative controls were selected. We assessed mostly small-medium-sized vessels. For inflammation (CD45), 7 (36%) of the HIV+ had moderate/severe changes compared with none for the HIV− group (p < 0.001). Moderate/severe increase in smooth muscle remodeling (SMA) was found in 8 (42%) HIV+ and 0 HIV− brains (p < 0.001). Moderate/severe lipoprotein deposition (LOX-1) was found in 3 (15%) and 0 HIV−brains (p < 0.001). ART was associated with less inflammation [5 (63%) no ART versus 2 (18%) on ART (p = 0.028)] but was not associated with reduced lipid deposition or smooth muscle damage. In HIV infection, there are pre-clinical small- to medium-sized vessel atherosclerotic changes and ART may have limited impact on these changes. This could have implications on the increasing burden of cerebrovascular disease in HIV populations and warrants further investigation.
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Affiliation(s)
- Olusola Daramola
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE UK
- Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Wirral, Birkenhead, CH49 5PE UK
| | - Hebah Ali
- Haematological Malignancy Diagnostic Service (HMDS, St James University Hospital Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - Chris-Anne Mckenzie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB UK
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB UK
| | - Laura A. Benjamin
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE UK
- Stroke Research Centre, UCL Queen Square Institute of Neurology, First Floor Russell Square House 10-12 Russell Square, London, WC1B 5EH UK
| | - Tom Solomon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 7BE UK
- Walton Centre NHS Foundation Trust, Liverpool, L69 7LJ UK
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