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Batterham RL, Bedimo RJ, Diaz RS, Guaraldi G, Lo J, Martínez E, McComsey GA, Milinkovic A, Naito T, Noe S, O'Shea D, Paredes R, Schapiro JM, Sulkowski MS, Venter F, Waters L, Yoruk IU, Young B. Cardiometabolic health in people with HIV: expert consensus review. J Antimicrob Chemother 2024; 79:1218-1233. [PMID: 38656584 PMCID: PMC11144490 DOI: 10.1093/jac/dkae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To develop consensus data statements and clinical recommendations to provide guidance for improving cardiometabolic health outcomes in people with HIV based on the knowledge and experience of an international panel of experts. METHODS A targeted literature review including 281 conference presentations, peer-reviewed articles, and background references on cardiometabolic health in adults with HIV published between January 2016 and April 2022 was conducted and used to develop draft consensus data statements. Using a modified Delphi method, an international panel of 16 experts convened in workshops and completed surveys to refine consensus data statements and generate clinical recommendations. RESULTS Overall, 10 data statements, five data gaps and 14 clinical recommendations achieved consensus. In the data statements, the panel describes increased risk of cardiometabolic health concerns in people with HIV compared with the general population, known risk factors, and the potential impact of antiretroviral therapy. The panel also identified data gaps to inform future research in people with HIV. Finally, in the clinical recommendations, the panel emphasizes the need for a holistic approach to comprehensive care that includes regular assessment of cardiometabolic health, access to cardiometabolic health services, counselling on potential changes in weight after initiating or switching antiretroviral therapy and encouraging a healthy lifestyle to lower cardiometabolic health risk. CONCLUSIONS On the basis of available data and expert consensus, an international panel developed clinical recommendations to address the increased risk of cardiometabolic disorders in people with HIV to ensure appropriate cardiometabolic health management for this population.
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Affiliation(s)
- Rachel L Batterham
- UCL Division of Medicine, UCL School of Life and Medical Sciences, University College London, Gower Street, London WC1E 6BT, UK
- University College London Hospitals Biomedical Research Centre, National Institute for Health and Care Research, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Roger J Bedimo
- Infectious Disease Section, VA North Texas Health Care System, 4500 S Lancaster Road, Dallas, TX 75216, USA
- Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Ricardo S Diaz
- Infectious Diseases Department, Paulista School of Medicine, Federal University of São Paulo, R. Sena Madureira, 1500 Vila Clementino, São Paulo, 04021-001, Brazil
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Via Università 4, 41121 Modena, Italy
| | - Janet Lo
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Esteban Martínez
- Infectious Diseases Unit, Hospital Clinic and University of Barcelona, C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Grace A McComsey
- Case Center for Diabetes, Obesity and Metabolism, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ana Milinkovic
- Global Medical, ViiV Healthcare, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
- HIV Services, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
- Imperial College London, Exhibition Road, South Kensington, London SW7 2BX, UK
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan
| | - Sebastian Noe
- MVZ Karlsplatz, MVZ Karlsplatz 8, 80335, Munich, Germany
| | - Donal O'Shea
- Health Sciences Centre, University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
| | - Roger Paredes
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Jonathan M Schapiro
- National Hemophilia Center, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Tel Aviv, Israel
| | - Mark S Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - François Venter
- Ezintsha, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
| | - Laura Waters
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, 350 Euston Road, Regent's Place, London NW1 3AX, UK
| | - Ilksen Ungan Yoruk
- General Medicines Europe, GSK, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Benjamin Young
- Global Medical, ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA
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Batterham RL, Espinosa N, Katlama C, McKellar M, Scholten S, Smith DE, Ait-Khaled M, George N, Wright J, Gordon LA, Moodley R, Wynne B, van Wyk J. Cardiometabolic Parameters 3 Years After Switch to Dolutegravir/Lamivudine vs Maintenance of Tenofovir Alafenamide-Based Regimens. Open Forum Infect Dis 2023; 10:ofad359. [PMID: 37520420 PMCID: PMC10375426 DOI: 10.1093/ofid/ofad359] [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: 03/28/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cardiometabolic outcomes were investigated 3 years after switching to the 2-drug regimen dolutegravir/lamivudine (DTG/3TC) vs continuing 3-/4-drug tenofovir alafenamide (TAF)-based regimens in a multicenter phase 3 noninferiority study based on an open-label randomized design. Method Adults with virologically suppressed HIV-1 switched to once-daily DTG/3TC (n = 369) or continued TAF-based regimens (n = 372). Cardiometabolic health parameters were assessed through week 144 via mixed-model repeated measures or logistic regression analyses, adjusting for baseline variables. Results At week 144, 13% (42/316) of the DTG/3TC group and 12% (37/303) of the TAF-based regimen group had ≥10% weight gain from baseline (adjusted odds ratio, 1.11; 95% CI, .68-1.80). Adjusted change from baseline in serum leptin, a surrogate marker of adiposity, was similar between groups (treatment ratio, 1.00; 95% CI, .89-1.13). The lipid profile generally favored DTG/3TC in the baseline boosted subgroup. Adjusted odds revealed no clinically meaningful differences between groups: homeostatic model assessment of insulin resistance ≥2 (adjusted odds ratio, 0.79; 95% CI, .50-1.26), metabolic syndrome (International Diabetes Federation criteria, 0.99; .59-1.68), hepatic fibrosis (fibrosis-4 index score ≥1.45, 1.39; .63-3.06), and coronary artery disease risk (Framingham risk score ≥10%, 0.92; .56-1.49). Baseline variables and characteristics associated with odds of each cardiometabolic parameter outcome were consistent with known risk factors, including age, sex, race, and some disease characteristics. Conclusions Cardiometabolic health 3 years after switching to DTG/3TC was comparable to that for individuals continuing TAF-based regimens, further supporting DTG/3TC as a robust switch option with a stable metabolic profile. Trial registration ClinicalTrials.gov NCT03446573.
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Affiliation(s)
- Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Nuria Espinosa
- Hospital Universitario Virgen del Rocío, Sevilla, Andalucía, Spain
| | - Christine Katlama
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, INSERM–Sorbonne Universités, Paris, France
| | - Mehri McKellar
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | - Brian Wynne
- ViiV Healthcare, Durham, North Carolina, USA
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Tseng ZH, Moffatt E, Kim A, Vittinghoff E, Ursell P, Connolly A, Olgin JE, Wong JK, Hsue PY. Sudden Cardiac Death and Myocardial Fibrosis, Determined by Autopsy, in Persons with HIV. N Engl J Med 2021; 384:2306-2316. [PMID: 34133860 PMCID: PMC8415173 DOI: 10.1056/nejmoa1914279] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The incidence of sudden cardiac death and sudden death caused by arrhythmia, as determined by autopsy, in persons with human immunodeficiency virus (HIV) infection has not been clearly established. METHODS Between February 1, 2011, and September 16, 2016, we prospectively identified all new deaths due to out-of-hospital cardiac arrest among persons 18 to 90 years of age, with or without known HIV infection, for comprehensive autopsy and toxicologic and histologic testing. We compared the rates of sudden cardiac death and sudden death caused by arrhythmia between groups. RESULTS Of 109 deaths from out-of-hospital cardiac arrest among 610 unexpected deaths in HIV-positive persons, 48 met World Health Organization criteria for presumed sudden cardiac death; of those, fewer than half (22) had an arrhythmic cause. A total of 505 presumed sudden cardiac deaths occurred between February 1, 2011, and March 1, 2014, in persons without known HIV infection. Observed incidence rates of presumed sudden cardiac death were 53.3 deaths per 100,000 person-years among persons with known HIV infection and 23.7 deaths per 100,000 person-years among persons without known HIV infection (incidence rate ratio, 2.25; 95% confidence interval [CI], 1.37 to 3.70). Observed incidence rates of sudden death caused by arrhythmia were 25.0 and 13.3 deaths per 100,000 person-years, respectively (incidence rate ratio, 1.87; 95% CI, 0.93 to 3.78). Among all presumed sudden cardiac deaths, death due to occult drug overdose was more common in persons with known HIV infection than in persons without known HIV infection (34% vs. 13%). Persons who were HIV-positive had higher histologic levels of interstitial myocardial fibrosis than persons without known HIV infection. CONCLUSIONS In this postmortem study, the rates of presumed sudden cardiac death and myocardial fibrosis were higher among HIV-positive persons than among those without known HIV infection. One third of apparent sudden cardiac deaths in HIV-positive persons were due to occult drug overdose. (Supported by the National Heart, Lung, and Blood Institute.).
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Affiliation(s)
- Zian H Tseng
- From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco
| | - Ellen Moffatt
- From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco
| | - Anthony Kim
- From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco
| | - Eric Vittinghoff
- From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco
| | - Phil Ursell
- From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco
| | - Andrew Connolly
- From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco
| | - Jeffrey E Olgin
- From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco
| | - Joseph K Wong
- From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco
| | - Priscilla Y Hsue
- From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco
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Liver Fibrosis during Antiretroviral Treatment in HIV-Infected Individuals. Truth or Tale? Cells 2021; 10:cells10051212. [PMID: 34063534 PMCID: PMC8156893 DOI: 10.3390/cells10051212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
After the introduction of antiretroviral treatment (ART) back in 1996, the lifespan of people living with HIV (PLWH) has been substantially increased, while the major causes of morbidity and mortality have switched from opportunistic infections and AIDS-related neoplasms to cardiovascular and liver diseases. HIV itself may lead to liver damage and subsequent liver fibrosis (LF) through multiple pathways. Apart from HIV, viral hepatitis, alcoholic and especially non-alcoholic liver diseases have been implicated in liver involvement among PLWH. Another well known cause of hepatotoxicity is ART, raising clinically significant concerns about LF in long-term treatment. In this review we present the existing data and analyze the association of LF with all ART drug classes. Published data derived from many studies are to some extent controversial and therefore remain inconclusive. Among all the antiretroviral drugs, nucleoside reverse transcriptase inhibitors, especially didanosine and zidovudine, seem to carry the greatest risk for LF, with integrase strand transfer inhibitors and entry inhibitors having minimal risk. Surprisingly, even though protease inhibitors often lead to insulin resistance, they do not seem to be associated with a significant risk of LF. In conclusion, most ART drugs are safe in long-term treatment and seldom lead to severe LF when no liver-related co-morbidities exist.
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Rasoulinejad M, Seyed Alinaghi SA, Sohrabi MR, Badie BM, Manshadi SAD, Nezhad MH, Khatami SR. Prevalence and Factors Associated with Hepatic Steatosis and Fibrosis Using Fibroscan in HIV-positive Patients Treated with Anti-retroviral (ARV) Medicines Referred to the Biggest Hospital in Tehran, 2018 to 2019. Open AIDS J 2020. [DOI: 10.2174/1874613602014010108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Liver injury is a characteristic feature of HIV infection, which is the second most common cause of mortality among HIV positive patients. Non-alcoholic fatty liver disease (NAFLD) has become a new concern in the management of people living with HIV (PLWH). The condition encompasses a spectrum of diseases from non-alcoholic steatohepatitis (NASH) to fibrosis and cirrhosis. The current study was to evaluate hepatic steatosis and fibrosis using fibroscan among PLWH treated with anti-retroviral (ARV) medicines.
Methods:
The present research was designed as a cross-sectional study and 100 HIV positive patients under antiretroviral treatment (ART) were enrolled in the study. All PLWH, including 49 men (49%) and 51 women (51%) (Mean age of 39.9 years), were evaluated by Transient Elastography (TE) in Imam Khomeini Hospital during 2018 and 2019.
Results:
The mean CD4 count was 610 cells/μl, 4% with CD4 < 200 cells/μl, 30% between 201 and 500cells/μl, and 66% with CD4 >500 cells/μl. Based on the TE result, 10% of patients had significant fibrosis (F2:6% and F3:4%) and most of the patients had mild fibrosis (F1:77%). A significant, direct relationship was found between HIV infection duration and fibrosis, especially in the duration of more than five years of the disease. There was no significant association between liver fibrosis and other factors (P>0.05).
Conclusion:
The presence of hepatic fibrosis and steatosis demonstrates the main health concern for PLWH mono-infection, and mainly transient elastography is recommended for HIV mono-infected patients, especially if their infection period is over five years.
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Ganesan M, Dagur RS, Makarov E, Poluektova LI, Kidambi S, Osna NA. Matrix stiffness regulate apoptotic cell death in HIV-HCV co-infected hepatocytes: Importance for liver fibrosis progression. Biochem Biophys Res Commun 2018; 500:717-722. [PMID: 29679566 PMCID: PMC6863049 DOI: 10.1016/j.bbrc.2018.04.142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/17/2018] [Indexed: 02/06/2023]
Abstract
HIV-HCV co-infection causes rapid progression of liver fibrosis. These outcomes to liver cirrhosis can be improved, but not stopped by specific antiviral therapies. Due to high significance of HIV-HCV interactions for morbidity and mortality in co-infected patients, our attention was attracted to the multi-component pathogenesis of fibrosis progression as the transition to end-stage liver disease development. In this study, we hypothesize that increased matrix stiffness enhances apoptosis in HCV-HIV-co-infected hepatocytes and that capturing of apoptotic bodies (AB) derived from these infected hepatocytes by hepatic stellate cells (HSC) drives the fibrosis progression. As the source of viruses, JFH1 (HCV genotype 2a) and HIV-1ADA (either purified or containing in infected macrophage supernatants) were chosen. Using Huh7.5-CYP (RLW) cells and primary human hepatocytes mono-infected with HCV and HIV or co-infected, we have shown that both HCV and HIV RNA levels were increased in co-infected cells, which was accompanied by hepatocyte apoptosis. This apoptosis was attenuated by azidothymidine treatment. The levels of both infections and apoptosis were more prominent in primary hepatocytes cultured on substrates mimicking fibrotic stiffness (24 kPa-stiff) compared to substrates mimicking healthy liver (2.4 kPa-soft). The engulfment of AB from pathogen-exposed hepatocytes activated pro-fibrotic mRNAs in HSC. Overall, the increased matrix stiffness is not only a consequence of liver inflammation/fibrosis, but the condition that further accelerates liver fibrosis development. This is attributed to the switching of HSC to pro-fibrotic phenotype by capturing of excessive amounts of apoptotic HCV- and HIV-infected hepatocytes.
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Affiliation(s)
- Murali Ganesan
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Raghubendra Singh Dagur
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Edward Makarov
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Larisa I Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Srivatsan Kidambi
- Department of Chemical and Biomolecular Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Natalia A Osna
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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