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Jumare J, Dakum P, Sam-Agudu N, Memiah P, Nowak R, Bada F, Oguama U, Odonye G, Adebiyi R, Cairo C, Kwaghe V, Adebamowo C, Abimiku A, Charurat M. Prevalence and characteristics of metabolic syndrome and its components among adults living with and without HIV in Nigeria: a single-center study. BMC Endocr Disord 2023; 23:160. [PMID: 37507703 PMCID: PMC10375691 DOI: 10.1186/s12902-023-01419-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Persons living with HIV (PLHIV) now live longer due to effective combination antiretroviral therapy. However, emerging evidence indicates that they may be at increased risk for some cardiometabolic disorders. We compared the prevalence of metabolic syndrome (MetS) and its component disorders between persons living with and without HIV in Nigeria. METHODS This was a cross-sectional analysis of baseline data from a prospective cohort study of non-communicable diseases among PLHIV along with age- and sex-matched persons without HIV (PWoH) at the University of Abuja Teaching Hospital Nigeria. We collected sociodemographic and clinical data, including anthropometric measures and results of relevant laboratory tests. MetS was defined using a modification of the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) criteria. RESULTS Of the 440 PLHIV and 232 PWoH, women constituted 50.5% and 51.3% respectively. The median age of the PLHIV was 45 years while that of the PWoH was 40 years. The prevalence of MetS was 30.7% (95% CI: 26.4%, 35.2%) and 22.8% (95% CI: 17.6%, 28.8%) among the PLHIV and PWoH respectively (P = 0.026). Independent associations were found for older age (P < 0.001), female sex (P < 0.001), family history of diabetes (P < 0.001), family history of hypertension (P = 0.013) and alcohol use (P = 0.015). The prevalence of component disorders for PLHIV versus PWoH were as follows: high blood pressure (22.3% vs 20.3%), prediabetes (33.8% vs 21.1%), diabetes (20.5% vs 8.2%), high triglycerides (24.5% vs 17.2%), low HDL-Cholesterol (51.1% vs 41.4%), and abdominal obesity (38.4% vs 37.1%). Adjusting for age and sex, prediabetes, diabetes, and low HDL-Cholesterol were significantly associated with HIV status. Duration on antiretroviral therapy, protease inhibitor-based regimen, CD4 count, and viral load were associated with some of the disorders mostly in unadjusted analyses. CONCLUSION We found a high burden of MetS and its component disorders, with significantly higher prevalence of dysglycemia and dyslipidemia among PLHIV as compared to PWoH. Integration of strategies for the prevention and management of MetS disorders is needed in HIV treatment settings.
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Affiliation(s)
- Jibreel Jumare
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria.
| | - Patrick Dakum
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Nadia Sam-Agudu
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Peter Memiah
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Rebecca Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Florence Bada
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Uzoamaka Oguama
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - George Odonye
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Ruxton Adebiyi
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Cristiana Cairo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Vivian Kwaghe
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Clement Adebamowo
- Department of Epidemiology and Public Health, and Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Alash'le Abimiku
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Morton ZP, Christina Mehta C, Wang T, Palella FJ, Naggie S, Golub ET, Anastos K, French AL, Kassaye S, Taylor TN, Fischl MA, Adimora AA, Kempf MC, Tien PC, Ofotokun I, Sheth AN, Collins LF. Cumulative Human Immunodeficiency Virus (HIV)-1 Viremia Is Associated With Increased Risk of Multimorbidity Among US Women With HIV, 1997-2019. Open Forum Infect Dis 2023; 10:ofac702. [PMID: 36751648 PMCID: PMC9897021 DOI: 10.1093/ofid/ofac702] [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: 11/09/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022] Open
Abstract
Background To evaluate the effect of cumulative human immunodeficiency virus (HIV)-1 viremia on aging-related multimorbidity among women with HIV (WWH), we analyzed data collected prospectively among women who achieved viral suppression after antiretroviral therapy (ART) initiation (1997-2019). Methods We included WWH with ≥2 plasma HIV-1 viral loads (VL) <200 copies/mL within a 2-year period (baseline) following self-reported ART use. Primary outcome was multimorbidity (≥2 nonacquired immune deficiency syndrome comorbidities [NACM] of 5 total assessed). The trapezoidal rule calculated viremia copy-years (VCY) as area-under-the-VL-curve. Cox proportional hazard models estimated the association of time-updated cumulative VCY with incident multimorbidity and with incidence of each NACM, adjusting for important covariates (eg, age, CD4 count, etc). Results Eight hundred six WWH contributed 6368 women-years, with median 12 (Q1-Q3, 7-23) VL per participant. At baseline, median age was 39 years, 56% were Black, and median CD4 was 534 cells/mm3. Median time-updated cumulative VCY was 5.4 (Q1-Q3, 4.7-6.9) log10 copy-years/mL. Of 211 (26%) WWH who developed multimorbidity, 162 (77%) had incident hypertension, 133 (63%) had dyslipidemia, 60 (28%) had diabetes, 52 (25%) had cardiovascular disease, and 32 (15%) had kidney disease. Compared with WWH who had time-updated cumulative VCY <5 log10, the adjusted hazard ratio of multimorbidity was 1.99 (95% confidence interval [CI], 1.29-3.08) and 3.78 (95% CI, 2.17-6.58) for those with VCY 5-6.9 and ≥7 log10 copy-years/mL, respectively (P < .0001). Higher time-updated cumulative VCY increased the risk of each NACM. Conclusions Among ART-treated WWH, greater cumulative viremia increased the risk of multimorbidity and of developing each NACM, and hence this may be a prognostically useful biomarker for NACM risk assessment in this population.
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Affiliation(s)
- Zoey P Morton
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - C Christina Mehta
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tingyu Wang
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Frank J Palella
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susanna Naggie
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Audrey L French
- Division of Infectious Diseases, CORE Center, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Tonya N Taylor
- SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Margaret A Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adaora A Adimora
- Gillings School of Global Public Health and the School of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Phyllis C Tien
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
- Medical Service, Department of Veterans Affairs, San Francisco, California, USA
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
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3
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Rivera AS, Rusie L, Plank M, Siddique J, Beach LB, Lloyd-Jones D, Feinstein MJ. Association of Cumulative Viral Load With the Incidence of Hypertension and Diabetes in People With HIV. Hypertension 2022; 79:e135-e142. [PMID: 36378919 PMCID: PMC9673163 DOI: 10.1161/hypertensionaha.122.19302] [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: 03/20/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND HIV induces several metabolic derangements that contribute to cardiovascular disease, but it is unclear if HIV increases diabetes or hypertension risk. Refining longitudinal relationships between HIV-specific factors and cardiovascular disease risk factors across different care settings may help inform cardiovascular disease prevention among people with HIV (PWH). METHODS We tested the hypothesis that long-term higher cumulative viral load (viremia-copy-year) is associated with higher risk of diabetes and hypertension by analyzing electronic records of PWH from 2 distinct health systems in Chicago (Northwestern Medicine and Howard Brown Health Care) receiving care in 2004 to 2019. We used joint longitudinal-survival models to assess multivariable-adjusted associations. Subgroup analyses per site were also conducted. RESULTS We observed 230 (3.0%) incident diabetes cases in 7628 PWH without baseline diabetes and 496 (6.7%) hypertension cases in 7450 PWH without baseline hypertension. Pooled analysis showed a direct association of viremia-copy-year with incident hypertension (hazards ratio, 1.20 [95% CI, 1.14-1.26]) but not with diabetes (hazards ratio, 1.03 [95% CI, 0.96-1.10]). However, site-specific differences existed whereby the Northwestern-only analysis demonstrated a significant association of viremia-copy-year with hypertension (hazards ratio, 1.29 [95% CI, 1.08-1.32]). Additionally, higher social deprivation index (both sites) and diagnosis of mental health disorder (Howard Brown Health only) was associated with higher diabetes and hypertension risk. CONCLUSIONS Cumulative viral load may be associated with incident hypertension among PWH. Associations of HIV control with cardiovascular disease risk factors among PWH may differ by health care system context.
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Affiliation(s)
- Adovich S. Rivera
- Institute for Public Health and Management, Feinberg School
of Medicine, Northwestern University
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
| | | | | | - Juned Siddique
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
| | - Lauren B. Beach
- Institute for Sexual and Gender Minority Health, Feinberg
School of Medicine, Northwestern University
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
- Department of Medicine, Feinberg School of Medicine,
Northwestern University
| | - Matthew J. Feinstein
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University
- Institute for Sexual and Gender Minority Health, Feinberg
School of Medicine, Northwestern University
- Department of Pathology, Feinberg School of Medicine,
Northwestern University
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4
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Byonanebye DM, Polizzotto MN, Neesgaard B, Sarcletti M, Matulionyte R, Braun DL, Castagna A, de Wit S, Wit F, Fontas E, Vehreschild J, Vesterbacka J, Greenberg L, Hatleberg C, Garges H, Gallant J, Volny Anne A, Öllinger A, Mozer‐Lisewska I, Surial B, Spagnuolo V, Necsoi C, van der Valk M, Mocroft A, Law M, Ryom L, Petoumenos K. Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium. HIV Med 2022; 23:895-910. [PMID: 35233903 PMCID: PMC9545382 DOI: 10.1111/hiv.13273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts. METHODS Eligible people with HIV were aged ≥18 years who initiated a new three-drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow-up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline. RESULTS Overall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113-130) mmHg, 78 (70-82) mmHg, and 43 (34-50) years, respectively. Over 8380.4 person-years (median follow-up 1.5 [IQR 1.0-2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person-years, 95% confidence interval [CI] 118.9-134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47-2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89-1.29). The results were similar when the analysis was stratified by ART status at baseline. CONCLUSION Although unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART-naïve and ART-experienced participants within RESPOND.
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Affiliation(s)
- Dathan M. Byonanebye
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia,School of Public HealthMakerere UniversityKampalaUganda
| | - Mark N. Polizzotto
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Bastian Neesgaard
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Mario Sarcletti
- Department of Dermatology, Venerology and AllergologyMedical University InnsbruckInnsbruckAustria
| | - Raimonda Matulionyte
- Department of Infectious Diseases and DermatovenerologyFaculty of MedicineVilnius University Hospital Santaros KlinikosVilnius UniversityVilniusLithuania
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital EpidemiologySwitzerland Swiss HIV Cohort Study (SHCS)Institute of Medical VirologyUniversity Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Antonella Castagna
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Stéphane de Wit
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands
| | - Eric Fontas
- Nice HIV CohortUniversité Côte d’Azur et Centre Hospitalier UniversitaireNiceFrance
| | - Jörg Janne Vehreschild
- Medical Department 2Hematology/OncologyUniversity Hospital of FrankfurtFrankfurtGermany,Department I for Internal MedicineUniversity Hospital of CologneCologneGermany
| | - Jan Vesterbacka
- Swedish InfCare HIV CohortKarolinska University HospitalHuddingeSweden
| | - Lauren Greenberg
- Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Camilla Hatleberg
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | | | | | - Angela Öllinger
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | - Bernard Surial
- Department of Infectious Diseases, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Vincenzo Spagnuolo
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Coca Necsoi
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Marc van der Valk
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands,Division of Infectious DiseasesDepartment of Internal MedicineAmsterdam Institute for Infection and ImmunityAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Amanda Mocroft
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark,Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Matthew Law
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lene Ryom
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Kathy Petoumenos
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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Musekwa R, Hamooya BM, Koethe JR, Nzala S, Masenga SK. Prevalence and correlates of hypertension in HIV-positive adults from the Livingstone Central Hospital, Zambia. Pan Afr Med J 2021; 39:237. [PMID: 34659610 PMCID: PMC8498662 DOI: 10.11604/pamj.2021.39.237.29718] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction HIV-infection and treatment with antiretroviral therapy (ART) are risk factors for the development of hypertension, which is more prevalent in people living with HIV compared with the general population. Although there is a shift to Integrase Strand Transfer Inhibitor (INSTI)-based ART across the sub-Saharan Africa, there is limited information with regard to INSTIs and hypertension association in this region, making this, a critical question to address. Hence, the study aimed to determine the relationship between hypertension and ART regimen in people living with HIV. Methods this was a cross-sectional study conducted at the Livingstone Central Hospital, southern province of Zambia. This study utilized programmatic data. Demographic and clinical data of 348 persons living with HIV who had been on ART for more than 2 years was abstracted in the adult ART database registry. Descriptive and inferential statistics were used for analyses of data. Results prevalence of hypertension was 18.4% (n=64). Hypertensives were older than normotensives with median (interquartile range) age of 55 (49, 61) and 46 (41, 52), respectively. At multivariate analysis, age (aOR: 1.07, 95% CI 1.04-1.11; p = 0.001) and body mass index (aOR: 1.10, 95% CI 1.04-1.16; p = 0.002) were positively associated with hypertension. Participants on dolutegravir based regimen were 2 times (aOR: 2.44, 95% CI 1.22-4.86; p = 0.01) more likely to be hypertensive compared to those on non-nucleoside reverse transcriptase inhibitors (efavirenz or nevirapine). Conclusion we confirm that increasing age, body mass index (BMI) and use of dolutegravir are risk factors for hypertension. Close monitoring for persons with HIV with these known risk factors is required.
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Affiliation(s)
- Robert Musekwa
- School of Medicine and Health Sciences, Mulungushi University, Hand Research Group, Livingstone, Zambia
| | - Benson Malambo Hamooya
- School of Medicine and Health Sciences, Mulungushi University, Hand Research Group, Livingstone, Zambia
| | - John Robert Koethe
- Vanderbilt University Medical Center, Nashville, Tennesse United States of America
| | | | - Sepiso Kenias Masenga
- School of Medicine and Health Sciences, Mulungushi University, Hand Research Group, Livingstone, Zambia
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Sarteschi G, Di Biagio A, Focà E, Taramasso L, Bovis F, Celotti A, Mirabella M, Magnasco L, Mora S, Giacomini M, Bassetti M. Viremia copy-years and risk of estimated glomerular filtration rate reduction in adults living with perinatal HIV infection. PLoS One 2020; 15:e0240550. [PMID: 33057418 PMCID: PMC7561100 DOI: 10.1371/journal.pone.0240550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
Among people with perinatal HIV infection (PHIV), non-communicable diseases, such as chronic kidney disease, are increasing. Both HIV replication and antiretroviral therapy are recognised causes of renal impairment. Objective of the study is to describe the impact of viremia copy-years (VCY) and antiretroviral therapy on trend of estimated glomerular filtration rate (eGFR) in a cohort of adults with perinatal HIV infection. We conducted a multicentre observational study in sixty adults living with PHIV across a 9-year period, from January 2010 to December 2018. The mean values of eGFR were analysed at the first (T0) and last year of observation (T1). VCY was defined as the area under HIV-RNA curve during the study period. We analysed data according to antiretroviral therapy: tenofovir disoproxil (TDF), non-nucleoside reverse transcriptase inhibitors (NNRTI), boosted protease inhibitors (PI/b), integrase inhibitors (INI). We observed a mean overall eGFR reduction from 126.6 mL/min (95%CI: 119.6–133.5) to 105.0 mL/min (95%CI: 99.55–110.6) (p<0.001). Older age, higher baseline eGFR, higher VCY and longer exposure to INI treatment were associated with eGFR reduction at univariate analysis. In the multivariate model, older age (p = 0.039), baseline eGFR (p<0.001) and VCY (p = 0.069), were retained. We also observed a longer exposure to PI/b and INI in patients with lower control on HIV-RNA, expressed as VCY>2 log10. Our study outlines a progressive eGFR reduction in young adults with PHIV, related to the lower control on HIV-RNA VCY and related to aging.
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Affiliation(s)
- Giovanni Sarteschi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- * E-mail: (GS); (ADB)
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- * E-mail: (GS); (ADB)
| | - Emanuele Focà
- Infectious and Tropical Diseases Department, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Lucia Taramasso
- Department of Pathophysiology and Transplantation, Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- MultidisciplinAry ResearCh in Health Science (MACH), Milan, Italy
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Anna Celotti
- Infectious and Tropical Diseases Department, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Michele Mirabella
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Magnasco
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Sara Mora
- Department of Informatics Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino Hospital, Genoa, Italy
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7
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Chidambaram V, Gupte A, Wang JY, Golub JE, Karakousis PC. The Impact of Hypertension and Use of Calcium Channel Blockers on Tuberculosis Treatment Outcomes. Clin Infect Dis 2020; 73:e3409-e3418. [PMID: 32971534 DOI: 10.1093/cid/ciaa1446] [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: 07/20/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Hypertension induces systemic inflammation, but its impact on the outcome of infectious diseases like tuberculosis (TB) is unknown. Calcium channel blockers (CCB) improve TB treatment outcomes in pre-clinical models, but their effect in patients with TB remain unclear. METHODS This retrospective cohort study, including all patients > 18 years receiving treatment for culture-confirmed, drug-sensitive TB from 2000 to 2016 at the National Taiwan University Hospital, assessed the association of hypertension and CCB use with all-cause and infection-related mortality during the first 9 months of TB treatment, as well as sputum-smear microscopy and sputum-culture positivity at 2 and 6 months. RESULTS 1052 of the 2894 patients (36.4%) had hypertension. Multivariable analysis revealed that hypertension was associated with increased mortality due to all causes (HR 1.57, 95% confidence interval[CI], 1.23-1.99) and infections (HR 1.87, 95%CI, 1.34-2.6), but there was no statistical difference in microbiological outcomes when stratified based on hypertensive group. Dihydropyridine-CCB (DHP-CCB) use was associated with reduced all-cause mortality (HR 0.67, 95%CI: 0.45-0.98) only by univariate Cox regression. There was no association between DHP-CCB use and infection-related mortality (HR 0.78, 95%CI: 0.46-1.34) or microbiological outcomes in univariate or multivariate regression analyses. CONCLUSIONS Patients with hypertension have increased all-cause mortality and infection-related mortality during the 9 months following TB treatment initiation. DHP-CCB use may lower all-cause mortality in TB patients with hypertension. The presence of hypertension or the use of CCB did not result in a significant change in microbiological outcomes.
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Affiliation(s)
- Vignesh Chidambaram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Akshay Gupte
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Jonathan E Golub
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Petros C Karakousis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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