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Gehrke B, Farias MLF, Wildemberg LE, Ferraiuoli GI, Ribeiro V, Bosgnoli R, Paranhos Neto FDP, de Mendonça LMC, Madeira M, Coelho MCA. Evaluation of bone mineral density, microarchitecture, and detection of fractures on young patients living with human immunodeficiency virus: when and how to screen? Endocrine 2024; 83:214-226. [PMID: 37673836 DOI: 10.1007/s12020-023-03501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE People living with the human immunodeficiency virus (PLWH) developed higher life expectancy along with chronic bone disease over the past years. Our purpose is to evaluate bone mineral density, bone microarchitecture and fractures in young PLWH and understand the disease's contribution to bone derangements and fracture risk. METHODS Eighty-one HIV-infected and 54 control young (20-50 years) male and female subjects were enrolled in this study. Methods for patient evaluation included DXA-VFA (dual energy X-rays and vertebral fracture assessment), HR-pQCT (high resolution peripheral quantitative computed tomography), biochemistry and FRAX. RESULTS Fifty participants from each group completed all exams. Median age was 40 (25-49) vs. 36.5 (22-50) for the HIV and control groups, respectively (p 0.120). Ethnicity, body mass index, serum phosphorus, 25-hydroxyvitamin D, PTH and CTX were similar between groups, although ALP and OC suggested higher bone turnover in PLWH. VFA identified morphometric vertebral fractures in 12% of PLWH. PLWH had lower values for lumbar spine areal BMD and Z score, volumetric BMD, trabecular bone fraction (BV/TV) and trabecular number measured at the distal tibia by HR-pQCT; as a consequence, trabecular separation and heterogeneity were higher (all p < 0.05). The FRAX-estimated risk for hip and major osteoporotic fractures was statistically higher in PLWH (p < 0.001). CONCLUSION Our results confirm severe bone impairment and fractures associated with HIV in young patients. Thus, we developed a screening protocol for young PLWH to detect bone fragility, reduce skeletal disease progression and morbimortality, decrease fracture risk, and increase quality of life.
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Affiliation(s)
- Bárbara Gehrke
- Programa de Pós-graduação em Fisiopatologia Clínica e Experimental (FISCLINEX) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil.
- Centro de Pesquisa Clínica Multiusuário (CePeM) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil.
- Divisão de Endocrinologia, Departamento de Medicina Interna, Faculdade de Ciências Médicas - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, 20550-900, RJ, Brasil.
| | - Maria Lucia Fleiuss Farias
- Divisão de Endocrinologia - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil
| | - Luiz Eduardo Wildemberg
- Divisão de Neuroendocrinologia - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, 20231-092, RJ, Brasil
| | - Giovanna Ianini Ferraiuoli
- Divisão de Infectologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil
| | - Valéria Ribeiro
- Divisão de Infectologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil
| | - Rogério Bosgnoli
- Labhor - Laboratório de Hormônios da Endocrinologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil
| | | | - Laura Maria Carvalho de Mendonça
- Divisão de Reumatologia, Departamento de Medicina Interna - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil
| | - Miguel Madeira
- Divisão de Endocrinologia - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil
| | - Maria Caroline Alves Coelho
- Programa de Pós-graduação em Fisiopatologia Clínica e Experimental (FISCLINEX) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil
- Centro de Pesquisa Clínica Multiusuário (CePeM) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil
- Divisão de Endocrinologia, Departamento de Medicina Interna, Faculdade de Ciências Médicas - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, 20550-900, RJ, Brasil
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Muacevic A, Adler JR, Danji K. HIV-Associated Conditions in Older Adults. Cureus 2022; 14:e32661. [PMID: 36660505 PMCID: PMC9844266 DOI: 10.7759/cureus.32661] [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] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
Geriatric practices will see more people living with human immunodeficiency virus (HIV), as their life expectancy is close to the general population due to effective antiretroviral therapy (ART). Geriatricians focus more on HIV-associated, non-acquired immunodeficiency syndrome (AIDS) disorders than HIV alone. We will review the most common chronic illnesses and conditions associated with aging and HIV. Even though fall frequency in older adults living with HIV is similar to or lower than in people without HIV, fall assessment is appropriate, especially in the high-risk elderly living with HIV. HIV also impacts motor function and memory loss, especially in advanced cases. ART doesn't cross the blood-brain barrier, leading to major neurocognitive disorders with age. The etiology of HIV and cardiovascular disease (CVD) is multifactorial, including the effect of ART. Pitavastatin and pravastatin cause fewer interactions with ART. While the treatment for HIV decreases the risk of opportunistic infections, it may cause several bone-related abnormalities, including low bone mineral density (BMD), osteoporosis, and fractures. Polypharmacy is associated with disability and mortality and may increase the risk of ART drug-drug interaction. The oral health status of HIV-infected patients is commonly inadequate, and the presence of dental care managers may improve clinical outcomes and increase medication adherence. Furthermore, people aging with HIV (PAWH) have an increased mortality risk when co-infected with coronavirus disease 2019 (COVID-19). In summary, older adults living with HIV may face unique challenges. Therefore, providing comprehensive medical care and psychosocial support through an interdisciplinary team can significantly impact their lives.
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How Do Drugs Affect the Skeleton? Implications for Forensic Anthropology. BIOLOGY 2022; 11:biology11040524. [PMID: 35453723 PMCID: PMC9030599 DOI: 10.3390/biology11040524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2022] [Accepted: 03/18/2022] [Indexed: 01/10/2023]
Abstract
Simple Summary Forensic anthropologists analyze human remains to assist in the identification of the deceased, predominantly by assessing age-at-death, sex, stature, ancestry and any unique identifying features. Whilst methods have been established to create this biological profile of the skeleton, these may be influenced by a number of factors. This paper, for the first time, provides an overview from a reading of the clinical and pharmacological literature to explore whether the intake of drugs can affect the skeleton and whether these may have implications for forensic anthropology casework. In effect, drugs such as tobacco, heroin, and prescription medications can alter bone mineral density, can increase the risk of fractures, destroy bone and changes to the dentition. By considering how drugs can affect the skeleton, forensic anthropologists can be aware of this when attempting to identify the deceased. Abstract Forensic anthropologists rely on a number of parameters when analyzing human skeletal remains to assist in the identification of the deceased, predominantly age-at-death, sex, stature, ancestry or population affinity, and any unique identifying features. During the examination of human remains, it is important to be aware that the skeletal features considered when applying anthropological methods may be influenced and modified by a number of factors, and particular to this article, prescription drugs (including medical and non-medical use) and other commonly used drugs. In view of this, this paper aims to review the medical, clinical and pharmacological literature to enable an assessment of those drug groups that as side effects have the potential to have an adverse effect on the skeleton, and explore whether or not they can influence the estimation of age-at-death, sex and other indicators of the biological profile. Moreover, it may be that the observation of certain alterations or inconsistencies in the skeleton may relate to the use of drugs or medication, and this in turn may help narrow down the list of missing persons to which a set of human remains could belong. The information gathered from the clinical and medical literature has been extracted with a forensic anthropological perspective and provides an awareness on how several drugs, such as opioids, cocaine, corticosteroids, non-steroidal anti-inflammatory drugs, alcohol, tobacco and others have notable effects on bone. Through different mechanisms, drugs can alter bone mineral density, causing osteopenia, osteoporosis, increase the risk of fractures, osteonecrosis, and oral changes. Not much has been written on the influence of drugs on the skeleton from the forensic anthropological practitioner perspective; and this review, in spite of its limitations and the requirement of further research, aims to investigate the current knowledge of the possible effects of both prescription and recreational drugs on bones, contributing to providing a better awareness in forensic anthropological practice and assisting in the identification process of the deceased.
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Konya P, Demirtürk N. Evaluation of Tenofovir Disoproxil Fumarate Treatment in Patients with Chronic Hepatitis B. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:47-54. [PMID: 38633545 PMCID: PMC11022821 DOI: 10.36519/idcm.2022.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 02/20/2022] [Indexed: 04/19/2024]
Abstract
Objective The main purpose of chronic hepatitis B (CHB) treatment is to improve the patients' life quality and prevent the disease from progressing to cirrhosis or hepatocellular carcinoma. Continuous suppression of hepatitis B virus (HBV) DNA with nucleoside or nucleotide analogues is the most critical way to achieve this goal. This study aimed to evaluate the CHB patients retrospectively followed up with tenofovir disoproxil fumarate (TDF) treatment. Materials and Methods The study was planned as retrospective research by Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology between January 2001 and December 2020. We evaluated all treatment-naive and treatment-experienced patients who received TDF (245 mg/day) treatment with the diagnosis of CHB. The data were obtained by reviewing the file information registered in the hospital automation system. HBsAg, Anti-HBs, HBeAg, Anti-HBe, HBV DNA, aspartate aminotransferase (AST), alanine aminotransferase (ALT) values of the patients were evaluated at 1st, 3rd, 6th, 12th months, and 6-month follow-ups throughout the treatment. Virological (HBV-DNA of < 50 IU/ml), biochemical (decrease below 40 IU/Ml in patients with pre-treatment value of ALT >40 IU/ml) and serological (Anti-HBe seroconversion in HBeAg positives and HBsAg negative and anti-HBs seroconversion in all patients) responses were examined. Adverse effects were also assessed during the treatment. Results Data from 131 patients who received TDF treatment were evaluated. Virological responses were determined as 78.6%, 81.3%, 94.2%, and 100% in the patients at 24th week, 48th week, 4th year, and 8th year, respectively. While there was no Anti-HBs seroconversion in any patients in four years of the treatment, it was observed at a rate of 10.5% in the eighth year. We did not determine any significant adverse effects requiring discontinuation of the treatment in the long-term follow-up of 131 patients under TDF treatment. Conclusion As a result of our study, TDF was an effective and well-tolerated choice for CHB treatment.
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Affiliation(s)
- Petek Konya
- Department of Infectious Disease and Clinical Microbiology, Afyonkarahisar Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Neşe Demirtürk
- Department of Infectious Disease and Clinical Microbiology, Afyonkarahisar Health Sciences University School of Medicine, Afyonkarahisar, Turkey
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Andrade LBD, Nogueira TF, Vargas DM. Height adjustment reduces occurrence of low bone mineral density in children and adolescents with HIV. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:1240-1245. [PMID: 34816914 DOI: 10.1590/1806-9282.20210137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the reduction of bone mineral density with and without height adjustment. METHODS A cross-sectional study was performed with 69 Brazilian children and adolescents vertically infected by HIV. Bone mineral density was measured by dual-energy absorptiometry in the lumbar spine. Anthropometric, demographic, and clinical variables were analyzed. A specific calculator was used for height adjustment. RESULTS The majority of participants (52.2%) were adolescents and did not present with immunological alterations (61%). Reduced bone mineral density (Z-score <-1) was present in 23.2% and low bone mass (Z-score <-2) in 5.8%. After height adjustment, these occurrences decreased to 11.6% and 0%, respectively. Patients with reduced bone mineral density had a higher mean age and lower body mass index than patients with normal bone mineral density. CONCLUSION The occurrence of reduced bone mineral density decreased after adjustment for height.
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Affiliation(s)
| | - Thiago Fachini Nogueira
- Universidade de Blumenau, Centro de Ciências de Saúde, Departamento de Medicina - Blumenau (SC), Brazil
| | - Deisi Maria Vargas
- Universidade de Blumenau, Centro de Ciências de Saúde, Departamento de Medicina e Programa de Pós-graduação em Saúde Coletiva - Blumenau (SC), Brazil
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Atencio P, Conesa-Buendía FM, Cabello-Ubeda A, Llamas-Granda P, Pérez-Tanoira R, Prieto-Pérez L, Álvarez BÁ, Acosta IC, Arboiro-Pinel R, Díaz-Curiel M, Largo R, Herrero-Beaumont G, Górgolas M, Mediero A. Bone deleterious effects of different nrtis in treatment-naïve HIV patients after 12 and 48 weeks of treatment. Curr HIV Res 2021; 19:434-447. [PMID: 34353266 PMCID: PMC9175084 DOI: 10.2174/1570162x19666210805094434] [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: 03/08/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
Abstract
Background Bone alterations have been observed in the course of HIV infection, characterized by a marked decrease in bone mineral density (BMD) and an increase in the frequency of fractures as a result of fragility. We aim to evaluate early changes in bone metabolic profile and the possible association with tenofovir and other nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) in treatment-naïve HIV patients. Methods We conducted a prospective study in naïve HIV-infected adults (under 50 years), separated into three groups according to NRTI therapy: tenofovir disoproxil fumarate (TDF); tenofovir alafenamide (TAF) and abacavir (ABC). BMD and epidemiological, immunological and metabolic bone parameters were evaluated. Bone markers were analyzed in plasma at baseline, 12 and 48 weeks after initiating treatment. Results Average age of patients was 34.8 years (± 9.6). 92.4% of them with CD4 count > 200 cel/μL. At week 12 after starting treatment, both TDF [increase in PN1P (31.7%, p = 0.004), TRAP (11.1%, p = 0.003), OPN (19.3%, p = 0.045) and OC (38.6%, p = 0.001); decrease in OPG (-23.4%, p = 0.003)] and TAF [increase in 42.6% for CTX (p = 0.011), 27.3% for OC (p = 0.001) and 21% for TRAP (p = 0.008); decrease in OPG (-28.8%, p = 0.049)] presented a deep resorption profile compared to ABC, these differences in bone molecular markers, a tendency to equalize at week 48, where no significant differences were observed. Patients treated with TDF showed the greatest decrease in Z-score in both lumbar spine (LS) and femoral neck (FN) at week 48 without statistically significant differences. Conclusion Treatment-naïve HIV patients have a high prevalence of low bone density. Treatment with TDF is associated with greater bone deterioration at 12 and 48 weeks. TAF seems to present similar early bone deterioration at 12 weeks which disappears at 48 weeks.
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Affiliation(s)
- Patricia Atencio
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | | | - Alfonso Cabello-Ubeda
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Patricia Llamas-Granda
- Bone and Joint Research Unit. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Ramón Pérez-Tanoira
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Laura Prieto-Pérez
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Beatriz Álvarez Álvarez
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Irene Carrillo Acosta
- Division of Infectious Diseases. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Rosa Arboiro-Pinel
- Internal Medicine, Bone Disease Department. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Manuel Díaz-Curiel
- Internal Medicine, Bone Disease Department. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Raquel Largo
- Bone and Joint Research Unit. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Miguel Górgolas
- Internal Medicine, Bone Disease Department. Fundación Jiménez Díaz University Hospital. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
| | - Aránzazu Mediero
- Bone and Joint Research Unit. Research Health Institute, Autónoma de Madrid University (IIS-FJD, UAM). Madrid 28040. Spain
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Mumena CH, Mudhihiri MH, Sasi R, Mlawa M, Nyerembe S, Akimbekov NS, Razzaque MS. The relevance of vitamin D in the oral health of HIV infected patients. J Steroid Biochem Mol Biol 2021; 211:105905. [PMID: 33962013 DOI: 10.1016/j.jsbmb.2021.105905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 01/09/2023]
Abstract
HIV infection affects 36.9 million people globally, and vitamin D deficiency is a global public health concern for HIV patients. Approximately 70 %-80 % of HIV-infected patients have vitamin D deficiency. The deficiency is associated with many pathologies such as immune disorders, infectious diseases, chronic inflammation, oral diseases, as well as the fast progression of HIV. The causes of vitamin D deficiency in HIV infections include HIV itself, traditional factors such as less sun exposure, mal-absorption, hypercholesterolemia, seasonal variation, poor nutrition as well as some HAART drugs like efavirenz. Vitamin D has an immunomodulatory, anti-inflammatory, and anti-proliferative function. In the oral cavity, it plays a significant role in preventing oral infections such as periodontal and gum diseases, dental caries, and oral candidiasis. The consequences of vitamin D deficiency are bone resorption, increased productions of pro-inflammatory cytokines, T-lymphocytes, increased T-helper-1 functions, and decreased T-helper-2 functions. Consequently, this leads to increased infections, chronic inflammation, and the occurrence of oral diseases such as oral candidiasis, periodontal and gum diseases, and dental caries. The majority of these oral diseases are encountered in HIV patients. Vitamin D deficiency is significantly found in HIV patients. There is a lack of studies that directly link vitamin D to most oral diseases in HIV patients; however, the role of vitamin D in immunoregulation, prevention of oral diseases, and HIV infection is substantiated.
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Affiliation(s)
- Chrispinus Hakimu Mumena
- Copper Belt University, School of Medicine, Department of Dental Clinical Sciences, Ndola, Zambia.
| | | | - Rajabu Sasi
- Copper Belt University, School of Medicine, Department of Dental Clinical Sciences, Ndola, Zambia
| | - Majuto Mlawa
- Copper Belt University, School of Medicine, Department of Dental Clinical Sciences, Ndola, Zambia
| | - Severine Nyerembe
- Copper Belt University, School of Medicine, Department of Dental Clinical Sciences, Ndola, Zambia
| | - Nuraly S Akimbekov
- Department of Biotechnology, al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Mohammed S Razzaque
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
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Ma R, He J, Xu B, Zhao R, Zhang Q. Negative correlation between bone mineral density and subclinical fractures in patients with human immunodeficiency virus. J Int Med Res 2021; 49:300060520980639. [PMID: 33528283 PMCID: PMC7871090 DOI: 10.1177/0300060520980639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Although low bone mineral density (BMD) is associated with an increased risk of fracture, few studies have assessed fracture rates in patients with human immunodeficiency virus (HIV). Methods The occurrence of subclinical fractures in patients with HIV was assessed. Pearson’s chi-square test was used to analyze the relationship between subclinical fractures and related factors. Results Fifty patients with HIV were included, among whom 11 were diagnosed with subclinical fractures. These 11 patients had a mean body mass index of 24.127 ± 3.482 kg/m2, smoked a mean of 142.091 ± 3.482 cigarettes/month, drank a mean of 61.545 ± 13.026 mL/day of alcohol, had a mean CD4+ T cell count of 247.727 ± 181.679 cells/mm3, had a mean duration of acquired immunodeficiency syndrome (AIDS) of 4.27 ± 0.786 years, and had a mean BMD of the third lumbar spine of 0.810 ± 0.063 g/cm3. The AIDS duration and BMD of the third lumbar spine were significantly associated with subclinical fractures. The BMD of the third lumbar spine was negatively correlated with subclinical fractures. Conclusion A significant negative correlation was found between the BMD of the third lumbar spine and subclinical fractures.
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Affiliation(s)
| | | | | | | | - Qiang Zhang
- Qiang Zhang, Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun Dong Jie, Chaoyang District, Beijing 100015, China.
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Ho MW, Li TM, Li JP, Chiou JS, Chiu ML, Chen CJ, Cheng CF, Tsai FJ, Wu YC, Lin TH, Liao CC, Huang SM, Lin YN, Chou CH, Liang WM, Lin YJ. Chinese Herbal Medicine Usage Reduces Overall Mortality in HIV-Infected Patients With Osteoporosis or Fractures. Front Pharmacol 2021; 12:593434. [PMID: 33935696 PMCID: PMC8085888 DOI: 10.3389/fphar.2021.593434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/29/2021] [Indexed: 01/05/2023] Open
Abstract
The survival of patients with HIV has greatly improved, due to Anti-Retroviral Therapy (ART). However, long-term HIV survivors often develop serious bone abnormalities, possibly due to the interplay of osteoblasts, osteoclasts, HIV ad ART. We evaluated in a nation-wide study in Taiwan the effect of Chinese herbal medicine (CHM) on overall mortality in HIV patients with osteoporosis or fractures. Enrollment period was between 1998 and 2011. Patients with osteoporosis or fractures before the HIV infection, and those with less than 14 days CHM use, were excluded. This left 498 patients, 160 CHM users, 338 without CHM. Univariate Kaplan-Meier and multivariate Cox regression analysis were used to compare the overall mortality in these 2 groups. Due to the nature of Chinese medicine, CHMs inevitably varied. We therefore also used rule mining and network analysis to determine which major CHM clusters were prescribed to the patients. CHM users had a much Lower mortality (hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.24–0.77, p < 0.005) and higher survival (p = 0.004, log-rank test). Although the CHMs greatly varied, network analysis identified one main cluster of strongly related CHM combinations (Chuan-Xiong-Cha-Tiao-San (CXCTS), Gan-Cao (GC; Glycyrrhiza uralensis Fisch.), Liu-He-Tang (LHT), Huang-Qin-Tang (HQT), Jia-Wei-Ping-Wei-San (JWPWS), and Dang-Gui-Long-Hui-Wan (DGLHuiW)). CHM as an additional treatment strongly improves overall survival in HIV-infected patients with osteoporosis and fractures.
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Affiliation(s)
- Mao-Wang Ho
- Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Internal Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Te-Mao Li
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ju-Pi Li
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jian-Shiun Chiou
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Mu-Lin Chiu
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chao-Jung Chen
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.,Proteomics Core Laboratory, Department of Medical Research, Genetic Center, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Fung Cheng
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Proteomics Core Laboratory, Department of Medical Research, Genetic Center, China Medical University Hospital, Taichung, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Proteomics Core Laboratory, Department of Medical Research, Genetic Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
| | - Yang-Chang Wu
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ting-Hsu Lin
- Proteomics Core Laboratory, Department of Medical Research, Genetic Center, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Chu Liao
- Proteomics Core Laboratory, Department of Medical Research, Genetic Center, China Medical University Hospital, Taichung, Taiwan
| | - Shao-Mei Huang
- Proteomics Core Laboratory, Department of Medical Research, Genetic Center, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Ning Lin
- Proteomics Core Laboratory, Department of Medical Research, Genetic Center, China Medical University Hospital, Taichung, Taiwan
| | - Chen-Hsing Chou
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Miin Liang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ying-Ju Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Proteomics Core Laboratory, Department of Medical Research, Genetic Center, China Medical University Hospital, Taichung, Taiwan
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Cazzaniga A, Scrimieri R, Galli M, Maier J, Rusconi S. Unveiling the basis of antiretroviral therapy-induced osteopenia: the effects of Dolutegravir, Darunavir and Atazanavir on osteogenesis. AIDS 2021; 35:213-218. [PMID: 33394669 DOI: 10.1097/qad.0000000000002732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Osteopenia is frequent in HIV-infected patients treated with antiretroviral therapy (ART) and has been linked to increased osteoclastogenesis. Little is known about the effects of ART on osteogenesis. DESIGN We investigated the effect on human mesenchymal stem cells (hMSC) and osteoblasts of Darunavir and Dolutegravir, the most highly used as anchor drugs within a three-drug regimen, and Atazanavir, which was widely utilized in the past. RESULTS We found that Atazanavir and Dolutegravir delay the osteogenic differentiation of hMSC, impair the activity of osteoblasts and inhibit their conversion into osteocytes, whereas Darunavir exerts no effect. CONCLUSION Atazanavir and Dolutegravir impair osteogenesis. It is essential to diagnose impaired osteogenesis early and to devise effective therapeutic interventions to preserve bone health in ART-treated HIV patients, putting it in the context of a correct antiretroviral combination.
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Affiliation(s)
| | | | - Massimo Galli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | | | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
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11
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Punekar YS, Parks D, Joshi M, Kaur S, Evitt L, Chounta V, Radford M, Jha D, Ferrante S, Sharma S, Van Wyk J, de Ruiter A. Effectiveness and safety of dolutegravir two-drug regimens in virologically suppressed people living with HIV: a systematic literature review and meta-analysis of real-world evidence. HIV Med 2021; 22:423-433. [PMID: 33529489 PMCID: PMC8248313 DOI: 10.1111/hiv.13050] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 01/21/2023]
Abstract
Objectives Dolutegravir (DTG) is widely recommended within three‐drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two‐drug regimens in clinical trials. This study evaluated the real‐world effectiveness and discontinuations in people living with HIV‐1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV). Methods This was a one‐arm meta‐analysis utilizing data from a systematic literature review. Data from real‐world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations. Results Pooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4–1.3] and 0.6% (95% CI: 0.0–1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3–87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0–97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1–16.2) and 7.2% (95% CI: 2.1–14.4) of patients, respectively, at W48. Similar results were observed at W96. Conclusions Treatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.
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Affiliation(s)
| | - D Parks
- GlaxoSmithKline, Collegeville, PA, USA
| | - M Joshi
- GlaxoSmithKline Knowledge Centre, Gurgaon, India
| | - S Kaur
- Parexel India, Chandigarh, India
| | - L Evitt
- ViiV Healthcare, Brentford, UK
| | | | | | - D Jha
- GlaxoSmithKline Knowledge Centre, Gurgaon, India
| | | | - S Sharma
- Parexel India, Chandigarh, India
| | | | - A de Ruiter
- ViiV Healthcare, Brentford, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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El Moussaoui M, Lambert I, Maes N, Sauvage AS, Frippiat F, Meuris C, Uurlings F, Lecomte M, Léonard P, Fombellida K, Vaira D, Vercheval C, Moutschen M, Darcis G. Evolution of Drug Interactions With Antiretroviral Medication in People With HIV. Open Forum Infect Dis 2020; 7:ofaa416. [PMID: 33204748 PMCID: PMC7651038 DOI: 10.1093/ofid/ofaa416] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/08/2020] [Indexed: 01/02/2023] Open
Abstract
Background Polypharmacy and drug interactions are important issues for HIV-infected individuals. The number and nature of those interactions are continuously evolving with the use of new antiretroviral drugs and the aging of HIV-infected individuals. We aimed to analyze this evolution over time. Methods This retrospective cohort study was conducted in the University Hospital of Liège (Belgium). Treatments of HIV-infected outpatients attending Liège University Hospital were collected and analyzed in 2012 and 2016. The University of Liverpool HIV drug interactions database was used to determine drug interactions. Results We included 1038 patients in 2016, of whom 78% had 1 comedication. Polypharmacy was seen in 20% of the cohort. Four percent of the patients presented red flag interactions, and 38% had orange flag interactions. Nonantiretroviral (non-ARV) therapeutic classes involved in drug interactions were mostly cardiovascular and central nervous system drugs. They were followed by hormone drugs and dietary supplements for orange flag interactions. Two factors significantly contributed to both red and orange flag interactions: the number of non-ARV comedications and protease inhibitor–based ARV regimens. The proportion of patients with red or orange flag interactions remained stable from 2012 to 2016. Conclusions This study highlights the persistence of an alarming number of contraindicated drug interactions and a high prevalence of potential drug interactions over time. Identification, prevention, and management of drug interactions remain a key priority in HIV care.
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Affiliation(s)
| | - Iseult Lambert
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Nathalie Maes
- Department of Biostatistics, Liège University Hospital, Liège, Belgium.,Department of Medico-Economic Information, Liège University Hospital, Liège, Belgium
| | | | - Frédéric Frippiat
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Christelle Meuris
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Françoise Uurlings
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Marianne Lecomte
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Philippe Léonard
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Karine Fombellida
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Dolores Vaira
- AIDS Reference Laboratory, Liège University, Liège, Belgium
| | | | - Michel Moutschen
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium.,AIDS Reference Laboratory, Liège University, Liège, Belgium
| | - Gilles Darcis
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
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13
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Sutton SS, Magagnoli J, Hardin JW, Hsu LI, Beaubrun A, Majethia S, Cummings TH. Association of tenofovir disoproxil fumarate exposure with chronic kidney disease and osteoporotic fracture in US veterans with HIV. Curr Med Res Opin 2020; 36:1635-1642. [PMID: 32856940 DOI: 10.1080/03007995.2020.1816538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF)-based regimens have been associated with impaired kidney function and loss of bone mineral density among patients living with HIV (PLWH). We assess the association between TDF exposure and the odds of chronic kidney disease (CKD) and osteoporotic fracture in HIV patients. METHODS Demographics, administrative claims, and pharmacy dispensation were extracted from the Veterans Affairs Informatics and Computing Infrastructure (VINCI). Patients were categorized based on TDF utilization. Incidence rates for patients exposed and unexposed to TDF were calculated per 1000 patient-years (PYs). Logistic regression was used to calculate the odds of outcome after adjusting for baseline and clinical characteristics. RESULTS The sample included 4,630 PLWH who were currently exposed to TDF and 1,181 who were never exposed to TDF for the CKD analyses. For fracture analyses, the sample included 6,883 PLWH who were currently exposed to TDF and 1,951 who were never exposed to TDF. In adjusted models, current TDF exposure was associated with increased odds of CKD compared to never having been exposed (OR: 1.48, 95% CI: 1.18-1.85). Odds of fracture were 2.32 times higher for patients who were currently on a TDF regimen (OR: 2.32, 95% CI: 1.58-3.42) compared to those who had never been exposed to TDF in adjusted models. CONCLUSIONS In a large cohort of US veterans with HIV, current exposure to TDF was associated with a 48% higher odds of CKD and a greater than two-fold increase in the odds of osteoporotic fracture.
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Affiliation(s)
- S Scott Sutton
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
- WJB Dorn Veterans Affairs Medical Center, Dorn Research Institute, Columbia, SC, USA
| | - Joseph Magagnoli
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
- WJB Dorn Veterans Affairs Medical Center, Dorn Research Institute, Columbia, SC, USA
| | - James W Hardin
- WJB Dorn Veterans Affairs Medical Center, Dorn Research Institute, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ling-I Hsu
- Gilead Sciences Inc., Foster City, CA, USA
| | | | | | - Tammy H Cummings
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
- WJB Dorn Veterans Affairs Medical Center, Dorn Research Institute, Columbia, SC, USA
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14
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Mikuła T, Sapuła M, Suchacz MM, Kozłowska J, Krankowska D, Stańczak W, Wiercińska-Drapało A. Risk Factors of Hypovitaminosis D in HIV-Infected Patients on Suppressive Antiretroviral Therapy. AIDS Res Hum Retroviruses 2020; 36:676-680. [PMID: 32408752 DOI: 10.1089/aid.2019.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Low serum vitamin D levels are very common in human immunodeficiency virus (HIV)-infected patients. In our cross-sectional study, we investigated the association between 25-hydroxyvitamin D (25(OH)D) levels and serum inflammation markers [C-reactive protein (CRP), white blood cells (WBC), D-dimers, platelet count (PLT)] in 148 HIV-infected patients on combined antiretroviral therapy [28 on tenofovir alafenamide (TAF)] and 40 healthy controls. The controls were significantly older (56.6 ± 19.1 years for HIV(-) vs. 45.1 ± 11.8 years for HIV(+); p = .001) and more females were observed in this group (65% for HIV(-) vs. 16.7% for HIV(+); p = .001). The vitamin D serum level was comparable in the two studied groups (74.2 ± 35.9 nmol/L for HIV(+) vs. 78.0 ± 27.6 nnmol/L for HIV(-), p = .545). In HIV-infected group, a significant positive correlation between CD4+ cell percentage and vitamin D level was observed (r = 0.17; p = .036). Furthermore, the significant negative correlation between vitamin D level and CD8+ cell percentage, PLT, CRP, and D-dimers was seen. In univariate analysis, only TAF use and AIDS status was associated with vitamin D level deficiency. No other antiretroviral (ARV) drug nor gender or smoking had influence on vitamin D serum level. In multivariate analysis, only AIDS status and CRP level were correlated with vitamin D level (slope estimate = 11.6 and p = .032 and slope estimate = -0.83 and p = .002; respectively). In summary, we report that low vitamin D level may be associated with high CRP level in HIV-infected patients on suppressive antiretroviral therapy, especially in AIDS phase. More larger studies are required to assess our observation concerning TAF use and vitamin D level in HIV-positive patients.
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Affiliation(s)
- Tomasz Mikuła
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Sapuła
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena M. Suchacz
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Kozłowska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - Dagny Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Stańczak
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
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15
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Thomas A, Hammarlund E, Gao L, Holman S, Michel KG, Glesby M, Villacres MC, Golub ET, Roan NR, French AL, Augenbraun MH, Slifka MK. Loss of Preexisting Immunological Memory Among Human Immunodeficiency Virus-Infected Women Despite Immune Reconstitution With Antiretroviral Therapy. J Infect Dis 2020; 222:243-251. [PMID: 31867597 PMCID: PMC7323495 DOI: 10.1093/infdis/jiz678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It is unclear whether human immunodeficiency virus (HIV) infection results in permanent loss of T-cell memory or if it affects preexisting antibodies to childhood vaccinations or infections. METHODS We conducted a matched cohort study involving 50 pairs of HIV-infected and HIV-uninfected women. Total memory T-cell responses were measured after anti-CD3 or vaccinia virus (VV) stimulation to measure T cells elicited after childhood smallpox vaccination. VV-specific antibodies were measured by means of enzyme-linked immunosorbent assay (ELISA). RESULTS There was no difference between HIV-infected and HIV-uninfected study participants in terms of CD4+ T-cell responses after anti-CD3 stimulation (P = .19) although HIV-infected participants had significantly higher CD8+ T-cell responses (P = .03). In contrast, there was a significant loss in VV-specific CD4+ T-cell memory among HIV-infected participants (P = .04) whereas antiviral CD8+ T-cell memory remained intact (P > .99). VV-specific antibodies were maintained indefinitely among HIV-uninfected participants (half-life, infinity; 95% confidence interval, 309 years to infinity) but declined rapidly among HIV-infected participants (half-life; 39 years; 24-108 years; P = .001). CONCLUSIONS Despite antiretroviral therapy-associated improvement in CD4+ T-cell counts (nadir, <200/μL; >350/μL after antiretroviral therapy), antigen-specific CD4+ T-cell memory to vaccinations or infections that occurred before HIV infection did not recover after immune reconstitution, and a previously unrealized decline in preexisting antibody responses was observed.
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Affiliation(s)
- Archana Thomas
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
| | - Erika Hammarlund
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
| | - Lina Gao
- Biostatistics Shared Resource, Knight Cancer Institute, Biostatistics & Bioinformatics Core, Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Susan Holman
- Division of Infectious Diseases, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Katherine G Michel
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Marshall Glesby
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Maria C Villacres
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia R Roan
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Audrey L French
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois, USA
| | - Michael H Augenbraun
- Division of Infectious Diseases, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
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16
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Oliveira VHF, Borsari AL, Webel AR, Erlandson KM, Deminice R. Sarcopenia in people living with the Human Immunodeficiency Virus: a systematic review and meta-analysis. Eur J Clin Nutr 2020; 74:1009-1021. [PMID: 32341489 DOI: 10.1038/s41430-020-0637-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/05/2023]
Abstract
People living with HIV (PLHIV) experience greater loss of muscle mass and function than people without HIV. However, HIV is not routinely recognized as a sarcopenia risk factor outside of HIV literature. The purposes of this study were to establish the prevalence and predictors of sarcopenia among PLHIV, and to compare the prevalence of sarcopenia among PLHIV and people without HIV. A systematic literature search of the PubMed, Embase, Cinahl, and Scielo databases was performed following PRISMA and MOOSE guidelines. Identified articles were included if they evaluated sarcopenia among PLHIV using either the presence of low muscle mass only or low muscle mass in association with low muscle function. The pooled prevalence of sarcopenia among PLHIV and the odds ratio for sarcopenia in PLHIV compared with controls were calculated. From 13 studies and 2267 participants, the prevalence of sarcopenia among PLHIV was 24.1% (95% CI = 17.8-31.0%). PLHIV presented 6.1 greater odds (95% CI = 1.1-33.5) of sarcopenia compared with people without HIV, matched by age, sex, BMI, and ethnicity. Longer exposure to specific HIV drugs, tobacco and alcohol, lower education and employment rates, and greater HIV duration were associated with sarcopenia. In conclusion, PLHIV had a high prevalence of sarcopenia, related to both HIV and non-HIV risk factors. HIV should be considered a risk factor for sarcopenia in the general population. CRD42019131449.
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Affiliation(s)
- Vitor H F Oliveira
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil.
| | - Ana L Borsari
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Rafael Deminice
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
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17
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Lee C. Controversial Effects of Vitamin D and Related Genes on Viral Infections, Pathogenesis, and Treatment Outcomes. Nutrients 2020; 12:nu12040962. [PMID: 32235600 PMCID: PMC7230640 DOI: 10.3390/nu12040962] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
Vitamin D (VD) plays an essential role in mineral homeostasis and bone remodeling. A number of different VD-related genes (VDRG) are required for the metabolic activation of VD and the subsequent induction of its target genes. They include a set of genes that encode for VD-binding protein, metabolic enzymes, and the VD receptor. In addition to its well-characterized skeletal function, the immunoregulatory activities of VD and the related polymorphisms of VDRG have been reported and linked to its therapeutic and preventive actions for the control of several viral diseases. However, in regards to their roles in the progression of viral diseases, inconsistent and, in some cases, contradictory results also exist. To resolve this discrepancy, I conducted an extensive literature search by using relevant keywords on the PubMed website. Based on the volume of hit papers related to a certain viral infection, I summarized and compared the effects of VD and VDRG polymorphism on the infection, pathogenesis, and treatment outcomes of clinically important viral diseases. They include viral hepatitis, respiratory viral infections, acquired immunodeficiency syndrome (AIDS), and other viral diseases, which are caused by herpesviruses, dengue virus, rotavirus, and human papillomavirus. This review will provide the most current information on the nutritional and clinical utilization of VD and VDRG in the management of the key viral diseases. This information should be valuable not only to nutritionists but also to clinicians who wish to provide evidence-based recommendations on the use of VD to virally infected patients.
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Affiliation(s)
- Choongho Lee
- College of Pharmacy, Dongguk University, Goyang 10326, Korea
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18
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Faber J, Bech A, van Bentum P, Gisolf J, Hassing RJ, de Boer H. Long-Term Impact of Calcium and Vitamin D Supplementation on Bone Density in HIV + Patients with Documented Deficiencies. AIDS Res Hum Retroviruses 2020; 36:58-64. [PMID: 31523978 DOI: 10.1089/aid.2019.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To assess the efficacy of long-term calcium and vitamin D treatment on bone mineral density (BMD) in HIV+ patients on combined antiretroviral therapy (cART). A retrospective, single-center cohort study. Between March 2010 and July 2012, 268 HIV+ patients were screened for vitamin D and calcium deficiency. Those with proven vitamin D or calcium deficiency received supplementation according to a predefined protocol, and were offered further evaluation of BMD by dual-energy X-ray absorptiometry (DEXA). Calcium and vitamin D status and BMD were assessed at baseline (T0) and approximately one (T1) and 4-6 years (T2) later. Percentual change in BMD of the lumbar spine and hip was compared with reported rates of change in HIV+ patients on cART without standard calcium and vitamin D treatment. The prevalence of vitamin D deficiency and calcium deficiency was 46% and 43%, respectively. Thirteen percent of patients had secondary hyperparathyroidism at baseline. DEXA performed in patients with a deficiency revealed osteopenia in 40% and osteoporosis in 8% of patients. The expected long-term change in lumbar spine and hip BMDs at T2 was -0.7%, -1.5%, and -1.5%, respectively. The measured changes were +2.3%, -0.6%, and -0.6%, respectively. The difference between measured and expected rate of change was significant for the lumbar spine (3.0%, p < .05), but not for the hip. Long-term vitamin D and calcium supplementation improves lumbar spine BMD of HIV+ patients with osteopenia or osteoporosis and with proven calcium and/or vitamin D deficiencies. Screening and treatment are recommended to become part of regular care.
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Affiliation(s)
- Jasmijn Faber
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Anneke Bech
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Petra van Bentum
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jet Gisolf
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Robert-Jan Hassing
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hans de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
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19
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Abstract
Drugs may cause bone loss by lowering sex steroid levels (e.g., aromatase inhibitors in breast cancer, GnRH agonists in prostate cancer, or depot medroxyprogestone acetate - DMPA), interfere with vitamin D levels (liver inducing anti-epileptic drugs), or directly by toxic effects on bone cells (chemotherapy, phenytoin, or thiazolidinedions, which diverts mesenchymal stem cells from forming osteoblasts to forming adipocytes). However, besides effects on the mineralized matrix, interactions with collagen and other parts of the unmineralized matrix may decrease bone biomechanical competence in a manner that may not correlate with bone mineral density (BMD) measured by dual energy absorptiometry (DXA).Some drugs and drug classes may decrease BMD like the thiazolidinediones and consequently increase fracture risk. Other drugs such as glucocorticoids may decrease BMD, and thus increase fracture risk. However, glucocorticoids may also interfere with the unmineralized matrix leading to an increase in fracture risk, not mirrored in BMD changes. Some drugs such as selective serotonin reuptake inhibitors (SSRI), paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs) may not per se be associated with bone loss, but fracture risk may be increased, possibly stemming from an increased risk of falls stemming from effects on postural balance mediated by effects on the central nervous system or cardiovascular system.This paper performs a systematic review of drugs inducing bone loss or associated with fracture risk. The chapter is organized by the Anatomical Therapeutic Chemical (ATC) classification.
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Affiliation(s)
- Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
- Steno Diabetes Center North Jutland, Aalborg, Denmark.
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20
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Sadie-Van Gijsen H. The Regulation of Marrow Fat by Vitamin D: Molecular Mechanisms and Clinical Implications. Curr Osteoporos Rep 2019; 17:405-415. [PMID: 31749086 DOI: 10.1007/s11914-019-00546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review the available literature regarding a possible relationship between vitamin D and bone marrow adipose tissue (BMAT), and to identify future avenues of research that warrant attention. RECENT FINDINGS Results from in vivo animal and human studies all support the hypothesis that vitamin D can suppress BMAT expansion. This is achieved by antagonizing adipogenesis in bone marrow stromal cells, through inhibition of PPARγ2 activity and stimulation of pro-osteogenic Wnt signalling. However, our understanding of the functions of BMAT is still evolving, and studies on the role of vitamin D in modulating BMAT function are lacking. In addition, many diseases and chronic conditions are associated with low vitamin D status and low bone mineral density (BMD), but BMAT expansion has not been studied in these patient populations. Vitamin D suppresses BMAT expansion, but its role in modulating BMAT function is poorly understood.
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Affiliation(s)
- Hanel Sadie-Van Gijsen
- Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University Tygerberg Campus, Francie van Zijl Drive, PO Box 241, Parow, Cape Town, 8000, South Africa.
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21
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Drug-induced osteoporosis/osteomalacia: analysis in the French and Spanish pharmacovigilance databases. Eur J Clin Pharmacol 2019; 75:1705-1711. [DOI: 10.1007/s00228-019-02743-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/09/2019] [Indexed: 12/26/2022]
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22
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Biehler-Gomez L, Cabrini A, De Angelis D, Cattaneo C. How do skeletons with HIV present? A study on the identified CAL Milano Cemetery Skeletal Collection. Leg Med (Tokyo) 2018; 33:11-16. [PMID: 29704727 DOI: 10.1016/j.legalmed.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 04/22/2018] [Indexed: 11/25/2022]
Abstract
With the Human Immunodeficiency Virus (HIV) infection and Acquired Immune Deficiency Syndrome (AIDS) pandemic, the study of HIV/AIDS on bones has become of pivotal interest for research in bone pathologies, forensic applications (especially in the matter of identification when confronted to antemortem data) and medical purposes. In this paper, we document and discuss the macroscopic lesions found on the skeletons of nine individuals with known HIV, including four with known AIDS, coming from the identified CAL Milano Cemetery Skeletal Collection. As a result, several types of lesions were observed on bones: periosteal new bone formation, dental lesions, thickening of the frontal diploë, destructive localized porosity and evidence of trauma. None of the lesions reported can be directly linked to HIV because the virus does not directly affect bones in a macroscopic way. However, HIV/AIDS-induced infections and inflammations and HIV-related risk factors may leave bone markers. The differential diagnosis of each of the lesions noted in this research and its potential link to HIV or AIDS was discussed. Although it is not possible to diagnose HIV on bare bones, this was not the focus of this study. To our knowledge, no anthropological study has ever been performed on known HIV individuals. With this paper, we present for the first time skeletons with known HIV.
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Affiliation(s)
- Lucie Biehler-Gomez
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Milan, Italy.
| | - Antonio Cabrini
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Milan, Italy
| | - Danilo De Angelis
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Milan, Italy
| | - Cristina Cattaneo
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Milan, Italy
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