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Masters MC, Tassiopoulos K, Bao Y, Wu K, Koletar SL, Rubin LH, Yang J, Overton ET, Letendre S, Brown TT, Erlandson KM, Palella FJ. Risk factors for progression from prediabetes to diabetes among older people with HIV. AIDS 2024; 38:1740-1748. [PMID: 38923420 PMCID: PMC11365760 DOI: 10.1097/qad.0000000000003970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Risk factors for progression from prediabetes mellitus (pre-DM) to diabetes mellitus (DM) among people with HIV (PWH) receiving modern antiretroviral therapy (ART) require better characterization. DESIGN AIDS Clinical Trials Group (ACTG) A5322 (HAILO) was an observational cohort study of PWH ≥40 years old. Participants initiated ART through ACTG randomized clinical trials. METHODS We used Cox proportional hazards regression models to identify risk factors for development of DM among HAILO participants with pre-DM. RESULTS Among 1035 HAILO participants, 74 (7%) had pre-DM at entry and another 679 (66%) developed pre-DM during follow-up. Of 753 PWH with pre-DM, 167 (22%) developed DM. In multivariable models, the risk of developing DM was greater with higher BMI, lower CD4 count (≤200 cells/mm 3 ), hypertriglyceridemia, or higher waist circumference at pre-DM diagnosis ( P < 0.01). CONCLUSION Rates of pre-DM and progression to DM remain high among virally suppressed PWH receiving modern ART regimens. Traditional risks for DM, such as higher BMI or waist circumference, are associated with increased risk of incident DM among PWH with pre-DM. The association between lower CD4 + and progression to DM suggests a role for advanced immunodeficiency and inflammation. Further investigation of interventions aimed at preventing DM among PWH with pre-DM is needed. Optimizing prevention and treatment for DM may be an intervenable opportunity to improve long-term outcomes for PWH.
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Affiliation(s)
| | | | - Yajing Bao
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kunling Wu
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | - Edgar T Overton
- University of Alabama at Birmingham and ViiV Healthcare, Birmingham, Alabama
| | - Scott Letendre
- University of California, San Diego, San Diego, California
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Castle AC, Moosa Y, Claassen H, Shenoi S, Magodoro I, Manne-Goehler J, Hanekom W, Bassett IV, Wong EB, Siedner MJ. Prior tuberculosis, radiographic lung abnormalities and prevalent diabetes in rural South Africa. BMC Infect Dis 2024; 24:690. [PMID: 38992607 PMCID: PMC11238449 DOI: 10.1186/s12879-024-09583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Growing evidence suggests that chronic inflammation caused by tuberculosis (TB) may increase the incidence of diabetes. However, the relationship between post-TB pulmonary abnormalities and diabetes has not been well characterized. METHODS We analyzed data from a cross-sectional study in KwaZulu-Natal, South Africa, of people 15 years and older who underwent chest X-ray and diabetes screening with hemoglobin A1c testing. The analytic sample was restricted to persons with prior TB, defined by either (1) a self-reported history of TB treatment, (2) radiologist-confirmed prior TB on chest radiography, and (3) a negative sputum culture and GeneXpert. Chest X-rays of all participants were evaluated by the study radiologist to determine the presence of TB lung abnormalities. To assess the relationships between our outcome of interest, prevalent diabetes (HBA1c ≥6.5%), and our exposure of interest, chest X-ray abnormalities, we fitted logistic regression models adjusted for potential clinical and demographic confounders. In secondary analyses, we used the computer-aided detection system CAD4TB, which scores X-rays from 10 to 100 for detection of TB disease, as our exposure interest, and repeated analyses with a comparator group that had no history of TB disease. RESULTS In the analytic cohort of people with prior TB (n = 3,276), approximately two-thirds (64.9%) were women, and the average age was 50.8 years (SD 17.4). The prevalence of diabetes was 10.9%, and 53.0% of people were living with HIV. In univariate analyses, there was no association between diabetes prevalence and radiologist chest X-ray abnormalities (OR 1.23, 95%CI 0.95-1.58). In multivariate analyses, the presence of pulmonary abnormalities was associated with an 29% reduction in the odds of prevalent diabetes (aOR 0.71, 95%CI 0.53-0.97, p = 0.030). A similar inverse relationship was observed for diabetes with each 10-unit increase in the CAD4TB chest X-ray scores among people with prior TB (aOR 0.92, 95%CI 0.87-0.97; p = 0.002), but this relationship was less pronounced in the no TB comparator group (aOR 0.96, 95%CI 0.94-0.99). CONCLUSIONS Among people with prior TB, pulmonary abnormalities on digital chest X-ray are inversely associated with prevalent diabetes. The severity of radiographic post-TB lung disease does not appear to be a determinant of diabetes in this South African population.
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Affiliation(s)
- Alison C Castle
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America.
- Harvard Medical School, Boston, MA, United States of America.
| | - Yumna Moosa
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- University of KwaZulu-Natal, KwaZulu-Natal, Durban, South Africa
| | - Helgard Claassen
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Sheela Shenoi
- Division of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Itai Magodoro
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Willem Hanekom
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- University of KwaZulu-Natal, KwaZulu-Natal, Durban, South Africa
| | - Ingrid V Bassett
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- University of KwaZulu-Natal, KwaZulu-Natal, Durban, South Africa
- Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, United States of America
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- University of KwaZulu-Natal, KwaZulu-Natal, Durban, South Africa
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MOHAMMAD GS, YANG X, GAO H, CHEN S, ZHANG J, OLATOSI B, LI X. Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors. AIDS 2024; 38:1057-1065. [PMID: 38329087 PMCID: PMC11062823 DOI: 10.1097/qad.0000000000003856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND OBJECTIVE The risk factors of diabetes mellitus (DM) in people with HIV (PWH) may be dynamic in a life course manner. This study aimed to describe incidence of DM and investigate the trajectory of changes in risk factor associated with DM incidence over around 15 years among a statewide cohort of PWH in South Carolina (SC). DESIGN This is a population-based cohort study. METHODS Data were retrieved from the integrated statewide electronic health records between 2006 and 2020 in SC. Separate subgroup analysis was conducted according to the patients' different follow up duration (i.e., 5, 10, and 15 years) to observe the evolving risk factors of DM development, using multivariable logistic regressions. RESULTS The DM incidence among a total of 9115 PWH was 8.9 per 1000 person-years. In the overall model, being >60 years old, hypertension, and obesity were positively associated with DM while alcohol consumption, years of HIV diagnosis and high percentage days of viral suppression were negatively associated with the outcome. In the subgroup analyses, similar risk factors were observed. The odds of DM increased in a graded fashion with age. Hypertension was positively associated with DM in all groups and retention to care was negatively associated with the outcome in groups 1 and 3. CONCLUSION This large-scale population-based study has revealed a relatively lower incidence of DM among PWH than some other US States. The evolving risk factors over time underline the need for maintaining retention to care to prevent the occurrence of DM.
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Affiliation(s)
- Gazi Sakir MOHAMMAD
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
| | - Xueying YANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Haoyuan GAO
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Shujie CHEN
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Jiajia ZHANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Bankole OLATOSI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina
| | - Xiaoming LI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
- Big Data Health Science Center, University of South Carolina
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Luo K, Peters BA, Moon JY, Xue X, Wang Z, Usyk M, Hanna DB, Landay AL, Schneider MF, Gustafson D, Weber KM, French A, Sharma A, Anastos K, Wang T, Brown T, Clish CB, Kaplan RC, Knight R, Burk RD, Qi Q. Metabolic and inflammatory perturbation of diabetes associated gut dysbiosis in people living with and without HIV infection. Genome Med 2024; 16:59. [PMID: 38643166 PMCID: PMC11032597 DOI: 10.1186/s13073-024-01336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Gut dysbiosis has been linked with both HIV infection and diabetes, but its interplay with metabolic and inflammatory responses in diabetes, particularly in the context of HIV infection, remains unclear. METHODS We first conducted a cross-sectional association analysis to characterize the gut microbial, circulating metabolite, and immune/inflammatory protein features associated with diabetes in up to 493 women (~ 146 with prevalent diabetes with 69.9% HIV +) of the Women's Interagency HIV Study. Prospective analyses were then conducted to determine associations of identified metabolites with incident diabetes over 12 years of follow-up in 694 participants (391 women from WIHS and 303 men from the Multicenter AIDS Cohort Study; 166 incident cases were recorded) with and without HIV infection. Mediation analyses were conducted to explore whether gut bacteria-diabetes associations are explained by altered metabolites and proteins. RESULTS Seven gut bacterial genera were identified to be associated with diabetes (FDR-q < 0.1), with positive associations for Shigella, Escherichia, Megasphaera, and Lactobacillus, and inverse associations for Adlercreutzia, Ruminococcus, and Intestinibacter. Importantly, the associations of most species, especially Adlercreutzia and Ruminococcus, were largely independent of antidiabetic medications use. Meanwhile, 18 proteins and 76 metabolites, including 3 microbially derived metabolites (trimethylamine N-oxide, phenylacetylglutamine (PAGln), imidazolepropionic acid (IMP)), 50 lipids (e.g., diradylglycerols (DGs) and triradylglycerols (TGs)) and 23 non-lipid metabolites, were associated with diabetes (FDR-q < 0.1), with the majority showing positive associations and more than half of them (59/76) associated with incident diabetes. In mediation analyses, several proteins, especially interleukin-18 receptor 1 and osteoprotegerin, IMP and PAGln partially mediate the observed bacterial genera-diabetes associations, particularly for those of Adlercreutzia and Escherichia. Many diabetes-associated metabolites and proteins were altered in HIV, but no effect modification on their associations with diabetes was observed by HIV. CONCLUSION Among individuals with and without HIV, multiple gut bacterial genera, blood metabolites, and proinflammatory proteins were associated with diabetes. The observed mediated effects by metabolites and proteins in genera-diabetes associations highlighted the potential involvement of inflammatory and metabolic perturbations in the link between gut dysbiosis and diabetes in the context of HIV infection.
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Affiliation(s)
- Kai Luo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mykhaylo Usyk
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Michael F Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York-Downstate Medical Center, Brooklyn, NY, USA
| | | | - Audrey French
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Todd Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rob Knight
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Daultrey H, Levett T, Oliver N, Vera J, Chakera AJ. HIV and type 2 diabetes: An evolving story. HIV Med 2024; 25:409-423. [PMID: 38111214 DOI: 10.1111/hiv.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 11/17/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Diabetes is widely reported to be more common in people living with HIV (PLWH). Much of the data supporting this originated during the earlier HIV era. The perceived increased risk of type 2 diabetes is reflected in HIV clinical guidelines that recommend screening for diabetes in PLWH on anti-retroviral therapy (ART). However, international HIV clinical guidelines do not agree on the best marker of glycaemia to screen for diabetes. This stems from studies that suggest HbA1c underestimates glycaemia in PLWH. METHODS Within this review we summarise the literature surrounding the association of HIV and type 2 diabetes and how this has changed over time. We also present the evidence on HbA1c discrepancy in PLWH. CONCLUSION We suggest there is no basis to any international guidelines to restrict HbA1c based on HIV serostatus. We recommend, using the current evidence, that PLWH should be screened annually for diabetes in keeping with country specific guidance. Finally, we suggest future work to elucidate phenotype and natural history of type 2 diabetes in PLWH across all populations.
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Affiliation(s)
| | - Tom Levett
- Brighton and Sussex Medical School, Brighton, UK
| | | | - Jaime Vera
- Brighton and Sussex Medical School, Brighton, UK
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Schrock JM. Accelerated aging in people living with HIV: The neuroimmune feedback model. Brain Behav Immun Health 2024; 36:100737. [PMID: 38356933 PMCID: PMC10864877 DOI: 10.1016/j.bbih.2024.100737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/02/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024] Open
Abstract
People living with HIV (PLWH) experience earlier onset of aging-related comorbidities compared to their counterparts without HIV. This paper lays out a theoretical model to explain why PLWH experience accelerated aging. Briefly, the model is structured as follows. PLWH experience disproportionately heavy burdens of psychosocial stress across the life course. This psychosocial stress increases risks for depressive symptoms and problematic substance use. Depressive symptoms and problematic substance use interfere with long-term adherence to antiretroviral therapy (ART). Lower ART adherence, in turn, exacerbates the elevated systemic inflammation stemming from HIV infection. This inflammation increases risks for aging-related comorbidities. Systemic inflammation also reduces connectivity in the brain's central executive network (CEN), a large-scale brain network that is critical for coping with stressful circumstances. This reduced capacity for coping with stress leads to further increases in depressive symptoms and problematic substance use. Together, these changes form a neuroimmune feedback loop that amplifies the impact of psychosocial stress on aging-related comorbidities. In this paper, I review the existing evidence relevant to this model and highlight directions for future research.
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Affiliation(s)
- Joshua M. Schrock
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, United states
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7
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Kibirige D, Andia-Biraro I, Olum R, Adakun S, Zawedde-Muyanja S, Sekaggya-Wiltshire C, Kimuli I. Tuberculosis and diabetes mellitus comorbidity in an adult Ugandan population. BMC Infect Dis 2024; 24:242. [PMID: 38389045 PMCID: PMC10885501 DOI: 10.1186/s12879-024-09111-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity. METHODS In this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in < 2 months) for DM. All participants were screened with five tests; initially with a random blood glucose (RBG) test, and then later with fasting blood glucose (FBG), laboratory-based glycated hemoglobin (HbA1c), point-of-care (POC) HbA1c, and oral glucose tolerance test (OGTT) if the RBG was ≥ 6.1 mmol/l. The WHO guidelines for diagnosing and managing DM were used to support the DM diagnosis. To identify the factors associated with DM-TB comorbidity, logistic regression was used. RESULTS A total of 232 participants with recently diagnosed TB were screened for DM. Of these, 160 (69%) were female. The median (IQR) age, body mass index, and RBG of all study participants was 35 (27-42) years, 19.2 (17.6-21.3) kg/m2, and 6.1 (5.5-7.2) mmol/l, respectively. About half of the participants (n = 117, 50.4%) had RBG level ≥ 6.1 mmol/l. Of these, 75 (64.1%) participants returned for re-testing. Diabetes mellitus was diagnosed in 32 participants, corresponding to a prevalence of 13.8% (95% CI 9.9-18.9). A new diagnosis of DM was noted in 29 (90.6%) participants. On logistic regression, age ≥ 40 years was associated with increased odds of TB and DM comorbidity (AOR 3.12, 95% CI 1.35-7.23, p = 0.008) while HIV coinfection was protective (AOR 0.27, 95% CI 0.10-0.74, p = 0.01). CONCLUSION TB and DM comorbidity was relatively common in this study population. Routine screening for DM in adult Ugandan patients with recently diagnosed TB especially among those aged ≥ 40 years and HIV-negative patients should be encouraged in clinical practice.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda.
- Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Makerere University School of Public Health, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis ward, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
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Bailin SS, Koethe JR, Rebeiro PF. The pathogenesis of obesity in people living with HIV. Curr Opin HIV AIDS 2024; 19:6-13. [PMID: 37934696 PMCID: PMC10842175 DOI: 10.1097/coh.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW The public health challenge of overweight and obesity increasingly affects people living with HIV (PWH). These effects have also accelerated as the prevalence of antiretroviral therapy (ART) use has increased among PWH. It is therefore also critical that we examine and understand the pathogenesis of obesity among PWH.This review will aim to summarize relevant and recent literature related to the risks of weight gain and obesity associated with HIV disease progression, cardiometabolic disease, and multimorbidity among PWH. Further, we will discuss adipose tissue changes associated with weight gain and obesity and how these changes relate to metabolic complications. RECENT FINDINGS Several observational and experimental studies in recent years have evaluated the role of contemporary ART regimens, particularly integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF), as contributors to weight gain, obesity, and cardiometabolic disease, though the mechanisms remain unclear. Metabolic dysregulation has also been linked to ectopic fat deposition and alterations in innate and adaptive immune cell populations in adipose tissue that accompany HIV and obesity. These factors continue to contribute to an increasing burden of metabolic diseases in an aging HIV population. SUMMARY Obesity accompanies an increasing burden of metabolic disease among PWH, and understanding the role of fat partitioning and HIV and ART-related adipose tissue dysfunction may guide prevention and treatment strategies.
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Affiliation(s)
| | - John R Koethe
- Department of Medicine, Division of Infectious Diseases
| | - Peter F Rebeiro
- Department of Medicine, Division of Infectious Diseases
- Department of Medicine, Division of Epidemiology
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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9
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Khunti K, Chudasama YV, Gregg EW, Kamkuemah M, Misra S, Suls J, Venkateshmurthy NS, Valabhji J. Diabetes and Multiple Long-term Conditions: A Review of Our Current Global Health Challenge. Diabetes Care 2023; 46:2092-2101. [PMID: 38011523 DOI: 10.2337/dci23-0035] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/26/2023] [Indexed: 11/29/2023]
Abstract
Use of effective treatments and management programs is leading to longer survival of people with diabetes. This, in combination with obesity, is thus contributing to a rise in people living with more than one condition, known as multiple long-term conditions (MLTC or multimorbidity). MLTC is defined as the presence of two or more long-term conditions, with possible combinations of physical, infectious, or mental health conditions, where no one condition is considered as the index. These include a range of conditions such as cardiovascular diseases, cancer, chronic kidney disease, arthritis, depression, dementia, and severe mental health illnesses. MLTC has major implications for the individual such as poor quality of life, worse health outcomes, fragmented care, polypharmacy, poor treatment adherence, mortality, and a significant impact on health care services. MLTC is a challenge, where interventions for prevention and management are lacking a robust evidence base. The key research directions for diabetes and MLTC from a global perspective include system delivery and care coordination, lifestyle interventions and therapeutic interventions.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Yogini V Chudasama
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Edward W Gregg
- School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Monika Kamkuemah
- Innovation Africa and Department of Architecture, Faculty of Engineering, Built Environment and Information Technology, University of Pretoria, Pretoria, South Africa
| | - Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Jerry Suls
- Institute for Health System Science, Feinstein Institutes for Medical Research Northwell Health, New York, NY
| | - Nikhil S Venkateshmurthy
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
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10
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Jiménez-Villalba YZ, Madrigal-Santillán EO, González-Virla BJG, Iniestra-Frías LA, Durán-Gómez V. [Associated factors for prediabetes in patients with human immunodeficiency virus]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:S380-S386. [PMID: 37934732 PMCID: PMC10732694 DOI: 10.5281/zenodo.8319825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/09/2023] [Indexed: 11/09/2023]
Abstract
Introduction HIV disease was transformed from a fatal condition to one with metabolic complications. In Mexico City, the associated factors for prediabetes in this population are unknown; investigating it is relevant to improve their quality of life. Objective To determine the risk association factors for prediabetes in people living with HIV. Material and methods Cross-analytical, retrospective study. Records of patients living with HIV were reviewed, exposure factors and fasting glucose concentration were recorded. Patients from 18 to 65 years of age were included, on co-formulated antiretroviral treatment, without adjustment of antiretroviral treatment in the last two years, with a BMI of 18.5-40 kg/m2. Results 148 patients were included, 68 presented prediabetes. The factors with risk association that were identified are: age over 60 years (OR 9.48, 95% CI 1.68-40.13), treatment with Efavirenz/Tenofovir/Emtricitabine (OR 9.28, 95% CI 2.55-33.74) and treatment time antiretroviral older than 12 months (OR 2.53, 95% CI .912-7.041). Conclusion The prevalence of prediabetes in people living with HIV is 46%. The main associated factor was the consumption of Atripla. This study has clinical relevance since it will allow the implementation of prevention, diagnosis and treatment strategies for prediabetes in order to reduce associated morbidity and mortality.
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Affiliation(s)
- Yeimmy Zuyenn Jiménez-Villalba
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 27 “Dr. Alfredo Badallo García”, Servicio de Medicina Interna. Ciudad de México, México Instituto Mexicano del Seguro SocialMéxico
- Instituto Politécnico Nacional, Unidad de Posgrado, Escuela Superior de Medicina. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Eduardo Osiris Madrigal-Santillán
- Instituto Politécnico Nacional, Unidad de Posgrado, Escuela Superior de Medicina. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Baldomero José Gregorio González-Virla
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades “Dr. Bernardo Sepúlveda Gutiérrez”, Servicio de Endocrinología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Luis Angel Iniestra-Frías
- Instituto Politécnico Nacional, Dirección y Centros de Lenguas Extranjeras, Plantel Santo Tomas. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Verónica Durán-Gómez
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 27 “Dr. Alfredo Badallo García”, Servicio de Medicina Interna. Ciudad de México, México Instituto Mexicano del Seguro SocialMéxico
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11
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Magagnoli J, Pereira F, Narendran S, Huang P, Cummings T, Hardin JW, Nguyen J, Sutton SS, Ambati J. Anti-HIV Drugs Reduce Risk of Prediabetes and Progression to Type 2 Diabetes in HIV-Infected Patients. MEDCOMM - FUTURE MEDICINE 2023; 2:e37. [PMID: 37692282 PMCID: PMC10489210 DOI: 10.1002/mef2.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/17/2023] [Indexed: 09/12/2023]
Abstract
The aim of this study was to investigate whether the use of nucleoside reverse transcriptase inhibitors (NRTIs) impacts the incidence of prediabetes or type 2 diabetes mellitus (T2DM) or the progression from prediabetes to T2DM in people living with HIV (PLWH). We conducted a retrospective cohort study using the U.S. Veterans Health Administration database among adult patients with an HIV diagnosis from the year 2000 until 2021 to determine the incidence of prediabetes and further progression to T2DM among NRTI exposed and unexposed patients. A multistate model was used to evaluate progression from normoglycemia to prediabetes and then to T2DM, and covariate adjustment with the Cox proportional hazards model was used to estimate the hazard ratios. Among 32,240 veterans diagnosed with HIV, prediabetes and T2DM were observed among 20.2% and 20.7% of patients, respectively. Among those diagnosed with prediabetes, 31.8% progressed to T2DM. Patients exposed to NRTIs at any time (86.6%), had a reduced risk of prediabetes [HR 0.50 (0.47-0.53 95% CI)] and among prediabetics, a lower risk of progression to T2DM [HR 0.73 (0.63-0.85 95% CI)] when compared to patients who never used NRTIs. In summary, NRTIs may reduce the risk of developing prediabetes and the progression from prediabetes to T2DM in PLWH.
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Affiliation(s)
- Joseph Magagnoli
- Dorn Research Institute, Columbia VA Health Care System, Columbia, SC 29209
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC 29208
| | - Felipe Pereira
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA 22908
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA 22908
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
| | - Siddharth Narendran
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA 22908
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA 22908
- Aravind Eye Hospital System, Madurai 625020, India
| | - Peirong Huang
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA 22908
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA 22908
| | - Tammy Cummings
- Dorn Research Institute, Columbia VA Health Care System, Columbia, SC 29209
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC 29208
| | - James W. Hardin
- Dorn Research Institute, Columbia VA Health Care System, Columbia, SC 29209
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC 29208
| | - Joseph Nguyen
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA 22908
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA 22908
| | - S. Scott Sutton
- Dorn Research Institute, Columbia VA Health Care System, Columbia, SC 29209
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC 29208
| | - Jayakrishna Ambati
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA 22908
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA 22908
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA 22908
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA 22908
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12
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Krause R, Warren CM, Simmons JD, Rebeiro PF, Maruri F, Karim F, Sterling TR, Koethe JR, Leslie A, van der Heijden YF. Failure to decrease HbA1c levels following TB treatment is associated with elevated Th1/Th17 CD4+ responses. Front Immunol 2023; 14:1151528. [PMID: 37313404 PMCID: PMC10258338 DOI: 10.3389/fimmu.2023.1151528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/17/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction The rising global burden of metabolic disease impacts the control of endemic tuberculosis (TB) in many regions, as persons with diabetes mellitus (DM) are up to three times more likely to develop active TB than those without DM. Active TB can also promote glucose intolerance during both acute infection and over a longer term, potentially driven by aspects of the immune response. Identifying patients likely to have persistent hyperglycemia following TB treatment would enable closer monitoring and care, and an improved understanding of underlying immunometabolic dysregulation. Methods We measured the relationship of plasma cytokine levels, T cell phenotypes and functional responses with the change in hemoglobin A1c (HbA1c) before and after treatment of pulmonary TB in a prospective observational cohort in Durban, South Africa. Participants were stratified based on stable/increased HbA1c (n = 16) versus decreased HbA1c (n = 46) levels from treatment initiation to 12 month follow-up. Results CD62 P-selectin was up- (1.5-fold) and IL-10 downregulated (0.85-fold) in plasma among individuals whose HbA1c remained stable/increased during TB treatment. This was accompanied by increased pro-inflammatory TB-specific IL-17 production (Th17). In addition, Th1 responses were upregulated in this group, including TNF-α production and CX3CR1 expression, with decreased IL-4 and IL-13 production. Finally, the TNF-α+ IFNγ+ CD8+ T cells were associated with stable/increased HbA1c. These changes were all significantly different in the stable/increased HbA1c relative to the decreased HbA1c group. Discussion Overall, these data suggest that patients with stable/increased HbA1c had an increased pro-inflammatory state. Persistent inflammation and elevated T cell activity in individuals with unresolved dysglycemia following TB treatment may indicate failure to fully resolve infection or may promote persistent dysglycemia in these individuals, and further studies are needed to explore potential mechanisms.
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Affiliation(s)
- Robert Krause
- Africa Health Research Institute (AHRI), Durban, South Africa
- College of Health Sciences, School of Laboratory Medicine & Medical Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Christian M. Warren
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Joshua D. Simmons
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Peter F. Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Fernanda Maruri
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Farina Karim
- Africa Health Research Institute (AHRI), Durban, South Africa
- College of Health Sciences, School of Laboratory Medicine & Medical Sciences, University of KwaZulu Natal, Durban, South Africa
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Timothy R. Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - John R. Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Al Leslie
- Africa Health Research Institute (AHRI), Durban, South Africa
- College of Health Sciences, School of Laboratory Medicine & Medical Sciences, University of KwaZulu Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Yuri F. van der Heijden
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
- The Aurum Institute, Johannesburg, South Africa
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13
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Kajogoo VD, Amogne W, Medhin G. New onset type 2 diabetes mellitus risks with integrase strand transfer inhibitors-based regimens: A systematic review and meta-analysis. Metabol Open 2023; 17:100235. [PMID: 36923992 PMCID: PMC10009287 DOI: 10.1016/j.metop.2023.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/23/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Objectives The development of diabetes mellitus (DM) in patients taking integrase strand transfer inhibitors (INSTIs) has raised concerns. It's critical because, in most guidelines, INSTIs are the preferred third agent at first-line regimens. This study investigates the excess risk of developing DM among people living with HIV (PWH) on INSTIs-based regimens compared to those with other combination antiretroviral therapies (cART). Methods A search from PubMed, clinicaltrials.gov, Latin America and Caribbean health sciences literature, Cochrane, and google scholar to retrieve case-control and cohort studies were done. The literature search was performed for studies from January 2007 to January 2021. Data were extracted from studies and pooled as risk ratios (RR) with a 95% confidence interval (CI) using Stata 14 software. The protocol was registered in PROSPERO, ID: CRD42021230282. Results This review included ten studies, resulting in 62 400 participants. There was no significant difference in the incidence of DM between participants receiving INSTIs-based regimens versus other cARTs (RR 0.97, 95% CI: 0.92-1.03; participants = 50 958; studies = 4; I2 = 86.8%, chi-square = 22.67). There is no statistically significant difference in DM among people treated with INSTIs-based regimens compared to those treated with boosted protease inhibitors (PIs)-based regimens (RR 0.97, 95% CI 0.92-1.03; participants = 49 840; studies = 3; I2 = 89.3%, chi-square = 18.65). DM incidence was lower in INSTIs-based regimens than in those using non-nucleoside reverse transcriptase inhibitors (NNRTIs)-based regimens (RR 0.80, 95% CI 0.69-0.91; participants = 42 346; studies = 2; I2 = 0%, chi-square = 0.18). Conclusion The present review shows a nonsignificant difference in the incidence of DM in patients receiving INSTIs-based regimens compared to other regimens. However, there was a lower incidence of DM in the INSTIs group compared to the NNRTIs-based and PIs compared to the NNRTIs-based. When the INSTIs drugs dolutegravir, raltegravir, and elvitegravir were compared, there was a lower incidence of DM in raltegravir compared with elvitegravir.
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Affiliation(s)
- Violet Dismas Kajogoo
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | - Wondwossen Amogne
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, Ethiopia.,Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Girmay Medhin
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, Ethiopia.,Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
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14
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Bailin SS, Koethe JR. Diabetes in HIV: the Link to Weight Gain. Curr HIV/AIDS Rep 2023; 20:9-18. [PMID: 36418528 PMCID: PMC10184162 DOI: 10.1007/s11904-022-00642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The burden of metabolic diseases, including type 2 diabetes mellitus (T2DM), is rising among persons with HIV (PWH) on antiretroviral therapy (ART). This increase coincides with an aging population and a greater proportion who are overweight/obese. This review summarizes the changing epidemic of T2DM on contemporary ART, the role of weight gain, and therapeutic options. RECENT FINDINGS Recent studies confirm that PWH face an epidemic of obesity and T2DM, similar to the general population. Contemporary ART is associated with greater weight gain and may contribute to the risk of T2DM. Recent advances in medical weight loss therapy offer a way forward in the prevention and treatment of weight-associated T2DM. Weight gain is one of the biggest contributors to T2DM in PWH. Future studies on the role of adipose tissue distribution, adipose tissue function and clinical use of effective weight loss medications may change the paradigm of care for PWH.
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Affiliation(s)
- Samuel S Bailin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Veterans Affairs, Tennessee Valley Health System, Nashville, TN, 37212, USA
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15
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Viruses and Endocrine Diseases. Microorganisms 2023; 11:microorganisms11020361. [PMID: 36838326 PMCID: PMC9967810 DOI: 10.3390/microorganisms11020361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Viral infections have been frequently associated with physiological and pathological changes in the endocrine system for many years. The numerous early and late endocrine complications reported during the current pandemic of coronavirus disease 2019 (COVID-19) reinforce the relevance of improving our understanding of the impact of viral infections on the endocrine system. Several viruses have been shown to infect endocrine cells and induce endocrine system disturbances through the direct damage of these cells or through indirect mechanisms, especially the activation of the host antiviral immune response, which may lead to the development of local or systemic inflammation or organ-specific autoimmunity. In addition, endocrine disorders may also affect susceptibility to viral infections since endocrine hormones have immunoregulatory functions. This review provides a brief overview of the impact of viral infections on the human endocrine system in order to provide new avenues for the control of endocrine diseases.
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16
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Spieler G, Westfall AO, Long DM, Cherrington A, Burkholder GA, Funderburg N, Raper JL, Overton ET, Willig AL. Trends in diabetes incidence and associated risk factors among people with HIV in the current treatment era. AIDS 2022; 36:1811-1818. [PMID: 35950938 PMCID: PMC9529800 DOI: 10.1097/qad.0000000000003348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine type 2 diabetes mellitus incidence and associated risk factors among people with HIV (PWH). DESIGN A retrospective clinical cohort study of PWH at a Southeastern US academic HIV clinic between 2008 and 2018. METHODS PWH who attended at least two clinic visits were evaluated with demographic and clinical data extracted from the electronic medical record (EMR). Diabetes was defined as: hemoglobin A1C ≥6.5% and/or 2 glucose results >200 mg/dl (at least 30 days apart), diagnosis of diabetes in the EMR, or exposure to diabetes medication. Time to diabetes incidence was computed from the entire clinic population for each year. Multivariable Cox proportional hazard regression models with time-dependent covariates were created to evaluate the independent association between covariates and time to incident diabetes. RESULTS Among 4113 PWH, we identified 252 incident cases of diabetes. Incidence increased from 1.04 incidents per 1000 person years (PY) in 2008, to 1.55 incidents per 1000 PY in 2018. Body mass index (hazard ratio [HR] 10.5 (6.2, 17.7)), liver disease (HR 1.9 (1.2, 3.1)), steroid exposure (HR 1.5 (1.1, 1.9)), and use of integrase inhibitors (HR 1.5 (1.1, 2.0)) were associated with incident diabetes. Additional associated factors included lower CD4 + cell counts, duration of HIV infection, exposure to nonstatin lipid-lowering therapy, and dyslipidemia. CONCLUSIONS Rapidly increasing incident diabetes rates among PWH were associated with both traditional and HIV-related associated risk factors, particularly body weight, steroid exposure, and use of Integrase Inhibitors. Notably, several of the risk factors identified are modifiable and can be targeted for intervention.
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Affiliation(s)
| | | | | | - Andrea Cherrington
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Nicholas Funderburg
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
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17
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Borkowska T, Chkhartishvili N, Karkashadze E, Chokoshvili O, Gabunia P, Sharvadze L, Tsertsvadze T. The prevalence of hyperglycemia and its impact on mortality among people living with HIV in Georgia. PLoS One 2022; 17:e0276749. [PMID: 36301817 PMCID: PMC9612544 DOI: 10.1371/journal.pone.0276749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Life expectancy and quality of life of people living with HIV have been dramatically improved after introducing antiretroviral therapy, and the prevalence of non-communicable diseases has increased. Several studies have found that hyperglycemia with or without type 2 diabetes was associated with poor outcomes in people living with HIV. The study's objective was to determine the prevalence of hyperglycemia and assess its impact on mortality. MATERIALS AND METHODS A retrospective cohort study was conducted among people living with HIV diagnosed in 2012-2018 and followed through 2020 at the Infectious Diseases, AIDS and Clinical Immunology Research Center in Tbilisi, Georgia. Primary outcomes of interest included the prevalence of hyperglycemia and mortality. Causes of death were classified according to the Coding of Death in HIV (CoDe) protocol. RESULTS Our study included 2914 people living with HIV. Two hundred and forty-two (8.3%) patients had hyperglycemia, with an increasing prevalence by age. Three hundred one (9.7%) participants died over the median 3.71 (IQR: 2.14-5.37) years of follow-up. Among these, 139 (46.2%) were due to AIDS- related causes, 123 (40.9%)-were due to non-AIDS causes, and in 39 (12.9%) cases, the cause of death could not be determined. Overall, the cohort contributed to 11,148 person-years of follow-up (PYFU), translating into a mortality rate of 2.70 deaths per 100 PYFU. The mortality rate was significantly higher among individuals with hyperglycemia-11.17 deaths per 100 PYFU vs 2.07 deaths per 100 PYFU among normoglycemic patients(p<0.0001). CONCLUSIONS Hyperglycemia was associated with increased odds of mortality. Screening and management of hyperglycemia should be integrated into routine HIV clinical services as part of a comprehensive care package.
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Affiliation(s)
- Tea Borkowska
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
- * E-mail:
| | | | | | - Otar Chokoshvili
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
| | - Pati Gabunia
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
| | - Lali Sharvadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
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Konishi K, Nakagawa H, Asaoka T, Kasamatsu Y, Goto T, Shirano M. Sarcopenia among people living with HIV and the effect of antiretroviral therapy on body composition. Medicine (Baltimore) 2022; 101:e31349. [PMID: 36281131 PMCID: PMC9592382 DOI: 10.1097/md.0000000000031349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To investigate the prevalence of sarcopenia among people living with HIV (PLWH) in Japan and analyze the relationship between HIV infection and ART effects on the body composition of Japanese PLWH for more appropriate drug selection and lifestyle guidance. Cross-sectional observational study. We included male patients aged ≥ 60 years whose body composition was measured by InBody 570 body composition analyzer during outpatient visits. Patients were classified by body shape based on body mass index (BMI) and body fat percentage measurements and by tenofovir alafenamide administration. Hidden obesity is a condition wherein the BMI is within the standard range but the body fat percentage is higher than the reference. Patients with low muscle mass and strength were considered to have sarcopenia, whereas those with only low muscle strength were considered to have pre-sarcopenia. In total, 87 patients were included. Based on body shape determined by BMI and body fat percentage, most patients had hidden obesity (40 patients, 46.0%). Sarcopenia was detected in 9 patients (10.3%) and pre-sarcopenia in 14 patients (16.1%). The tenofovir alafenamide (TAF) use group had significantly higher BMI, higher skeletal muscle mass, body fat mass, and skeletal muscle mass index relative to the non-TAF use group. Hidden obesity is a risk for lifestyle diseases. It is important to recognize it based on body composition measurements because it can be missed by BMI measurement alone. Tenofovir alafenamide therapy increases skeletal muscle mass, which may result in the prevention of sarcopenia. To clarify how TAF affects the development of sarcopenia and lifestyle diseases, future studies on a larger cohort are warranted.
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Affiliation(s)
- Keiji Konishi
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
- *Correspondence: Keiji Konishi, Department of Infectious Diseases, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka-shi, Osaka 534-0021, Japan (e-mail: )
| | - Hidenori Nakagawa
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Tomohiro Asaoka
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Yu Kasamatsu
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
- Department of Infectious Diseases, University Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsushi Goto
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
- Department of Infectious Diseases, Osaka City Juso Hospital, Osaka, Japan
| | - Michinori Shirano
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
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Ward AR, Thomas AS, Stevenson EM, Huang SH, Keating SM, Gandhi RT, McMahon DK, Bosch RJ, Macatangay BJ, Cyktor JC, Eron JJ, Mellors JW, Jones RB. No evidence that circulating HIV-specific immune responses contribute to persistent inflammation and immune activation in persons on long-term ART. AIDS 2022; 36:1617-1628. [PMID: 35730388 PMCID: PMC9444951 DOI: 10.1097/qad.0000000000003301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE People with HIV (PWH) have persistently elevated levels of inflammation and immune activation despite suppressive antiretroviral therapy (ART), with specific biomarkers showing associations with non-AIDS-defining morbidities and mortality. We investigated the potential role of the HIV-specific adaptive immune response, which also persists under ART, in driving levels of these clinically relevant biomarkers. DESIGN Cohort-based study. METHODS HIV-specific IFN-γ-producing T-cell responses and antibody concentrations were measured in blood at study entry in the ACTG A5321 cohort, following a median of 7 years of suppressive ART. HIV persistence measures including cell-associated (CA)-DNA, CA-RNA, and plasma HIV RNA (single-copy assay) were also assessed at study entry. Plasma inflammatory biomarkers and T-cell activation and cycling were measured at a pre-ART time point and at study entry. RESULTS Neither the magnitudes of HIV-specific T-cell responses nor HIV antibody levels were correlated with levels of the inflammatory or immune activation biomarkers, including hs-CRP, IL-6, neopterin, sCD14, sCD163, TNF-α, %CD38 + HLA-DR + CD8 + and CD4 + cells, and %Ki67 + CD8 + and CD4 + cells - including after adjustment for pre-ART biomarker level. Plasma HIV RNA levels were modestly correlated with CD8 + T-cell activation ( r = 0.25, P = 0.027), but other HIV persistence parameters were not associated with these biomarkers. In mediation analysis, relationships between HIV persistence parameters and inflammatory biomarkers were not influenced by either HIV-specific T-cell responses or antibody levels. CONCLUSION Adaptive HIV-specific immune responses do not appear to contribute to the elevated inflammatory and immune activation profile in persons on long-term ART.
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Affiliation(s)
- Adam R. Ward
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC USA
- PhD Program in Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Allison S. Thomas
- Department of Microbiology, Boston University School of Medicine, Boston, MA USA
| | - Eva M. Stevenson
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Szu-Han Huang
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC USA
| | - Sheila M. Keating
- GigaGen, Inc., San Francisco, CA USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA USA
| | - Rajesh T. Gandhi
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA USA
| | - Deborah K. McMahon
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Ronald J. Bosch
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Bernard J. Macatangay
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Joshua C. Cyktor
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Joseph J. Eron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - John W. Mellors
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - R. Brad Jones
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC USA
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20
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Wetherill MS, Bakhsh C, Caywood L, Williams MB, Hartwell ML, Wheeler DL, Hubach RD, Teague TK, Köhler G, Hebert JR, Weiser SD. Unpacking determinants and consequences of food insecurity for insulin resistance among people living with HIV: Conceptual framework and protocol for the NOURISH-OK study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3. [PMID: 36225538 PMCID: PMC9552993 DOI: 10.3389/fcdhc.2022.947552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Over the past four decades, advances in HIV treatment have contributed to a longer life expectancy for people living with HIV (PLWH). With these gains, the prevention and management of chronic co-morbidities, such as diabetes, are now central medical care goals for this population. In the United States, food insecurity disproportionately impacts PLWH and may play a role in the development of insulin resistance through direct and indirect pathways. The Nutrition to Optimize, Understand, and Restore Insulin Sensitivity in HIV for Oklahoma (NOURISH-OK) will use a novel, multi-level, integrated framework to explore how food insecurity contributes to insulin resistance among PLWH. Specifically, it will explore how food insecurity may operate as an intermediary risk factor for insulin resistance, including potential linkages between upstream determinants of health and downstream consequences of poor diet, other behavioral risk factors, and chronic inflammation. Methods/design: This paper summarizes the protocol for the first aim of the NOURISH-OK study, which involves purposeful cross-sectional sampling of PLWH (n=500) across four levels of food insecurity to test our conceptual framework. Developed in collaboration with community stakeholders, this initial phase involves the collection of anthropometrics, fasting blood samples, non-blood biomarkers, 24-hour food recall to estimate the Dietary Inflammatory Index (DII®) score, and survey data. A 1-month, prospective observational sub-study (total n=100; n=25 for each food security group) involves weekly 24-hour food recalls and stool samples to identify temporal associations between food insecurity, diet, and gut microbiome composition. Using structural equation modeling, we will explore how upstream risk factors, including early life events, current discrimination, and community food access, may influence food insecurity and its potential downstream impacts, including diet, other lifestyle risk behaviors, and chronic inflammation, with insulin resistance as the ultimate outcome variable. Findings from these analyses of observational data will inform the subsequent study aims, which involve qualitative exploration of significant pathways, followed by development and testing of a low-DII® food as medicine intervention to reverse insulin resistance among PLWH (ClinicalTrials.gov Identifier: NCT05208671). Discussion: The NOURISH-OK study will address important research gaps to inform the development of food as medicine interventions to support healthy aging for PLWH.
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Affiliation(s)
- Marianna S. Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Tulsa Schusterman Center, Tulsa, OK, United States
- Department of Family and Community Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK, United States
- *Correspondence: Marianna S. Wetherill,
| | | | - Lacey Caywood
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Tulsa Schusterman Center, Tulsa, OK, United States
| | - Mary B. Williams
- Department of Family and Community Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK, United States
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Tulsa Schusterman Center, Tulsa, OK, United States
| | - Micah L. Hartwell
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Denna L. Wheeler
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Randolph D. Hubach
- Department of Public Health, Purdue University, West Lafayette, IN, United States
| | - T. Kent Teague
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, United States
- Department of Psychiatry, University of Oklahoma School of Community Medicine, Tulsa, OK, United States
- Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Gerwald Köhler
- Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - James R. Hebert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States
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21
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Masters MC, Yang J, Lake JE, Abraham AG, Kingsley L, Brown TT, Palella FJ, Erlandson KM. Diabetes mellitus is associated with declines in physical function among men with and without HIV. AIDS 2022; 36:637-646. [PMID: 34999609 PMCID: PMC8957604 DOI: 10.1097/qad.0000000000003160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the longitudinal relationships between abnormal glucose metabolism and physical function in persons with HIV (PWH) and without HIV. DESIGN Prospective cohort study of men with or at risk for HIV in four United States cities between 2006 and 2018. METHODS Men with or at risk for HIV from the Multicenter AIDS Cohort Study (MACS) had semi-annual assessments of glycemic status, grip strength, and gait speed. We used linear mixed models with random intercept to assess associations between glycemic status and physical function. Glycemic status was categorized as normal, impaired fasting glucose (IFG), controlled diabetes mellitus [hemoglobin A1C (HbA1C) <7.5%], or uncontrolled diabetes mellitus (HbA1C ≥ 7.5%). RESULTS Of 2240 men, 52% were PWH. Diabetes mellitus was similar among PWH (7.7%) vs. persons without HIV (6.7%, P = 0.36) at baseline. PWH had slower gait speed (1.17 vs. 1.20 m/s, P < 0.01) but similar grip strength (40.1 vs. 39.8 kg, P = 0.76) compared with persons without HIV at baseline. In multivariate models, gait speed decline was greater with controlled diabetes mellitus [-0.018 m/s (-0.032 to -0.005), P = 0.01] and grip strength decline was greater with controlled [-0.560 kg (-1.096 to -0.024), P = 0.04] and uncontrolled diabetes mellitus [-0.937 kg (-1.684 to -0.190), P = 0.01), regardless of HIV serostatus compared with normoglycemic individuals. DISCUSSION Abnormal glucose metabolism was associated with declines in gait speed and grip strength regardless of HIV serostatus. These data suggest that improvement in glucose control should be investigated as an intervenable target to prevent progression of physical function limitations among PWH.
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Affiliation(s)
- Mary C Masters
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jingyan Yang
- Department of Epidemiology, Mailman School of Public Heath, Columbia University, New York, New York
| | - Jordan E Lake
- Department of Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins University School of Medicine
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Frank J Palella
- Department of Medicine, Northwestern University, Chicago, Illinois
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22
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BAILIN SS, KUNDU S, WELLONS M, FREIBERG MS, DOYLE MF, TRACY RP, JUSTICE AC, WANJALLA CN, LANDAY AL, SO-ARMAH K, MALLAL S, KROPSKI JA, KOETHE JR. Circulating CD4+ TEMRA and CD4+ CD28- T cells and incident diabetes among persons with and without HIV. AIDS 2022; 36:501-511. [PMID: 34860194 PMCID: PMC8881388 DOI: 10.1097/qad.0000000000003137] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A higher proportion of circulating memory CD4+ T cells is associated with prevalent diabetes mellitus in persons with HIV (PWH) and HIV-negative persons. We assessed whether circulating T-cell subsets could also identify individuals who will subsequently develop diabetes. DESIGN This is a longitudinal follow-up study of PWH and similar HIV-negative individuals from the Veterans Aging Cohort Study who provided peripheral mononuclear blood cells between 2005 and 2007. METHODS We quantified T-cell subsets using flow cytometry and functional assays to identify CD4+ and CD8+ naive, activated, senescent, memory (central, effector, and effector RA+), and TH1, TH2, and TH17-phenotype cells. The occurrence of an incident diabetes diagnosis (i.e. after baseline blood draw) was adjudicated by a two-physician chart review. Cox proportional hazards models adjusted for traditional risk factors, cytomegalovirus serostatus, and plasma inflammatory biomarkers assessed the relationship between T-cell subsets and incident diabetes. RESULTS One thousand, eight hundred and thirty-seven participants (1259 PWH) without diabetes at baseline were included; 69% were black, 95% were men, and median follow-up was 8.6 years. Higher baseline frequencies of CD4+ T effector memory RA+ (TEMRA) cells defined as CD45RA+ CD27- (P = 0.04) and senescent T cells defined as CD4+ CD28- (P = 0.04) were associated with incident diabetes in PWH only. CONCLUSIONS Higher frequencies of CD4+ TEMRA and CD4+ CD28- T cells were associated with incident diabetes in PWH only after adjustment for other factors. Additional studies are necessary to assess whether these cells act in blood via inflammatory mediators or reflect T-cell populations in metabolically active tissues.
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Affiliation(s)
- Samuel S. BAILIN
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Suman KUNDU
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa WELLONS
- Divison of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew S. FREIBERG
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Margaret F. DOYLE
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Russell P. TRACY
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Amy C. JUSTICE
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, West Haven, Connecticut, USA
| | - Celestine N. WANJALLA
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan L. LANDAY
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kaku SO-ARMAH
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Simon MALLAL
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Translational Immunology and Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan A. KROPSKI
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John R. KOETHE
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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23
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Birabaharan M, Strunk A, Kaelber DC, Smith DM, Martin TC. Sex differences in type 2 diabetes mellitus prevalence among persons with HIV. AIDS 2022; 36:383-389. [PMID: 34750292 PMCID: PMC8795484 DOI: 10.1097/qad.0000000000003127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine whether type 2 diabetes mellitus (T2DM) is more common among women with HIV (WWH) than men with HIV (MWH). DESIGN A cross-sectional analysis of a demographically heterogenous population-based sample of more than 64 million patients in the United States. METHODS Using the Explorys (IBM) database, compare the prevalence of T2DM among men and women without HIV and influence of HIV on T2DM by sex controlling for confounding factors. RESULTS From 19 182 775 persons included in the study, 39 485 were with HIV. Rates of obesity was higher among WWH than MWH (58 vs. 35%). Prevalence of T2DM among WWH was 23% compared with 16% among MWH (P < 0.001). In sex-stratified adjusted analysis, WWH had 1.31 [95% confidence interval (CI), 1.24-1.38] times the odds of having T2DM than women without HIV. Women with HIV was associated with T2DM across all demographic subgroups. In contrast, no association between HIV and T2DM was observed among men (OR 1.01; 95% CI 0.98-1.05). CONCLUSION These data suggest that HIV confers a sex-specific increase in odds of T2DM among women but not men.
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Affiliation(s)
- Morgan Birabaharan
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California, San Diego, La Jolla, California,
USA
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and
Population and Quantitative Health Sciences, School of Medicine, Case Western
Reserve University, Cleveland, Ohio, USA
- Center for Clinical Informatics Research and Education, The
MetroHealth System, Cleveland, Ohio, USA
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California, San Diego, La Jolla, California,
USA
- San Diego Veterans Affairs Healthcare System, San Diego,
CA, USA
| | - Thomas C.S. Martin
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California, San Diego, La Jolla, California,
USA
- San Diego Veterans Affairs Healthcare System, San Diego,
CA, USA
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24
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Sehl ME, Breen EC, Shih R, Chen L, Wang R, Horvath S, Bream JH, Duggal P, Martinson J, Wolinsky SM, Martinez-Maza O, Ramirez CM, Jamieson BD. Increased Rate of Epigenetic Aging in Men Living With HIV Prior to Treatment. Front Genet 2022; 12:796547. [PMID: 35295196 PMCID: PMC8919029 DOI: 10.3389/fgene.2021.796547] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/06/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Epigenetic aging is accelerated in tissues of persons living with HIV (PLWH) and may underlie the early onset of age-related illnesses. This study examines the rate-of-change in epigenetic age in PLWH following HIV infection but before HAART, using archived longitudinal samples from the Multicenter AIDS Cohort Study. Methods: DNA was isolated from cryopreserved peripheral blood mononuclear cells from 101 men living with HIV, with baseline visit <2.5 years after HIV seroconversion (Visit 1) and follow-up visit <1.5 years before the initiation of HAART (Visit 2), and 100 HIV-uninfected men matched on age and visits with comparable time intervals. DNA methylation (DNAm) age was estimated for five clocks (Pan-tissue, Extrinsic, Phenotypic, Grim, and Skin & Blood age), and a DNAm-based estimate of telomere length (DNAmTL). Multivariate linear regression models were used to examine baseline factors associated with rate-of-aging, defined as (DNAm age visit 2-DNAm age visit 1)/(age visit 2-age visit 1). Results: Epigenetic age increased approximately twice as fast in PLWH as uninfected controls (Pan-tissue, Extrinsic, and Phenotypic clocks). Shortening of DNAmTL was nearly 3-fold faster in PLWH than controls. Faster rate-of-aging was associated with HIV status (Pan-Tissue, Extrinsic, Phenotypic, and DNAmTL), white race (Extrinsic, DNAmTL), higher cumulative HIV viral load (Grim), and lower baseline DNAm age (Phenotypic, Skin & Blood). Conclusion: Epigenetic rates-of-aging were significantly faster for untreated PLWH. Our findings expand on the important impact of HIV infection on biologic aging, both in elevating epigenetic age and increasing the rate-of-aging in the years following infection.
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Affiliation(s)
- Mary E. Sehl
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Crabb Breen
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roger Shih
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Larry Chen
- UCLA Computational and Systems Biology Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ruibin Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jay H. Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Immunology Training Program, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Priya Duggal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven M. Wolinsky
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Otoniel Martinez-Maza
- Departments of Obstetrics and Gynecology and Microbiology, Immunology and Molecular Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Christina M. Ramirez
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Beth D. Jamieson
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
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25
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Huličiak M, Vokřál I, Holas O, Martinec O, Štaud F, Červený L. Evaluation of the Potency of Anti-HIV and Anti-HCV Drugs to Inhibit P-Glycoprotein Mediated Efflux of Digoxin in Caco-2 Cell Line and Human Precision-Cut Intestinal Slices. Pharmaceuticals (Basel) 2022; 15:ph15020242. [PMID: 35215354 PMCID: PMC8875242 DOI: 10.3390/ph15020242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/23/2022] Open
Abstract
The inhibition of P-glycoprotein (ABCB1) could lead to increased drug plasma concentrations and hence increase drug toxicity. The evaluation of a drug’s ability to inhibit ABCB1 is complicated by the presence of several transport-competent sites within the ABCB1 binding pocket, making it difficult to select appropriate substrates. Here, we investigate the capacity of antiretrovirals and direct-acting antivirals to inhibit the ABCB1-mediated intestinal efflux of [3H]-digoxin and compare it with our previous rhodamine123 study. At concentrations of up to 100 µM, asunaprevir, atazanavir, daclatasvir, darunavir, elbasvir, etravirine, grazoprevir, ledipasvir, lopinavir, rilpivirine, ritonavir, saquinavir, and velpatasvir inhibited [3H]-digoxin transport in Caco-2 cells and/or in precision-cut intestinal slices prepared from the human jejunum (hPCIS). However, abacavir, dolutegravir, maraviroc, sofosbuvir, tenofovir disoproxil fumarate, and zidovudine had no inhibitory effect. We thus found that most of the tested antivirals have a high potential to cause drug–drug interactions on intestinal ABCB1. Comparing the Caco-2 and hPCIS experimental models, we conclude that the Caco-2 transport assay is more sensitive, but the results obtained using hPCIS agree better with reported in vivo observations. More inhibitors were identified when using digoxin as the ABCB1 probe substrate than when using rhodamine123. However, both approaches had limitations, indicating that inhibitory potency should be tested with at least these two ABCB1 probes.
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Affiliation(s)
- Martin Huličiak
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, 50005 Hradec Králové, Czech Republic; (M.H.); (O.M.); (F.Š.); (L.Č.)
| | - Ivan Vokřál
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, 50005 Hradec Králové, Czech Republic; (M.H.); (O.M.); (F.Š.); (L.Č.)
- Correspondence:
| | - Ondřej Holas
- Department of Pharmaceutical Technology, Faculty of Pharmacy in Hradec Králové, Charles University, 50005 Hradec Králové, Czech Republic;
| | - Ondřej Martinec
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, 50005 Hradec Králové, Czech Republic; (M.H.); (O.M.); (F.Š.); (L.Č.)
| | - František Štaud
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, 50005 Hradec Králové, Czech Republic; (M.H.); (O.M.); (F.Š.); (L.Č.)
| | - Lukáš Červený
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, 50005 Hradec Králové, Czech Republic; (M.H.); (O.M.); (F.Š.); (L.Č.)
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26
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Tepekule B, Kusejko K, Zeeb M, Tarr PE, Calmy A, Battegay M, Furrer H, Cavassini M, Bernasconi E, Notter J, Günthard HF, Nemeth J, Kouyos RD. Impact of Latent Tuberculosis Infection on the Incidence of Type 2 Diabetes Mellitus in HIV-Infected Participants in the Swiss HIV Cohort Study. J Infect Dis 2022; 225:2229-2234. [PMID: 35172332 DOI: 10.1093/infdis/jiac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
While an increased risk of active and latent tuberculosis infection (LTBI) in people with type-2 diabetes (DM) has been demonstrated, it is less well characterized whether LTBI is associated with an increased risk of developing DM. We investigated the link between LTBI and DM in people living with HIV (PHIV) in the Swiss HIV Cohort Study via time-dependent cox proportional hazards models. We found that LTBI significantly increased the risk of developing DM (HR=1.47), which was robust across different adjustment and censoring techniques. Our results thus suggest that LTBI may be associated with an increased risk of developing DM.
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Affiliation(s)
- Burcu Tepekule
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Marius Zeeb
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Philip E Tarr
- Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases & Hospital Hygiene, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital, Lausanne, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Julia Notter
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Johannes Nemeth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
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27
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Zerumbone suppresses high glucose and LPS-induced inflammation in THP-1-derived macrophages by inhibiting the NF-κB/TLR signaling pathway. Nutr Res 2022; 100:58-69. [DOI: 10.1016/j.nutres.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 12/28/2021] [Accepted: 01/16/2022] [Indexed: 02/06/2023]
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28
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Zuñiga JA, Sales A, Jang DE, West Ohueri C, Burkholder G, Moore R, Davy-Méndez T, Christopoulos K, García AA. Self-Management Model fails to Predict Quality of Life for People Living with Dual Diagnosis of HIV and Diabetes. AIDS Behav 2022; 26:488-495. [PMID: 34351517 PMCID: PMC8816808 DOI: 10.1007/s10461-021-03405-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
The objective of this study was to test a self-management model for self-management in people living with HIV and type 2 diabetes (PLWH + T2DM). We conducted a predictive, longitudinal study of data from a national research cohort of PLWH using lag analysis to test short- and long-term health outcomes for PLWH + T2DM. We used a dataset from the Center for AIDS Research (CFAR) Network of Integrated Clinic Systems (CNICS), a nation-wide research network of 8 clinics that serves PLWH. Patient-reported outcomes, collected at clinic visit, included depression, adherence, CD4 cell count, and health-related quality of life (HRQoL). We computed summary statistics to describe the sample. Using lag analysis, we then modeled the three variables of adherence, CD4 count, and HRQoL as a function of their predecessors in our conceptual model. In the final model, an increase of in medication adherence corresponded to a small increase in HRQoL. An increase in CD4 count corresponded to a small increase in HRQoL. An increase in lagged depression was associated with a small decrease in HRQoL. The model was not sufficient to predict short- or long-term outcomes in PLWH + T2DM. Although depression had a moderate impact, the final model was not clinically significant. For people with a dual diagnosis of HIV and T2DM, variables other than those traditionally addressed in self-management interventions may be more important.
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Affiliation(s)
| | - Adam Sales
- Worcester Polytechnic Institute, Worcester, USA
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Fuseini H, Smith R, Nochowicz CH, Simmons JD, Hannah L, Wanjalla CN, Gabriel CL, Mashayekhi M, Bailin SS, Castilho JL, Hasty AH, Koethe JR, Kalams SA. Leptin Promotes Greater Ki67 Expression in CD4 + T Cells From Obese Compared to Lean Persons Living With HIV. Front Immunol 2022; 12:796898. [PMID: 35111163 PMCID: PMC8801429 DOI: 10.3389/fimmu.2021.796898] [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] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
While antiretroviral therapy (ART) has proven effective in suppressing viremia and disease progression among people living with human immunodeficiency virus (HIV; PLWH), suboptimal CD4+ T cell reconstitution remains a major obstacle in nearly 30% of ART-treated individuals. Epidemiological studies demonstrate that obesity, or a body mass index (BMI) ≥ 30 kg/m2, is positively correlated with greater CD4+ T cell recovery in PLWH on ART. Leptin is a known immunomodulator that is produced in proportion to fat mass and is increased in obese individuals, including PLWH. We hypothesized that CD4+ T cells from obese PLWH have increased cell proliferation and cytokine production compared to cells from lean PLWH, potentially modulated by differential effects of leptin signaling. To test this hypothesis, peripheral blood mononuclear cells from obese and lean PLWH with long-term virologic suppression on the same ART regimen were pretreated with recombinant leptin and then stimulated with anti-CD3/CD28 or PMA/ionomycin to measure Ki67 expression, leptin receptor (LepR) surface expression and cytokine production. In the absence of leptin, Ki67 expression and IL-17A production were significantly higher in CD4+ T cells from obese compared to lean PLWH. However, LepR expression was significantly lower on CD4+ T cells from obese compared to lean PLWH. After leptin treatment, Ki67 expression was significantly increased in CD4+ T cells from obese PLWH compared to the lean participants. Leptin also increased IL-17A production in CD4+ T cells from obese healthy controls. In contrast, leptin decreased IL-17A production in CD4+ T cells from both obese and lean PLWH. Combined, these results demonstrate that obesity is associated with greater CD4+ T cell proliferation among PLWH, and that higher circulating leptin levels in obesity may contribute to improved CD4+ T reconstitution in PLWH initiating ART.
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Affiliation(s)
- Hubaida Fuseini
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Rita Smith
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Cindy H. Nochowicz
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Joshua D. Simmons
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - LaToya Hannah
- Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Celestine N. Wanjalla
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Curtis L. Gabriel
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mona Mashayekhi
- Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Samuel S. Bailin
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jessica L. Castilho
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Alyssa H. Hasty
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, United States
- The Veterans Affairs Tennessee Healthcare System, Nashville, TN, United States
| | - John R. Koethe
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
- The Veterans Affairs Tennessee Healthcare System, Nashville, TN, United States
| | - Spyros A. Kalams
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
- Tennessee Center for AIDS Research, Vanderbilt University Medical Center, Nashville, TN, United States
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Marconi VC, Moser C, Gavegnano C, Deeks SG, Lederman MM, Overton ET, Tsibris A, Hunt PW, Kantor A, Sekaly RP, Tressler R, Flexner C, Hurwitz SJ, Moisi D, Clagett B, Hardin WR, del Rio C, Schinazi RF, Lennox JJ. Randomized Trial of Ruxolitinib in Antiretroviral-Treated Adults With Human Immunodeficiency Virus. Clin Infect Dis 2022; 74:95-104. [PMID: 33693561 PMCID: PMC8752257 DOI: 10.1093/cid/ciab212] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inflammation is associated with end-organ disease and mortality for people with human immunodeficiency virus (PWH). Ruxolitinib, a Jak 1/2 inhibitor, reduces systemic inflammation for individuals without human immunodeficiency virus (HIV) and HIV reservoir markers ex vivo. The goal of this trial was to determine safety and efficacy of ruxolitinib for PWH on antiretroviral therapy (ART). METHODS AIDS Clinical Trials Group (ACTG) A5336 was an open-label, multisite, randomized controlled trial (RCT). Participants were randomly assigned (2:1) using centralized software to ruxolitinib (10 mg twice daily) plus stable ART for 5 weeks vs ART alone, stratified by efavirenz use. Eligible participants were suppressed on ART for ≥2 years, without comorbidities, and had >350 CD4+ T cells/µL. Primary endpoints were premature discontinuation, safety events, and change in plasma interleukin 6 (IL-6). Secondary endpoints included other measures of inflammation/immune activation and HIV reservoir. RESULTS Sixty participants were enrolled from 16 May 2016 to 10 January 2018. Primary safety events occurred in 2.5% (1 participant) for ruxolitinib and 0% for controls (P = .67). Three participants (7.5%) prematurely discontinued ruxolitinib. By week 5, differences in IL-6 (mean fold change [FC], 0.93 vs 1.10; P = .18) and soluble CD14 (mean FC, 0.96 vs 1.08; relative FC, 0.96 [90% confidence interval {CI}, .90-1.02]) levels for ruxolitinib vs controls was observed. Ruxolitinib reduced CD4+ T cells expressing HLA-DR/CD38 (mean difference, -0.34% [90% CI, -.66% to -.12%]) and Bcl-2 (mean difference, -3.30% [90% CI, -4.72% to -1.87%]). CONCLUSIONS In this RCT of healthy, virologically suppressed PWH on ART, ruxolitinib was well-tolerated. Baseline IL-6 levels were normal and showed no significant reduction. Ruxolitinib significantly decreased markers of immune activation and cell survival. Future studies of Jak inhibitors should target PWH with residual inflammation despite suppressive ART. CLINICAL TRIALS REGISTRATION NCT02475655.
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Affiliation(s)
- Vincent C Marconi
- Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Emory Vaccine Center, Atlanta, Georgia, USA
| | - Carlee Moser
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Steven G Deeks
- University of California, San Francisco, San Francisco, California, USA
| | | | - Edgar T Overton
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Athe Tsibris
- Harvard Medical School, Boston, Massachusetts, USA
| | - Peter W Hunt
- University of California, San Francisco, San Francisco, California, USA
| | - Amy Kantor
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | | | | | - Daniela Moisi
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Brian Clagett
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Carlos del Rio
- Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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Lang J, Xin X, Chen P, Ning Z, Xiao S. Distinct patterns of fasting plasma glucose and lipid profile levels over time in adults tested positive for HIV on HAART in Shanghai, China, revealed using growth mixture models. Front Med (Lausanne) 2022; 9:1071431. [PMID: 36733932 PMCID: PMC9887111 DOI: 10.3389/fmed.2022.1071431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives This study sought to identify potential change patterns and predictors of fasting plasma glucose (FPG) and lipid levels after initiating highly active antiretroviral therapy (HAART). Methods A retrospective cohort study was conducted on 1,572 patients tested positive for HIV who initiated HAART between January 2010 and October 2020 in Shanghai, China. The growth mixture models (GMM) were used for capturing subgroups of FPG trajectories as well as triglyceride (TG) and total cholesterol (TC) dual-trajectories. Multinomial logistic regression models identified correlates of given trajectories. Results The median follow-up time was 2.0 years (IQR 1.0-4.7). Three FPG trajectory subgroups were identified as FPG low-stable (62.3%), medium-stable (30.5%), and high-increasing (7.2%). Furthermore, three subgroups of TG and TC dual-trajectories were identified as TG and TC high-slight increasing (13.7%), low-rapid increasing (27.6%), and a subgroup of medium-stable TC and slight-decreasing TG (58.7%). Older age, high TG, FPG, BMI, CD4 count of <200 at baseline, and initial use of zidovudine (AZT) and protease inhibitors (PIs) helped to identify the class with increasing glucose or lipid metabolism trajectories. Conclusion The change patterns of plasma glucose and lipid in patients tested positive for HIV were heterogeneous and tailored interventions should be considered in specific subgroups.
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Affiliation(s)
- Jingjing Lang
- School of Public Health, Fudan University, Shanghai, China
| | - Xin Xin
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Panpan Chen
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Zhen Ning
- Shanghai Center for Disease Control and Prevention, Shanghai, China
| | - Shaotan Xiao
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
- *Correspondence: Shaotan Xiao
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Bavaro DF, Laghetti P, Poliseno M, De Gennaro N, Di Gennaro F, Saracino A. A Step Closer to the "Fourth 90": A Practical Narrative Review of Diagnosis and Management of Nutritional Issues of People Living with HIV. Diagnostics (Basel) 2021; 11:diagnostics11112047. [PMID: 34829394 PMCID: PMC8618448 DOI: 10.3390/diagnostics11112047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 12/02/2022] Open
Abstract
The quality of life of people living with HIV (PLWH) has remarkably increased thanks to the introduction of combined antiretroviral therapy. Still, PLWH are exposed to an increased risk of cardiovascular diseases, diabetes, chronic kidney disease, and liver disease. Hence, the purpose of this review is to summarize the current knowledge about diagnosis and nutritional management with specific indication of macro and micronutrients intake for the main comorbidities of PLWH. In fact, a prompt diagnosis and management of lifestyle behaviors are fundamental steps to reach the “fourth 90”. To achieve an early diagnosis of these comorbidities, clinicians have at their disposal algorithms such as the Framingham Score to assess cardiovascular risk; transient elastography and liver biopsy to detect NAFLD and NASH; and markers such as the oral glucose tolerance test and GFR to identify glucose impairment and renal failure, respectively. Furthermore, maintenance of ideal body weight is the goal for reducing cardiovascular risk and to improve diabetes, steatosis and fibrosis; while Mediterranean and low-carbohydrate diets are the dietetic approaches proposed for cardioprotective effects and for glycemic control, respectively. Conversely, diet management of chronic kidney disease requires different nutritional assessment, especially regarding protein intake, according to disease stage and eventually concomitant diabetes.
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Affiliation(s)
- Davide Fiore Bavaro
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
- Correspondence: ; Tel.: +39-080-559-2477; Fax: +39-080-559-230
| | - Paola Laghetti
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
| | | | - Nicolò De Gennaro
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
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Simon L, Torres D, Saravia A, Levitt DE, Vande Stouwe C, McGarrah H, Coleman L, Dufour JP, Amedee AM, Molina PE. Chronic binge alcohol and ovariectomy-mediated impaired insulin responsiveness in SIV-infected female rhesus macaques. Am J Physiol Regul Integr Comp Physiol 2021; 321:R699-R711. [PMID: 34524906 PMCID: PMC8616623 DOI: 10.1152/ajpregu.00159.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/24/2021] [Accepted: 09/09/2021] [Indexed: 12/13/2022]
Abstract
Aging people living with HIV (PLWH), especially postmenopausal women may be at higher risk of comorbidities associated with HIV, antiretroviral therapy (ART), hypogonadism, and at-risk alcohol use. Our studies in simian immunodeficiency virus (SIV)-infected male macaques demonstrated that chronic binge alcohol (CBA) reduced acute insulin response to glucose (AIRG), and at-risk alcohol use decreased HOMA-β in PLWH. The objective of this study was to examine the impact of ovariectomy (OVX) on glucose-insulin dynamics and integrity of pancreatic endocrine function in CBA/SIV-infected female macaques. Female macaques were administered CBA (12-15 g/kg/wk) or isovolumetric water (VEH) intragastrically. Three months after initiation of CBA/VEH administration, all macaques were infected with SIVmac251, and initiated on antiretroviral therapy (ART) 2.5 mo postinfection. After 1 mo of ART, macaques were randomized to OVX or sham surgeries (n = 7 or 8/group), and euthanized 8 mo post-OVX (study endpoint). Frequently sampled intravenous glucose tolerance tests (FSIVGTT) were performed at selected time points. Pancreatic gene expression and islet morphology were determined at study endpoint. There was a main effect of CBA to decrease AIRG at Pre-SIV and study endpoint. There were no statistically significant OVX effects on AIRG (P = 0.06). CBA and OVX decreased the expression of pancreatic markers of insulin docking and release. OVX increased endoplasmic stress markers. CBA but not OVX impaired glucose-insulin expression dynamics in SIV-infected female macaques. Both CBA and OVX altered integrity of pancreatic endocrine function. These findings suggest increased vulnerability of PLWH to overt metabolic dysfunction that may be exacerbated by alcohol use and ovarian hormone loss.
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Affiliation(s)
- Liz Simon
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Diego Torres
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Ari Saravia
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Danielle E Levitt
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Curtis Vande Stouwe
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Heather McGarrah
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Larry Coleman
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jason P Dufour
- Division of Veterinary Medicine, Tulane National Primate Research Center, Covington, Louisiana
| | - Angela M Amedee
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patricia E Molina
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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SLAMA L, BARRETT BW, ABRAHAM AG, PALELLA FJ, KINGSLEY L, VIARD JP, LAKE JE, BROWN TT. Risk for incident diabetes is greater in prediabetic men with HIV than without HIV. AIDS 2021; 35:1605-1614. [PMID: 33859110 PMCID: PMC8898036 DOI: 10.1097/qad.0000000000002922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diabetes mellitus is a major comorbidity in people with HIV (PWH). Hyperglycemia below diabetic range defines prediabetes (prediabetes mellitus). We compared the progression from prediabetes mellitus to diabetes mellitus in PWH and people without HIV (PWOH). METHODS Fasting glucose was measured semiannually in the MACS since 1999. Men with prediabetes mellitus (fasting glucose between 100 and 125 mg/dl, confirmed within a year by fasting glucose in the prediabetes mellitus range or HbA1c between 5.7 and 6.4%) were included. The first visit with prediabetes mellitus was the baseline visit. Incident diabetes mellitus was defined as fasting glucose at least 126 mg/dl, confirmed at a subsequent visit, or self-reported diabetes mellitus, or use of anti-diabetes mellitus medication. We used binomial transition models to compare the progression from prediabetes mellitus to diabetes mellitus by HIV serostatus, adjusted for age, number of previous prediabetes mellitus to diabetes mellitus transitions, ethnicity, BMI, family history of diabetes mellitus, and hepatitis C virus (HCV) infection. RESULTS Between 1999 and 2019, 1584 men (793 PWH; 791 PWOH) with prediabetes mellitus were included. At baseline, PWH were younger (48 vs. 51 years, P < 0.01), had lower BMI (26 vs. 27), were more frequently nonwhite (47 vs. 30%), and HCV-infected as per last measure (8 vs. 4%) than PWOH (all P < 0.01). Over a median 12-year follow-up, 23% of participants developed diabetes mellitus. In adjusted analyses, the risk for incident diabetes mellitus was 40% (95% CI: 0--80%) higher among PWH than PWOH (P = 0.04). CONCLUSION Among men with prediabetes mellitus, PWH had an increased risk of incident diabetes mellitus adjusted for competing risk factors, warranting the evaluation of diabetes mellitus prevention strategies.
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Affiliation(s)
- Laurence SLAMA
- Infectious Diseases Unit Hôtel-Dieu Hospital, APHP centre, Université de Paris, F-75004, France
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - Frank J. PALELLA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Jean Paul VIARD
- Infectious Diseases Unit Hôtel-Dieu Hospital, APHP centre, Université de Paris, F-75004, France
| | - Jordan E. LAKE
- University of Texas Health Science Center, Houston, TX. USA
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Pino M, Pereira Ribeiro S, Pagliuzza A, Ghneim K, Khan A, Ryan E, Harper JL, King CT, Welbourn S, Micci L, Aldrete S, Delman KA, Stuart T, Lowe M, Brenchley JM, Derdeyn CA, Easley K, Sekaly RP, Chomont N, Paiardini M, Marconi VC. Increased homeostatic cytokines and stability of HIV-infected memory CD4 T-cells identify individuals with suboptimal CD4 T-cell recovery on-ART. PLoS Pathog 2021; 17:e1009825. [PMID: 34449812 PMCID: PMC8397407 DOI: 10.1371/journal.ppat.1009825] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/23/2021] [Indexed: 01/12/2023] Open
Abstract
Clinical outcomes are inferior for individuals with HIV having suboptimal CD4 T-cell recovery during antiretroviral therapy (ART). We investigated if the levels of infection and the response to homeostatic cytokines of CD4 T-cell subsets contributed to divergent CD4 T-cell recovery and HIV reservoir during ART by studying virologically-suppressed immunologic responders (IR, achieving a CD4 cell count >500 cells/μL on or before two years after ART initiation), and virologically-suppressed suboptimal responders (ISR, did not achieve a CD4 cell count >500 cells/μL in the first two years after ART initiation). Compared to IR, ISR demonstrated higher levels of HIV-DNA in naïve, central (CM), transitional (TM), and effector (EM) memory CD4 T-cells in blood, both pre- and on-ART, and specifically in CM CD4 T-cells in LN on-ART. Furthermore, ISR had higher pre-ART plasma levels of IL-7 and IL-15, cytokines regulating T-cell homeostasis. Notably, pre-ART PD-1 and TIGIT expression levels were higher in blood CM and TM CD4 T-cells for ISR; this was associated with a significantly lower fold-changes in HIV-DNA levels between pre- and on-ART time points exclusively on CM and TM T-cell subsets, but not naïve or EM T-cells. Finally, the frequency of CM CD4 T-cells expressing PD-1 or TIGIT pre-ART as well as plasma levels of IL-7 and IL-15 predicted HIV-DNA content on-ART. Our results establish the association between infection, T-cell homeostasis, and expression of PD-1 and TIGIT in long-lived CD4 T-cell subsets prior to ART with CD4 T-cell recovery and HIV persistence on-ART.
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Affiliation(s)
- Maria Pino
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Susan Pereira Ribeiro
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Amélie Pagliuzza
- Centre de Recherche du CHUM and Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, QC, Canada
| | - Khader Ghneim
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Anum Khan
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Emily Ryan
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Justin L. Harper
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Colin T. King
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Sarah Welbourn
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
| | - Luca Micci
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
| | - Sol Aldrete
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Keith A. Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| | - Theron Stuart
- Emory Vaccine Center, Emory University, Hope Clinic, Decatur, Georgia, United States of America
| | - Michael Lowe
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| | - Jason M. Brenchley
- Barrier Immunity Section, Laboratory of Viral Diseases, National Institutes of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Cynthia A. Derdeyn
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Rafick P. Sekaly
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Nicolas Chomont
- Centre de Recherche du CHUM and Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, QC, Canada
| | - Mirko Paiardini
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Vincent C. Marconi
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Atlanta, Georgia, United States of America
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, United States of America
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Katusiime MG, Van Zyl GU, Cotton MF, Kearney MF. HIV-1 Persistence in Children during Suppressive ART. Viruses 2021; 13:v13061134. [PMID: 34204740 PMCID: PMC8231535 DOI: 10.3390/v13061134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/16/2022] Open
Abstract
There is a growing number of perinatally HIV-1-infected children worldwide who must maintain life-long ART. In early life, HIV-1 infection is established in an immunologically inexperienced environment in which maternal ART and immune dynamics during pregnancy play a role in reservoir establishment. Children that initiated early antiretroviral therapy (ART) and maintained long-term suppression of viremia have smaller and less diverse HIV reservoirs than adults, although their proviral landscape during ART is reported to be similar to that of adults. The ability of these early infected cells to persist long-term through clonal expansion poses a major barrier to finding a cure. Furthermore, the effects of life-long HIV persistence and ART are yet to be understood, but growing evidence suggests that these individuals are at an increased risk for developing non-AIDS-related comorbidities, which underscores the need for an HIV cure.
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Affiliation(s)
- Mary Grace Katusiime
- HIV Dynamics and Replication Program, CCR, National Cancer Institute, Frederick, MD 21702, USA;
- Correspondence:
| | - Gert U. Van Zyl
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Service Tygerberg, Cape Town 8000, South Africa;
| | - Mark F. Cotton
- Department of Pediatrics and Child Health, Tygerberg Children’s Hospital and Family Center for Research with Ubuntu, Stellenbosch University, Cape Town 7505, South Africa;
| | - Mary F. Kearney
- HIV Dynamics and Replication Program, CCR, National Cancer Institute, Frederick, MD 21702, USA;
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Webel AR, Schexnayder J, Cioe PA, Zuñiga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. J Assoc Nurses AIDS Care 2021; 32:322-346. [PMID: 33595986 PMCID: PMC8815414 DOI: 10.1097/jnc.0000000000000240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT People living with HIV are living longer, high-quality lives; however, as they age, this population is at increased risk for developing chronic comorbidities, including cardiovascular disease, certain types of cancer (e.g., lung, anal, and liver), and diabetes mellitus. The purpose of this state-of-the-science review is to provide an evidence-based summary on common physical comorbidities experienced by people living and aging with HIV. We focus on those chronic conditions that are prevalent and growing and share behavioral risk factors that are common in people living with HIV. We will discuss the current evidence on the epidemiology, physiology, prevention strategies, screening, and treatment options for people living with HIV across resource settings.
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Affiliation(s)
- Allison R Webel
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie Schexnayder
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Patricia A Cioe
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie A Zuñiga
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
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Bares SH, Smeaton LM, Scott SE, Smith BA, Godfrey C, McComsey GA. The Association Between Weight Gain, Sex and Immune Activation Following the Initiation of Antiretroviral Therapy. J Infect Dis 2021; 224:1765-1774. [PMID: 33870433 DOI: 10.1093/infdis/jiab210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Immune activation persists despite suppressive antiretroviral therapy (ART) and may be affected by sex or body composition. We explored these relationships in a subset of participants who initiated ART in two large randomized trials. METHODS Purposeful sampling selected participants who achieved virologic suppression on ART and either maintained weight within +/- 0.5 kg/m 2 or gained 2.6-6.4 kg/m 2 from baseline to 96 weeks. We measured 7 markers of inflammation and immune activation at weeks 0 and 96. Multivariable linear regression explored associations of weight gain, sex, and pre-ART BMI with pre-ART and changes in biomarker concentrations. RESULTS 340 participants were selected; median pre-ART age 42 years, CD4+ cell count 273 cells/mm 3, HIV-1 RNA 4.7 log10 copies/mL; 49% were women, 33% white, 42% black, and 24% Hispanic. Among participants with a normal pre-ART BMI, higher pre-ART levels of IL-6, sTNF-RI and RII, CXCL-10, sCD163 and hsCRP were associated with weight gain. Association of weight gain with week 96 changes of these biomarkers differed by sex; women who gained weight had smaller declines in most measured biomarkers compared to men who gained. CONCLUSIONS Among women, weight gain is associated with attenuated decline in several immune activation markers following ART initiation.
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Affiliation(s)
- Sara H Bares
- University of Nebraska Medical Center, Omaha, NE, U.S
| | | | - Sarah E Scott
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, U.S
| | - Beth A Smith
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, U.S
| | - Catherine Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington D.C., U.S
| | - Grace A McComsey
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, U.S
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Differences in Health-Related Quality of Life Predictors in People Living With HIV With and Without Diabetes. J Assoc Nurses AIDS Care 2021; 31:544-552. [PMID: 31789685 DOI: 10.1097/jnc.0000000000000138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Diabetes is one of the most common comorbid conditions in people living with HIV (PLWH). Diabetes may affect health-related quality of life (HRQoL) for PLWH because they experience more symptoms, are prescribed more medications, and are required to do self-care activities. The purpose of our study was to compare predictors of the HRQoL for PLWH with and without diabetes. The study was a secondary analysis of data from the Center for AIDS Research Network of Integrated Clinical Systems cohort using multiple regression. Significant differences were found between PLWH with and without diabetes. The significant predictors of HRQoL for PLWH-alone were depression, anxiety, medication adherence, physical activity, smoking, and age. For PLWH with diabetes, the only significant predictors of HRQoL were anxiety and depression.
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40
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Basil RC, Brown TT, Haberlen S, Rubin LH, Plankey M, Becker JT, Lake JE, Palella FJ, Sarkar S. The relationship between diabetes and depressive symptoms in men with or at risk of HIV infection. HIV Med 2021; 22:37-46. [PMID: 32975014 PMCID: PMC8211402 DOI: 10.1111/hiv.12958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to compare the prevalence of comorbid diabetes and depressive symptoms in men living with HIV (MLWH) with that in men without HIV infection and to determine associations between glycaemic control and depressive symptoms. METHODS Participants included 920 MLWH and 840 men without HIV infection from the Multicenter AIDS Cohort Study (MACS) with available data regarding glycaemic status [categorized as normal for fasting blood glucose (FBG) < 100 mg/dL, prediabetes for FBG 100-125 mg/dL, and diabetes, defined by self-report, diabetes medication use or FBG ≥ 126 mg/dL on at least two consecutive visits, with diabetes classified as controlled if Hemoglobin A1c (HbA1C) < 7.5% and uncontrolled if HbA1C ≥ 7.5%]. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) score, with CES-D ≥ 16 scores classified as elevated depressive symptoms. A modified Poisson regression model with robust variance was used and adjusted for covariates including HIV serostatus. RESULTS Compared to men without HIV infection, MLWH had a higher mean CES-D score, but a similar prevalence of diabetes (11.3% versus 12.8%, respectively; P = 0.33). The concomitant prevalence of diabetes and elevated depressive symptoms did not differ by HIV serostatus (P = 0.215). In an adjusted analysis, men with uncontrolled diabetes had a greater prevalence of depressive symptoms compared to men with normoglycaemia (prevalence ratio = 1.43; 95% confidence interval 1.11, 1.84). The association between glycaemic status and depressive symptoms did not differ by HIV serostatus (P = 0.22 for interaction). CONCLUSIONS Both controlled and uncontrolled diabetes were independently associated with a greater prevalence of depressive symptoms, regardless of HIV serostatus. These results highlight the importance of identifying depression in people with diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | - Frank J. Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL
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41
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Haile ZT, Sarfo B, Bonney EY, Mensah EA, Deletsu S. Association between Antiretroviral Treatment and Markers of Systemic Inflammation among HIV Patients in Ghana. Curr HIV Res 2020; 18:466-474. [PMID: 32807057 DOI: 10.2174/1570162x18666200817111152] [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] [Received: 02/19/2020] [Revised: 06/27/2020] [Accepted: 07/17/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Studies from high-income countries have reported that even after receiving antiretroviral treatment (ART), HIV-infected adults may not achieve normal levels of certain inflammatory markers that are known to be associated with the onset and development of non-communicable diseases. OBJECTIVE The aim of this study is to examine the relationship between ART and markers of systemic inflammation in HIV/AIDS patients at an urban antiretroviral clinic in Ghana. METHODS We examined serum levels of high sensitivity CRP (hsCRP), interleukin-6 (IL-6), interleukin- 18(IL-18), and tumor necrosis factor-α (sTNFR1 and sTNFR2) from 40 HIV infected patients. Kruskal-Wallis Test was used to examine the differences in markers of systemic inflammation according to the types of ART medication taken. We then utilized generalized additive models (GAM) with non-linear function to examine the association between ART and markers of systemic inflammation after adjusting for potential confounders. RESULTS Overall, 30 (75.0%) of the participants received ART and 35 (85%) were female. Kruskal- Wallis Test revealed no significant differences in the markers of systemic inflammation among the three categories of ART (none, AZT, 3TC, EFV/NVP, and TDF, 3TC/FTC, EFV/NVP). In the multivariable- adjusted GAM model, we found a significant but non-linear association between time since diagnosis and CRP levels (p=0.006). CONCLUSION Although the relatively small sample size limits the scope of the study's findings, these results suggest that individuals on ART need to be screened periodically for the development of chronic conditions. This line of investigation has the potential to influence treatment and clinical guidelines that will improve the quality of care for HIV-infected patients.
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Affiliation(s)
- Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin OH-43016, United States
| | - Bismark Sarfo
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Legon, Ghana
| | - Evelyn Y Bonney
- Department of Virology, University of Ghana Noguchi Memorial Institute for Medical Research, Legon, Ghana
| | - Eric A Mensah
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
| | - Selase Deletsu
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
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42
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Bloch M, John M, Smith D, Rasmussen TA, Wright E. Managing HIV-associated inflammation and ageing in the era of modern ART. HIV Med 2020; 21 Suppl 3:2-16. [PMID: 33022087 DOI: 10.1111/hiv.12952] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This paper aims to address the concerns around ongoing immune activation, inflammation, and resistance in those ageing with HIV that represent current challenges for clinicians. METHODS Presentations at a symposium addressing issues of ageing with HIV infection were reviewed and synthesised. RESULTS The changing natural history and demographics of human immunodeficiency virus (HIV)-infected individuals means new challenges in contemporary management. In the early years of the epidemic,management was focussed on acute, potentially life-threatening AIDS-related complications. From initial monotherapy with first-generation antiretroviral therapy (ART), the development of combination highly active ART (HAART) allowed HIV control but ART toxicities, treatment adherence and drug resistance emerged as major issues. Today, the availability of potent and tolerable ART has made viral suppression achievable in most people living with HIV (PLHIV), and clinicians are confronted with managing a chronic condition among an ageing population. The combination of diseases of ageing and the co-morbidities associated with HIV-infection, even when well controlled, results in a complex set of challenges for many older PLHIV. There is a growing appreciation that many non-AIDS-related co-morbidities are caused, at least in part, by persistent, low-grade immune activation, inflammation, and hypercoagulability, despite suppressive ART. CONCLUSIONS In order to further improve HIV management, it is important to understand the enduring effects of chronically suppressed HIV infection, the potential contribution of these factors to the ageing process, the possibility of drug resistance, and the impact of different treatment strategies, including early ART initiation.
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Affiliation(s)
- M Bloch
- Holdsworth House Medical Practice, Sydney, NSW, Australia.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M John
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Royal Perth Hospital, Perth, WA, Australia.,Institute of Immunology and Infectious Disease, Perth, WA, Australia
| | - D Smith
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.,The Albion Centre, Sydney, NSW, Australia
| | - T A Rasmussen
- Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia
| | - E Wright
- The Alfred Hospital, Melbourne, Vic., Australia.,Centre for Inflammatory Diseases, Monash University, Melbourne, Vic., Australia.,The Burnett Institute, Melbourne, Vic., Australia
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43
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Mitchell BI, Laws EI, Chow DC, Sah Bandar IN, Gangcuangco LMA, Shikuma CM, Ndhlovu LC. Increased Monocyte Inflammatory Responses to Oxidized LDL Are Associated with Insulin Resistance in HIV-Infected Individuals on Suppressive Antiretroviral Therapy. Viruses 2020; 12:v12101129. [PMID: 33028018 PMCID: PMC7601436 DOI: 10.3390/v12101129] [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] [Received: 09/03/2020] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022] Open
Abstract
Despite long term antiretroviral therapy (ART), insulin resistance (IR) is common among people living with HIV/AIDS (PLWHA) exposing this population to a greater risk of cardiometabolic complications when compared to their uninfected counterparts. We previously identified an expansion in monocyte subpopulations in blood that were linked to the degree of IR in persons with HIV on stable ART. In this study, we directly assessed monocyte inflammatory functional properties from PLWHA on ART (n = 33) and HIV-uninfected controls (n = 14) of similar age, gender, and cardiovascular disease risk and determined the relationship with IR (homeostatic model assessment-insulin resistance (HOMA-IR)), calculated from fasting blood glucose and insulin measurements. Peripheral blood mononuclear cells were stimulated with oxidized low-density lipoproteins (oxLDL) and polyfunctional monocyte cytokine responses (IL-1β, IL-6, IL-8, or TNF-α) were determined by flow cytometry. Higher monocyte IL-1β and IL-8 responses to oxLDL were associated with higher IR in PLWHA but not in the control group. We observed that higher basal monocyte cytokine responses were associated with both duration since HIV diagnosis and ART initiation. In the management of IR in chronic HIV, strategies lowering monocyte IL-1β and IL-8 responses should be considered in addition to ART in order to limit adverse cardio-metabolic outcomes.
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44
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Ohuche IO, Chikani UN, Oyenusi EE, Onu JU, Oduwole A. Correlates of fasting blood glucose among children living with hiv in a Nigerian tertiary hospital: a cross-sectional study. BMC Pediatr 2020; 20:458. [PMID: 33008390 PMCID: PMC7532655 DOI: 10.1186/s12887-020-02335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background There is growing concern as regards the emergence of metabolic disorders among children living with the Human Immunodeficiency Virus (HIV) worldwide. However, there is paucity of data on the correlates of metabolic indices among HIV-positive children in Africa. Methods This study examined 84 HIV-positive children on HAART recruited from the paediatric infectious diseases clinic of the University of Nigeria Teaching Hospital for blood glucose levels using finger-prick testing with an Accu-check glucose meter and test strips. Clinical information was obtained via clinical history and medical records. Data was analyzed to examine the relationship between FBG and the classes of HAART, duration of illness and treatment using analysis of variance (ANOVA). Results FBG was significantly associated with the classes of HAART (x2=12.4, p = 0.017). In addition, there was a significant association between FBG and duration of illness [F(2, 81) = 6.0; P = 0.004], as well as FBG and duration on HAART [F(2, 81) = 7.9; P = 0.001]. However, duration on HAART and type of HAART were the significant predictors of FBG in this study accounting for 10.5% and 4.1% of the variance, respectively. Conclusions There is a greater risk of dysglycemia in paediatric patients with a longer cumulative exposure to HAART. Routine blood glucose checks among children on HAART, especially those who have received HAART for a longer duration of time may therefore be useful in their management.
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Affiliation(s)
- Ijeoma Onyinye Ohuche
- Department of Paediatrics, Niger Foundation Hospital, Enugu, Nigeria. .,Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria. .,Paediatric Endocrinology Training Centre for West Africa, LUTH, Lagos, Nigeria.
| | - Ugo Nnenna Chikani
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Elizabeth Eberechi Oyenusi
- Paediatric Endocrinology Training Centre for West Africa, LUTH, Lagos, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Justus Uchenna Onu
- Mental Health Unit, Department of Internal Medicine, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
| | - Abiola Oduwole
- Paediatric Endocrinology Training Centre for West Africa, LUTH, Lagos, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
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45
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Bailin SS, McGinnis KA, McDonnell WJ, So-Armah K, Wellons M, Tracy RP, Doyle MF, Mallal S, Justice AC, Freiberg MS, Landay AL, Wanjalla C, Koethe JR. T Lymphocyte Subsets Associated With Prevalent Diabetes in Veterans With and Without Human Immunodeficiency Virus. J Infect Dis 2020; 222:252-262. [PMID: 32052044 PMCID: PMC7323499 DOI: 10.1093/infdis/jiaa069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A higher proportion of circulating memory CD4+ T cells is associated with prevalent diabetes mellitus in the general population. Given the broad changes in adaptive immunity, including memory T-cell expansion, and rising prevalence of diabetes in the human immunodeficiency virus (HIV) population, we assessed whether similar relationships were present in persons with HIV (PWH). METHODS Multiple CD4+ and CD8+ T-cell subsets were measured by flow cytometry, and prevalent diabetes cases were adjudicated by 2 physicians for PWH and HIV-negative participants in the Veterans Aging Cohort Study. Multivariable logistic regression models evaluated the association of T-cell subsets and diabetes stratified by HIV status, adjusted for cytomegalovirus serostatus and traditional risk factors. RESULTS Among 2385 participants (65% PWH, 95% male, 68% African American), higher CD45RO+ memory CD4+ T cells and lower CD38+ CD4+ T cells were associated with prevalent diabetes, and had a similar effect size, in both the PWH and HIV-negative (P ≤ .05 for all). Lower CD38+CD8+ T cells were also associated with diabetes in both groups. CONCLUSIONS The CD4+ and CD8+ T-cell subsets associated with diabetes are similar in PWH and HIV-negative individuals, suggesting that diabetes in PWH may be related to chronic immune activation.
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Affiliation(s)
- Samuel S Bailin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathleen A McGinnis
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Wyatt J McDonnell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kaku So-Armah
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Melissa Wellons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Margaret F Doyle
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Simon Mallal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, West Haven, Connecticut, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Celestine Wanjalla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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El Kamari V, Moser C, Hileman CO, Currier JS, Brown TT, Johnston L, Hunt PW, McComsey GA. Lower Pretreatment Gut Integrity Is Independently Associated With Fat Gain on Antiretroviral Therapy. Clin Infect Dis 2020; 68:1394-1401. [PMID: 30137242 DOI: 10.1093/cid/ciy716] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/17/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fat accumulation and insulin resistance remain a threat to the success of antiretroviral therapy (ART). The role of gut dysfunction in metabolic complications associated with ART initiation is unclear. METHODS Human immunodeficiency virus (HIV)-infected ART-naive participants were randomized to tenofovir disoproxil fumarate/emtricitabine plus atazanavir/ritonavir, darunavir/ritonavir, or raltegravir (RAL). Changes in the gut integrity markers zonulin, lipopolysaccharide-binding protein (LBP), and intestinal fatty acid and ileal bile acid binding proteins (I-FABP and I-BABP) were assessed over 96 weeks. Wilcoxon rank-sum tests were used to compare changes between groups and linear regression models to quantify associations between gut markers, insulin resistance, body mass index (BMI), and visceral, subcutaneous, and total adipose tissue (VAT, SAT, and TAT). RESULTS : 90% were male and 48% were White non-Hispanic. The median age was 36 years, HIV-1 ribonucleic acid was 4.56 log10 copies/mL, and CD4 count was 338 cells/µL. An overall 1.7-fold increase in I-FABP was observed throughout 96 weeks, with no difference between arms. Zonulin levels increased with RAL compared to protease inhibitor-based regimens (week 96, P = .02); minimal changes in I-BABP or LBP levels were observed. Higher baseline I-FABP levels were associated with increases in VAT, TAT, and BMI (16%, 9%, and 2.5%, respectively; P < .04) over 96 weeks. CONCLUSIONS While ART induces changes in the markers of gut barrier dysfunction, the extent to which they improve or worsen the gut barrier function remains unclear. Nevertheless, markers of gut barrier dysfunction in ART-naive individuals predict increases in total and visceral abdominal fat with treatment initiation.
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Affiliation(s)
- Vanessa El Kamari
- Case Western Reserve University, Ohio.,University Hospitals Cleveland Medical Center, Ohio
| | - Carlee Moser
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Corrilynn O Hileman
- Case Western Reserve University, Ohio.,MetroHealth Medical Center, Cleveland, Ohio
| | | | | | - Liz Johnston
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Grace A McComsey
- Case Western Reserve University, Ohio.,University Hospitals Cleveland Medical Center, Ohio
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47
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Zuniga JA, García AA, Lee J, Park J. Retention in care in aging adults with a dual diagnosis of HIV infection and type 2 diabetes mellitus: a longitudinal retrospective cross-sectional study. AIDS Res Ther 2020; 17:29. [PMID: 32471484 PMCID: PMC7260810 DOI: 10.1186/s12981-020-00286-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the measures of retention in care (RIC) in persons living with HIV (PLWH) and type 2 diabetes mellitus (T2DM) by age group (younger vs. older adults). METHODS This was a longitudinal retrospective cross-sectional study that used secondary data from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). We examined RIC in 798 adult PLWH + T2DM who visited a CNICS clinic at least once in 2015. Six measures of RIC were examined: missed visits [measured as a continuous variable (total number of missed visits) and dichotomous variable (0 = never missed, 1 = missed)], visit adherence, 6-month visit gap, 4-month visit constancy, and the Health and Resources Services Administration HIV/AIDS Bureau's RIC measure. We calculated Spearman correlation coefficients and conducted logistic regression and multi-group path analysis. RESULTS Most RIC measures were significantly correlated (p < 0.05) with one another; only 4-month visit constancy was not correlated with other measures. Except for the number of missed visits in older adult PLWH + T2DM, we found no significant relationships between RIC measures and CD4 cell count using logistic regression. However, multi-group path analysis demonstrated significant positive relationships between most RIC measures and CD4 cell count in both age groups. In younger adults living with HIV (YALWH) + T2DM, HbA1c level, but not CD4 count, was significantly associated with most RIC measures. CONCLUSIONS RIC is related to disease control (CD4 cell count and HbA1c level) in PLWH + T2DM and notably, HbA1c level was only significantly affected in YALWH + T2DM. A future study is needed to find more accurate reasons for the fact that only HbA1c level had significant relationships in YALWH + T2DM. The findings from this study provide guidance in measuring RIC in PLWH who have comorbidities.
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HIV-associated gut dysbiosis is independent of sexual practice and correlates with noncommunicable diseases. Nat Commun 2020; 11:2448. [PMID: 32415070 PMCID: PMC7228978 DOI: 10.1038/s41467-020-16222-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/15/2020] [Indexed: 02/08/2023] Open
Abstract
Loss of gut mucosal integrity and an aberrant gut microbiota are proposed mechanisms contributing to chronic inflammation and increased morbidity and mortality during antiretroviral-treated HIV disease. Sexual practice has recently been uncovered as a major source of microbiota variation, potentially confounding prior observations of gut microbiota alterations among persons with HIV (PWH). To overcome this and other confounding factors, we examine a well-powered subset of AGEhIV Cohort participants comprising antiretroviral-treated PWH and seronegative controls matched for age, body-mass index, sex, and sexual practice. We report significant gut microbiota differences in PWH regardless of sex and sexual practice including Gammaproteobacteria enrichment, Lachnospiraceae and Ruminococcaceae depletion, and decreased alpha diversity. Men who have sex with men (MSM) exhibit a distinct microbiota signature characterized by Prevotella enrichment and increased alpha diversity, which is linked with receptive anal intercourse in both males and females. Finally, the HIV-associated microbiota signature correlates with inflammatory markers including suPAR, nadir CD4 count, and prevalence of age-associated noncommunicable comorbidities.
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Abstract
PURPOSE OF REVIEW The proportion of overweight and obese persons with HIV (PWH) has increased since the introduction of antiretroviral therapy (ART). We aim to summarize recent literature on risks of weight gain, discuss adipose tissue changes in HIV and obesity, and synthesize current understanding of how excess adiposity and HIV contribute to metabolic complications. RECENT FINDINGS Recent studies have implicated contemporary ART regimens, including use of integrase strand transfer inhibitors and tenofovir alafenamide, as a contributor to weight gain, though the mechanisms are unclear. Metabolic dysregulation is linked to ectopic fat and alterations in adipose immune cell populations that accompany HIV and obesity. These factors contribute to an increasing burden of metabolic diseases in the aging HIV population. Obesity compounds an increasing burden of metabolic disease among PWH, and understanding the role of fat partitioning and HIV- and ART-related adipose tissue dysfunction may guide prevention and treatment strategies.
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Affiliation(s)
- Samuel S Bailin
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA
| | - Curtis L Gabriel
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Celestine N Wanjalla
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA
| | - John R Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA.
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Aurpibul L, Namwongprom S, Sudjaritruk T, Ounjaijean S. Metabolic syndrome, biochemical markers, and body composition in youth living with perinatal HIV infection on antiretroviral treatment. PLoS One 2020; 15:e0230707. [PMID: 32226033 PMCID: PMC7105120 DOI: 10.1371/journal.pone.0230707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/06/2020] [Indexed: 12/20/2022] Open
Abstract
People living with HIV who are on antiretroviral treatment are at increased risk of developing premature cardiovascular disease. Children with perinatal HIV infection (PHIV) have survived through their adolescence and are entering adulthood. We determined the prevalence of metabolic syndrome, abnormal biochemical markers, and characterized body composition parameters in youth living with perinatal HIV infection. This cross-sectional study was conducted at the Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand from December 2017 to February 2018. PHIV-youths between 15 <25 years of age who were receiving ART were enrolled. Data collection included ART-related history, blood pressure, and anthropometric measurements. Body composition including android, gynoid fat mass, and total body fat were measured by dual-energy X-ray absorptiometry. Fasting blood was drawn to test for lipid profile, glucose, and high sensitivity c-reactive protein (hsCRP). One hundred and twenty PHIV-youths (48% female) were enrolled. Their mean age and the median duration on ART were 20.3 (SD2.6) and 14.1 (IQR 10.4–14.9) years, respectively; 76 (63%) were on first-line non-nucleoside reverse transcriptase inhibitors-based regimens. Thirty-three (28%), 74 (62%), and 13 (11%) of PHIV-youths were underweight (BMI < 18.5 kg/m2), normal (BMI 18.5–24.9 kg/m2), and overweight (BMI ≥ 25.0 kg/m2), respectively. The prevalence of metabolic syndrome was 10.6% (95%CI 5.0–16.0). Seventy-six of 113 (67.3%) of PHIV-youths had lipid alteration; the most prevalent types being low HDL (46.9%) and increased triglycerides (27.4%). Overall 43 (35.9%) had increased hsCRP (16.7% with immediate and 19.2% with high risk for CVD). Females had significantly higher percentage of android and gynoid fat, but lower Android to gynoid ratio (AGR) compared to males. There were 77%, 31%, and 21% of PHIV-youths in the overweight, normal weight, and underweight group with AGR in tertile 3, respectively. In conclusion, we documented presence of metabolic syndrome in 10.6% of PHIV-youths on ART. Increase AGR representing abdominal obesity was detected even in youths with normal BMI or underweight.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
| | - Sirianong Namwongprom
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tavitiya Sudjaritruk
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical and Molecular Epidemiology of Emerging and Re-emerging Infectious Diseases Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sakaewan Ounjaijean
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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