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Yeboah K, Musah L, Essel S, Agyekum JA, Bedu-Addo K. Asymptomatic peripheral arterial disease in HIV patients in Ghana: A case-control study. JOURNAL OF VASCULAR NURSING 2023; 41:203-208. [PMID: 38072573 DOI: 10.1016/j.jvn.2023.07.001] [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: 10/25/2022] [Revised: 05/16/2023] [Accepted: 07/12/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is common in HIV patients and can be diagnosed noninvasively using the ankle-brachial index (ABI). The burden of PAD has not been investigated in Ghanaian HIV patients. We investigated the prevalence and risk factors associated with PAD in HIV patients at a periurban hospital in Ghana. METHODS In a case-control design, ABI was measured in 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls with no clinical symptoms of CVDs. PAD was defined as ABI ≤ 0.9. A structured questionnaire was used to collect socio-demographic and clinical data. Fasting venous blood samples were collected to measure plasma levels of glucose, lipid profile, and CD4+ lymphocytes. RESULTS The prevalence of PAD was 13.9% among cART-treated HIV patients, 21.3% among cART-naïve HIV patients, and 15.4% among non-HIV controls. Patients with PAD had increased odds of having low CD4+ cell counts [OR (95% CI) = 3.68 (1.41-12.85)]. In cART-treated HIV patients, those on TDF-based [5.76 (1.1-30.01), p = 0.038] and EFV-based [9.28 (1.51-57.12), p = 0.016] regimens had increased odds of having PAD. CONCLUSION In our study population, there was no difference in the prevalence of PAD between cART-treated HIV patients compared to cART-naïve HIV patients or non-HIV controls. Having a low CD4 cell count and being on TDF- or EFV-based regimens were associated with an increased likelihood of having PAD.
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Affiliation(s)
- Kwame Yeboah
- Department of Physiology, University of Ghana Medical School, P O Box 4236, Accra, Ghana.
| | - Latif Musah
- Department of Physiology, University of Ghana Medical School, P O Box 4236, Accra, Ghana
| | - Samuel Essel
- Department of Physiology, University of Ghana Medical School, P O Box 4236, Accra, Ghana; Department of Physician Assistant Studies, Central University, Accra, Ghana
| | - Jennifer Adjepong Agyekum
- Department of Physiology, University of Ghana Medical School, P O Box 4236, Accra, Ghana; Medical Laboratory Unit, Mamprobi Hospital, Ghana Health Service, Accra, Ghana
| | - Kweku Bedu-Addo
- Department of Physiology, School of Medicine and Dentistry, KNUST, Kumasi, Ghana
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2
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Teng AE, Kennedy KF, Parikh RV, Armstrong EJ, Hsue PY, Secemsky EA. Temporal trends and outcomes of peripheral artery disease revascularization and amputation among the HIV population. AIDS 2022; 36:1717-1724. [PMID: 35848583 PMCID: PMC9444880 DOI: 10.1097/qad.0000000000003309] [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: 02/04/2023]
Abstract
OBJECTIVE With antiretroviral therapy, people with HIV (PWH) are developing age-related diseases, including peripheral arterial disease (PAD). This study examined frequency and outcomes of peripheral vascular intervention (PVI) and primary amputation in PWH. DESIGN We used the National Inpatient Sample (NIS) database to examine demographics, comorbidities, and temporal trends among PVI and primary amputation admissions by HIV status from 2012 to 2018. METHODS Inverse probability of treatment weighting was used to calculate adjusted odds of in-hospital death and amputation. Cost of hospitalization and length of stay were compared by HIV status and revascularization approach. RESULTS Of the 347 824 hospitalizations for PVI/amputation, 0.6% were PWH, which was stable over time. PWH had more renal and hepatic disease, whereas uninfected individuals had more traditional PAD risk factors. 55.2% of HIV+ admissions were endovascular compared with 49.3% in HIV- admissions, and 28.9% of the HIV+ admissions were elective compared with 42.1% among HIV-. HIV status did not impact amputation following PVI. In-hospital death was similar between groups following PVI or primary amputation. PWH had lower costs of hospitalization and a trend towards shorter hospital stays. CONCLUSION Although PWH are developing more age-related chronic illnesses, the number of PAD-associated procedures has remained flat. Despite being younger with fewer traditional PAD risk factors, PWH had higher rates of unplanned PVI admissions and endovascular revascularization but similar in-hospital outcomes. These findings suggest PWH have different risk factors for PAD and are likely underdiagnosed and undertreated, whereas those who are treated have similar outcomes to the general population.
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Affiliation(s)
- Alexandra E Teng
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Kevin F Kennedy
- Department of Biostatistics, St. Luke's Health System, Kansas City, Missouri
| | - Rushi V Parikh
- Division of Cardiology, Department of Medicine, University of California, Los Angeles
| | - Ehrin J Armstrong
- Division of Cardiology, Department of Medicine, Adventist Heart and Vascular Institute, St. Helena
| | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital. San Francisco, California
| | - Eric A Secemsky
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Desormais I, Harimenshi D, Niyongabo T, Lacroix P, Aboyans V, Preux PM. HIV clinical stages and lower extremity arterial disease among HIV infected outpatients in Burundi. Sci Rep 2021; 11:8296. [PMID: 33859308 PMCID: PMC8050048 DOI: 10.1038/s41598-021-87862-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/30/2021] [Indexed: 12/26/2022] Open
Abstract
Chronic disease of people living with human immunodeficiency virus (HIV) infection are now approaching those of the general population. Previous, in vitro studies shown that HIV causes arterial injuries resulting in inflammation and atherosclerosis but direct relationship between HIV infection clinical stages and lower extremity arterial disease (LEAD) remain controversial. No study assessed, with an accurate method, both the prevalence of LEAD and the influence of HIV severity on LEAD in HIV outpatients in Central Africa.
A cross-sectional study was conducted among 300 HIV-infected outpatients, aged ≥ 40 years in Bujumbura, Burundi. All patients underwent ankle-brachial index (ABI) measurement and LEAD was diagnosed by ABI ≤ 0.9. The prevalence of LEAD was 17.3% (CI 95% 13.2–22.1). The mean age was 49.6 ± 7.1 years. On multivariable analysis, factors associated with LEAD were hypertension (OR = 2.42; 95% CI 1.10–5.80), and stage IV HIV clinical infection (OR = 4.92, 95% CI 1.19–20.36). This is the first study performed on a large HIV population in Central Africa, reporting high LEAD prevalence. It underlines the influence of HIV infection on peripheral atherosclerosis at latest clinical stages and the need for LEAD screening in HIV-infected patients.
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Affiliation(s)
- Ileana Desormais
- Department of Vascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France. .,CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, INSERM, Univ. Limoges, Limoges, France.
| | - Deo Harimenshi
- CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, INSERM, Univ. Limoges, Limoges, France
| | | | - Philippe Lacroix
- Department of Vascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France.,CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, INSERM, Univ. Limoges, Limoges, France
| | - Victor Aboyans
- CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, INSERM, Univ. Limoges, Limoges, France.,Department of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Pierre Marie Preux
- CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, INSERM, Univ. Limoges, Limoges, France
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4
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Calza L, Borderi M, Colangeli V, Borioni A, Coladonato S, Granozzi B, Viale P. No progression of subclinical atherosclerosis in HIV-infected patients starting an initial regimen including tenofovir alafenamide/emtricitabine plus raltegravir, dolutegravir or elvitegravir/cobicistat during a two-year follow-up. Infect Dis (Lond) 2019; 52:249-256. [PMID: 31876437 DOI: 10.1080/23744235.2019.1707279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives: Cardiovascular disease has become one of the most common comorbidities among HIV-infected patients, but available data about the correlation between antiretroviral drugs and progression rate of atherosclerotic disease are still limited. We evaluated the progression rate of carotid atherosclerosis in patients starting an initial antiretroviral regimen including one integrase strand transfer inhibitor (INSTI).Methods: Observational, prospective study involving HIV-1-infected, antiretroviral therapy-naive, adult patients who started an antiretroviral regimen including tenofovir alafenamide/emtricitabine (TAF/FTC) plus raltegravir (RAL group), elvitegravir/cobicistat (EVG/c group), or dolutegravir (DTG group). Patients with known cardiovascular disease or diabetes mellitus were excluded from the study. The progression rate of atherosclerosis has been assessed by carotid Doppler ultrasonography at baseline and after 24 months.Results: Overall, 102 patients were enrolled into the study: 73 males, with mean age of 48.7 years: 32, 36 and 34 patients were included in the RAL, EVG/c and DTG groups, respectively. The baseline features of the enrolled patients were comparable across the three groups. At 24 months, the mean intima-media thickness (IMT) increase at the carotid bifurcation was 0.026 mm in the RAL group, 0.029 mm in EVG/c group and 0.032 mm in DTG group. The mean IMT increases after 24 months were comparable across the three groups and statistically not significant in all the evaluated anatomical sites.Conclusions: The initial antiretroviral therapy with TAF/FTC plus RAL, EVG/c or DTG for 24 months led to a comparable and not significant effect on the progression rate of carotid atherosclerosis.
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Affiliation(s)
- Leonardo Calza
- Department of Medical and Surgical Sciences, Section of Infectious Diseases, "Alma Mater Studiorum", University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Borderi
- Department of Medical and Surgical Sciences, Section of Infectious Diseases, "Alma Mater Studiorum", University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Colangeli
- Department of Medical and Surgical Sciences, Section of Infectious Diseases, "Alma Mater Studiorum", University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Aurora Borioni
- Department of Medical and Surgical Sciences, Section of Infectious Diseases, "Alma Mater Studiorum", University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Simona Coladonato
- Department of Medical and Surgical Sciences, Section of Infectious Diseases, "Alma Mater Studiorum", University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Bianca Granozzi
- Department of Medical and Surgical Sciences, Section of Infectious Diseases, "Alma Mater Studiorum", University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Section of Infectious Diseases, "Alma Mater Studiorum", University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Brief Report: Prevalence of Peripheral Artery Disease Is Higher in Persons Living With HIV Compared With Uninfected Controls. J Acquir Immune Defic Syndr 2019; 79:381-385. [PMID: 29985264 DOI: 10.1097/qai.0000000000001795] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Ankle-brachial index is an excellent tool for diagnosing peripheral artery disease (PAD). We aimed to determine the prevalence and risk factors for PAD in people living with HIV (PLWH) compared with uninfected controls. We hypothesized that prevalence of PAD would be higher among PLWH than among controls independent of traditional cardiovascular disease (CVD) risk factors. METHODS PLWH aged 40 years and older were recruited from the Copenhagen comorbidity in HIV infection (COCOMO) study. Sex- and age-matched uninfected controls were recruited from the Copenhagen General Population Study. We defined PAD as ankle-brachial index ≤0.9 and assessed risk factors for PAD using logistic regression adjusting for age, sex, smoking status, dyslipidemia, diabetes, hypertension, and high-sensitivity C-reactive protein. RESULTS Among 908 PLWH and 11,106 controls, PAD was detected in 112 [12% confidence interval: (95% 10 to 14)] and 623 [6% (95% 5 to 6)], respectively (P < 0.001), odds ratio = 2.4 (95% 1.9 to 2.9), and adjusted odds ratio = 1.8 (95% 1.3 to 2.3, P < 0.001). Traditional CVD risk factors, but not HIV-related variables, were associated with PAD. The strength of the association between PAD and HIV tended to be higher with older age (P = 0.052, adjusted test for interaction). CONCLUSIONS Prevalence of PAD is higher among PLWH compared with uninfected controls, especially among older persons, and remains so after adjusting for traditional CVD risk factors. Our findings expand the evidence base that PLWH have excess arterial disease to also include PAD. The exact biological mechanisms causing this excess risk remain to be elucidated. Until then, focus on management of modifiable traditional risk factors is important.
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So-Armah K, Freiberg MS. HIV and Cardiovascular Disease: Update on Clinical Events, Special Populations, and Novel Biomarkers. Curr HIV/AIDS Rep 2019; 15:233-244. [PMID: 29752699 DOI: 10.1007/s11904-018-0400-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The objective of this review is to provide an update on the link between HIV infection and cardiovascular disease (CVD). We will focus our review mainly on literature describing clinical CVD events and understudied topics of importance. RECENT FINDINGS Heart failure, peripheral artery disease, and stroke are CVD modalities deserving more attention in the context of HIV infection in the highly active antiretroviral therapy era. Incidence data on clinical CVD from HIV populations in low- and middle-income countries are limited. Multisubstance use is common in HIV, but understudied as a moderator or mediator of the association between HIV and CVD. CVD risk assessment in HIV remains challenging, but new research into novel biomarkers may provide further insights. There is also a need for inclusion of non-biologic factors in our attempts to understand, quantify, and predict CVD risk among PLWHA. Significant attention has been paid to generating and testing hypotheses to understand the mechanisms of myocardial infarction in HIV. Similar attention is deserving for heart failure, PAD, stroke, and cardiovascular disease risk in resource-limited settings and among substance users with HIV.
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Affiliation(s)
- Kaku So-Armah
- School of Medicine, Boston University, Boston, MA, USA.
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7
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Masiá M, Padilla S, García JA, García-Abellán J, Fernández M, Bernardino I, Montero M, Peraire J, Pernas B, Gutiérrez F. Evolving understanding of cardiovascular, cerebrovascular and peripheral arterial disease in people living with HIV and role of novel biomarkers. A study of the Spanish CoRIS cohort, 2004-2015. PLoS One 2019; 14:e0215507. [PMID: 31026289 PMCID: PMC6485642 DOI: 10.1371/journal.pone.0215507] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/04/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyze the incidence rates (IR) and spectrum of vascular events in people living with HIV (PLWH) in Spain from 2004 to 2015. Serial measurements of different plasma cardiovascular biomarkers were assessed in relation to disease development. METHODS Longitudinal study in a nationwide contemporary multicenter cohort of PLWH. A nested case-control study was performed to evaluate the predictive value of cardiovascular biomarkers. Additive generalized and Cox mixed models were used for the analyses. RESULTS 9,712 PLWH and 48,341 person-years of follow-up were analysed. During 2004-2015, 147 persons developed 154 vascular events; 80 (54.42%) coronary-related; 65 (44.22%) cerebrovascular-related, and 9 (6.12%) peripheral arterial disease. The 2004-2015 IR (95% confidence interval) of vascular events was 3.17 (2.69-3.71) x1,000 person-years; 1.64 (1.30-2.05) for coronary events; 1.34 (1.03-1.70) for cerebrovascular events; and 0.19 (0.09-0.35) for peripheral arterial disease (p<0.001). IR of vascular events gradually increased from 0.37 (0.12-0.85) x1,000 patient-years in the stratum 25-34-years to 19.65 (6.38-45.85) x1,000 patient-years in the stratum 75-84-years. Compared to the general population, there was a higher incidence of acute myocardial infarction (AMI) in men (sIR ratio 1.29 [95% CI 1.16-1.42]), of cerebrovascular events in women (sIR ratio 2.44 [95% CI 1.68-3.19]), and of both types of events specifically among the younger age-strata. CD4 count (hazard ratio 0.80, [95% CI, 0.79-0.81]), age (1.86 [1.47-2.34] for 45-65 years and 3.44 [2.37-4.97] for >65 years) and vascular event (1.81 [1.12-2.94]) were associated with total mortality. Adjusted levels of intercellular-adhesion-molecule (sICAM), pro-b-type-natriuretic-peptide (pro-BNP) and marginally sCD14, were higher among patients who subsequently developed vascular events. CONCLUSION Vascular events in PLWH do preferentially occur in the older age-strata, they are associated with increased mortality and, compared to the general population, the excess risk occurs at younger ages. Peripheral arterial disease is unusual. Vascular events are preceded by increased levels of sICAM, pro-BNP and, marginally, sCD14.
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Affiliation(s)
- Mar Masiá
- Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Sergio Padilla
- Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - José A. García
- Statistics, Centro de Investigación Operativa, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Javier García-Abellán
- Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Marta Fernández
- Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Ignacio Bernardino
- Infectious Diseases Unit, Hospital La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Marta Montero
- Infectious Diseases Unit, Hospital La Fe, Valencia, Spain
| | - Joaquim Peraire
- Infectious Diseases Unit, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Berta Pernas
- Infectious Diseses Unit, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
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Kamdem F, Mapoure Y, Hamadou B, Souksouna F, Doualla MS, Jingi AM, Kenmegne C, Lekpa FK, Fenkeu JK, Imandy G, Mefo'o JPN, Luma H. Prevalence and risk factors of peripheral artery disease in black Africans with HIV infection: a cross-sectional hospital-based study. Vasc Health Risk Manag 2018; 14:401-408. [PMID: 30584314 PMCID: PMC6287665 DOI: 10.2147/vhrm.s165960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background The prevalence of peripheral artery disease (PAD) is not well known among HIV-infected patients in Africa. The aim of this study was to determine the prevalence and associated risk factors of PAD among HIV-infected patients at the Douala General Hospital (DGH). Methods This was a cross-sectional descriptive and analytic study between November 2015 and April 2016. We recruited patients aged ≥21 years, diagnosed with HIV infection, and who were receiving care at the DGH. We collected sociodemographic data and past medical history of patients. We measured their ankle-brachial index (ABI). We defined PAD as an ABI <0.9. We also measured their fasting blood glucose and lipid profile. Results We recruited 144 patients for this study. The mean age was 46±9 years, and 72.2% were females. Of which, 89% were on antiretroviral treatment (ARV). Their mean CD4+ T lymphocytes count was 451±306 cells/mm3. Their mean ABI was 1.12±0.17 and 1.07±0.11, respectively, on the left and right legs (P>0.05). The prevalence of PAD was 6.9% (95% CI: 3.4–12.4), and 60% of patients with PAD were symptomatic. After adjusting for age, sex and ARV, ARV treatment was protective (aOR: 0.18, [95% CI: 0.04–0.82], P=0.034), while WHO stages III or IV was associated with PAD (aOR: 11.1, [95% CI: 2.19–55.92], P=0.004). Conclusion The prevalence of PAD was not as high as expected in this group of patients with high cardiovascular risk infected with HIV. Advanced HIV disease was associated with PAD, while ARV was protective.
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Affiliation(s)
- Félicité Kamdem
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Yacouba Mapoure
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Ba Hamadou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon,
| | - Fanny Souksouna
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Marie Solange Doualla
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon.,Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon,
| | - Ahmadou Musa Jingi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon,
| | - Caroline Kenmegne
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon
| | - Fernando Kemta Lekpa
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon.,Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Gisèle Imandy
- Chemical Pathology Laboratory, Douala General Hospital, Douala, Cameroon
| | - Jean Pierre Nda Mefo'o
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.,Chemical Pathology Laboratory, Douala General Hospital, Douala, Cameroon
| | - Henry Luma
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon.,Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon,
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9
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Aurpibul L, Sugandhavesa P, Srithanaviboonchai K, Sitthi W, Tangmunkongvorakul A, Chariyalertsak C, Rerkasem K. Peripheral artery disease in HIV-infected older adults on antiretroviral treatment in Thailand. HIV Med 2018; 20:54-59. [PMID: 30160365 DOI: 10.1111/hiv.12671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES HIV infection has become a chronic disease requiring long-term treatment. Premature cardiovascular disease resulting from atherosclerosis in the HIV-infected population has been observed. We assessed the prevalence of peripheral artery disease (PAD), a common consequence of atherosclerosis, in HIV-infected patients aged ≥ 50 years receiving antiretroviral treatment (ART). METHODS This cross-sectional study was conducted in 12 community hospitals in Chiang Mai, Thailand. Inclusion criteria were as follows: (1) age ≥ 50 years, (2) positive HIV status, and (3) currently receiving ART. Age- and sex-matched hospital patients without documented HIV infection were enrolled as a comparison group. Clinical data were extracted from hospital records. Personal information and details of PAD-related symptoms were obtained through face-to-face interviews. The diagnosis of PAD was made using ankle-brachial index (ABI) measurement. RESULTS Seven hundred and twenty-four participants were enrolled in the study (362 HIV-infected patients and 362 patients in the comparison group). In the HIV-infected group, 43% were male; the mean (± standard deviation) age was 57.8 ± 5.6 years. The mean (± standard deviation) times from HIV diagnosis and ART initiation were 10.0 ± 4.3 and 8.6 ± 3.5 years, respectively. The prevalence of abnormal ABI (< 1.00) was significantly lower in the HIV-infected group than in the comparison group (20 versus 27%, respectively; P = 0.03), while that of PAD (ABI ≤ 0.90) was not significantly different between the two groups (5 and 7%, respectively). In the HIV-infected group, female sex and low body mass index were independently associated with abnormal ABI. CONCLUSIONS The prevalence of PAD when measured by ABI in HIV-infected older adults was relatively low. A follow-up study to determine the incidence of PAD and its persistence with time is warranted.
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Affiliation(s)
- L Aurpibul
- Center of Excellence in HIV/AIDS Research, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai
| | - P Sugandhavesa
- Center of Excellence in HIV/AIDS Research, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai
| | - K Srithanaviboonchai
- Center of Excellence in HIV/AIDS Research, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai.,Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
| | - W Sitthi
- Center of Excellence in HIV/AIDS Research, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai
| | - A Tangmunkongvorakul
- Center of Excellence in HIV/AIDS Research, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai
| | | | - K Rerkasem
- Center of Excellence in Non-Communicable Disease, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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10
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Barnes RP, Lacson JCA, Bahrami H. HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease. Curr Atheroscler Rep 2017; 19:20. [PMID: 28315199 DOI: 10.1007/s11883-017-0652-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) increasingly afflicts people living with HIV (PLWH) in the contemporary era of antiretroviral therapy (ART). Coronary artery disease (CAD) is the most widely studied cardiovascular problem in PLWH; however, less is known about other clinically relevant subtypes of CVD such as heart failure (HF), cerebrovascular disease, sudden cardiac death, pericardial diseases, and pulmonary hypertension. This paper reviews evidence of other subtypes of CVD as emerging issues in the post-ART era. RECENT FINDINGS Recent studies have shown that PLWH have higher risk of HF as well as subclinical impairment of left ventricular (LV) mechanics (systolic and diastolic dysfunction) and myocardial abnormalities (fibrosis and steatosis). The underlying mechanisms, however, are not well-understood. A few studies have also shown higher rates of atrial fibrillation and sudden cardiac death in PLWH. Ischemic stroke is the most common stroke type in the post-ART era, with underlying mechanisms like those identified in CAD: chronic inflammation and associated vasculopathy. Studies of great vessels (carotid artery and aorta) and peripheral arterial disease show heterogeneous results. Small subclinical pericardial effusions are common in PLWH in post-ART era. Pulmonary hypertension continues to be an underdiagnosed and potentially fatal complication of HIV infection. PLWH remain at higher risk for all types of CVD including heart failure, stroke, and arrhythmias in the post-ART era. Chronic inflammation may play an important role in this increased risk. More studies are needed to further elucidate the extent of non-coronary CVD in PLWH and the underlying mechanisms for them.
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Affiliation(s)
- Revery P Barnes
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John Charles A Lacson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hossein Bahrami
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Division of Cardiovascular Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, USA. .,Department of Radiology, Keck School of Medicine, University of Southern California, 2020 Zonal Ave, Los Angeles, CA, 90033, USA.
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Jean M, Saada M, Collin F, Roustant F, Aumaître H. Prevalence and factors associated with discordant intima-media thickness and arterial stiffness combined measurements in people living with HIV. Infect Dis (Lond) 2016; 48:857-9. [DOI: 10.1080/23744235.2016.1201854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Maxime Jean
- Infectious Diseases Unit, Centre Hospitalier Saint Jean, Perpignan, France
| | - Matthieu Saada
- Infectious Diseases Unit, Centre Hospitalier Saint Jean, Perpignan, France
| | - Fideline Collin
- Clinical Research Unit, Centre Hospitalier Saint Jean, Perpignan, France
| | | | - Hugues Aumaître
- Infectious Diseases Unit, Centre Hospitalier Saint Jean, Perpignan, France
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Aranda F, Perés Wingeyer S, de Larrañaga G. D-Dimer as a prognostic marker of morbidity and mortality among HIV patients: a call for attention. Infect Dis (Lond) 2016; 48:860-1. [PMID: 27347612 DOI: 10.1080/23744235.2016.1201855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Federico Aranda
- a Hemostasis and Thrombosis Laboratory , Hospital of Infectious Diseases FJ Muñiz , Buenos Aires , Argentina
| | - Silvia Perés Wingeyer
- a Hemostasis and Thrombosis Laboratory , Hospital of Infectious Diseases FJ Muñiz , Buenos Aires , Argentina
| | - Gabriela de Larrañaga
- a Hemostasis and Thrombosis Laboratory , Hospital of Infectious Diseases FJ Muñiz , Buenos Aires , Argentina
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13
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Glindvad Ahlstrom M, Feldt-Rasmussen B, Gerstoft J, Obel N. Routine urine protein/creatinine ratio testing in an outpatient setting of Danish HIV-infected individuals. Infect Dis (Lond) 2016; 48:560-2. [PMID: 26950430 DOI: 10.3109/23744235.2016.1154600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Bo Feldt-Rasmussen
- b Department of Nephrology , Copenhagen University Hospital , Rigshospitalet , Denmark
| | - Jan Gerstoft
- a Department of Infectious Diseases , Copenhagen University Hospital , Rigshospitalet , Denmark ;,c Faculty of Health Sciences , University of Copenhagen , Denmark
| | - Niels Obel
- a Department of Infectious Diseases , Copenhagen University Hospital , Rigshospitalet , Denmark ;,c Faculty of Health Sciences , University of Copenhagen , Denmark
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