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Chen YC, Chen CC, Lin WK, Toh HS, Ko NY, Lin CY. Variations in the sleep-related breathing disorder index on polysomnography between men with HIV and controls: a matched case-control study. BMC Infect Dis 2024; 24:456. [PMID: 38689220 PMCID: PMC11062006 DOI: 10.1186/s12879-024-09322-z] [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: 12/09/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Both sleep-related breathing disorders (SRBDs) and HIV infection can interfere with normal sleep architecture, and also cause physical and psychological distress. We aimed to understand the differences in the obstructive patterns, sleep architecture, physical and psychological distress when compared between people living with HIV (PLWH) and matched the severity of SRBDs controls. METHODS A comparative study using matched case-control design was conducted. Men with HIV infection (case group) were enrolled from 2016 to 2019. A control group with HIV seronegative men were matched for SRBDs severity, and were selected from sleep medicine center database for comparison. RESULTS The mean age of the 108 men (including 54 cases and 54 matched controls) was 33.75 years. Central-apnea index (CI) was higher in the case group rather than matched controls (mean CI, 0.34 vs. 0.17, p = 0.049). PLWH had a lower mean percentage of stage 3 sleep (10.26% vs. 13.94%, p = 0.034) and a higher percentage of rapid eye movement sleep (20.59% vs. 17.85%, p = 0.011) compared to matched controls. Nocturnal enuresis and sleepiness causing traffic accidents were more frequent complaint in PLWH compared to controls. CONCLUSIONS Early detected SRBDs and subtypes in PLWH to begin treatment for the underlying cause could reduce the risk of sleepiness-related traffic accidents.
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Affiliation(s)
- Yen-Chin Chen
- College of Medicine, National Sun Yat-sen University, Tainan, Taiwan.
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Research and Development Committee, Taiwan AIDS Nurse Association, Taipei, Taiwan.
- , No. 70, Lianhai Road, Gushan District, 80424, Kaohsiung City, Taiwan.
| | - Chang-Chun Chen
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, United States
| | - Wen-Kuei Lin
- Sleep Medicine Center, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Han Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Research and Development Committee, Taiwan AIDS Nurse Association, Taipei, Taiwan
| | - Cheng-Yu Lin
- Sleep Medicine Center, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
- , No. 70, Lianhai Road, Gushan District, 80424, Kaohsiung City, Taiwan.
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Reisert H, Miner B, Farhadian S. Sleep deficiency among people living with human immunodeficiency virus: A growing challenge. HIV Med 2024; 25:5-15. [PMID: 37485570 PMCID: PMC10803648 DOI: 10.1111/hiv.13526] [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: 01/13/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review is to consolidate and summarize the existing literature on sleep deficiency among people living with human immunodeficiency virus (HIV; PLWH), to discuss the potential impact of antiretroviral therapy on sleep deficiency and to identify priorities for future research in this area. RECENT FINDINGS Three important domains of sleep deficiency include alterations in sleep quality (including sleep disorders), duration and timing. The existing HIV and sleep deficiency literature, which is robust for sleep quality but sparser for sleep duration or sleep timing, has identified epidemiological correlates and outcomes associated with sleep deficiency including sociodemographic factors, HIV-specific factors, aspects of physical and mental health and cognition. SUMMARY Sleep deficiency is a common problem among PLWH and is likely underdiagnosed, although more high-quality research is needed in this area. Sleep quality has received the most attention in the literature via methodologies that assess subjective/self-reported sleep quality, objective sleep quality or both. There is significantly less research on sleep duration and minimal research on sleep timing. Use of certain antiretroviral therapy drugs may be associated with sleep deficiency for some individuals. Future research should utilize larger, longitudinal studies with consistent, comprehensive and validated methods to assess both subjective and objective measures of sleep deficiency to better understand the prevalence, correlates and clinical implications of sleep deficiency in PLWH.
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Affiliation(s)
- Hailey Reisert
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Brienne Miner
- Yale School of Medicine, Section of Geriatrics, New Haven, CT, USA
| | - Shelli Farhadian
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
- Yale School of Medicine, Department of Neurology, New Haven, CT, USA
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA
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Viruses and Endocrine Diseases. Microorganisms 2023; 11:microorganisms11020361. [PMID: 36838326 PMCID: PMC9967810 DOI: 10.3390/microorganisms11020361] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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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Cody SL, Hobson JM, Gilstrap SR, Thomas SJ, Galinat D, Goodin BR. Sleep Disturbances and Chronic Pain in People with HIV: Implications for HIV-Associated Neurocognitive Disorders. CURRENT SLEEP MEDICINE REPORTS 2022; 8:124-131. [PMID: 36687512 PMCID: PMC9851157 DOI: 10.1007/s40675-022-00236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/14/2022]
Abstract
Purpose of Review Antiretroviral therapy has significantly reduced morbidity and mortality in people with HIV. Despite being virally suppressed, sleep disturbances, chronic pain, and neurocognitive impairments persist which can negatively impact quality of life for people with HIV. This article presents relevant literature related to sleep disturbances and chronic pain in people with HIV. The potential impact of these comorbidities on cognition is discussed with implications for managing HIV-associated neurocognitive disorder (HAND). Recent Findings People with HIV and chronic pain report greater insomnia and depressive symptoms compared to those without chronic pain. The neurotoxic effects of HIV itself and sleep and chronic pain induced inflammation can contribute to poorer cognitive outcomes. Summary Sleep disturbances and chronic pain are prevalent conditions in people with HIV that may perpetuate the development and exacerbation of HAND. Sleep and pain interventions may preserve cognitive function and improve quality of life for people aging with HIV.
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Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, U.S.A
| | - Joanna M Hobson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Shannon R Gilstrap
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - S Justin Thomas
- Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - David Galinat
- Alabama Water Institute, The University of Alabama, Tuscaloosa, Alabama, U.S.A
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
- Center for Addiction & Pain Prevention & Intervention (CAPPI), University of Alabama at Birmingham, Birmingham, AL, U.S.A
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5
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Schmickl CN, Bosompra NO, DeYoung PN, Gilbertson D, Orr JE, Malhotra A, Grant I, Ancoli-Israel S, Young MK, Owens RL. Diagnostic performance of screening tools for the detection of obstructive sleep apnea in people living with HIV. J Clin Sleep Med 2022; 18:1797-1804. [PMID: 35383569 DOI: 10.5664/jcsm.9964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Many people living with HIV (PLWH) have undiagnosed obstructive sleep apnea (OSA), which may contribute to commonly reported fatigue and the high cardiovascular disease burden in this population. Our objective was to assess the utility of traditional OSA screening tools (STOP-BANG, Berlin Questionnaire (BQ), and Epworth Sleepiness Scale (ESS)) for detecting OSA in PLWH. METHODS Adult PLWH were recruited from sleep/HIV clinics and the community into a larger clinical trial which included completion of these questionnaires before in-laboratory polysomnography. Discriminatory performance of these screening tools was assessed using area under receiver operating characteristic curves (AUC). The reference standard for the primary analysis was OSA based on an AHI≥5/h using recommended "1A"-criteria (hypopnea with 3%-desaturation and/or arousal). Secondary analyses explored acceptable "1B"-criteria (hypopnea with 4%-desaturation) and/or higher AHI cut-offs (≥15/h). RESULTS 120 PLWH were included (mean-age: 50±11 years; body mass index: 27±4 kg/m2, 84% male) and OSA was diagnosed in 75% using 1A-criteria. In the primary analysis, the discriminatory performance of the three screening tools was low (AUCs 0.58 to 0.70) and similar across the tools (P≥0.14). In secondary analyses, STOP-BANG showed moderate-high discriminatory ability (AUCs 0.77-0.80) and performed significantly better (P≤0.008) than the BQ or ESS (AUCs 0.53-0.62). CONCLUSIONS OSA was highly prevalent in our cohort of PLWH. Although STOP-BANG could reasonably identify moderate-severe OSA, the tools were not reliable for mild disease. Specifically, the questionnaires perform poorly for PLWH with mild OSA manifesting with arousals, yet such people may be at risk of fatigue/sleepiness and impaired memory consolidation. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Obstructive Sleep Apnea Endotypes and Impact on Phenotypes of People Living With HIV (PLWH/OSA); Identifier: NCT03575143; URL: https://clinicaltrials.gov/ct2/show/NCT03575143.
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Affiliation(s)
| | | | | | | | - Jeremy E Orr
- University of California San Diego, La Jolla, California
| | - Atul Malhotra
- University of California San Diego, La Jolla, California
| | - Igor Grant
- University of California San Diego, La Jolla, California
| | | | | | - Robert L Owens
- University of California San Diego, La Jolla, California
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Ngarka L, Siewe Fodjo JN, Aly E, Masocha W, Njamnshi AK. The Interplay Between Neuroinfections, the Immune System and Neurological Disorders: A Focus on Africa. Front Immunol 2022; 12:803475. [PMID: 35095888 PMCID: PMC8792387 DOI: 10.3389/fimmu.2021.803475] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/13/2021] [Indexed: 12/31/2022] Open
Abstract
Neurological disorders related to neuroinfections are highly prevalent in Sub-Saharan Africa (SSA), constituting a major cause of disability and economic burden for patients and society. These include epilepsy, dementia, motor neuron diseases, headache disorders, sleep disorders, and peripheral neuropathy. The highest prevalence of human immunodeficiency virus (HIV) is in SSA. Consequently, there is a high prevalence of neurological disorders associated with HIV infection such as HIV-associated neurocognitive disorders, motor disorders, chronic headaches, and peripheral neuropathy in the region. The pathogenesis of these neurological disorders involves the direct role of the virus, some antiretroviral treatments, and the dysregulated immune system. Furthermore, the high prevalence of epilepsy in SSA (mainly due to perinatal causes) is exacerbated by infections such as toxoplasmosis, neurocysticercosis, onchocerciasis, malaria, bacterial meningitis, tuberculosis, and the immune reactions they elicit. Sleep disorders are another common problem in the region and have been associated with infectious diseases such as human African trypanosomiasis and HIV and involve the activation of the immune system. While most headache disorders are due to benign primary headaches, some secondary headaches are caused by infections (meningitis, encephalitis, brain abscess). HIV and neurosyphilis, both common in SSA, can trigger long-standing immune activation in the central nervous system (CNS) potentially resulting in dementia. Despite the progress achieved in preventing diseases from the poliovirus and retroviruses, these microbes may cause motor neuron diseases in SSA. The immune mechanisms involved in these neurological disorders include increased cytokine levels, immune cells infiltration into the CNS, and autoantibodies. This review focuses on the major neurological disorders relevant to Africa and neuroinfections highly prevalent in SSA, describes the interplay between neuroinfections, immune system, neuroinflammation, and neurological disorders, and how understanding this can be exploited for the development of novel diagnostics and therapeutics for improved patient care.
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Affiliation(s)
- Leonard Ngarka
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Joseph Nelson Siewe Fodjo
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Esraa Aly
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
| | - Willias Masocha
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
| | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
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7
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Orr JE, Edwards BA, Schmickl CN, Karris M, DeYoung PN, Darquenne C, Theilmann R, Jain S, Malhotra A, Hicks CB, Owens RL. Pathogenesis of obstructive sleep apnea in people living with HIV. J Appl Physiol (1985) 2021; 131:1671-1678. [PMID: 34672765 PMCID: PMC8714978 DOI: 10.1152/japplphysiol.00591.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea (OSA) is highly prevalent in people living with human immunodeficiency virus (HIV) (PLWH), and it might contribute to frequently reported symptoms and comorbidities. Traditional risk factors for OSA are often absent in PLWH, suggesting that HIV or HIV medications might predispose to OSA. Therefore, we measured the anatomical and nonanatomical traits important for OSA pathogenesis in those with and without HIV. We recruited virally suppressed PLWH who had been previously diagnosed with OSA (PLWH + OSA) adherent to positive airway pressure (PAP) therapy, along with age-, sex-, and body mass index (BMI)-matched OSA controls. All participants underwent a baseline polysomnogram to assess OSA severity and a second overnight research sleep study during which the airway pressure was adjusted slowly or rapidly to measure the OSA traits. Seventeen PLWH + OSA and 17 OSA control participants were studied [median age = 58 (IQR = 54-65) yr, BMI = 30.7 (28.4-31.8) kg/m2, apnea-hypopnea index = 46 (24-74)/h]. The groups were similar, although PLWH + OSA demonstrated greater sleepiness (despite PAP) and worse sleep efficiency on baseline polysomnography. On physiological testing during sleep, there were no statistically significant differences in OSA traits (including Veupnea, Varousal, Vpassive, Vactive, and loop gain) between PLWH + OSA and OSA controls, using mixed-effects modeling to account for age, sex, and BMI and incorporating each repeated measurement (range = 72-334 measures/trait). Our data suggest that well-treated HIV does not substantially impact the pathogenesis of OSA. Given similar underlying physiology, existing available therapeutic approaches are likely to be adequate to manage OSA in PLWH, which might improve symptoms and comorbidities.NEW & NOTEWORTHY Clinical data suggest an increased risk of obstructive sleep apnea (OSA) in people living with HIV (PLWH), while OSA might account for chronic health issues in this population. We characterized the anatomical and nonanatomical OSA traits in PLWH + OSA compared with OSA controls, using detailed physiological measurements obtained during sleep. Our data suggest against a major impact of HIV on OSA pathogenesis. Available OSA management strategies should be effective to address this potentially important comorbidity in PLWH.
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Affiliation(s)
- Jeremy E Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Christopher N Schmickl
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Maile Karris
- Division of Infectious Disease, University of California San Diego, San Diego, California
| | - Pamela N DeYoung
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Chantal Darquenne
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Rebecca Theilmann
- Department of Radiology, University of California San Diego, San Diego, California
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Charles B Hicks
- Division of Infectious Disease, University of California San Diego, San Diego, California
| | - Robert L Owens
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
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O’Brien KE, Riddell NE, Gómez-Olivé FX, Rae DE, Scheuermaier K, von Schantz M. Sleep Disturbances in HIV Infection and their Biological Basis. Sleep Med Rev 2021; 65:101571. [DOI: 10.1016/j.smrv.2021.101571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
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De Francesco D, Sabin CA, Winston A, Rueschman MN, Doyle ND, Anderson J, Vera JH, Boffito M, Sachikonye M, Mallon PWG, Haddow L, Post FA, Redline S, Kunisaki KM. Sleep health and cognitive function among people with and without HIV: the use of different machine learning approaches. Sleep 2021; 44:zsab035. [PMID: 33592094 PMCID: PMC8361343 DOI: 10.1093/sleep/zsab035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES We investigated associations between actigraphy-assessed sleep measures and cognitive function in people with and without HIV using different analytical approaches to better understand these associations and highlight differences in results obtained by these approaches. METHODS Cognitive and 7-day/night actigraphy data were collected from people with HIV (PWH) and lifestyle-similar HIV-negative individuals from HIV and sexual health clinics in the United Kingdom/Ireland. A global cognitive T-score was obtained averaging the standardized individual cognitive test scores accounting for sociodemographics. Average and SD of 11 sleep measures over 7 days/nights were obtained. Rank regression, partial least-squares (PLS) regression, random forest, sleep dimension construct, and latent class analysis (LCA) were applied to evaluate associations between global T-scores and sleep measures. RESULTS In 344 PWH (median age 57 years, 86% males), average sleep duration, efficiency, and wake after sleep onset were not associated with global T-scores according to rank regression (p = 0.51, p = 0.09, p = 0.16, respectively). In contrast, global T-scores were associated with average and SD of length of nocturnal awakenings, SD of maintenance efficiency, and average out-of-bed time when analyzed by PLS regression and random forest. No associations were found when using sleep dimensions or LCA. Overall, findings observed in PWH were similar to those seen in HIV-negative individuals (median age 61 years, 67% males). CONCLUSIONS Using multivariable analytical approaches, measures of sleep continuity, timing, and regularity were associated with cognitive performance in PWH, supporting the utility of newer methods of incorporating multiple standard and novel measures of sleep-wake patterns in the assessment of health and functioning.
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Affiliation(s)
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK
| | - Michael N Rueschman
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nicki D Doyle
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Jaime H Vera
- Brighton and Sussex Medical School, Brighton, UK
| | - Marta Boffito
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | | | - Lewis Haddow
- Institute for Global Health, University College London, London, UK
- Kingston Hospital NHS Foundation Trust, London, UK
| | - Frank A Post
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Susan Redline
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ken M Kunisaki
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
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Agreement between self-reported and objective measures of sleep in people with HIV and lifestyle-similar HIV-negative individuals. AIDS 2021; 35:1051-1060. [PMID: 33635846 PMCID: PMC9328164 DOI: 10.1097/qad.0000000000002852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the agreement between self-reported sleep measures and insomnia with objectively measured sleep parameters in people with HIV (PWH) and HIV-negative individuals. DESIGN A cross-sectional analysis of PWH and lifestyle-similar HIV-negative individuals. METHODS Self-reported measures included time spent in bed, sleep onset latency and a validated insomnia questionnaire. Objective measures were assessed via 7-days/nights of actigraphy data to determine average and intra-individual variability of several sleep measures (including time spent in bed and onset latency). Spearman's correlation coefficient and Cohen's κ were used to assess the agreement between self-reported and actigraphy-assessed measures. Associations between insomnia and actigraphy-assessed sleep parameters were evaluated using partial least-square discriminant analysis (PLS-DA). RESULTS We found fair correlation between self-reported and actigraphy-assessed time spent in bed in 342 PWH (rs = 0.46) and 119 HIV-negative individuals (rs = 0.48). Among PWH, the correlation did not differ by age, education, depressive symptoms and self-reported insomnia (all P > 0.05), but was stronger in men (P = 0.05) and in those with a BMI of at least 25 kg/m2 (P < 0.001). Agreement between self-reported and actigraphy-assessed sleep onset latency was poor in both PWH (κ = 0.002, P = 0.49) and HIV-negative individuals (κ = 0.009, P = 0.65). According to PLS-DA, self-reported insomnia most strongly correlated with intra-individual variability of sleep duration, movement index and efficiency. CONCLUSION We report poor-to-fair agreement between self-reported and actigraphy-assessed sleep measures in PWH. Insomnia symptoms correlated with regularity of sleep duration, quality and efficiency. These findings highlight the importance of both patient-reported and objective measures of daily sleep variation, for better understanding sleep disorders in PWH.
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11
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Chen CC, Lin CY, Chen YC, Ko WC, Li CY, Ko NY. High sleep-related breathing disorders among HIV-infected patients with sleep complaints. Sleep Med 2020; 75:218-224. [PMID: 32861059 DOI: 10.1016/j.sleep.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sleep-related breathing disorders (SRBD) not only adversely impact cardiovascular and pulmonary functions but also reduce the quality of life. This study attempted to investigate the severity and related factors of SRBD among human immunodeficiency virus (HIV)-infected people with sleep complaints. METHODS A cross-sectional study was conducted among HIV-infected people with Pittsburgh Sleep Quality Index (PSQI) values above 5 points. SRBDs were defined as Apnea-Hypopnea Index (AHI) over 5 events/hour by full channel home-based polysomnography (PSG). An AHI greater than 30 was categorized as moderate to severe apnea. All of the participants were asked to rate the severity of their snoring, complete a snore outcomes survey (SOS) and complete the PSQI. Multiple logistic regression analysis was conducted to examine the associated factors of severity of SRBD among HIV-infected people. RESULTS Of 54 male HIV-positive patients with sleep complaints, 34 subjects (62.96%) were diagnosed with SRBDs, and 29.63% were categorized as having moderate to severe SRBD. SOS score was significantly associated with HIV patients with moderate to severe SRBD (adjusted odds ratio = 0.93, 95% CI: 0.87-1.00, p = 0.045). CONCLUSIONS SRBDs is highly prevalent in male HIV-infected people with sleep complaints. Intensive snoring was one of the indicators associated with the occurrence of moderate to severe SRBDs among HIV-infected people. Healthcare professionals should include snoring screening in the regular course of clinical HIV care.
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Affiliation(s)
- Chang-Chun Chen
- International Doctoral Program in Nursing, Department of Nursing, National Cheng Kung University, No.1, University Road, Tainan City 70101, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan City, 70403, Taiwan; Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan City, 70403, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan City, 70403, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 70101, Taiwan.
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 70101, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 70101, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan City, 70403, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 70101, Taiwan.
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12
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Owens RL, Hicks CB. A Wake-up Call for Human Immunodeficiency Virus (HIV) Providers: Obstructive Sleep Apnea in People Living With HIV. Clin Infect Dis 2019; 67:472-476. [PMID: 29746617 DOI: 10.1093/cid/ciy217] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/15/2018] [Indexed: 12/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) is defined by repetitive collapse of the upper airway during sleep leading to transient hypoxemia and arousals from sleep. Surges in sympathetic activity, repeated oxygen desaturation, and sleep fragmentation can lead to cardiovascular (eg, myocardial infarction) and neurocognitive (eg, excessive daytime sleepiness) consequences. Emerging data suggest that OSA is common in people living with human immunodeficiency virus (PLWH) and that traditional risk factors for OSA, such as obesity, are not highly predictive of OSA in PLWH. Untreated OSA is associated with increased fatigue and levels of inflammation. Despite these data, most PLWH with OSA remain undiagnosed and untreated. Improved awareness of OSA among healthcare providers and greater use of OSA diagnostic approaches have the potential to substantially improve quality of life and outcomes in PLWH.
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Affiliation(s)
- Robert L Owens
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, La Jolla
| | - Charles B Hicks
- Division of Infectious Disease, University of California, San Diego, La Jolla
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Mulenga LB, Musonda P, Chirwa L, Siwingwa M, Mweemba A, Suwilanji S, Fwoloshi S, Phiri H, Phiri D, Mulenga PL, Chisenga T, Nsakanya R, Shibemba A, Todd J, Nzala S, Kaile T, Kankasa C, Hachaambwa L, Claassen C, Sikazwe I, Koethe JR, Sinkala E, Heimburger DC, Wester CW. Insulin Resistance is Associated with Higher Plasma Viral Load Among HIV-Positive Adults Receiving Longer-Term (1 Year) Combination Antiretroviral Therapy (ART). JOURNAL OF INFECTIOUS DISEASE AND THERAPY 2019; 7:406. [PMID: 35538928 PMCID: PMC9082628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND As HIV-positive persons survive longer due to the success of combination antiretroviral therapy (ART) in decreasing mortality, the burden of non-communicable diseases including diabetes mellitus (DM) is anticipated to rise. HIV is characterized by systemic inflammations, markers of which decrease quickly following ART initiation, but typically do not completely normalize. Inflammation may be accompanied by insulin resistance (IR), and both are implicated in the pathogenesis of DM in HIV-positive individuals. Sub-Saharan Africa accounts for almost two-thirds of the global HIV burden but there are few reports of IR, DM and HIV in this region. We assessed the relationship between IR and viral suppression among HIV-positive adults in the Zambian national ART program. METHODS We conducted a cross-sectional survey evaluating HIV-positive adults that had received first line ART (usually TDF/FTC/EFV) for 12 months (± 3 months). Twenty clinics were sampled systematically based on the random starting-point, sampling interval and cumulative population size. Eligible patients had plasma viral load (VL), fasting insulin, and glucose performed. Insulin resistance was determined using Homeostatic model assessment (HOMA). We determined proportions for each outcome using linearized standard error 95% confidence intervals and summary estimates. Viral suppression was defined according to the detection threshold of<20 copies/mL and treatment failure was defined as VL>1,000 copies/mL. RESULTS Of 473 patients enrolled, 46.8% were male and 53.2% were female. 142 (30%) [95% CI: 0.26-0.34] had IR. Among those with IR, 55 (38.7%) were male whereas 87 (61.3%) were female (p value=0.104). 19% of individuals with IR had treatment failure compared to 5.7% without IR (p value<0.0001). 427 (90.3%) participants had treatment success (VL<1,000 copies/mL), and this was associated with a lower likelihood of IR (odds ratio (OR)=0.26 [0.14, 0.48], p value<0.0001). In addition, a significantly lower proportion of patients with IR were virologically suppressed at one-year compared to individuals without IR, 58% [0.54-0.70] versus 70% [0.65-0.75], respectively (p value=0.042). CONCLUSION In Zambian adults on ART for a year, the development of insulin resistance was strongly associated with suboptimal HIV outcomes, specifically non-viral suppression and treatment failure. Further investigations are warranted to determine if this positive association between IR and VL is causally related, and if so in which direction.
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Affiliation(s)
- LB Mulenga
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- Ministry of Health, Ndeke House, Lusaka, Zambia
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - P Musonda
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
| | - L Chirwa
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - M Siwingwa
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - A Mweemba
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - S Suwilanji
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - S Fwoloshi
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - H Phiri
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - D Phiri
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - PL Mulenga
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - T Chisenga
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - R Nsakanya
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - A Shibemba
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - J Todd
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Nzala
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
| | - T Kaile
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
| | - C Kankasa
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - L Hachaambwa
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- University of Maryland, Baltimore, MD, USA
| | - C Claassen
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- University of Maryland, Baltimore, MD, USA
| | - I Sikazwe
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- Centre for Infectious Diseases Research, Lusaka, Zambia
| | - JR Koethe
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - E Sinkala
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - DC Heimburger
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
| | - CW Wester
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
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Chen YC, Lin CY, Li CY, Zhang Y, Ko WC, Ko NY. Obstructive sleep apnea among HIV-infected men in the highly active antiretroviral therapy era: a nation-wide longitudinal cohort study in Taiwan, 2000-2011. Sleep Med 2019; 65:89-95. [PMID: 31739231 DOI: 10.1016/j.sleep.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study compared the incidence of obstructive sleep apnea (OSA) between HIV-infected and matched non-infected persons and aimed to determine the effect of highly active antiretroviral therapy (HAART) on the incidence of OSA among HIV-infected men. METHODS A population-based cohort design was conducted using the National Health Insurance Research Database (NHIRD), which contained 13,552 HIV-infected persons and 134,361 matched age-, sex-, and index year-controls. The incidence density rates (IRR) were calculated to estimate the OSA incidence both in the HIV group and matched controls. Cox proportional hazard models were applied to assess the HAART effect on the incidence of OSA among HIV-infected men. RESULTS The IRR of OSA was lower in the HIV group than in the matched controls (1.91 vs. 2.26 per 1000 person-years, respectively). The associated factors for OSA in HIV-infected men were higher monthly salary (adjusted hazard ratio [aHR], 1.97, p < 0.01), obesity (aHR, 3.99, p < 0.01), and chronic obstructive pulmonary disease (aHR, 2.02, p < 0.01). Continued HAART at least a half year was associated with less diagnosed OSA (AHR, 0.70, p = 0.03) in HIV-infected men. CONCLUSIONS HIV-infected persons had a lower rate of OSA diagnosis compared to the matched controls. Healthcare providers are needed to increase awareness in HIV-infected men with sleep disorders, especially for those with low social economic status, comorbidities, and non-continuous HAART use.
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Affiliation(s)
- Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Yingze Zhang
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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15
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Chuang LP, Chen NH, Lin SW, Hu HC, Kao KC, Li LF, Yang CT, Huang CC, Pang JHS. Monocytic C-C chemokine receptor 5 expression increases in in vitro intermittent hypoxia condition and in severe obstructive sleep apnea patients. Sleep Breath 2019; 23:1177-1186. [PMID: 30778913 PMCID: PMC6867987 DOI: 10.1007/s11325-019-01797-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 01/26/2019] [Accepted: 01/31/2019] [Indexed: 12/14/2022]
Abstract
Purpose Obstructive sleep apnea (OSA) patients have higher risk of cardiovascular disease. C-C chemokine receptor 5 (CCR5), as an important receptor for monocyte recruitment and the initiation of atherosclerosis, was studied under intermittent hypoxia and in OSA patients. Methods The expression and function of CCR5 regulated by intermittent hypoxia in monocytic THP-1 cells were investigated in an in vitro intermittent hypoxia culture system. The expression levels of protein and mRNA were analyzed by western blot and RT/real-time PCR analysis. Cell adhesion assay and transwell filter migration assay were carried out to investigate the adhesion and chemotaxis of monocytes. In addition, the mRNA expression of CCR5 in monocytes isolated from peripheral blood of 72 adults was analyzed. Results Intermittent hypoxia upregulated the expression of CCR5 in THP-1 cells and enhanced the adhesion and chemotaxis of monocytes to vascular endothelial cells mediated by RANTES. The CCR5 expression induced by intermittent hypoxia was inhibited by inhibitor for p42/44 MAPK. Besides, the expression of CCR5 in monocytes increased along the AHI value especially in severe OSA patients that was statistically significant compared with mild and moderate OSA groups. Conclusions This study demonstrated the increased monocytic CCR5 gene expression in patients with severe OSA. Intermittent hypoxia, the characteristic of OSA, induced monocytic CCR5 gene expression and the enhanced RANTES-mediated chemotaxis and adhesion through p42/44 MAPK signal pathways.
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Affiliation(s)
- Li-Pang Chuang
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Shih-Wei Lin
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Han-Chung Hu
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Kuo-Chin Kao
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Li-Fu Li
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Cheng-Ta Yang
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chung-Chi Huang
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Jong-Hwei S Pang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.
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Shikuma CM, Kohorn L, Paul R, Chow DC, Kallianpur KJ, Walker M, Souza S, Gangcuangco LMA, Nakamoto BK, Pien FD, Duerler T, Castro L, Nagamine L, Soll B. Sleep and neuropsychological performance in HIV+ subjects on efavirenz-based therapy and response to switch in therapy. HIV CLINICAL TRIALS 2018; 19:139-147. [PMID: 30451595 DOI: 10.1080/15284336.2018.1511348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The antiretroviral drug efavirenz (EFV) has been linked to disordered sleep and cognitive abnormalities. We examined sleep and cognitive function and subsequent changes following switch to an alternative integrase inhibitor-based regimen. Thirty-two HIV-infected individuals on EFV, emtricitabine, and tenofovir (EFV/FTC/TDF) without traditional risk factors for obstructive sleep apnea (OSA) were randomized 2:1 to switch to elvitegravir/cobicistat/emtricitabine/tenofovir (EVG/COBI/FTC/TDF) or to continue EFV/FTC/TDF therapy for 12 weeks. Overnight polysomnography and standardized sleep and neuropsychological assessments were performed at baseline and at 12 weeks. No significant differences in change over 12 weeks were noted between the two arms in any sleep or neuropsychological test parameter. At entry, however, the rate of sleep disordered breathing (SDB) was substantially higher in study subjects compared to published age-matched norms and resulted in a high assessed OSA rate of 59.4%. Respiratory Disturbance Index (RDI), a measure of SDB, correlated with age- and education-adjusted global neuropsychological Z-score (NPZ) (r = -0.35, p = 0.05). Sleep Maintenance Efficiency, Wake after Sleep Onset, REM Sleep and RDI correlated with domain-specific NPZ for learning and memory (all p-values ≤ 0.05). Among HIV-infected individuals on EFV-based therapy and without traditional risk factors for OSA, sleep and neuropsychological abnormalities do not readily reverse after discontinuation of EFV. High baseline rates of SDB and abnormalities in sleep architecture exist in this population correlating with neuropsychological impairment. The role of HIV immuno-virologic or lifestyle factors as contributing etiologies should be explored. OSA may be an under-recognized etiology for cognitive dysfunction during chronic HIV.
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Affiliation(s)
- Cecilia M Shikuma
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA
| | - Lindsay Kohorn
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA
| | - Robert Paul
- b Missouri Institute of Mental Health, University of Missouri , St. Louis , MO , USA
| | - Dominic C Chow
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA.,c Queen's Medical Center , Honolulu , HI , USA
| | - Kalpana J Kallianpur
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA
| | - Maegen Walker
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA
| | - Scott Souza
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA.,c Queen's Medical Center , Honolulu , HI , USA
| | | | - Beau K Nakamoto
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA.,d Straub Medical Center , Honolulu , HI , USA
| | - Francis D Pien
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA
| | - Timothy Duerler
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA
| | | | - Lorna Nagamine
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA
| | - Bruce Soll
- a John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA.,c Queen's Medical Center , Honolulu , HI , USA
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Karamchand S, Leisegang R, Schomaker M, Maartens G, Walters L, Hislop M, Dave JA, Levitt NS, Cohen K. Risk Factors for Incident Diabetes in a Cohort Taking First-Line Nonnucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy. Medicine (Baltimore) 2016; 95:e2844. [PMID: 26945366 PMCID: PMC4782850 DOI: 10.1097/md.0000000000002844] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Efavirenz is the preferred nonnucleoside reverse transcriptase inhibitor (NNRTI) in first-line antiretroviral therapy (ART) regimens in low- and middle-income countries, where the prevalence of diabetes is increasing. Randomized control trials have shown mild increases in plasma glucose in participants in the efavirenz arms, but no association has been reported with overt diabetes. We explored the association between efavirenz exposure and incident diabetes in a large Southern African cohort commencing NNRTI-based first-line ART. Our cohort included HIV-infected adults starting NNRTI-based ART in a private sector HIV disease management program from January 2002 to December 2011. Incident diabetes was identified by the initiation of diabetes treatment. Patients with prevalent diabetes were excluded. We included 56,298 patients with 113,297 patient-years of follow-up (PYFU) on first-line ART. The crude incidence of diabetes was 13.24 per 1000 PYFU. Treatment with efavirenz rather than nevirapine was associated with increased risk of developing diabetes (hazard ratio 1.27 (95% confidence interval (CI): 1.10-1.46)) in a multivariate analysis adjusting for age, sex, body mass index, baseline CD4 count, viral load, NRTI backbone, and exposure to other diabetogenic medicines. Zidovudine and stavudine exposure were also associated with an increased risk of developing diabetes. We found that treatment with efavirenz, as well as stavudine and zidovudine, increased the risk of incident diabetes. Interventions to detect and prevent diabetes should be implemented in ART programs, and use of antiretrovirals with lower risk of metabolic complications should be encouraged.
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Affiliation(s)
- Sumanth Karamchand
- From the Division of Clinical Pharmacology (SK, RL, GM, KC), Division of Endocrinology, Department of Medicine (JAD, NSL), Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town (MS), Aid for AIDS Management (Pty) Limited (MH), Health Intelligence Unit, Medscheme (Pty) Limited (LW), Chronic Disease Initiative for Africa, Cape Town (JAD, NSL), South Africa
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Wirth MD, Jaggers JR, Dudgeon WD, Hébert JR, Youngstedt SD, Blair SN, Hand GA. Association of Markers of Inflammation with Sleep and Physical Activity Among People Living with HIV or AIDS. AIDS Behav 2015; 19:1098-107. [PMID: 25399034 DOI: 10.1007/s10461-014-0949-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study examined associations of sleep and minutes spent in moderate-vigorous physical activity (MVPA) with C-reactive protein (CRP) and interleukin (IL)-6 among persons living with HIV. Cross-sectional analyses (n = 45) focused on associations of inflammatory outcomes (i.e., CRP and IL-6) with actigraph-derived sleep duration, latency, and efficiency; sleep onset; wake time; and wake-after-sleep-onset; as well as MVPA. Least square means for CRP and IL-6 by levels of sleep and MVPA were computed from general linear models. Individuals below the median of sleep duration, above the median for sleep onset, and below the median of MVPA minutes had higher CRP or IL-6 levels. Generally, individuals with both low MVPA and poor sleep characteristics had higher inflammation levels than those with more MVPA and worse sleep. Understanding the combined impact of multiple lifestyle/behavioral factors on inflammation could inform intervention strategies to reduce inflammation and therefore, chronic disease risk.
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Affiliation(s)
- Michael D Wirth
- The South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Room 233, Columbia, SC, 29208, USA,
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Kunisaki KM, Akgün KM, Fiellin DA, Gibert CL, Kim JW, Rimland D, Rodriguez-Barradas MC, Yaggi HK, Crothers K. Prevalence and correlates of obstructive sleep apnoea among patients with and without HIV infection. HIV Med 2014; 16:105-13. [PMID: 25230851 DOI: 10.1111/hiv.12182] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES In HIV-uninfected populations, obstructive sleep apnoea (OSA) is commonly associated with cardiovascular disease, metabolic syndrome, and cognitive impairment. These comorbidities are common in HIV-infected patients, but there are scarce data regarding OSA in HIV-infected patients. Therefore, we examined the prevalence and correlates of OSA in a cohort of HIV-infected and uninfected patients. METHODS An observational cohort study was carried out. Electronic medical record and self-report data were examined in patients enrolled in the Veterans Aging Cohort Study (VACS) between 2002 and 2008 and followed until 2010. The primary outcome was OSA diagnosis, determined using International Classification of Diseases, 9th edition (ICD-9) codes, in HIV-infected compared with uninfected individuals. We used regression analyses to determine the association between OSA diagnosis, symptoms and comorbidities in adjusted models. RESULTS Of 3683 HIV-infected and 3641 uninfected patients, 143 (3.9%) and 453 (12.4%) had a diagnosis of OSA (p<0.0001), respectively. HIV-infected patients were more likely to report symptoms associated with OSA such as tiredness and fatigue. Compared with uninfected patients with OSA, HIV-infected patients with OSA were younger, had lower body mass indexes (BMIs), and were less likely to have hypertension. In models adjusting for these traditional OSA risk factors, HIV infection was associated with markedly reduced odds of OSA diagnosis (odds ratio 0.48; 95% confidence interval 0.39-0.60). CONCLUSIONS HIV-infected patients are less likely to receive a diagnosis of OSA. Future studies are needed to determine whether the lower prevalence of OSA diagnoses in HIV-infected patients is attributable to decreased screening and detection or to a truly decreased likelihood of OSA in the setting of HIV infection.
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Affiliation(s)
- K M Kunisaki
- Minneapolis VA Health Care System, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA
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