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Chaivichacharn P, Avihingsanon A, Gatechompol S, Ubolyam S, Punyawudho B. Dose optimization with population pharmacokinetics of ritonavir-boosted lopinavir for Thai people living with HIV with and without active tuberculosis. Drug Metab Pharmacokinet 2022; 47:100478. [DOI: 10.1016/j.dmpk.2022.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/11/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022]
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Teer E, Dominick L, Mukonowenzou NC, Essop MF. HIV-Related Myocardial Fibrosis: Inflammatory Hypothesis and Crucial Role of Immune Cells Dysregulation. Cells 2022; 11:cells11182825. [PMID: 36139400 PMCID: PMC9496784 DOI: 10.3390/cells11182825] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Although the underlying mechanisms driving human immunodeficiency virus (HIV)-mediated cardiovascular diseases (CVD) onset and progression remain unclear, the role of chronic immune activation as a significant mediator is increasingly being highlighted. Chronic inflammation is a characteristic feature of CVD and considered a contributor to diastolic dysfunction, heart failure, and sudden cardiac death. This can trigger downstream effects that result in the increased release of pro-coagulant, pro-fibrotic, and pro-inflammatory cytokines. Subsequently, this can lead to an enhanced thrombotic state (by platelet activation), endothelial dysfunction, and myocardial fibrosis. Of note, recent studies have revealed that myocardial fibrosis is emerging as a mediator of HIV-related CVD. Together, such factors can eventually result in systolic and diastolic dysfunction, and an increased risk for CVD. In light of this, the current review article will focus on (a) the contributions of a chronic inflammatory state and persistent immune activation, and (b) the role of immune cells (mainly platelets) and cardiac fibrosis in terms of HIV-related CVD onset/progression. It is our opinion that such a focus may lead to the development of promising therapeutic targets for the treatment and management of CVD in HIV-positive patients.
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Affiliation(s)
- Eman Teer
- Centre for Cardio-Metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Leanne Dominick
- Centre for Cardio-Metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Nyasha C. Mukonowenzou
- Centre for Cardio-Metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch 7600, South Africa
| | - M. Faadiel Essop
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
- Correspondence: ; Tel.: +27-21-938-9388
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Yang C, Wang D, Ma Y, Liu Z, Guo H, Sang F, Xu Q, Jin Y. Effectors of Hyperlipidemia among HIV/AIDS patients with second-line antiretroviral therapy based on register data. Curr HIV Res 2022; 20:CHR-EPUB-125359. [PMID: 35929632 PMCID: PMC9933044 DOI: 10.2174/1570162x20666220805103411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/31/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, we aimed to determine the prevalence and effectors of hyperlipidemia among people living with HIV/AIDS (PLWHA) and taking second-line antiretroviral therapy (ART) using registry data in central China. METHODS We conducted a cross-sectional study and collected information of PLWHA on second-line ART during 2018 from two medical registries. Hyperlipidemia was defined according to the 2016 Chinese guidelines for the management of dyslipidemia in adults. Univariate and multivariate logistic regression analyses were performed to explore the influencing factors of hyperlipidemia. We calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of 2886 PLWHA taking second-line ART were included in this study, and 978 (33.9%) had hyperlipidemia. Female patients, those with hyperglycemia, and patients with CD4+ cell counts >500 cells/μL had a higher prevalence of hyperlipidemia with 37.0%, 49.0%, and 41.3%, respectively. Multivariate analysis showed that CD4+ cell count 350-500 cells/μL (OR=1.72, 95% CI: 1.26-2.38), CD4+ cell count >500 cells/μL (OR=2.49, 95% CI: 1.85-3.38), and FPG >6.2 mmol/L (OR=2.08, 95% CI:1.64-2.65) were risk factors for hyperlipidemia. Male sex (OR=0.72, 95% CI: 0.61-0.85) and Hb <110 g/L (OR=0.59, 95% CI: 0.45-0.76) were protective factors against hyperlipidemia. CONCLUSIONS PLWHA on second-line ART had a higher prevalence of hyperlipidemia. Gender, CD4+ cell count, FPG, and hemoglobin were influencing factors of hyperlipidemia.
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Affiliation(s)
- Chunling Yang
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, China
| | - Dongli Wang
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yanmin Ma
- Center for AIDS/STD Control and Prevention, Center for Disease Control and Prevention of Henan Province, Zhengzhou, China
| | - Zhibin Liu
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Huijun Guo
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Feng Sang
- Henan Key Laboratory of Viral Diseases Prevention and Treatment of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Qianlei Xu
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yantao Jin
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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[Parenteral nutrition-associated complications in patients with SARS-CoV-2 infection]. NUTR HOSP 2022; 39:266-272. [PMID: 35012319 DOI: 10.20960/nh.03806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND it is unknown whether patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are at greater risk of developing complications associated with parenteral nutrition (PN). AIM to describe the incidence, risk factors, and clinical impact of complications in patients with ARDS-COVID-19 receiving PN. METHODS a prospective cohort study of 87 patients with ARDS-COVID-19 infection. The incidence of complications and odds ratios of risk factors were analysed. RESULTS age ≥ 65 years (OR, 2.52, 95 % CI: 1.16 to 5.46), obesity (OR, 3.34, 95 % CI: 2.35 to 4.33) and treatment with propofol (OR, 2.45, 95 % CI: 1.55 to 3.35) or lopinavir/ritonavir (OR, 4.98, 95 % CI: 3.60 to 6.29) were risk factors for hipertriglyceridemia. Obesity (OR, 3.11, 95 % CI: 1.10 to 8.75), dyslipidemia (OR, 3.22, 95 % CI: 1.23 to 8.40) or treatment with propofol (OR, 5.47, 95 % CI: 1.97 to 15.1) were risk factors for intravascular catheter-related infection. No risk factors were described for hiperglycemia. Mortality was higher in patients with intravascular catheter-related infection (46.7 % vs 10.8 %, p = 0.014). Mortality risk was higher in older patients (OR, 2.74, 95 % CI: 1.08 to 6.95) or patients with intravascular catheter-related infection (OR, 3.22, 95 % CI: 1.23 to 8.40). CONCLUSIONS the incidence of complications associated with PN in patients with COVID-19-related ARDS is frequent. The mortality risk is higher in older patients or those with catheter-related infection.
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Gonçalves AJ, Braga MVA, Santana PH, Resende LAPR, da Silva VJD, Correia D. Linear and non-linear analysis of heart rate variability in HIV-positive patients on two different antiretroviral therapy regimens. BMC Infect Dis 2021; 21:1022. [PMID: 34587909 PMCID: PMC8482565 DOI: 10.1186/s12879-021-06648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background Cardiac autonomic dysfunction in HIV+ patients on different antiretroviral therapy (ART) regimens has been described. We aimed to characterize parameters of heart rate variability (HRV) and correlate with different classes of ART in HIV+ patients in three experimental conditions: rest, cold face, and tilt tests. Methods Cross-sectional study with three groups of age- and gender-matched individuals: group 1, 44 HIV+ patients undergoing combination therapy, with two nucleoside reverse transcriptase inhibitors (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI); group 2, 42 HIV+ patients using two NRTI and protease inhibitors (PI’s); and group 3, 35 healthy volunteers with negative HIV serology (control group). Autonomic function at rest and during cold face- and tilt-tests was assessed through computerized analysis of HRV, via quantification of time- and frequency domains by linear and non-linear parameters in the three groups. Results Anthropometric and clinical parameters were similar between both HIV groups, except CD4+ T lymphocytes, which were significantly lower in group 2 (p = 0.039). At baseline, time-domain linear HRV parameters, RMSSD and pNN50, and the correlation dimension, a non-linear HRV parameter (p < 0.001; p = 0.018; p = 0.019, respectively), as well as response of RMSSD to cold face test were also lower in the HIV+ group than in the control individuals (p < 0.001), while no differences among groups were detected in HRV parameters during the tilt test. Conclusions Despite ART regimens, HIV+ patients presented lower cardiac vagal modulation than controls, whereas no difference was observed among the HIV groups, suggesting that higher cardiovascular risk linked to PIs may be associated with factors other than autonomic dysfunction.
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Affiliation(s)
- Anderson José Gonçalves
- Infectious Diseases Division, Internal Medicine Department, Federal University of the Triângulo Mineiro, Av. Getúlio Guaritá, 430, Bairro Nossa Senhora da Abadia, PO Box: 118, Uberaba, Minas Gerais State, CEP: 38025-350, Brazil
| | | | | | | | - Valdo José Dias da Silva
- Physiology Division, Biological Science Department, Federal University of the Triângulo Mineiro, Uberaba, Minas Gerais State, Brazil
| | - Dalmo Correia
- Infectious Diseases Division, Internal Medicine Department, Federal University of the Triângulo Mineiro, Av. Getúlio Guaritá, 430, Bairro Nossa Senhora da Abadia, PO Box: 118, Uberaba, Minas Gerais State, CEP: 38025-350, Brazil.
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Villa López G, Valero Zanuy MA, González Barrios I, Maíz Jiménez M, Gomis Muñóz P, León Sanz M. Acute Hypertriglyceridemia in Patients with COVID-19 Receiving Parenteral Nutrition. Nutrients 2021; 13:2287. [PMID: 34371797 PMCID: PMC8308259 DOI: 10.3390/nu13072287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022] Open
Abstract
Hypertriglyceridemia is a metabolic complication associated with parenteral nutrition (PN). It is unknown if patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are more at risk. Our aim was to describe the incidence, risk factors and clinical impact of hypertriglyceridemia in critically ill patients with ARDS-COVID-19 receiving PN. We designed a cohort study of patients with ARDS-COVID-19 infection that required admission to critical care units and nutritional support with PN. Individual PN prescriptions for macronutrients and insulin were provided. Lipid emulsion contained fish oil (SMOFlipid® or Lipoplus®). Hypertriglyceridemia was defined as plasma levels above 400 mg/dL. Eighty-seven patients, 66.6% men, 60.1 ± 10.8 years old, BMI 29.1 ± 5.6 kg/m2, 71% of whom received lopinavir/ritonavir, 56% received Propofol and 55% received Tocilizumab were included. The incidence of hypertriglyceridemia was 37 × 100 patient-days with PN. This complication was more frequent in obese patients (OR 3.34; 95% CI, 2.35-4.33) and in those treated with lopinavir/ritonavir (OR 4.98; 95% CI, 3.60-6.29) or Propofol (OR 2.45; 95% CI, 1.55-3.35). Total mortality was 33.3%, similar between the type of lipid emulsion (p = 0.478). On average, patients with hypertriglyceridemia had a longer requirement of PN compared to the group without elevated triglycerides (TG), probably because of their longer survival (p = 0.001). TG higher than 400 mg/dL was not a protective factor for mortality (OR 0.31; 95% CI, 0.01-1.30). In conclusion, the incidence of hypertriglyceridemia was 37 × 100 patient-days with PN. The risk of this complication is associated with obesity and the use of lopinavir/ritonavir or Propofol.
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Affiliation(s)
- Gema Villa López
- Clinical Nutrition Unit, Department of Endocrinology and Nutrition, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain; (G.V.L.); (M.A.V.Z.); (M.M.J.)
| | - Maria Angeles Valero Zanuy
- Clinical Nutrition Unit, Department of Endocrinology and Nutrition, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain; (G.V.L.); (M.A.V.Z.); (M.M.J.)
| | - Ivan González Barrios
- Department of Pharmacy, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (I.G.B.); (P.G.M.)
| | - Maria Maíz Jiménez
- Clinical Nutrition Unit, Department of Endocrinology and Nutrition, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain; (G.V.L.); (M.A.V.Z.); (M.M.J.)
| | - Pilar Gomis Muñóz
- Department of Pharmacy, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (I.G.B.); (P.G.M.)
| | - Miguel León Sanz
- Clinical Nutrition Unit, Department of Endocrinology and Nutrition, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain; (G.V.L.); (M.A.V.Z.); (M.M.J.)
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Raiteri A, Piscaglia F, Granito A, Tovoli F. Tocilizumab: From Rheumatic Diseases to COVID-19. Curr Pharm Des 2021; 27:1597-1607. [PMID: 33719967 DOI: 10.2174/1381612827666210311141512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023]
Abstract
Tocilizumab is a humanised interleukin-6 receptor-inhibiting monoclonal antibody that is currently approved for the treatment of rheumatoid arthritis and other immune-related conditions. Recently, tocilizumab has been investigated as a possible treatment for severe coronavirus-induced disease 2019 (COVID-19). Despite the lack of direct antiviral effects, tocilizumab could reduce the immune-induced organ damage caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) infection. Until recently, most reports on tocilizumab for COVID-19 included a limited number of patients, preventing an overall evaluation of its efficacy and safety for this specific condition. Therefore, we reviewed the literature regarding the physiopathological rationale of tocilizumab for COVID-19 and its outcomes. We searched the MEDLINE database with the string "(SARS-CoV-2 OR coronavirus OR COVID-19 OR MERS- cov OR SARS-cov) AND (IL-6 OR interleukin 6 OR tocilizumab)". While the scientific rationale supporting tocilizumab for COVID-19 is solid, the evidence regarding the outcomes remains controversial. Available data and results from ongoing trials will provide useful information in the event of new COVID-19 outbreaks or future pandemics from different coronaviruses.
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Affiliation(s)
- Alberto Raiteri
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| | - Alessandro Granito
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| | - Francesco Tovoli
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
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Sahay B, Mergia A. The Potential Contribution of Caveolin 1 to HIV Latent Infection. Pathogens 2020; 9:pathogens9110896. [PMID: 33121153 PMCID: PMC7692328 DOI: 10.3390/pathogens9110896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022] Open
Abstract
Combinatorial antiretroviral therapy (cART) suppresses HIV replication to undetectable levels and has been effective in prolonging the lives of HIV infected individuals. However, cART is not capable of eradicating HIV from infected individuals mainly due to HIV’s persistence in small reservoirs of latently infected resting cells. Latent infection occurs when the HIV-1 provirus becomes transcriptionally inactive and several mechanisms that contribute to the silencing of HIV transcription have been described. Despite these advances, latent infection remains a major hurdle to cure HIV infected individuals. Therefore, there is a need for more understanding of novel mechanisms that are associated with latent infection to purge HIV from infected individuals thoroughly. Caveolin 1(Cav-1) is a multifaceted functional protein expressed in many cell types. The expression of Cav-1 in lymphocytes has been controversial. Recent evidence, however, convincingly established the expression of Cav-1 in lymphocytes. In lieu of this finding, the current review examines the potential role of Cav-1 in HIV latent infection and provides a perspective that helps uncover new insights to understand HIV latent infection.
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Affiliation(s)
| | - Ayalew Mergia
- Correspondence: ; Tel.: +352-294-4139; Fax: +352-392-9704
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Maragh-Bass AC, Sloan DH, Alghanim F, Knowlton AR. A mixed-methods exploration of faith, spirituality, and health program interest among older African Americans with HIV. Qual Life Res 2020; 30:507-519. [PMID: 33052513 DOI: 10.1007/s11136-020-02656-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Persons living with HIV (PLWH) are living into old age with more complex care needs that non-PLWH. Promoting quality of life should include advance care planning (ACP) education, particularly among African Americans. We explored faith/spirituality-related correlates of interest in a future quality of life program among African American PLWH. METHODS Data were from the AFFIRM study. Participants were recruited from an HIV clinic and completed surveys, interviews, and focus groups. Quantitative analyses included Logistic regression. Qualitative data were coded using grounded theory. RESULTS Nearly half of participants had less than a high school education (47.9%), and roughly 90% had heard of at least one ACP-related topic (86.6%; N = 315). Qualitative themes related to quality of life and faith/spirituality were: (1) Coping with life challenges; (2) Motivation to improve health for loved ones; and (3) Support programs for people with HIV (N = 39). Satisfaction with religion/spirituality was associated with greater interest in a future program (p < .05); discussing ACP before getting sick was associated with less interest (p < .05). CONCLUSIONS/PRACTICE IMPLICATIONS Prioritizing skill-building and grounding in spirituality with input from faith leaders can reduce ACP inequities and improve health outcomes among African Americans.
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Affiliation(s)
- Allysha C Maragh-Bass
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA. .,FHI 360, Behavioral, Epidemiological, and Clinical Sciences Division, Durham, NC, USA.
| | - Danetta Hendricks Sloan
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
| | - Fahid Alghanim
- Internal Medicine Residency Program, Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy R Knowlton
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
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Dai L, Liu A, Zhang H, Wu H, Zhang T, Su B, Shao Y, Li J, Ye J, Scott SR, Mahajan SD, Schwartz SA, Yu H, Sun L. Impact of Lopinavir/Ritonavir and Efavirenz-Based Antiretroviral Therapy on the Lipid Profile of Chinese HIV/AIDS Treatment-Naïve Patients in Beijing: A Retrospective Study. Curr HIV Res 2020; 17:324-334. [PMID: 31654514 DOI: 10.2174/1570162x17666191025115508] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) is associated with lipid abnormalities that contribute to increased risk of cardiovascular (CV) events among patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Although disorders of lipid metabolism associated with ART have been described before in developed countries, data on lipid profile disorders associated with ART use in China are limited. This study aimed to examine the changes in lipid profile among patients with HIV/AIDS who initiated lopinavir/ritonavir LPV/r or efavirenz (EFV)-based antiretroviral treatment regimens, which continue to be widely used China and other developing countries. METHODS This is a retrospective, matched case-control study of HIV-positive patients initiating either LPV/r or EFV regimens at the Beijing You'an Hospital, Capital Medical University between July 2012 and January 2017. Generalized estimating equations were used to compare the differences in total cholesterol [TC], triglycerides [TG], low-density lipoprotein-cholesterol [LDL-C], and highdensity lipoprotein-cholesterol [HDL-C] at baseline and up to 24-months after ART initiation between the two treatment arms. RESULTS Baseline characteristics, including age, sex, CD4 cell count, viral load, and serum lipids, which were comparable between the two groups. The LPV/r-based regimen group had increased TC, TG, HDL-C, and LDL-C after 24-months of treatment. In the EFV-regimen group, TC, HDL-C, and LDL-C were increased compared to baseline, while the TC/HDL-C ratio decreased, and TG did not change significantly. After 24-months of treatment, the percentage of patients with dyslipidemia in the LPV/r group was much higher than in the EFV group (84.0% vs. 52.6%, P<0.001), and 17(10%) patients on LPV/r-based regimens had severe dyslipidemia. Patients on LPV/r-based regimens were at increased odds of hypercholesterolemia (odds ratio [OR]=1.709, P=0.038), hypertriglyceridemia (OR=4.315, P<0.001), and high TC/HDL-C ratio (OR=1.951, P=0.003). However, no significant difference was found in HDL-C (OR=1.246, P=0.186) or LDL-C (OR=1.253, P=0.410) between the treatment groups. CONCLUSION Both LPV/r or EFV treatment regimens impacted patients' lipid profiles. Compared to EFV-based regimens, patients on LPV/r-based regimens had increased odds of dyslipidemia, such as hypercholesterolemia, hypertriglyceridemia, or high TC/HDL-C ratio; however, there was no obvious effect on LDL-C, which is more relevant to the development of the cardiovascular disease.
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Affiliation(s)
- Lili Dai
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - An Liu
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Hongwei Zhang
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Hao Wu
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Tong Zhang
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Bin Su
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Ying Shao
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Jianwei Li
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Jiangzhu Ye
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Sarah Robbins Scott
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Supriya D Mahajan
- Department of Medicine, Division of Allergy, Immunology & Rheumatology, University at Buffalo, Clinical & Translational Research Center, Buffalo, NY 14203, United States
| | - Stanley A Schwartz
- Department of Medicine, Division of Allergy, Immunology & Rheumatology, University at Buffalo, Clinical & Translational Research Center, Buffalo, NY 14203, United States
| | - Hongwei Yu
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
| | - Lijun Sun
- Department of Infectious Disease, You'an Hospital Affiliated to the Capital Medical University, Beijing 100069, China
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Muya E, Kamuhabwa A. Comparative Assessment of the Magnitude of Hyperlipidemia in HIV-Infected Patients Receiving Lopinavir/r- and Atazanavir/r-Based Antiretroviral Drugs. J Int Assoc Provid AIDS Care 2020; 18:2325958219841908. [PMID: 30995874 PMCID: PMC6748546 DOI: 10.1177/2325958219841908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To assess prevalence of hyperlipidemia in patients receiving lopinavir boosted with ritonavir (LPV/r) and atazanavir boosted with ritonavir (ATV/r) antiretroviral drugs. Methods: HIV-infected patients (300) were recruited in the study between December 2015 and April 2016. Lipid profile including triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) were assessed. Results: Prevalence of derangement in TG was 71.0% in patients using LPV/r compared to 44% in those using ATV/r (P = .01). Use of LPV/r was independently associated with increased total cholesterol (TC; P = .001) and TG (P = .0003). Females had raised levels of TC compared to males (P = .00008). Body mass index of ≥ 25 kg/m2 was also associated with raised TC (P = .002) and LDL-C (P = .006). Conclusion: LPV/r was significantly associated with lipid derangements, indicating the need to regularly monitor lipid profile in patients using LPV/r.
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Affiliation(s)
- Esther Muya
- 1 Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Appolinary Kamuhabwa
- 1 Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Rubel AR, Chong PL, Abdullah MS, Asli R, Momin RN, Mani BI, Chong VH. Lipemic serum in patients with Coronavirus Disease 2019 (COVID-19) undergoing treatment. J Med Virol 2020; 92:1810-1811. [PMID: 32343413 PMCID: PMC7267578 DOI: 10.1002/jmv.25942] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Abdur Rahman Rubel
- Department of Internal Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam
| | - Pui Lin Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Muhammad Syafiq Abdullah
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam.,Institute of Health Science, PAPRSB, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Rosmonaliza Asli
- Infectious Disease Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Riamiza Natalie Momin
- Infectious Disease Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Babu Ivan Mani
- Department of Internal Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam
| | - Vui Heng Chong
- Department of Internal Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam.,Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam.,Institute of Health Science, PAPRSB, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
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13
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Meena DS, Rai M, Singh SK, Tapadar J, Kumar D. Metabolic changes in the patients on second-line highly active antiretroviral therapy (HAART): A prospective cohort study from north India. J Family Med Prim Care 2020; 9:1550-1554. [PMID: 32509648 PMCID: PMC7266244 DOI: 10.4103/jfmpc.jfmpc_1208_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction: In India, there is a genetic predisposition to insulin resistance and cardiovascular risk, the impact of ART (antiretroviral therapy) on lipid profile and blood sugar may be significant. The study of potential implications of highly active antiretroviral therapy (HAART)-associated metabolic syndrome is critical to prevent cardiovascular diseases in the Indian population. Aims: This study was done to determine the prevalence of metabolic changes (dyslipidaemia, hyperglycemia and insulin resistance) among HIV patients on second-line ART. Settings and Design: A prospective cohort study. Methods and Materials: We enrolled 150 patients, who were started on second-line HAART. Patients were investigated for fasting blood sugar, lipid profile and insulin level at baseline and after 6 months. Statistical Analysis: The data were analysed using SPSS software (version 20; IBM Corp., Armonk, N.Y., USA). Student's t-test was used to compare numerical variables in the two groups. P value < 0.05 was considered as statistically significant. Results: There was a significant increase in serum cholesterol, LDL and triglyceride in patients with protease inhibitors (PIs) containing regimens. LDL levels were increased from 65 to 80 mg/dL (P = <.003) after treatment. Triglycerides were increased from 138 to 152 mg/dL. (P = <0.001). Median fasting blood sugar was increased from 85 to 96 mg/dL (P = <0.002). HOMA-IR was also significantly increased in the PI group (1.54 vs. 2.1, P <.003). However, serum HDL did not change significantly. Conclusions: Appropriate drug selection with timely switching of ART is crucial to prevent metabolic complications in patients taking long-term PIs.
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Affiliation(s)
- Durga S Meena
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajsthan, India
| | - Madhukar Rai
- Department of Medicine, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | - Surya K Singh
- Department of Endocrinology, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | - Jaya Tapadar
- Department of Medicine, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | - Deepak Kumar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajsthan, India
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14
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Tsai FJ, Ho MW, Lai CH, Chou CH, Li JP, Cheng CF, Wu YC, Liu X, Tsang H, Lin TH, Liao CC, Huang SM, Lin JC, Lin CC, Hsieh CL, Liang WM, Lin YJ. Evaluation of Oral Antiretroviral Drugs in Mice With Metabolic and Neurologic Complications. Front Pharmacol 2018; 9:1004. [PMID: 30233379 PMCID: PMC6131569 DOI: 10.3389/fphar.2018.01004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/15/2018] [Indexed: 12/30/2022] Open
Abstract
Antiretroviral (ART) drugs has previously been associated with lipodystrophic syndrome, metabolic consequences, and neuropsychiatric complications. ART drugs include three main classes of protease inhibitors (PIs), nucleoside analog reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Our previous work demonstrated that a high risk of hyperlipidemia was observed in HIV-1-infected patients who received ART drugs in Taiwan. Patients receiving ART drugs containing either Abacavir/Lamivudine (Aba/Lam; NRTI/NRTI), Lamivudine/Zidovudine (Lam/Zido; NRTI/NRTI), or Lopinavir/Ritonavir (Lop/Rit; PI) have the highest risk of hyperlipidemia. The aim of this study was to investigate the effects of Aba/Lam (NRTI/NRTI), Lam/Zido (NRTI/NRTI), and Lop/Rit (PI) on metabolic and neurologic functions in mice. Groups of C57BL/6 mice were administered Aba/Lam, Lam/Zido, or Lop/Rit, orally, once daily for a period of 4 weeks. The mice were then extensively tested for metabolic and neurologic parameters. In addition, the effect of Aba/Lam, Lam/Zido, and Lop/Rit on lipid metabolism was assessed in HepG2 hepatocytes and during the 3T3-L1 preadipocyte differentiation. Administration with Aba/Lam caused cognitive and motor impairments in mice, as well as their metabolic imbalances, including alterations in leptin serum levels. Administration with Lop/Rit also caused cognitive and motor impairments in mice, as well as their metabolic imbalances, including alterations in serum levels of total cholesterol, and HDL-c. Treatment of mice with Aba/Lam and Lop/Rit enhanced the lipid accumulation in the liver, and the decrease in AMP-activated protein kinase (AMPK) phosphorylation and/or its downstream target acetyl-CoA carboxylase (ACC) protein expression. In HepG2 hepatocytes, Aba/Lam, Lam/Zido, and Lop/Rit also enhanced the lipid accumulation and decreased phosphorylated AMPK and ACC proteins. In 3T3-L1 pre-adipocyte differentiation, Aba/Lam and Lop/Rit reduced adipogenesis by decreasing expression of transcription factor CEBPb, implicating the lipodystrophic syndrome. Our results demonstrate that daily oral administration of Aba/Lam and Lop/Rit may produce cognitive, motor, and metabolic impairments in mice, regardless of HIV-1 infection.
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Affiliation(s)
- Fuu-Jen Tsai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Biotechnology, Asia University, Taichung, Taiwan
| | - Mao-Wang Ho
- Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Ho Lai
- Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan.,Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chen-Hsing Chou
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Ju-Pi Li
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Rheumatism Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Fung Cheng
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Yang-Chang Wu
- Graduate Institute of Natural Products and Research Center for Natural Products & Drug Development, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Xiang Liu
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Hsinyi Tsang
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Ting-Hsu Lin
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Chu Liao
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Shao-Mei Huang
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Chun Lin
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chien Lin
- Department of Cosmetic Science, Providence University, Taichung, Taiwan
| | - Ching-Liang Hsieh
- Graduate Institute of Integrated Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Ying-Ju Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Tsai FJ, Cheng CF, Lai CH, Wu YC, Ho MW, Wang JH, Tien N, Liu X, Tsang H, Lin TH, Liao CC, Huang SM, Li JP, Lin JC, Lin CC, Chen JH, Liang WM, Lin YJ. Effect of antiretroviral therapy use and adherence on the risk of hyperlipidemia among HIV-infected patients, in the highly active antiretroviral therapy era. Oncotarget 2017; 8:106369-106381. [PMID: 29290955 PMCID: PMC5739740 DOI: 10.18632/oncotarget.22465] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 10/28/2017] [Indexed: 12/12/2022] Open
Abstract
HIV-infected patients exposed to antiretroviral therapy (ART) have an increased risk for hyperlipidemia and cardiovascular disease. We performed a longitudinal, comprehensive, and population-based study to investigate the cumulative effect of different types of ART regimens on hyperlipidemia risk in the Taiwanese HIV/ART cohort. A total of 13,370 HIV-infected patients (2,674 hyperlipidemia and 10,696 non-hyperlipidemia patients) were recruited after matching for age, gender, and the first diagnosis date of HIV infection by using the National Health Insurance Research Database in Taiwan. Hyperlipidemia risk associated with cumulative ART use, ART adherence, and their combination was assessed. The matched hyperlipidemia group had a larger number of patients using ART and a higher incidence of comorbidities, specifically, respiratory disease and diabetes. Patients with high ART dosage and dose-dependent manner adherence, respectively, demonstrated an increased risk of hyperlipidemia. For single ART regimens, patients receiving nucleoside reverse-transcriptase inhibitors (NRTI/NRTI)- containing regimen had the highest hyperlipidemia risk, followed by protease inhibitor (PI)- containing and non-NRTI- containing regimens. For combination ART regimens, patients receiving a NRTI/NRTI + PI regimen had the highest hyperlipidemia risk. An increased cumulative drug dose was observed in patients who received the PI, NRTI/NRTI, NRTI, and NNRTI regimens in the hyperlipidemia group, when compared to the non-hyperlipidemia group. In conclusion, ART cumulative use, adherence, and regimen may affect hyperlipidemia risk among HIV-infected patients in a dose-dependent manner.
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Affiliation(s)
- Fuu-Jen Tsai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Asia University, Taichung, Taiwan
| | - Chi-Fung Cheng
- Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Chih-Ho Lai
- Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan
| | - Yang-Chang Wu
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Mao-Wang Ho
- Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jen-Hsien Wang
- Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ni Tien
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Xiang Liu
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Hsinyi Tsang
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ting-Hsu Lin
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Chu Liao
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Shao-Mei Huang
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Ju-Pi Li
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Rheumatism Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Chun Lin
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chien Lin
- Department of Cosmetic Science, Providence University, Taichung, Taiwan
| | - Jin-Hua Chen
- Biostatistics Center, College of Management, Taipei Medical University, Taipei, Taiwan.,School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Ying-Ju Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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