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Lazar-Poloczek E, Romuk E, Jacheć W, Wróbel-Nowicka K, Świętek A, Wojciechowska C. Association of NT-proBNP and sST2 with Left Ventricular Ejection Fraction and Oxidative Stress in Patients with Stable Dilated Cardiomyopathy. Biomedicines 2024; 12:707. [PMID: 38672063 PMCID: PMC11048168 DOI: 10.3390/biomedicines12040707] [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] [Received: 12/27/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this study was to analyze the relationship between levels of sST2, NT-proBNP and oxidative stress markers in patients with reduced ejection fraction (HFrEF) due to non-ischemic cardiomyopathy. A total of 88 patients with HFrEF were divided into four groups based on left ventricular ejection fraction (≤25% and >25%) and NYHA functional class (group 1-LVEF > 25% and NYHA class I or II; group 2-LVEF > 25% and NYHA class III or IV; group III-LVEF ≤ 25% and NYHA class I or II; group IV-LVEF ≤ 25% and NYHA class III or IV). In 39 (44.32%) patients LVEF was reduced below 25%, and 22 of them (56.41%) were in NYHA functional class III/IV. Of the 49 (55.68%) patients with LVEF ≥ 25%, only 18.37% were in NYHA functional class III/IV (p < 0.001). Patients with LVEF ≥ 25% had lower levels of NT-proBNP, total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI). The levels of NT-proBNP but not sST-2 correlated positively with NYHA functional class (p < 0.001) and negatively with LVEF (p < 0.001). The levels of sST-2 were associated with increased TAC (p = 0.009) and uric acid (p = 0.040). These findings indicate that only NT-proBNP was related to the severity of heart failure, whereas sST2 correlated with total antioxidant capacity. Therefore, in stable patients with HFrEF due to dilated cardiomyopathy, sST2 may be an additional biomarker reflecting the redox status, but not the severity of heart failure.
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Affiliation(s)
- Elżbieta Lazar-Poloczek
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 10, M.C-Skłodowska St., 41-800 Zabrze, Poland; (E.L.-P.); (W.J.)
| | - Ewa Romuk
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 19, Jordan St., 41-808 Zabrze, Poland;
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 10, M.C-Skłodowska St., 41-800 Zabrze, Poland; (E.L.-P.); (W.J.)
| | - Karolina Wróbel-Nowicka
- Medical Laboratory in Specialistic Hospital in Zabrze, 10, M.C-Skłodowska St., 41-800 Zabrze, Poland;
| | - Agata Świętek
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 19, Jordan St., 41-808 Zabrze, Poland;
- Silesia LabMed Research and Implementation Center, Medical University of Silesia in Katowice, 19, Jordan St., 41-808 Zabrze, Poland
| | - Celina Wojciechowska
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 10, M.C-Skłodowska St., 41-800 Zabrze, Poland; (E.L.-P.); (W.J.)
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Basta D, Latinovic OS, Tagaya Y, Silvestri G. Potential Advantages of a Well-balanced Nutrition Regimen for People Living with Human Immunodeficiency Virus Type -1. JOURNAL OF AIDS AND HIV TREATMENT 2024; 6:11-27. [PMID: 38845818 PMCID: PMC11155617 DOI: 10.33696/aids.6.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
This review underscores the important role of nutrition in enhancing the management of Human Immunodeficiency Virus type 1 (HIV-1). Highlighting the efficacy of dietary interventions, including, the importance of omega-3 fatty acids, vitamins D and B-12, and the Mediterranean diet, we delineate how these beneficial nutritional strategies can improve the effectiveness of combined antiretroviral therapy (cART), mitigate its side effects, and ameliorate metabolic disorders in people living with HIV-1 (PLWH). Our review advocates for the integration and implementation of personalized nutritional assessments into the care plan for PLWH, proposing actionable strategies for healthcare providers in HIV-1 field. Summarizing the current standing of the relevance of the nutritional and well-planned diet recommended for the PLWH and emphasizing on the future research directions, this review establishes a foundation for nutrition as a cornerstone in comprehensive HIV-1 management. Our review aims to improve patients' health outcomes and overall quality of life for PLWH.
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Affiliation(s)
- Daniele Basta
- Green Home scarl, Scientific Committee, Arcavacata di Rende (CS), Italy
| | - Olga S. Latinovic
- Department of Microbiology and Immunology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
| | - Yutaka Tagaya
- Division of Virology, Pathogenesis, and Cancer, Institute of Human Virology, University of Maryland School of Medicine, MD, 21201, USA
| | - Giovannino Silvestri
- Department of Medicine, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, 21201, USA
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3
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Freitas M, Neves C, Sarmento H, Cunha P, Cotter J. Assessment of Cardiovascular Risk and Arterial Stiffness in Patients With Human Immunodeficiency Virus. Cureus 2023; 15:e41784. [PMID: 37575811 PMCID: PMC10420332 DOI: 10.7759/cureus.41784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Several studies suggest that patients infected with the human immunodeficiency virus (HIV) under highly active antiretroviral therapy (HAART) have a higher cardiovascular risk than the general population. Arterial stiffness is an independent predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (PWV). The objectives of this study were to characterize a sample of HIV-infected patients under HAART regarding cardiovascular risk, compare PWV values of this group with those of uninfected controls, and investigate predictors of PWV in the HIV-infected group. METHODS PWV was measured, and data was collected from a sample of 125 HIV-infected patients under HAART. PWV measurements in the study group were compared with those in a control group of 250 subjects similar in sex, age, prevalence of hypertension, and type 2 diabetes mellitus (DM). A linear regression model was constructed to identify predictors of PWV in the HIV-infected group. RESULTS In the HIV-infected group, composed mostly of men, the mean age and respective standard deviation were 48.6 ± 11.6 years. In this group, 112 individuals (89.6%) presented moderate to very high cardiovascular risk. Significant differences were found in median PWV between HIV-infected and control groups (8.56 vs. 8.00 m/s, p = .002). Age, peripheral systolic blood pressure, presence of DM, amount of alcohol consumed, and current CD4+ T cell count were independent predictors of PWV in the HIV-infected group. Conclusions: The HIV-infected group showed higher cardiovascular risk and arterial stiffness measurements than the general population. PWV may be an important predictor of subclinical cardiovascular disease in HIV-infected patients.
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Affiliation(s)
- Mariana Freitas
- Nephrology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT
- School of Medicine, University of Minho, Braga, PRT
| | - Clarisse Neves
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Helena Sarmento
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Pedro Cunha
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Jorge Cotter
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
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Liao CT, Toh HS, Chang WT, Yang CT, Chen ZC, Tang HJ, Strong C. Assessment of subclinical cardiac dysfunction by speckle-tracking echocardiography among people living with human immunodeficiency virus. Front Cardiovasc Med 2023; 10:1200418. [PMID: 37288253 PMCID: PMC10242012 DOI: 10.3389/fcvm.2023.1200418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Background People living with HIV (PLWH) have an increased risk of developing cardiovascular diseases (CVD). As speckle-tracking echocardiography (STE) has been used to detect subclinical myocardial abnormalities, this study aims to detect early cardiac impairment among Asian PLWH using STE and to investigate the associated risk factors. Methods We consecutively recruited asymptomatic PLWH without previous CVD from a medical center of Taiwan, and their cardiac function was evaluated by conventional echocardiogram and STE. Enrolled PLWH were classified as antiretroviral therapy (ART)-experienced and ART-naive, and multivariable regressions were used to assess the association between myocardial strain and risk factors including traditional CVD and HIV-associated factors. Results A total of 181 PLWH (mean age: 36.4 ± 11.4 years, 173 males) were recruited and conventional echocardiogram parameters were within normal ranges. Decreased myocardial strain across the myocardium was found, with a mean left ventricular (LV) global longitudinal strain of -18.7 ± 2.9%. The LV strain in the ART-experienced group (-19.0 ± 2.9%) was significantly better than the ART-naive group (-17.9 ± 2.8%), despite a younger age and lesser CVD risk factors in the ART-naive group. Hypertension [B = 1.92, 95% confidence interval (95% CI) 0.19-3.62, p = 0.029] and ART-naive with both low and high viral loads (VL) (B = 1.09, 95% CI 0.03-2.16, p = 0.047; and B = 2.00, 95% CI, 0.22-3.79, p = 0.029) were significantly associated with reduced myocardial strain. Conclusion This is the first and largest cohort using STE to investigate myocardial strain in Asian PLWH. Our results suggest that hypertension and detectable VL are associated with impaired myocardial strain. Thus, timely ART administration with VL suppression and hypertension control are crucial in preventing CVD when making the management parallel with the improved life expectancy of PLWH on ART.
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Affiliation(s)
- Chia-Te Liao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - 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
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Ratku B, Sebestyén V, Erdei A, Nagy EV, Szabó Z, Somodi S. Effects of adult growth hormone deficiency and replacement therapy on the cardiometabolic risk profile. Pituitary 2022; 25:211-228. [PMID: 35106704 PMCID: PMC8894188 DOI: 10.1007/s11102-022-01207-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/12/2022]
Abstract
Adult growth hormone deficiency (AGHD) is considered a rare endocrine disorder involving patients with childhood-onset and adult-onset growth hormone deficiency (AoGHD) and characterized by adverse cardiometabolic risk profile. Besides traditional cardiovascular risk factors, endothelial dysfunction, low-grade inflammation, impaired adipokine profile, oxidative stress and hypovitaminosis D may also contribute to the development of premature atherosclerosis and higher cardiovascular risk in patients with AGHD. Growth hormone replacement has been proved to exert beneficial effects on several cardiovascular risk factors, but it is also apparent that hormone substitution in itself does not eliminate all cardiometabolic abnormalities associated with the disease. Novel biomarkers and diagnostic techniques discussed in this review may help to evaluate individual cardiovascular risk and identify patients with adverse cardiometabolic risk profile. In the absence of disease-specific guidelines detailing how to assess the cardiovascular status of these patients, we generally recommend close follow-up of the cardiovascular status as well as low threshold for a more detailed evaluation.
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Affiliation(s)
- Balázs Ratku
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
- Department of Emergency and Oxyology, Faculty of Health, University of Debrecen, Debrecen, Hungary
| | - Veronika Sebestyén
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Annamária Erdei
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Endre V Nagy
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
| | - Sándor Somodi
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary.
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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Kovacs L, Kress TC, Belin de Chantemèle EJ. HIV, Combination Antiretroviral Therapy, and Vascular Diseases in Men and Women. JACC Basic Transl Sci 2022; 7:410-421. [PMID: 35540101 PMCID: PMC9079796 DOI: 10.1016/j.jacbts.2021.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
Thanks to the advent of combination antiretroviral therapy (cART), people living with human immunodeficiency virus (HIV) (PLWH) experienced a marked increase in life expectancy but are now at higher risk for cardiovascular disease (CVD), the current leading cause of death in PLWH on cART. Although HIV preponderantly affects men over women, manifestations of HIV-related CVD differ by sex with women experiencing greater risks than men. Despite extensive investigation, the etiopathology of CVD, notably the respective contribution of viral infection and cART, remain ill-defined. However, both viral infection and cART have been reported to contribute to endothelial dysfunction, the precursor and major cause of atherosclerosis-associated CVD, through mechanisms involving endothelial cell activation, inflammation, and oxidative stress, all leading to reduced nitric oxide bioavailability. Therefore, preserving endothelial function in PLWH on cART should be a main target to reduce CVD morbidity and mortality, notably in females.
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Key Words
- CVD, cardiovascular disease
- FMD, flow-mediated dilatation
- HF, heart failure
- HIV
- HIV, human immunodeficiency virus
- MI, myocardial infarction
- NO, nitric oxide
- PAD, peripheral artery disease
- PH, pulmonary hypertension
- PLWH, people living with HIV
- cART, combination antiretroviral therapy
- cIMT, carotid intima-media thickness
- combination antiretroviral therapy
- endothelial dysfunction
- sex differences
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Affiliation(s)
- Laszlo Kovacs
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Taylor C Kress
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta Georgia, USA
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Shahbaz S, Okoye I, Blevins G, Elahi S. Elevated ATP via enhanced miRNA-30b, 30c, and 30e downregulates the expression of CD73 in CD8+ T cells of HIV-infected individuals. PLoS Pathog 2022; 18:e1010378. [PMID: 35325005 PMCID: PMC8947394 DOI: 10.1371/journal.ppat.1010378] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/17/2022] [Indexed: 12/24/2022] Open
Abstract
CD8+ T cells play a crucial role against chronic viral infections, however, their effector functions are influenced by the expression of co-stimulatory/inhibitory receptors. For example, CD73 works with CD39 to convert highly inflammatory ATP to adenosine. However, its expression on T cells in the context of viral infections has not been well defined. Here, we analyzed the expression of CD73 on human T cells in a cohort of 102 HIV-infected individuals including those on antiretroviral therapy (ART), ART-naïve, and long-term non-progressors who were not on ART. We found that the frequency of CD73+ T cells was markedly lower among T cell subsets (e.g. naïve, effector or memory) in the peripheral blood of all HIV-infected individuals. Notably, CD73 was decreased at the cell surface, intracellular and gene levels. Functionally, CD8+CD73+ T cells exhibited decreased cytokine expression (TNF-α, IFN-γ and IL-2) upon global or antigen-specific stimulation and impaired expression of cytolytic molecules at the gene and protein levels. In contrast, CD8+CD73+ T cells expressed elevated levels of homing receptors such as CCR7, α4β7 integrin, which suggests a migratory advantage for these cells as observed in vitro. We also observed significant migration of CD73+CD8+ T cells into the cerebrospinal fluids of multiple sclerosis (MS) patients at the time of disease relapse. Moreover, we found that elevated levels of ATP in the plasma of HIV-infected individuals upregulates the expression of miRNA30b-e in T cells in vitro. In turn, inhibition of miRNAs (30b, 30c and 30e) resulted in significant upregulation of CD73 mRNA in CD8+ T cells. Therefore, we provide a novel mechanism for the downregulation of CD73 via ATP-induced upregulation of miRNA30b, 30c and 30e in HIV infection. Finally, these observations imply that ATP-mediated downregulation of CD73 mainly occurs via its receptor, P2X1/P2RX1. Our results may in part explain why HIV-infected individuals have reduced risk of developing MS considering the role of CD73 for efficient T cell entry into the central nervous system. CD8+ T cells (killer T cells) play an important role against chronic viral infections, however, their functional properties get compromised during the course of HIV infection. CD73, is one of molecules that influences T cell functions, however, its role in the context of viral infections has not been well defined. Here, we analyzed the expression of CD73 on T cells in a cohort of 102 HIV-infected individuals including those on antiretroviral therapy (ART), ART-naïve, and long-term non-progressors who were not on ART. We found that the frequency of T cells expressing this molecule was markedly lower among different T cell subsets obtained from the blood of HIV-infected individuals. Notably, CD73 was decreased at the intracellular protein and gene levels. Furthermore, we found that T cells expressing this molecule (CD73) had impaired functional properties. In contrast, we observed that T cells expressing CD73 had elevated levels of homing receptors, which suggests a migratory advantage for these cells. This was also supported by increased CD73+ T cells in the cerebrospinal fluids of multiple sclerosis patients when they experienced disease replace. Moreover, we found that the elevated level of ATP in the plasma of HIV-infected individuals is responsible for the upregulation of miRNA30b, 30c and 30e, resulting in reduced expression of CD73.
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Affiliation(s)
- Shima Shahbaz
- School of Dentistry, Division of Foundational Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Isobel Okoye
- School of Dentistry, Division of Foundational Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Gregg Blevins
- Department of Medicine, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Shokrollah Elahi
- School of Dentistry, Division of Foundational Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Li Ka Shing Institute of Virology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- * E-mail:
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Gnoni M, Beas R, Raghuram A, Díaz-Pardavé C, Riva-Moscoso A, Príncipe-Meneses FS, Vásquez-Garagatti R. Potential role of intermittent fasting on decreasing cardiovascular disease in human immunodeficiency virus patients receiving antiretroviral therapy. World J Exp Med 2021; 11:66-78. [PMID: 34877266 PMCID: PMC8611195 DOI: 10.5493/wjem.v11.i5.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/18/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH.
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Affiliation(s)
- Martin Gnoni
- Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, OH 45220, United States
- Division of Infectious Diseases, Department of Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
| | - Renato Beas
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Anupama Raghuram
- Division of Infectious Diseases, Department of Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
- US Medical Affairs, Merck Research Laboratories, Kenilworth, NJ 07033, United States
| | - Celeste Díaz-Pardavé
- Division of Research and Academic Affairs, Larkin Health System, South Miami, FL 33143, United States
- School of Medicine, Universidad Científica del Sur, Lima 15837, Peru
| | - Adrian Riva-Moscoso
- Division of Research and Academic Affairs, Larkin Health System, South Miami, FL 33143, United States
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
- Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
| | - Fortunato S Príncipe-Meneses
- Division of Research and Academic Affairs, Larkin Health System, South Miami, FL 33143, United States
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
- Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
| | - Raúl Vásquez-Garagatti
- Hospital Medicine Department and Infectious Diseases, University of Tennessee Medical Center at Knoxville, Knoxville, TN 37920, United States
- Department of Internal Medicine, Cherokee Health, Knoxville, TN 37921, United States
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Bajdechi M, Mihai C, Scafa-Udriste A, Cherry A, Zamfir D, Dumitru I, Cernat R, Rugina S. Severe Coronary Artery Disease in a Person Living with HIV. ACTA ACUST UNITED AC 2021; 57:medicina57060595. [PMID: 34200527 PMCID: PMC8229972 DOI: 10.3390/medicina57060595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 01/18/2023]
Abstract
The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.
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Affiliation(s)
- Mircea Bajdechi
- Faculty of Medicine, University “Ovidius” of Constanta, 900470 Constanța, Romania; (I.D.); (R.C.)
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
- Correspondence: (M.B.); (S.R.); Tel.: +40-720569706 (M.B.)
| | - Cosmin Mihai
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
| | - Alexandru Scafa-Udriste
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
- 4th Department, Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 București, Romania
| | - Ali Cherry
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
| | - Diana Zamfir
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
| | - Irina Dumitru
- Faculty of Medicine, University “Ovidius” of Constanta, 900470 Constanța, Romania; (I.D.); (R.C.)
| | - Roxana Cernat
- Faculty of Medicine, University “Ovidius” of Constanta, 900470 Constanța, Romania; (I.D.); (R.C.)
| | - Sorin Rugina
- Faculty of Medicine, University “Ovidius” of Constanta, 900470 Constanța, Romania; (I.D.); (R.C.)
- Correspondence: (M.B.); (S.R.); Tel.: +40-720569706 (M.B.)
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Ashwitha SK, Jacob PA, Ajaj A, Shirke MM, Harky A. Management of cardiovascular diseases in HIV/AIDS patients. J Card Surg 2020; 36:236-243. [PMID: 33225472 DOI: 10.1111/jocs.15213] [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] [Received: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome, a pandemic in the current population causes severe weakness of the body's immune system making the infected patient more vulnerable to life-threatening conditions. The disease predisposes the infected patient to several cardiovascular diseases and cerebrovascular diseases such as heart failure and stroke. The decline in CD4 cells following HIV infection, vulnerability to opportunistic infections and underlying HIV pathology plays a major role in the development of cardiovascular manifestations, and treatment targeting cardiomyopathy in this specific patient subset is not well recognized. Patients living with HIV (PLWH) also experience discrimination in receiving cardiovascular disease care and this needs to be addressed by strengthening frameworks for monitoring and providing nonjudgmental healthcare. This review aims to study the profile of the cardiovascular disease in HIV patients, treatment, and provide evidence of the disparity in the provision of healthcare with regard to PLWH.
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Affiliation(s)
- Santoshi K Ashwitha
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Preethi A Jacob
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Abdullah Ajaj
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Manasi M Shirke
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Heart and Chest Hospital, Department of Cardiovascular Science, University of Liverpool, Liverpool, UK.,Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
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11
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Nguyen I, Kim AS, Chow FC. Prevention of stroke in people living with HIV. Prog Cardiovasc Dis 2020; 63:160-169. [PMID: 32014514 PMCID: PMC7237326 DOI: 10.1016/j.pcad.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 12/13/2022]
Abstract
In the era of effective antiretroviral therapy (ART), HIV has become a manageable disease marked by an elevated risk of non-AIDS-related comorbidities, including stroke. Rates of stroke are higher in people living with HIV (PLWH) compared with the general population. Elevated stroke risk may be attributable to traditional risk factors, HIV-associated chronic inflammation and immune dysregulation, and possible adverse effects of long-standing ART use. Tailoring stroke prevention strategies for PLWH requires knowledge of how stroke pathogenesis may differ from non-HIV-associated stroke, knowledge of long-term stroke outcomes in HIV, and accurate stroke risk assessment tools. As a result, the approach to primary and secondary stroke prevention in PLWH relies heavily on guidelines developed for the general population, with an emphasis on optimization of traditional vascular risk factors and early initiation of ART. This review summarizes existing evidence on HIV-associated stroke mechanisms and considerations for stroke prevention for PLWH.
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Affiliation(s)
- Ivy Nguyen
- Department of Neurology, University of California, San Francisco, CA, United States of America
| | - Anthony S Kim
- Department of Neurology, University of California, San Francisco, CA, United States of America
| | - Felicia C Chow
- Department of Neurology, University of California, San Francisco, CA, United States of America; Department of Medicine, Division of Infectious Diseases, University of California San Francisco, CA, United States of America.
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12
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Policarpo S, Rodrigues T, Moreira AC, Valadas E. Cardiovascular risk in HIV-infected individuals: A comparison of three risk prediction algorithms. Rev Port Cardiol 2019; 38:463-470. [PMID: 31522936 DOI: 10.1016/j.repc.2019.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 10/21/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Cardiovascular (CV) risk is known to be increased in HIV-infected individuals. Our aim was to assess CV risk in HIV-infected adults. METHODS CV risk was estimated for each patient using three different risk algorithms: SCORE, the Framingham risk score (FRS), and DAD. Patients were classified as at low, moderate or high CV risk. Clinical and anthropometric data were collected. RESULTS We included 571 HIV-infected individuals, mostly male (67.1%; n=383). Patients were divided into two groups according to antiretroviral therapy (ART): naïve (7.5%; n=43) or under ART (92.5%; n=528). The mean time since HIV diagnosis was 6.7±6.5 years in the naive group and 13.3±6.1 years in the ART group. Metabolic syndrome (MS) was identified in 33.9% (n=179) and 16.3% (n=7) of participants in the ART and naïve groups, respectively. MS was associated with ART (OR=2.7; p=0.018). Triglycerides ≥150 mg/dl (OR=13.643, p<0.001) was one of the major factors contributing to MS. Overall, high CV risk was found in 4.4% (n=23) of patients when the SCORE tool was used, in 20.5% (n=117) using the FRS, and in 10.3% (n=59) using the DAD score. The observed agreement between the FRS and SCORE was 55.4% (k=0.183, p<0.001), between the FRS and DAD 70.5% (k=0.465, p<0.001), and between SCORE and DAD 72.3% (k=0.347, p<0.001). CONCLUSION On the basis of the three algorithms, we detected a high rate of high CV risk, particularly in patients under ART. The FRS was the algorithm that classified most patients in the high CV risk category (20.5%). In addition, a high prevalence of MS was identified in this patient group.
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Affiliation(s)
- Sara Policarpo
- Serviço de Dietética e Nutrição, Hospital de Santa Maria, Lisboa, Portugal; Universidade de Lisboa, Faculdade de Medicina, Laboratório de Nutrição, Lisboa, Portugal.
| | - Teresa Rodrigues
- Universidade de Lisboa, Faculdade de Medicina, Laboratório de Biomatemática, Lisboa, Portugal
| | - Ana Catarina Moreira
- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal H&TRC - Centro de Investigação em Saúde e Tecnologia, Portugal
| | - Emília Valadas
- Universidade de Lisboa, Faculdade de Medicina, Clinica Universitária de Doenças Infecciosas, Lisboa, Portugal
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13
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Policarpo S, Rodrigues T, Moreira AC, Valadas E. Cardiovascular risk in HIV-infected individuals: A comparison of three risk prediction algorithms. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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14
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Masenga SK, Hamooya BM, Nzala S, Kwenda G, Heimburger DC, Mutale W, Munsaka SM, Koethe JR, Kirabo A. Patho-immune Mechanisms of Hypertension in HIV: a Systematic and Thematic Review. Curr Hypertens Rep 2019; 21:56. [PMID: 31165257 PMCID: PMC6548744 DOI: 10.1007/s11906-019-0956-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To systematically review recent findings on the role of immune cell activation in the pathogenesis of hypertension in people living with HIV (PLWH) and compare studies from Sub-Saharan Africa with what is reported in the USA and European literature according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RECENT FINDINGS PLWH have an increased risk for development of hypertension and cardiovascular disease. Chronic immune activation contributes to hypertension but the inflammatory milieu that predisposes PLWH to hypertension is poorly understood. We identified 45 relevant studies from 13 unique African countries. The prevalence of hypertension in PLWH on antiretroviral therapy (ART) and the ART-naive PLWH ranged from 6 to 50% and 2 to 41%, respectively. Interleukin (IL)-17A, interferon (IFN)-γ, and higher CD4+ T cell counts were associated with hypertension in ART-treated participants. Targeting adaptive immune activation could provide improved care for hypertensive PLWH. Further research is needed to characterize the inflammatory milieu contributing to hypertension in PLWH especially in African populations where the global burden of HIV is the highest.
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Affiliation(s)
- Sepiso K. Masenga
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- School of Health Sciences, Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia
- Vanderbilt Institute for Global Health, Nashville, TN USA
| | - Benson M. Hamooya
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | - Selestine Nzala
- Department of Medical Education Development, University of Zambia, Lusaka, Zambia
| | - Geoffrey Kwenda
- School of Health Sciences, Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia
| | | | - Wilbroad Mutale
- School of Public Health, Department of Health policy and Management, University of Zambia, Lusaka, Zambia
| | - Sody M. Munsaka
- School of Health Sciences, Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia
| | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN USA
| | - Annet Kirabo
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, 2215 Garland Avenue, P415C Medical Research Building IV, Nashville, TN 37232 USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN USA
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15
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Raggi P, Prandini N, Ligabue G, Braglia G, Esposito F, Milic J, Malagoli A, Scaglioni R, Besutti G, Beghetto B, Nardini G, Roncaglia E, Mussini C, Guaraldi G. Molecular Imaging of Vascular Calcification with 18F-Sodium-Fluoride in Patients Infected with Human Immunodeficiency Virus. Int J Mol Sci 2019; 20:ijms20051183. [PMID: 30857165 PMCID: PMC6429185 DOI: 10.3390/ijms20051183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
18F-Sodium Fluoride (NaF) accumulates in areas of active hydroxyapatite deposition and potentially unstable atherosclerotic plaques. We assessed the presence of atherosclerotic plaques in 50 adult patients with HIV (HIV+) who had undergone two cardiac computed tomography scans to measure coronary artery calcium (CAC) progression. CAC and its progression are predictive of an unfavorable prognosis. Tracer uptake was quantified in six arterial territories: aortic arch, innominate carotid artery, right and left internal carotid arteries, left coronary (anterior descending and circumflex) and right coronary artery. Thirty-one patients showed CAC progression and 19 did not. At least one territory with high NaF uptake was observed in 150 (50%) of 300 arterial territories. High NaF uptake was detected more often in non-calcified than calcified areas (68% vs. 32%), and in patients without than in those with prior CAC progression (68% vs. 32%). There was no correlation between clinical and demographic variables and NaF uptake. In clinically stable HIV+ patients, half of the arterial territories showed a high NaF uptake, often in the absence of macroscopic calcification. NaF uptake at one time point did not correlate with prior progression of CAC. Prospective studies will demonstrate the prognostic significance of high NaF uptake in HIV+ patients.
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Affiliation(s)
- Paolo Raggi
- Division of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, 11220 83rd Avenue, Suite 5A9-014, Edmonton, AB T6G 2B7, Canada.
| | - Napoleone Prandini
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Guido Ligabue
- Department of Radiology, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giovanni Braglia
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Francesco Esposito
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Jovana Milic
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Andrea Malagoli
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Riccardo Scaglioni
- Department of Radiology, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giulia Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Barbara Beghetto
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giulia Nardini
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Enrica Roncaglia
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
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16
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Demir OM, Candilio L, Fuster D, Muga R, Barbaro G, Colombo A, Azzalini L. Cardiovascular disease burden among human immunodeficiency virus-infected individuals. Int J Cardiol 2019; 265:195-203. [PMID: 29885686 DOI: 10.1016/j.ijcard.2018.03.137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/17/2018] [Accepted: 03/30/2018] [Indexed: 12/20/2022]
Abstract
Human Immunodeficiency Virus (HIV) infection affects 36.7 million people worldwide, it accounted for 1.1 million deaths in 2015. The advent of combined antiretroviral therapy (cART) has been associated with a decrease in HIV-related morbidity and mortality. However, there are increasing concerns about long-lasting effects of chronic inflammation and immune activation, leading to premature aging and HIV-related mortality. Cardiovascular diseases, especially coronary artery disease, are among the leading causes of death in HIV-infected patients, accounting for up to 15% of total deaths in high income countries. Furthermore, as cART availability expands to low-income countries, the burden of cardiovascular related mortality is likely to rise. Hence, over the next decade HIV-associated cardiovascular disease burden is expected to increase globally. In this review, we summarize our understanding of the pathogenesis and risk factors associated with HIV infection and cardiovascular disease, in particular coronary artery disease.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Luciano Candilio
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Daniel Fuster
- Department of Internal Medicine, Addiction Unit, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Robert Muga
- Department of Internal Medicine, Addiction Unit, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Giuseppe Barbaro
- Department of Internal Medicine and Infectious Diseases, Policlinico Umberto Primo, Rome, Italy
| | - Antonio Colombo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
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17
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Al-Eisa RA, Al-Salmi FA, Hamza RZ, El-Shenawy NS. Role of L-carnitine in protection against the cardiac oxidative stress induced by aspartame in Wistar albino rats. PLoS One 2018; 13:e0204913. [PMID: 30403670 PMCID: PMC6221268 DOI: 10.1371/journal.pone.0204913] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/17/2018] [Indexed: 01/24/2023] Open
Abstract
Aspartame (ASP) has been used as an alternative to sucrose for diabetics and obese people worldwide. Co-administration of L-carnitine (LC) with ASP has a protective effect against the liver and kidney toxicity induced of ASP. The goal of the investigation was to assess the enhancement of LC effect on the cardiac toxicity caused of ASP. The rats were divided into 6 groups: control with saline, LC (10 mg/kg), ASP (75 mg/kg), ASP (150 mg/kg), LC with 75 mg/kg of ASP, and LC with 150 mg/kg ASP. The antioxidants were determined by measuring the activities of myeloperoxidase, xanthine oxidase, superoxide dismutase, catalase, and glutathione peroxidase, and by assessing the levels of lipid peroxidation, total thiols, and glutathione. There was a significant elevation in LPO, in conjunction with a significant decline in the enzymatic antioxidants superoxide dismutase, catalase, and glutathione peroxidase and the non-enzymatic antioxidants glutathione and thiols. The cardiac myofibrils were found in a disarrayed pattern in ASP treated-animals as compared to the control rats. The animals treated with ASP-HD showed more than one apoptotic cell with a large tail and a small head, and the relaxed loops of the damaged DNA were extended to form a comet-shaped structure. These effects may be due to the excessive generation of reactive oxygen species by ASP, which reduces cardiac function. Co-administration of LC with ASP improved all of the above-mentioned parameters that were disrupted of ASP alone. This study evidences a sufficient originality in showing how LC plays a positive role against cardiac toxicity of ASP.
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Affiliation(s)
- Rasha A. Al-Eisa
- Biology Department, Faculty of Science, Taif University, Taif, Saudi Arabia
| | | | - Reham Z. Hamza
- Biology Department, Faculty of Science, Taif University, Taif, Saudi Arabia
- Zoology Department, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - Nahla S. El-Shenawy
- Zoology Department, Faculty of Science, Suez Canal University, Ismailia, Egypt
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18
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Hidalgo JA, Florez A, Agurto C, Pinedo Y, Ayarza R, Rodriguez L, La Rosa A, Gutierrez R. Metabolic and Cardiovascular Comorbidities Among Clinically Stable HIV Patients on Long-Term ARV Therapy in Five Ambulatory Clinics in Lima-Callao, Peru. Open AIDS J 2018; 12:126-135. [PMID: 30450147 PMCID: PMC6198417 DOI: 10.2174/1874613601812010126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 12/17/2022] Open
Abstract
Background: There is scarcity of data about the prevalence of non-AIDS defining comorbidities among stable HIV-infected patients in Peru. Objective: We aimed to describe the most frequent cardiometabolic comorbidities found among ambulatory adults on ARV in Peru. Methods: A review of records for patients attending regular visits at 5 clinics in Lima-Callao in January-February 2016 is presented. Patients were adults on ARV for >6 months, with no recent AIDS-defining condition. Results: Three hundred and five medical charts were reviewed. Most patients were male (73.1%, n=223) with a mean age of 46.0 years. Mean time from HIV diagnosis was 9.41 yrs. and mean duration of ARV was 7.78 yrs. Most patients were on an NNRTI-based first line regimen (76.4%, n=233), and 12.1% (n=37) were on rescue regimens. Median CD4 count was 614.2 cells/µL and the proportion of patients with viral load <40 c/mL was 90.8% (n=277). Most frequent metabolic diagnoses were dyslipidemia (51.5%, n=157), obesity (11.1%, n=34), and diabetes mellitus (7.2%, n=22). Hypertension was diagnosed in 8.9% (n=27). Other diagnoses of cardiovascular disease were documented in 3.3% (n=10). Pharmacologic treatment was prescribed in 91.3% of patients with diabetes or hypertension, but in only 29.3% of patients with dyslipidemia. Conclusion: A high proportion of metabolic comorbidities was found, with dyslipidemia being the most frequent, followed by obesity and diabetes. In contrast, cardiovascular disease was documented less frequently. Medical treatment was started for only a third of dyslipidemia patients. HIV care policies need to consider proper management of chronic comorbidities to optimize long-term outcomes.
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Affiliation(s)
- Jose A Hidalgo
- Almenara Hospital, Lima, Peru.,Vía Libre HIV Clinic, Lima, Lima
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19
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Bauer S, Wa Mwanza M, Chilengi R, Holmes CB, Zyambo Z, Furrer H, Egger M, Wandeler G, Vinikoor MJ. Awareness and management of elevated blood pressure among human immunodeficiency virus-infected adults receiving antiretroviral therapy in urban Zambia: a call to action. Glob Health Action 2018; 10:1359923. [PMID: 28792285 PMCID: PMC5645688 DOI: 10.1080/16549716.2017.1359923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The prevalence of high blood pressure (HBP) and hypertension (HTN), awareness of the diagnoses, and use of anti-hypertensive drugs were examined among human immunodeficiency virus (HIV)-infected individuals on antiretroviral therapy (ART) in Zambia's capital Lusaka. Within a prospective cohort based at two public sector ART clinics, BP was measured at ART initiation and every 6 months thereafter as a routine clinic procedure. Predictors of HBP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) during one year on ART were analyzed using logistic regression, and the proportion with HTN (2+ episodes of HBP >3 months apart) described. A phone survey was used to understand patient awareness of HBP, use of anti-hypertensive drugs, and history of cardiovascular events (CVE; myocardial infarction or stroke). Among 896 cohort participants, 887 (99.0%) had at least one BP measurement, 98 (10.9%) had HBP, and 57 (6.4%) had HTN. Increasing age (10-year increase in age: adjusted odds ratio [AOR] = 1.50; 95% confidence interval [CI] 1.20-1.93), male sex (AOR = 2.33, 95% CI 1.43-3.80), and overweight/obesity (AOR = 4.07; 95% CI 1.94-8.53) were associated with HBP. Among 66 patients with HBP, 35 (53.0%) reported awareness of the condition, and nine (25.7%) of these reported having had a CVE. Only 14 (21.2%) of those reached reported ever taking an anti-hypertensive drug, and one (1.5%) was currently on treatment. These data suggest that major improvements are needed in the management of HBP among HIV-infected individuals in settings such as Zambia.
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Affiliation(s)
- Sophie Bauer
- a Department of Infectious Diseases , Bern University Hospital, University of Bern , Bern , Switzerland.,b Centre for Infectious Diseases Research in Zambia , Lusaka , Zambia
| | - Mwanza Wa Mwanza
- b Centre for Infectious Diseases Research in Zambia , Lusaka , Zambia
| | - Roma Chilengi
- b Centre for Infectious Diseases Research in Zambia , Lusaka , Zambia
| | - Charles B Holmes
- b Centre for Infectious Diseases Research in Zambia , Lusaka , Zambia.,c School of Medicine , Johns Hopkins University , Baltimore , USA
| | - Zude Zyambo
- b Centre for Infectious Diseases Research in Zambia , Lusaka , Zambia
| | - Hansjakob Furrer
- a Department of Infectious Diseases , Bern University Hospital, University of Bern , Bern , Switzerland
| | - Matthias Egger
- d Institute of Social and Preventive Medicine , University of Bern , Bern , Switzerland
| | - Gilles Wandeler
- a Department of Infectious Diseases , Bern University Hospital, University of Bern , Bern , Switzerland.,d Institute of Social and Preventive Medicine , University of Bern , Bern , Switzerland
| | - Michael J Vinikoor
- b Centre for Infectious Diseases Research in Zambia , Lusaka , Zambia.,e Department of Medicine , University of Alabama at Birmingham , Birmingham , USA.,f School of Medicine , University of Zambia , Lusaka , Zambia
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20
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D'Antoni ML, Mitchell BI, McCurdy S, Byron MM, Ogata-Arakaki D, Chow D, Mehta NN, Boisvert WA, Lefebvre E, Shikuma CM, Ndhlovu LC, Baumer Y. Cenicriviroc inhibits trans-endothelial passage of monocytes and is associated with impaired E-selectin expression. J Leukoc Biol 2018; 104:1241-1252. [PMID: 30088682 DOI: 10.1002/jlb.5a0817-328rrr] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 01/23/2023] Open
Abstract
Incidences of cardiovascular diseases (CVD) are high among virologically suppressed HIV-infected individuals. Monocyte activation and trafficking are key mechanisms in the evolution of CVD. We studied the ability of cenicriviroc (CVC), a dual C-C chemokine receptor type 2 (CCR2) and CCR5 antagonist, to influence the migration of monocytes from HIV-infected individuals on antiretroviral therapy (ART). Monocytes were derived from 23 ART-suppressed HIV-infected and 16 HIV-uninfected donors. In a trans-endothelial migration model, monocytes, and human aortic endothelial cells (HAoECs) were exposed to cenicriviroc and migrated monocytes, quantified. Expression of CCR2 and CCR5 on monocytes and adhesion molecules (E-selectin, ICAM-1, VCAM-1, PECAM-1, and CD99) on HAoECs were measured. The single antagonists, BMS-22 (CCR2), and maraviroc (CCR5), served as controls. When both HAoECs and monocytes together were exposed to the antagonists, cenicriviroc led to a greater decrease in monocyte migration compared to BMS-22 or vehicle in both HIV-infected and HIV-uninfected groups (P < 0.05), with maraviroc having no inhibitory effect. Cenicriviroc treatment of HAoECs alone decreased monocyte migration in the HIV-infected group when compared to vehicle (P < 0.01). Inhibition of migration was not evident when monocytes alone were exposed to cenicriviroc, BMS-22 or maraviroc. Incubation of HAoECs with cenicriviroc decreased E-selectin expression (P = 0.045) but had limited effects on the other adhesion molecules. Cenicriviroc inhibits monocyte trans-endothelial migration more effectively than single chemokine receptor blockade, which may be mediated via disruption of monocyte-endothelial tethering through reduced E-selectin expression. Cenicriviroc should be considered as a therapeutic intervention to reduce detrimental monocyte trafficking.
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Affiliation(s)
- Michelle L D'Antoni
- Hawaii Center for HIV/AIDS, University of Hawaii, Hawaii, USA.,Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Brooks I Mitchell
- Hawaii Center for HIV/AIDS, University of Hawaii, Hawaii, USA.,Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Sara McCurdy
- Department of Medicine, Center for Cardiovascular Research, University of Hawaii, Hawaii, USA
| | - Mary Margaret Byron
- Hawaii Center for HIV/AIDS, University of Hawaii, Hawaii, USA.,Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | | | - Dominic Chow
- Hawaii Center for HIV/AIDS, University of Hawaii, Hawaii, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - William A Boisvert
- Department of Medicine, Center for Cardiovascular Research, University of Hawaii, Hawaii, USA
| | | | | | - Lishomwa C Ndhlovu
- Hawaii Center for HIV/AIDS, University of Hawaii, Hawaii, USA.,Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Yvonne Baumer
- Hawaii Center for HIV/AIDS, University of Hawaii, Hawaii, USA.,Department of Medicine, Center for Cardiovascular Research, University of Hawaii, Hawaii, USA.,Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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21
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Teer E, Essop MF. HIV and Cardiovascular Disease: Role of Immunometabolic Perturbations. Physiology (Bethesda) 2018; 33:74-82. [PMID: 29212894 DOI: 10.1152/physiol.00028.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 01/07/2023] Open
Abstract
The successful rollout of anti-retroviral therapy ensured that HIV is increasingly managed as a chronic condition. HIV-positive persons are therefore exhibiting increased cardiovascular complications. This review focuses on the emerging role of "immunometabolism" within the context of HIV-related immune dysregulation and cardiovascular disease onset. Here, persistent immune activation contributes to pathophysiological perturbations during early infection, resulting in immune cell metabolic reprogramming and the activation of coagulation pathways in HIV-positive individuals.
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Affiliation(s)
- Eman Teer
- Department of Physiological Sciences, Cardio-Metabolic Research Group (CMRG), Stellenbosch University, Stellenbosch, South Africa
| | - M Faadiel Essop
- Department of Physiological Sciences, Cardio-Metabolic Research Group (CMRG), Stellenbosch University, Stellenbosch, South Africa
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22
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Pinto DSM, da Silva MJLV. Cardiovascular Disease in the Setting of Human Immunodeficiency Virus Infection. Curr Cardiol Rev 2018; 14:25-41. [PMID: 29189172 PMCID: PMC5872259 DOI: 10.2174/1573403x13666171129170046] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Since the introduction of Antiretroviral Therapy (ART), the life expectancy and health quality for patients infected with Human Immunodeficiency Virus (HIV) have significant-ly improved. Nevertheless, as a result of not only the deleterious effects of the virus itself and pro-longed ART, but also the effects of aging, cardiovascular diseases have emerged as one of the most common causes of death among these patients. Objective: The purpose of this review is to explore the new insights on the spectrum of Cardiovascu-lar Disease (CVD) in HIV infection, with emphasis on the factors that contribute to the atherosclerot-ic process and its role in the development of acute coronary syndrome in the setting of infection. Methods: A literature search using PubMed, ScienceDirect and Web of Science was performed. Ar-ticles up to Mar, 2017, were selected for inclusion. The search was conducted using MeSH terms, with the following key terms: [human immunodeficiency virus AND (cardiovascular disease OR coronary heart disease) AND (antiretroviral therapy AND (cardiovascular disease OR coronary heart disease))]. Results: Clinical cardiovascular disease tends to appear approximately 10 years before in infected in-dividuals, when compared to the general population. The pathogenesis behind the cardiovascular, HIV-associated complications is complex and multifactorial, involving traditional CVD risk factors, as well as factors associated with the virus itself - immune activation and chronic inflammation – and the metabolic disorders related to ART regimens. Conclusion: Determining the cardiovascular risk among HIV-infected patients, as well as targeting and treating conditions that predispose to CVD, are now emerging concerns among physicians.
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Affiliation(s)
- Daniela Sofia Martins Pinto
- Department of Medicine, Faculty of Medicine, Porto University, Al. Prof. Hernâni Monteiro 4200-319, Porto, Portugal
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23
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Pepin ME, Padgett LE, McDowell RE, Burg AR, Brahma MK, Holleman C, Kim T, Crossman D, Kutsch O, Tse HM, Wende AR, Habegger KM. Antiretroviral therapy potentiates high-fat diet induced obesity and glucose intolerance. Mol Metab 2018; 12:48-61. [PMID: 29731256 PMCID: PMC6001921 DOI: 10.1016/j.molmet.2018.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/28/2018] [Accepted: 04/02/2018] [Indexed: 12/22/2022] Open
Abstract
Objective Breakthroughs in HIV treatment, especially combination antiretroviral therapy (ART), have massively reduced AIDS-associated mortality. However, ART administration amplifies the risk of non-AIDS defining illnesses including obesity, diabetes, and cardiovascular disease, collectively known as metabolic syndrome. Initial reports suggest that ART-associated risk of metabolic syndrome correlates with socioeconomic status, a multifaceted finding that encompasses income, race, education, and diet. Therefore, determination of causal relationships is extremely challenging due to the complex interplay between viral infection, ART, and the many environmental factors. Methods In the current study, we employed a mouse model to specifically examine interactions between ART and diet that impacts energy balance and glucose metabolism. Previous studies have shown that high-fat feeding induces persistent low-grade systemic and adipose tissue inflammation contributing to insulin resistance and metabolic dysregulation via adipose-infiltrating macrophages. Studies herein test the hypothesis that ART potentiates the inflammatory effects of a high-fat diet (HFD). C57Bl/6J mice on a HFD or standard chow containing ART or vehicle, were subjected to functional metabolic testing, RNA-sequencing of epididymal white adipose tissue (eWAT), and array-based kinomic analysis of eWAT-infiltrating macrophages. Results ART-treated mice on a HFD displayed increased fat mass accumulation, impaired glucose tolerance, and potentiated insulin resistance. Gene set enrichment and kinomic array analyses revealed a pro-inflammatory transcriptional signature depicting granulocyte migration and activation. Conclusion The current study reveals a HFD-ART interaction that increases inflammatory transcriptional pathways and impairs glucose metabolism, energy balance, and metabolic dysfunction. Antiretroviral therapy (ART) exacerbates high-fat diet induced obesity and dysregulation of glucose homeostasis. Transcriptomic and Kinomic analyses identify increased pro-inflammatory, adipose-tissue macrophages after ART-treatment. ART and high-fat diet synergistically induce the G-protein coupled receptor, Gpr50, in white adipose tissue.
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Affiliation(s)
- Mark E Pepin
- Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lindsey E Padgett
- Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ruth E McDowell
- Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashley R Burg
- Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Manoja K Brahma
- Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cassie Holleman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Teayoun Kim
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Crossman
- Department of Genetics, Heflin Center for Genomic Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olaf Kutsch
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hubert M Tse
- Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam R Wende
- Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kirk M Habegger
- Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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24
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Abstract
Cardiovascular disease, including atherosclerosis and atherosclerosis-associated complications, is an increasing cause of morbidity and mortality in human immunodeficiency virus (HIV) patients in the post-antiretroviral therapy era. HIV alone accelerates atherosclerosis. Antiretroviral therapy; HIV-associated comorbidities, such as dyslipidemia, drug abuse, and opportunistic infections; and lifestyle are risk factors for HIV-associated atherosclerosis. However, our current understanding of HIV-associated atherogenesis is very limited and has largely been obtained from clinical observation. There is a pressing need to experimentally unravel the missing link between HIV and atherosclerosis. Understanding these mechanisms will help to better develop and design novel therapeutic interventions for the treatment of HIV-associated cardiovascular disease. HIV mainly infects T cells and macrophages resulting in the induction of oxidative and endoplasmic reticulum stress, the formation of the inflammasome, and the dysregulation of autophagy. These mechanisms may contribute to HIV-associated atherogenesis. In this review, we will summarize our current understanding and propose potential mechanisms of HIV-associated atherosclerosis.
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Affiliation(s)
- Alison Kearns
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jennifer Gordon
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Tricia H Burdo
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
| | - Xuebin Qin
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
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25
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Mosepele M, Hemphill LC, Moloi W, Moyo S, Nkele I, Makhema J, Bennett K, Triant VA, Lockman S. Pre-clinical carotid atherosclerosis and sCD163 among virally suppressed HIV patients in Botswana compared with uninfected controls. PLoS One 2017; 12:e0179994. [PMID: 28662159 PMCID: PMC5491105 DOI: 10.1371/journal.pone.0179994] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/07/2017] [Indexed: 12/18/2022] Open
Abstract
Objectives Human immune deficiency virus (HIV) is associated with increased cardiovascular disease (CVD) risk, yet the relationship between HIV and carotid atherosclerosis / monocyte activation among virally suppressed HIV-infected patients in sub-Saharan Africa is not well understood. Methods We measured traditional CVD risk factors, bilateral distal common carotid intima media thickness (cIMT), presence of carotid plaque and plasma sCD163 levels among virally suppressed HIV-infected adults and HIV-uninfected controls, in a cross-sectional study in Gaborone, Botswana. The associations between HIV status, traditional CVD risk factors, sCD163 and outcome of cIMT were assessed in univariate and multivariate linear regression models. Results We enrolled 208 HIV-infected adults (55% Female, mean age 39 years) who had undetectable HIV-1 RNA on antiretroviral therapy and 224 HIV-uninfected controls (47% Female, mean age 37 years). There was no difference in cIMT between study groups, with mean cIMT 0.607mm and 0.599mm in HIV-infected and HIV-uninfected, respectively (p = 0.37). Plasma sCD163 was significantly higher in HIV-infected versus HIV-uninfected persons (1917ng/ml vs 1593ng/ml, p = 0.003), but was not associated with cIMT (p = 0.43 among all, p = 0.72 for HIV-infected only). In the final multivariate model, increased cIMT was associated with older age, being treated for hypertension, and higher non-HDL cholesterol among all (p<0.001, p = 0.03, p<0.001 respectively), and with older age and waist-hip ratio in HIV-infected participants (p = 0.02 & p = 0.02 respectively). Carotid plaque was present in a significantly higher proportion of HIV-infected adults (RR 2.15, 95% CI 1.22, 3.81). Conclusions HIV-infected participants aged 30–50 years who have achieved viral suppression did not have increased cIMT when compared to HIV-uninfected controls in Botswana. However, well-controlled HIV was associated with excess monocyte activation. Future work should explore the impact of subclinical atherosclerosis on CVD events among HIV-infected and -uninfected adults in Botswana.
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Affiliation(s)
- Mosepele Mosepele
- Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- * E-mail: ,
| | - Linda C. Hemphill
- Harvard Medical School & Massachusetts General Hospital (Division of Cardiology-LCH and Divisions of Infectious Diseases and General Internal Medicine-VAT), Boston, Massachusetts, United States of America
| | - Walter Moloi
- Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Isaac Nkele
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kara Bennett
- Bennett Statistical Consulting Inc, Ballston Lake, New York, United States of America
| | - Virginia A. Triant
- Harvard Medical School & Massachusetts General Hospital (Division of Cardiology-LCH and Divisions of Infectious Diseases and General Internal Medicine-VAT), Boston, Massachusetts, United States of America
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology & Infectious Diseases Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Brigham & Women`s Hospital, Boston, Massachusetts, United States of America
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26
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Fourie CMT, Schutte AE. Early vascular aging in the HIV infected: Is arterial stiffness assessment the ideal tool? Virulence 2017; 8:1075-1077. [PMID: 28467147 DOI: 10.1080/21505594.2017.1325984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Carla M T Fourie
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom , South Africa.,b MRC Unit for Hypertension and Cardiovascular Disease , North-West University , Potchefstroom , South Africa
| | - Aletta E Schutte
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom , South Africa.,b MRC Unit for Hypertension and Cardiovascular Disease , North-West University , Potchefstroom , South Africa
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27
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Diazzi C, Brigante G, Ferrannini G, Ansaloni A, Zirilli L, De Santis MC, Zona S, Guaraldi G, Rochira V. Pituitary growth hormone (GH) secretion is partially rescued in HIV-infected patients with GH deficiency (GHD) compared to hypopituitary patients. Endocrine 2017; 55:885-898. [PMID: 27730472 DOI: 10.1007/s12020-016-1133-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
Abstract
Biochemical growth hormone deficiency is prevalent among human immunodeficiency virus-infected patients, but if this condition is clinically relevant remains challenging. The aim is to prospectively compare the growth hormone deficiency/insulin-like growth factor-1 status of 71 human immunodeficiency virus-infected patients with impaired growth hormone response to growth hormone releasing hormone + Arginine with that of 65 hypopituitary patients affected by a true growth hormone deficiency secondary to pituitary disease. The main outcomes were: basal serum growth hormone, insulin-like growth factor-1, insulin-like growth factor binding protein 3, growth hormone peak and area under the curve after growth hormone response to growth hormone releasing hormone + Arginine test, body mass index, waist and hip circumference, and body composition by dual energy X-ray absorptiometry. Insulin-like growth factor-1 binding protein 3, basal growth hormone (p < 0.005), growth hormone peak and area under the curve after growth hormone response to growth hormone releasing hormone + Arginine, waist to hip ratio, insulin-like growth factor-1, fasting glucose, insulin, and triglycerides (p < 0.0001) were lower in hypopituitary than human immunodeficiency virus-infected patients. Total and trunk fat mass by dual energy X-ray absorptiometry were higher in hypopituitary than in human immunodeficiency virus-infected patients (p < 0.0001). In all the patients total body fat was associated with both growth hormone peak and area under the curve at stepwise linear regression analysis. The degree of growth hormone deficiency is more severe in hypopituitary than in human immunodeficiency virus-infected patients, suggesting that the function of growth hormone/insulin-like growth factor-1 axis is partially rescued in the latter thanks to a preserved pituitary secretory reserve. Data from the current study suggest that human immunodeficiency virus-infected patients with peak growth hormone < 9 mg/L may have partial growth hormone deficiency and clinicians should be cautious before prescribing recombinant human growth hormone replacement treatment to patients living with human immunodeficiency virus.
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Affiliation(s)
- Chiara Diazzi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy
| | - Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy
| | | | - Anna Ansaloni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Zirilli
- Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy
| | - Maria Cristina De Santis
- Department of Laboratory Medicine and Pathological Anatomy, Azienda USL of Modena, Modena, Italy
| | - Stefano Zona
- HIV Metabolic Clinic, Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences for Adults and Children, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- HIV Metabolic Clinic, Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences for Adults and Children, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy.
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28
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Abstract
Treatment with highly active antiretroviral drugs (HAART) is associated with several endocrine and metabolic comorbidities. Pituitary growth hormone (GH) secretion seems to be altered in human immunodeficiency virus (HIV) infection, and about one-third of patients have biochemical GH deficiency (GHD). We undertake a historical review of the functioning of the GH/insulin-like growth factor-1 (IGF-1) axis in patients with acquired immunodeficiency syndrome, and provide an overview of the main changes of the GH/IGF-1 axis occurring today in patients with HIV. Both spontaneous GH secretion and GH response to provocative stimuli are reduced in patients with HIV infection, especially in those with HIV-related lipodystrophy. The role of fat accumulation on flattened GH secretion is discussed, together with all factors able to potentially interfere with the pituitary secretion of GH. Several factors contribute to the development of GHD, but the pathophysiologic mechanisms involved in the genesis of GHD are complex and not yet fully elucidated owing to the difficulty in separating the effects of HIV infection from those of HAART, comorbidities and body changes. An update on the putative mechanisms involved in the pathogenesis of altered GH secretion in these patients is provided, together with an overview on the therapeutic strategies targeting the GH/IGF-1 axis to counteract fat redistribution associated with HIV-related lipodystrophy. The clinical significance of GHD in the context of HIV infection is discussed. The administration of tesamorelin, a GH releasing hormone analogue, is effective in reducing visceral fat in HIV-infected patients with lipodystrophy. This treatment is promising and safer than treatment with high doses of recombinant human growth hormone, which has several side-effects.
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Affiliation(s)
- Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL of Modena, Modena, Italy.
| | - Giovanni Guaraldi
- HIV Metabolic Clinic, Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences for Adults and Children, University of Modena and Reggio Emilia, Modena, Italy
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Ou HT, Chang KC, Li CY, Yang CY, Ko NY. Intensive statin regimens for reducing risk of cardiovascular diseases among human immunodeficiency virus-infected population: A nation-wide longitudinal cohort study 2000-2011. Int J Cardiol 2016; 230:592-598. [PMID: 28062146 DOI: 10.1016/j.ijcard.2016.12.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/14/2016] [Accepted: 12/16/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study evaluated the risk of cardiovascular diseases (CVD) in a statin-treated HIV-infected population and the effects of intensive statin regimens (i.e., high-dose or potency) on CVD risks. METHODS 945 HIV-infected patients newly on statin treatment (144, 15.7% with CVD history) were identified from Taiwan's national HIV cohort. Using the median of the first year cumulative statin dosage as a cut-off point, patients were classified into either a high-dose or low-dose group. Patients were also classified as high-potency (i.e., atorvastatin) or low-potency (i.e., pravastatin) statin users. CVD, including ischemic stroke, coronary artery diseases, and heart failure, were identified after statin use to the end of 2011. Cox hazards regression was applied to assess the time-to-event hazards of CVD in association with intensive statin regimens. RESULTS In the HIV-infected population with CVD history, the high-dose group had a lower CVD risk compared to that of the low-dose group (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.39-1.99). The high-potency group showed a lower CVD risk compared to that of the low-potency group (HR: 0.42, 95% CI: 0.06-3.13). For those without CVD history, the corresponding figures were HR: 0.64 (95% CI: 0.30-1.35) and HR: 0.67 (95% CI: 0.16-2.87). The event rate of new-onset diabetes in high-dose statin group was higher than that in low-dose statin group (15.28% vs. 8.33%), while no muscle complications (i.e., myalgia, myositis, rhabdomyolysis) and dementia were observed in statin users. CONCLUSIONS There appears a trend showing a lower CVD risk in HIV patients receiving intensive statin therapy.
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Affiliation(s)
- Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Cheng Chang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chen-Yi Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan.
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30
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Gomes AR, Souteiro P, Silva CG, Sousa-Pinto B, Almeida F, Sarmento A, Carvalho D, Freitas P. Prevalence of testosterone deficiency in HIV-infected men under antiretroviral therapy. BMC Infect Dis 2016; 16:628. [PMID: 27809804 PMCID: PMC5096002 DOI: 10.1186/s12879-016-1892-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 10/01/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The prevalence of hypogonadism in HIV-infected patients is still a matter of debate as there is no standardized consensual diagnostic method. In addition, the etiology and endocrine/metabolic implications of hypogonadism in this population remain controversial. This study aims to determine the prevalence of testosterone deficiency in a single-site hospital and to evaluate its association with potential risk factors, lipodystrophy, metabolic syndrome, and cardiovascular risk. METHODS This study analyzed 245 HIV-infected men on combined antiretroviral therapy. Patients with low total testosterone (TT) levels (<2.8 ng/mL) and/or low calculated free testosterone (FT) levels (<6.5 ng/dL) were considered testosterone deficient. According to their LH and FSH levels, patients were classified as having hypogonadotropic or hypergonadotropic dysfunction. Other clinical, anthropometric, and analytic parameters were also collected and analyzed. RESULTS The prevalence of testosterone deficiency in our population was 29.4 %. Among them, 56.9 % had hypogonadotropic dysfunction and 43.1 % presented with hypergonadotropic dysfunction. Patients with testosterone deficiency were older (p < 0.001), had higher HbA1c levels (p = 0.016) and higher systolic blood pressure (p = 0.007). Patients with lower testosterone levels had higher prevalence of isolated central fat accumulation (p = 0.015) and had higher median cardiovascular risk at 10 years as measured by the Framingham Risk Score (p = 0.004) and 10-Year ASCVD risk (p = 0.002). CONCLUSIONS The prevalence of testosterone deficiency in this HIV population is high, with hypogonadotropic dysfunction being responsible for the majority of cases. Testosterone deficiency might predispose to, or be involved, in the pathogenesis of HIV-associated lipodystrophy. Patients with low testosterone levels have higher cardiovascular risk, highlighting the importance of early diagnosis of this condition.
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Affiliation(s)
- Ana Rita Gomes
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Pedro Souteiro
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Porto, Portugal
| | - Carolina Germana Silva
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Bernardo Sousa-Pinto
- Department of Health Information and Decision Sciences, Faculty of Medicine (CIDES), University of Porto, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal
| | - Francisco Almeida
- Infectious Diseases Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Davide Carvalho
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Paula Freitas
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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31
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Raggi P, Corwin C. Heart aging measured with coronary artery calcium scoring and cardiovascular risk assessment algorithms in HIV infected patients. Virulence 2016; 8:539-544. [PMID: 27410249 DOI: 10.1080/21505594.2016.1212154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABTRACT Many sources have highlighted the high incidence of premature cardiovascular events in HIV infected patients. This raises the suspicion of an accelerated aging of the vascular system in this disease characterized by chronic systemic subliminal inflammation and immune dysregulation. Unfortunately all currently available risk assessment algorithms based on traditional risk factors, and even those containing more HIV-specific factors, fail to accurately predict risk in a large proportion of patients. In the general population several models have implemented imaging data to refine risk assessment, and the concept of vascular aging has been of value in improving the performance of these algorithms. It is expected that HIV patients may benefit from a similar approach as it becomes clearer that vascular imaging provides valuable prognostic information in this patient category.
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Affiliation(s)
- Paolo Raggi
- a Mazankowski Alberta Heart Institute , University of Alberta , Edmonton , AB , Canada
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