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Lamesa TA. Biological Depiction of Lipodystrophy and Its Associated Challenges Among HIV AIDS Patients: Literature Review. HIV AIDS (Auckl) 2024; 16:123-132. [PMID: 38584795 PMCID: PMC10999207 DOI: 10.2147/hiv.s445605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Lipodystrophy syndrome is a medical condition characterized by the absence of adipose tissue without any underlying starvation or macromolecule breakdown. In HIV AIDS patients, the use of highly active antiretroviral therapy (HAART) can lead to an acquired form of lipodystrophy, with a prevalence ranging from 10% to 83% among HIV AIDS patients. It was aimed to review the current understanding of biological depiction and challenges related to lipodystrophy in AIDS patients. Relevant articles published in the English language were searched in PubMed, Google Scholar, and Google. Keywords used for the search were: lipodystrophy, lipodystrophy and HIV, ART and lipodystrophy, HIV treatment, metabolic syndrome and HIV. Articles with full abstract information were read for those that met the objective criteria of the review, then full text of the articles was accessed and used. It was revealed by the literature that patients who developed lipodystrophy are characterized by insulin abnormality, obesity, diabetes mellitus, dyslipidemia, fatty liver disease, and ovarian dysfunction. Anthropometric measurements have been known to change significantly with lipodystrophy. HIV patients suffering from hepatitis C virus, hepatitis B virus, who take a protease inhibitor, are changing treatment or duration of treatment, and are women are the common risk factors for lipodystrophy. The metabolic syndrome seen in HIV patients associated with lipodystrophy can further be complicated to different adverse health effects and can result in increased morbidity and mortality rate if not treated. Existing studies have successfully identified several challenges faced by HIV AIDS patients due to lipodystrophy, including low self-esteem, compromised quality of life, and poor treatment adherence. However, it is crucial to acknowledge that there may be numerous other challenges that have yet to be discovered, emphasizing the need for further studies. It is recommended that managing dyslipidemia, treating diabetes mellitus, modifying lifestyle, and improving the anthropometric measurements have crucial roles to halt further complications associated with lipodystrophy.
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Bantie B, Gebeyehu NA, Adella GA, Kassie GA, Mengstie MA, Abebe EC, Seid MA, Gesese MM, Tegegne KD, Anley DT, Zemene MA, Dessie AM, Feleke SF, Dejenie TA, Kebede YS, Chanie ES, Kerebeh G, Bayih WA, Moges N. Trends of Body Mass Index changes among adults on antiretroviral therapy in Northwest Ethiopia: a longitudinal data analysis. Sci Rep 2024; 14:5265. [PMID: 38438418 PMCID: PMC10912088 DOI: 10.1038/s41598-024-53701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Nutritional status is considered a major diagnostic and prognostic indicator of HIV/AIDS in adults. In this aspect, current HIV-treatment guidelines, particularly in low-income countries, recommend the regular monitoring of body mass index (BMI) to determine patients' clinical response to antiretroviral therapy (ART). However, data regarding the change in BMI status of HIV-positive adults on ART following the implementation of the test and treat strategy were limited in Ethiopia. Hence, this study is aimed at investigating the trends of BMI change over time and its associated factors among HIV-positive adults in Northwest Ethiopia. A retrospective longitudinal study was conducted among 404 randomly selected HIV-positive adults receiving ART in Felegehiwot Comprehensive Specialized Hospital (FHCSH), Northern Ethiopia. Data were extracted from the medical record charts of study participants, entered into Epi-data 4.6 software, and exported to Stata 14.2 software for analysis. A generalized estimating equation (GEE) model was fitted to determine the change in BMI status over time and its predictors in HIV-positive adults. The level of significance was declared at a p-value of < 0.05. More than half (201, or 51.73%) of the total 404 participants were female. In the cohort, both the baseline and follow-up mean body mass index levels of the participants fell in the normal range and increased from 20.34 (standard deviation/SD ± 2.8) to 21.41 (SD ± 3.13). The individual profile plots of 50 participants indicated that there is considerable variability in weight change across individuals. Duration of ART follow-up (β = 0.203, 95% confidence interval (CI) 0.16 to 0.24), unemployment (β = - 0.96, 95% CI 1.67 to - 0.25), WHO stage III/IV HIV disease (β = - 0.92, 95% CI - 1.57 to - 0.35),and Tenofovir/Lamivudine/Dolutegravir (TDF/3TC/DTG)ART regimen (β = 0.95, 95% CI 0.32 to 1.57) were identified as significant predictors of change in the BMI status of participants. Likewise, the interaction of TDF/3TC/DTG ART regimen * follow-up duration (β = 2.16, 95% CI 1.84 to 2.84), WHO stage III/IV clinical disease * follow-up duration (β = - 1.43, 95% CI - 1.71 to - 1.15) and TB/HIV co-infection * follow-up duration (β = 1.89, 95% CI 1.57 to 2.87) significantly affects the trend in BMI change status of HIV-positive adults. In this study, the BMI status of HIV-positive adults receiving ART increased with a linear trend. Unemployment, stage III/IV HIV diseases, and Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) ART-drug regimen decreases the mean BMI status of HIV-positive adults. Special consideration and strict follow-up need to be given to those individuals with advanced HIV/AIDS diseases and other identified risk group.
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Affiliation(s)
- Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yenealem Solomon Kebede
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Kerebeh
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Abdela AA, Yifter H, Reja A, Shewaamare A, Ofotokun I, Degu WA. Prevalence and risk factors of metabolic syndrome in Ethiopia: describing an emerging outbreak in HIV clinics of the sub-Saharan Africa - a cross-sectional study. BMJ Open 2023; 13:e069637. [PMID: 38070936 PMCID: PMC10729149 DOI: 10.1136/bmjopen-2022-069637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/19/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES HIV-induced chronic inflammation, immune activation and combination antiretroviral therapy (cART) are linked with adverse metabolic changes known to cause cardiovascular adversities. This study evaluates the prevalence of lipodystrophy, and metabolic syndrome (MetS), and analyses risk factors in HIV-infected Ethiopians taking cART. METHODS A multicentre cross-sectional study was conducted at tertiary-level hospitals. Eligible participants attending the HIV clinics were enrolled. Sociodemographic, anthropometric, clinical, HIV treatment variables, lipid profile, fasting blood glucose level, risk factors and components of MetS, also lipodystrophy, were studied. Data were analysed by SPSS statistical package V.25 with descriptive and analytical statistics. For multivariable analysis of risk factors, a logistic regression model was used. Results were presented in frequency and percentages, mean±SD, or median+IQR. Statistical significance was taken as p<0.05. RESULTS Among 518 studied participants, two-thirds were females, and the mean age of the study population was 45 years (SD=11). The mean duration of cART was 10 years (SD=4). Median CD4 count was 460 cells/mm3. The prevalence of MetS according to the Adult Treatment Panel III (2005) criteria was 37.6%. In multivariable analysis, independent risk factors for MetS were age >45 years (aHR 1.8, 95% CI 1.2 to 2.4), female sex (aHR 1.8, 95% CI 1.1 to 2.8), body mass index (BMI)>25 kg/m2 (aHR 2.7, 95% CI 1.8 to 4.1), efavirenz-based cART (aHR 2.8, 95% CI 1.6 to 4.8) and lopinavir/ritonavir-based cART (aHR 3.7, 95% CI 1.0 to 13.3). The prevalence of lipodystrophy was 23.6%. Prior exposure to a stavudine-containing regimen was independently associated with lipodystrophy (aHR 3.1, 95% CI 1.6 to 6.1). CONCLUSION Our study revealed 38% of the participants had MetS indicating considerable cardiovascular disease (CVD) risks. Independent risk factors for MetS were BMI≥25 kg/m2, efavirenz and lopinavir/ritonavir-based cART, female sex and age ≥45 years. In addition to prevention, CVD risk stratification and management will reduce morbidity and mortality in people with HIV infection.
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Affiliation(s)
| | - Helen Yifter
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Bartholo MF, Tenório JR, Andrade NS, Shibutani PP, Martins F, Gallottini M. Orofacial manifestations in Brazilian people living with HIV/AIDS under long-term antiretroviral therapy: a cross-sectional study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:436-441. [PMID: 37271609 DOI: 10.1016/j.oooo.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of this study was to assess the prevalence of orofacial manifestations in a Brazilian cohort of people living with HIV/AIDS (PLWHIV) using long-term combined antiretroviral therapy (cART) and to correlate the presence of these manifestations with clinical and laboratory characteristics. STUDY DESIGN A cross-sectional observational study evaluated 101 Brazilian PLWHIV. Demographic characteristics, medical history, and laboratory data were collected. Physical examination and measurement of stimulated salivary flow were performed. RESULTS The study included 101 participants who were mainly male (61%) and White (73%), with an average age of 48 years, using long-term cART. The most common oral manifestations were facial lipoatrophy (33%), xerostomia (30%), and salivary gland enlargement (12%). Facial lipoatrophy was linked to a longer duration of cART use (P = .002), whereas hairy leukoplakia was linked to a detectable viral load (P = .031). The salivary flow of <0.7 mL/min was associated with an HIV infection time >20 years (P = .023). CONCLUSIONS People living with HIV/AIDS who use cART often experience facial lipoatrophy, xerostomia, and bilateral enlargement of the parotid glands. Although opportunistic infections and malignant neoplasms are not frequent occurrences, they can still arise.
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Affiliation(s)
- Maria Fernanda Bartholo
- Department of Stomatology, Special Care Dentistry Center, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Jefferson R Tenório
- Department of Stomatology, Special Care Dentistry Center, School of Dentistry, University of São Paulo, São Paulo, Brazil; Department of Oral Pathology and Diagnosis, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Natália Silva Andrade
- Department of Stomatology, Special Care Dentistry Center, School of Dentistry, University of São Paulo, São Paulo, Brazil; Department of Dentistry, School of Dentistry, Federal University of Sergipe, Sergipe, Brazil
| | - Patrícia Pinheiro Shibutani
- Department of Stomatology, Special Care Dentistry Center, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Fabiana Martins
- Department of Stomatology, Special Care Dentistry Center, School of Dentistry, University of São Paulo, São Paulo, Brazil; School of Dentistry, University of Santo Amaro, São Paulo, Brazil
| | - Marina Gallottini
- Department of Stomatology, Special Care Dentistry Center, School of Dentistry, University of São Paulo, São Paulo, Brazil.
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Shi P, Wang X, Su M, Meng J, Wang H, Fan W. Treatment with Antiviral Drugs Will Significantly Inhibit the HIV-1 RNA POL Gene Expression and Viral Load in AIDS Patients. DISEASE MARKERS 2023; 2023:9910542. [PMID: 37091892 PMCID: PMC10121356 DOI: 10.1155/2023/9910542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 04/25/2023]
Abstract
Objective This study is to investigate the difference in HIV-1 RNA pol gene expression in AIDS patients before and after antiviral treatment and its effect on the expression level of CD4+/CD8+ T cells in peripheral blood. Methods The participants included 200 AIDS patients who had undergone antiviral medication, and the quantity of HIV-1 RNA pol gene was determined using nested polymerase chain reaction (nPCR). The levels of CD3+, CD4+, and CD8+ T lymphocytes in peripheral blood were measured by flow cytometry before and after therapy. The receiver operating characteristics (ROC) curve was used to assess the impact of HIV-1 RNA pol gene expression and the CD4+/CD8+ ratio on the prognosis of AIDS patients. Results After three months of therapy, the levels of HIV-1 RNA and viral load in the patients showed a drastic decline, while the levels of CD4+/CD8+ were markedly elevated (P < 0.05). Logistic analysis revealed that patients' viral loads were positively correlated with HIV-1 RNA and negatively correlated with CD4+/CD8+ (P < 0.05). The alanine aminotransferase (ALT), white blood cell (WBC) count, Serum creatinine (Cr), total cholesterol (TC), triglyceride (TG), and platelet (PLT) levels significantly increased following a 24-month therapy, while no significant changes were observed in the level of aspartate aminotransferase (AST), red blood cell (RBC), and neutrophil (NEU) (%). (P > 0.05). Conclusion Antiviral drugs significantly inhibit the HIV-1 RNA POL gene expression and viral load in AIDS patients but upregulate the expression level of CD4+/CD8+ T cells in peripheral blood.
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Affiliation(s)
- Penghui Shi
- Department of Laboratory Medicine, Baoding People's Hospital, Baoding City, Hebei Province 071000, China
| | - Xiaodong Wang
- Baoding People's Hospital, Baoding City, Hebei Province 071000, China
| | - Miaomiao Su
- Department of Infectious Diseases, Baoding People's Hospital, Baoding City, Hebei Province 071000, China
| | - Juan Meng
- Department of Infectious Diseases, Baoding People's Hospital, Baoding City, Hebei Province 071000, China
| | - Hao Wang
- Department of Laboratory Medicine, Baoding People's Hospital, Baoding City, Hebei Province 071000, China
| | - Weiguang Fan
- Department of Laboratory Medicine, Baoding People's Hospital, Baoding City, Hebei Province 071000, China
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Metabolic profiling of HIV infected individuals on an AZT-based antiretroviral treatment regimen reveals persistent oxidative stress. J Pharm Biomed Anal 2022; 220:114986. [DOI: 10.1016/j.jpba.2022.114986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
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Wilson NL, Hoffman TJ, Heath SL, Saag MS, Miaskowski C. HIV Symptom Clusters are Similar Using the Dimensions of Symptom Occurrence and Distress. J Pain Symptom Manage 2022; 63:943-952. [PMID: 35235857 PMCID: PMC10408902 DOI: 10.1016/j.jpainsymman.2022.02.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT People living with HIV infection (PLWH) in the United States continue to experience a high symptom burden despite improvements in antiretroviral therapy. OBJECTIVES The purpose of this study was to determine if the number and types of symptom clusters differed based on whether symptom occurrence rates or distress ratings were used to create the clusters. METHODS Data from 2,000 patients with complete symptom occurrence rates and distress scores on the 20-item HIV Symptom Index from their first ambulatory clinic visit at one of six national HIV centers of excellence in the Center for AIDS Research Network of Integrated Clinical Systems were used in these analyses. Exploratory factor analysis was used to create the symptom clusters. RESULTS The same four symptom clusters (i.e., gastrointestinal, psychological, pain, body image) were identified using occurrence rates and distress ratings. For both dimensions of the symptom experience, the psychological, pain, and body image clusters each had the same symptoms. For the gastrointestinal cluster, four symptoms loaded on the occurrence dimension and six symptoms loaded on the distress dimension. CONCLUSION The number and types of symptom clusters were relatively similar across the occurrence and distress dimensions of the symptom experience. Symptom clusters in PLWH may provide insights into the development of targeted interventions for multiple co-occurring symptoms.
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Affiliation(s)
- Natalie L Wilson
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, USA.
| | - Thomas J Hoffman
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Sonya L Heath
- Division of Infectious Diseases, School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Michael S Saag
- Division of Infectious Diseases, School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
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Iacob SA, Iacob DG. Non-Alcoholic Fatty Liver Disease in HIV/HBV Patients - a Metabolic Imbalance Aggravated by Antiretroviral Therapy and Perpetuated by the Hepatokine/Adipokine Axis Breakdown. Front Endocrinol (Lausanne) 2022; 13:814209. [PMID: 35355551 PMCID: PMC8959898 DOI: 10.3389/fendo.2022.814209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is strongly associated with the metabolic syndrome and is one of the most prevalent comorbidities in HIV and HBV infected patients. HIV plays an early and direct role in the development of metabolic syndrome by disrupting the mechanism of adipogenesis and synthesis of adipokines. Adipokines, molecules that regulate the lipid metabolism, also contribute to the progression of NAFLD either directly or via hepatic organokines (hepatokines). Most hepatokines play a direct role in lipid homeostasis and liver inflammation but their role in the evolution of NAFLD is not well defined. The role of HBV in the pathogenesis of NAFLD is controversial. HBV has been previously associated with a decreased level of triglycerides and with a protective role against the development of steatosis and metabolic syndrome. At the same time HBV displays a high fibrogenetic and oncogenetic potential. In the HIV/HBV co-infection, the metabolic changes are initiated by mitochondrial dysfunction as well as by the fatty overload of the liver, two interconnected mechanisms. The evolution of NAFLD is further perpetuated by the inflammatory response to these viral agents and by the variable toxicity of the antiretroviral therapy. The current article discusses the pathogenic changes and the contribution of the hepatokine/adipokine axis in the development of NAFLD as well as the implications of HIV and HBV infection in the breakdown of the hepatokine/adipokine axis and NAFLD progression.
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Affiliation(s)
- Simona Alexandra Iacob
- Department of Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Infectious Diseases, National Institute of Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, Romania
| | - Diana Gabriela Iacob
- Department of Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Infectious Diseases, Emergency University Hospital, Bucharest, Romania
- *Correspondence: Diana Gabriela Iacob,
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Youn I, Cheong MJ, Kim J, Kim SI, Kim HK, Kwon M, Seo J, Nam D, Leem J. Understanding the experiences and perception of people living with HIV on integrative traditional East Asian medicine management in Korea: an interview protocol for qualitative research. BMJ Open 2021; 11:e051880. [PMID: 34887276 PMCID: PMC8663099 DOI: 10.1136/bmjopen-2021-051880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patients with HIV/AIDS have been able to experience the average life expectancy of the general population due to medical advancements. However, they face physical, emotional and social difficulties that worsen their quality of life. The pharmacological approach is often the first choice to address these issues, but it involves some limitations. Integrative traditional East Asian medicine (ITEAM) can compensate for the limitations of drugs and can be applied to treat physiological and psychiatric problems. In Korea, ITEAM interventions are easily accessible under the government insurance. However, the experiences, perceptions and barriers to the use of ITEAM in patients with HIV/AIDS are less studied. Therefore, we will interview them to explore their experiences and examine the strengths, limitations, barriers and improvements in the use of ITEAM. METHODS AND ANALYSIS This is a qualitative study using a phenomenological framework. We will conduct one-to-one interviews with 3-10 patients with HIV/AIDS who have been treated with ITEAM from March 2021 to January 2022. We will present semistructured open-ended questions and analyse them using experiential phenomenological research methods. The results will be reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies. ETHICS AND DISSEMINATION This research was approved by the Institutional Review Board of the National Medical Center (IRB number, NMC-2101-008). The results of this study will be disseminated through journal articles, newspapers and conference proceedings. TRIAL REGISTRATION NUMBER Clinical Research Information Service: KCT0005855; Pre-results.
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Affiliation(s)
- Inae Youn
- Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Department of Acupuncture & Moxibustion, National Medical Center, Seoul, Republic of Korea
| | - Moon Joo Cheong
- Rare Disease Integrated Treatment Research Center, Wankwang University Jangheung Integrative Medical Hospital, Jangheung, Jeollanam-do, Republic of Korea
| | - Jinwon Kim
- Department of Internal Korean Medicine, National Medical Center, Seoul, Republic of Korea
| | - Soo Im Kim
- Department of Counseling, Dankook University, Yongin, Gyeonggi-do, Republic of Korea
| | - Hye Kyung Kim
- Psychological Counseling Office, LG Electronics Gasan Research and Development Campus, Geumcheon-gu, Seoul, Republic of Korea
| | - Miri Kwon
- Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Joohee Seo
- Department of Korean Neuropsychiatry, National Medical Center, Seoul, Republic of Korea
| | - Dongwoo Nam
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Jungtae Leem
- Research Center of Traditional Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, Republic of Korea
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Excisional lipectomy versus liposuction in HIV-associated lipodystrophy. Arch Plast Surg 2021; 48:685-690. [PMID: 34818717 PMCID: PMC8627937 DOI: 10.5999/aps.2020.02285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy. Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed. Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient’s postoperative course was complicated by seroma formation. Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.
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Ramos SR, O’Hare OM, Colon AH, Jacobs SK, Campbell B, Kershaw T, Vorderstrasse A, Reynolds HR. Purely Behavioral: A Scoping Review of Nonpharmacological Behavioral and Lifestyle Interventions to Prevent Cardiovascular Disease in Persons Living With HIV. J Assoc Nurses AIDS Care 2021; 32:536-547. [PMID: 33481464 PMCID: PMC8289919 DOI: 10.1097/jnc.0000000000000230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 900,000 deaths annually. People living with HIV are at a higher risk of developing CVD. We conducted a scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis. In July 2020, six databases were searched: PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Embase, and The Cochrane Central Register of Controlled Trials, as well as reference lists of relevant studies and key journals. Our review identified 18 studies that addressed nonpharmacological behavioral interventions into the following: physical activity (n = 6), weight loss (n = 2), dietary interventions (n = 1), and multicomponent interventions (n = 9). In the past 10 years, there has been an increased emphasis on nonpharmacological behavioral approaches, including the incorporation of multicomponent interventions, to reduce cardiovascular risk in people living with HIV. The extant literature is limited by underrepresentation of geographic regions and populations that disproportionately experience CVD.
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Affiliation(s)
- S. Raquel Ramos
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Olivia M. O’Hare
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | | | - Susan Kaplan Jacobs
- Health Sciences Librarian/Curator, New York University, New York, New York, USA
| | - Brynne Campbell
- Health Sciences Reference Associate, New York University, New York, New York, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, and Director, P30 Center for Interdisciplinary Research on AIDS and R25 REIDS HIV Training Programs, School of Public Health, Yale, University, New Haven, Connecticut, USA
| | | | - Harmony R. Reynolds
- Sarah Ross, Soter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, and Associate Professor, Department of Medicine, NYU School of Medicine, NYU LangoneHealth, New York, New York, USA
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12
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Kemal A, Ahmed M, Sinaga Teshome M, Abate KH. Central Obesity and Associated Factors among Adult Patients on Antiretroviral Therapy (ART) in Armed Force Comprehensive and Specialized Hospital, Addis Ababa, Ethiopia. J Obes 2021; 2021:1578653. [PMID: 34504719 PMCID: PMC8423545 DOI: 10.1155/2021/1578653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/09/2020] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Similar to the general population, the prevalence of central obesity is increasing among HIV-infected persons. There are little data on the burden of abdominal obesity using the waist-to-hip ratio measurement in HIV-infected patients in resource-limited settings, including Ethiopia. Therefore, this study aimed to assess the prevalence and associated factors of central obesity among HIV patients taking ART in an armed force comprehensive and specialized hospital, Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted from March to April 2018. A systematic sampling method was used to select 353 study participants. Pretested World Health Organization stepwise questionnaire, document review, and anthropometric and biochemical measurements were used to collect data on different variables under the study. The collected data were entered into EpiData version 3 and analyzed by SPSS version 21. An adjusted odds ratio with 95% CI was considered to declare a statistically significant association. Results The prevalence of central obesity in this study was 71.7% (95% CI: 67%-76.4%). Besides, the odds of central obesity were associated with being female (AOR: 85.6; 95% CI: 20.09, 364.6), among merchants (AOR: 18.8; 95% CI: 1.39, 255.7), CD4 count <200 cells/mm3 (AOR: 0.03; 95% CI: 0.007, 0.160), among respondents taking AZT + 3TC + EFV-based ART regimen (AOR: 8.73; 95% CI: 1.33, 57.17), ABC + 3TC + ATV/r-based regimen (AOR: 0.18; 95% CI: 0.03, 0.94), increased BMI (AOR: 3.50; 95% CI: 1.36, 3.89), and abnormal blood pressure (AOR: 2.53; 95%: 1.13, 5.67). Conclusion It is possible to conclude that central obesity is a huge public health problem among the HIV-infected population in the study area. Being female, increased BMI, low CD4 count, AZT + 3TC + EFV, ABC + 3TC + ATV/r-based regimen, and abnormal blood pressure were associated with central obesity. Therefore, adequate attention must be paid to primary and secondary control of these factors to reduce the prevalence of abdominal obesity among HIV-infected patients.
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Affiliation(s)
- Adnan Kemal
- Department of Public Health, College of Health Science, Defense University, Addis Ababa, Ethiopia
| | - Mohammed Ahmed
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
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Siqueira LR, Cunha GHD, Galvão MTG, Fontenele MSM, Fechine FV, Medeiros MS, Moreira LA. Effect of lipodystrophy on self-esteem and adherence to antiretroviral therapy in people living with HIV. AIDS Care 2021; 34:1031-1040. [PMID: 34082636 DOI: 10.1080/09540121.2021.1936442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to determine the effect of lipodystrophy on self-esteem and adherence to antiretroviral therapy (ART) in people living with HIV (PLHIV). A cross-sectional and comparative study was carried out in an infection clinic, with 125 patients with lipodystrophy and 125 without lipodystrophy. Sociodemographic, clinical and epidemiological data were collected, using the Rosenberg Self-Esteem Scale and Assessment of Adherence to Antiretroviral Treatment Questionnaire (CEAT-VIH). Descriptive statistics and univariate and multivariate logistic regression analysis were used. Of the total sample, 57.2% had unsatisfactory self-esteem and 57.6% adequate adherence to ART. Self-esteem was lower in PLHIV with lipodystrophy (66.4%). PLHIV with monthly income less than or equal to two minimum wages (P < 0.001) and those with lipodystrophy had more unsatisfactory self-esteem (P < 0.001). Catholics had better self-esteem (P = 0.012), when compared to those without religion. Patients with monthly income less than or equal to two minimum wages (P = 0.021) and people with unsatisfactory self-esteem had more inadequate adherence to ART (P = 0.001). Catholics had better adherence to antiretrovirals (P = 0.007). In conclusion, lipodystrophy and low income negatively affect the self-esteem of PLHIV. Low income and unsatisfactory self-esteem make adherence to ART difficult. Religion is a protective factor for satisfactory self-esteem and adherence to antiretrovirals.
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14
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Anyanwu EG, Onuchukwu CL. Does plantar lipoatrophy affect dynamic balance in HIV infected persons? Gait Posture 2021; 86:101-105. [PMID: 33711612 DOI: 10.1016/j.gaitpost.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 02/07/2021] [Accepted: 02/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic inflammation in HIV infection and antiretroviral therapy have been shown to cause balance disorders due to neuromusculoskeletal damage, sensorimotor deficits, failure of foot mechanoreceptors and/or plantar lipoatrophy. However, despite evidence of plantar lipoatrophy in HIV patients, there is a dearth of information on how this relates to walking balance. This study sought to investigate how plantar fat thickness affects dynamic balance in HIV infected persons. RESEARCH QUESTION Can plantar lipoatrophy significantly affect walking balance in HIV infected persons? METHODS This is a cross sectional study of 367 persons (106 HIV seronegative control subjects, 211 HIV seropositive subjects on antiretroviral therapy (HIV_ART) and 50 HIV ART naïve subjects (HIV_NonART)). Plantar fat thickness (PFT) was measured using diagnostic ultrasound. Subjects were asked to walk at 5 self-selected speeds, from very slow to very fast on a level 15-meter walkway. Average number of steps and time taken to complete the study distance were obtained, used to calculate gait parameters and plot the velocity field diagram for gait analysis. RESULTS Findings from this study showed significant reduction in plantar fat thickness, velocity of travel, stride frequency and a significant increase in stride and double support duration (p < 0.01) in HIV-seropositive individuals compared to healthy controls but none were observed between HIV_ART and NonART groups. CONCLUSION HIV infection significantly affects dynamic balance and increases the risk of falls, fracture and mobility impairment in this patient population. SIGNIFICANCE This study will help clinicians to recognize plantar lipoatrophy as a significant cause of gait pathology in HIV infected persons and thus, make targeted interventions to minimize deformity and impairment, promote functional independence and improve quality of life.
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Affiliation(s)
- Emeka G Anyanwu
- Department of Anatomy, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Chioma L Onuchukwu
- Department of Physiotherapy, Enugu State University Teaching Hospital Park Lane, Enugu, Enugu State, Nigeria.
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15
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Xu X, Lin H, Chen X, Zhu B, Shen W, Ning C, Qiao X, Xu X, Shi R, Liu X, Wong FY, He N, Ding Y. Differences in hypertension and prehypertension among people living with and without HIV in China: role of HIV infection and antiretroviral therapy. HIV Med 2021; 22:409-417. [PMID: 33421323 DOI: 10.1111/hiv.13040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Hypertension is a growing health concern in people living with HIV (PLWH). However, association between HIV infection and hypertension is equivocal. METHODS In all, 1472 PLWH and 2944 HIV-negative individuals frequency-matched by age and sex were derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China. Prehypertension was defined as systolic blood pressure (BP) of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg. RESULTS Despite the fact that prevalence of hypertension was overall lower among PLWH than among HIV-negative people (21.1% vs. 29.1%, P < 0.001), it was similar at ages 18-29 (7.6% vs. 8.5%) and 30-44 years (17.1% vs. 18.5%) but significantly lower in PLWH at ages 45-59 (26.1% vs. 40.7%) and 60-75 years (37.1% vs. 57.3%). Prehypertension prevalence was consistently higher in PLWH across all age groups. In the model adjusting for traditional risk factors, HIV infection was associated with hypertension (adjusted odds ratio [aOR] = 1.27, 95% confidence interval: 1.04-1.55) and prehypertension (aOR = 1.77, 95% CI: 1.51-2.08), and attenuated after additional adjustment for abdominal obesity. Age-stratified analysis showed that these associations of HIV with hypertension were observed at ages 18-29 and 30-44 years and associations with prehypertension were observed at ages 18-29, 30-44 and 45-59 years only. Years since HIV diagnosis and stavudine use were the HIV-specific factors independently associated with hypertension or/and prehypertension. CONCLUSIONS HIV infection is independently associated with prehypertension and hypertension especially at younger ages, and this risk may increase as treatment becomes prolonged. Our findings reinforce the urgent necessity for active BP screening and control strategies be adopted for PLWH in China.
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Affiliation(s)
- X Xu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - H Lin
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - X Chen
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - B Zhu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - W Shen
- Taizhou City Center for Disease Control and Prevention, Taizhou City, Zhejiang Province, China
| | - C Ning
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - X Qiao
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - X Xu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - R Shi
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - X Liu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - F Y Wong
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Center for Population Sciences and Health Equity (C-PSHE), Florida State University, Tallahassee, FL, USA.,Department of Psychology, University of Hawai`i at Mānoa, Honolulu, HI, USA
| | - N He
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, Shanghai, China
| | - Y Ding
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
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Santiprabhob J, Chokephaibulkit K, Khantee P, Maleesatharn A, Phonrat B, Phongsamart W, Lapphra K, Wittawatmongkol O, Rungmaitree S, Tanchaweng S, Maturapat S, Lermankul W, Tungtrongchitr R. Adipocytokine dysregulation, abnormal glucose metabolism, and lipodystrophy in HIV-infected adolescents receiving protease inhibitors. Cytokine 2020; 136:155145. [PMID: 32920318 DOI: 10.1016/j.cyto.2020.155145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/30/2020] [Accepted: 05/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Lipodystrophy is common in HIV-infected patients receiving protease inhibitors (PIs), stavudine, and zidovudine. Adipocytokines may be altered in lipodystrophy. We evaluated risk factors, adipocytokine levels, insulin resistance, and lipid profiles in HIV-infected adolescents with different lipodystrophy types. METHODS A cross-sectional study was conducted in 80 perinatally HIV-infected adolescents receiving PI-based highly active antiretroviral therapy for ≥ 6 months. Patients underwent oral glucose tolerance tests and measurements of high-molecular-weight (HMW) adiponectin, leptin, resistin, insulin, and lipids. They were classified into 3 groups based on the clinical findings: no lipodystrophy, isolated lipoatrophy, and any lipohypertrophy (isolated lipohypertrophy or combined type). RESULTS Of the 80 patients (median age, 16.7 years), 18 (22.5%) had isolated lipoatrophy, while 8 (10%) had any lipohypertrophy (four with isolated lipohypertrophy, and four with the combined type). In a multivariate analysis, longer exposure to stavudine (OR: 1.03; 95% CI, 1.01-1.06; p = 0.005) and indinavir (OR: 1.03; 95% CI, 1.01-1.06; p = 0.012) were associated with lipoatrophy, while longer exposure to didanosine (OR: 1.04; 95% CI, 1.01-1.08; p = 0.017) and indinavir (OR: 1.10; 95% CI, 1.00-1.21; p = 0.045) were associated with any lipohypertrophy. Leptin levels were highest in the any-lipohypertrophy group and lowest in the isolated-lipoatrophy group (p = 0.013). HMW adiponectin levels were significantly lowest in the any-lipohypertrophy group and highest in the no-lipodystrophy group (p = 0.001). There were no significant differences in the levels of resistin among the three groups (p = 0.234). The prevalence of insulin resistance (p = 0.002) and prediabetes/diabetes (p < 0.001) were significantly highest in the any-lipohypertrophy group. Patients with lipoatrophy and those without lipodystrophy had comparable degrees of insulin resistance (p = 0.292). In multiple linear regression analysis, adjusted for age, sex, and waist-height ratio, HMW adiponectin levels were associated with Matsuda index (β = 0.5; p = 0.003) and quantitative insulin sensitivity check index (QUICKI) (β = 40.1; p = 0.010) and almost significantly associated with homeostatic model assessment of insulin resistance (HOMA-IR) (p = 0.054). Leptin and resistin levels were not associated with HOMA-IR, Matsuda index, or QUICKI (all p > 0.05). CONCLUSIONS Abnormal glucose metabolism and dysregulation of adipocytokines were common in the HIV-infected adolescents with lipohypertrophy and the combined type. Preventive screening for cardiovascular diseases caused by metabolic alterations should be routinely performed.
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Affiliation(s)
- Jeerunda Santiprabhob
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Kulkanya Chokephaibulkit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Puttichart Khantee
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Alan Maleesatharn
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Benjaluck Phonrat
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Wanatpreeya Phongsamart
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Keswadee Lapphra
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Orasri Wittawatmongkol
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Supattra Rungmaitree
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Surapong Tanchaweng
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Sirinoot Maturapat
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Watcharee Lermankul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Rungsunn Tungtrongchitr
- Department of Tropical Nutrition and Food Science, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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The Effect of Lipectomy/Liposuction on Lipid Profiles in Antiretroviral Drug-induced Lipodystrophy Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3171. [PMID: 33173685 PMCID: PMC7647642 DOI: 10.1097/gox.0000000000003171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022]
Abstract
Background One of the adverse effects of antiretroviral (ARV) drugs in the treatment of human immunodeficiency virus is lipodystrophy, which is often associated with metabolic complications such as hyperlipidemia, increased cardiovascular risk factors, and altered body fat distribution. This is characterized by a dorsal hump, hypermastia, or abdominal pannus deformity. The reasons for corrective surgery are aesthetic, psychosocial, and medical benefits. Methods This is a prospective study investigating 52 consecutive patients with ARV-induced lipodystrophy syndrome referred for surgical correction (liposuction for dorsal hump, abdominoplasty for increased abdominal pannus, and bilateral breast reduction for hypermastia). Fasting serum lipograms, including cholesterol, triglycerides, high-density cholesterol (HDL), and low-density cholesterol (LDL), were taken preoperatively and repeated 9-12 months post lipectomy/liposuction. Results A subgroup of 35 patients with deranged preoperative triglycerides (P = 0.004), cholesterol (P = 0.001), and or LDL cholesterol (P = 0.017) showed a statistically significant (P < 0.05) decrease in postoperative levels. If preoperative lipogram values were normal, there is no statistically significant reduction postoperatively. Conclusions In ARV-associated lipodystrophy, when the preoperative fasting lipograms are deranged, then after surgical correction there is a statistically significant reduction in triglyceride, total cholesterol, and LDL levels. This influences their cardiovascular risk profile, mortality, morbidity, and quality of life.
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Abstract
Early in the HIV epidemic, lipodystrophy, characterized by subcutaneous fat loss (lipoatrophy), with or without central fat accumulation (lipohypertrophy), was recognized as a frequent condition among people living with HIV (PLWH) receiving combination antiretroviral therapy. The subsequent identification of thymidine analogue nucleoside reverse transcriptase inhibitors as the cause of lipoatrophy led to the development of newer antiretroviral agents; however, studies have demonstrated continued abnormalities in fat and/or lipid storage in PLWH treated with newer drugs (including integrase inhibitor-based regimens), with fat gain due to restoration to health in antiretroviral therapy-naive PLWH, which is compounded by the rising rates of obesity. The mechanisms of fat alterations in PLWH are complex, multifactorial and not fully understood, although they are known to result in part from the direct effects of HIV proteins and antiretroviral agents on adipocyte health, genetic factors, increased microbial translocation, changes in the adaptive immune milieu after infection, increased tissue inflammation and accelerated fibrosis. Management includes classical lifestyle alterations with a role for pharmacological therapies and surgery in some patients. Continued fat alterations in PLWH will have an important effect on lifespan, healthspan and quality of life as patients age worldwide, highlighting the need to investigate the critical uncertainties regarding pathophysiology, risk factors and management.
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Nyamaruze P, Govender K. "I like the way I am, but I feel like I could get a little bit bigger": Perceptions of body image among adolescents and youth living with HIV in Durban, South Africa. PLoS One 2020; 15:e0227583. [PMID: 31923249 PMCID: PMC6953798 DOI: 10.1371/journal.pone.0227583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/20/2019] [Indexed: 12/05/2022] Open
Abstract
Body image concerns are common among people living with HIV (PLHIV). Research into how young people living with HIV (YPLHIV) experience and make sense of feared or actual body changes is limited, yet these changes have emotional, psychological and interpersonal implications for young people who associate physical attractiveness with social desirability. The current study examined the subjective perceptions of body appearance and coping mechanisms among a sample of YPLHIV in Durban, South Africa. An interpretive qualitative inquiry was adopted to understand their lived experiences in relation to their body image and body satisfaction. In-depth interviews were conducted with 18 YPLHIV (15–24 years). Findings indicate physical and psychosocial effects of living with HIV among young people including weight loss, skin sores, body dissatisfaction, loss of self-esteem and social withdrawal. The study builds on previous research suggesting that PLHIV may experience a discrepancy between their actual self and ideal self. Enhancing existing coping mechanisms such as religious beliefs, support networks and physical exercises among YPLHIV can counter the physical and psychosocial effects of living with HIV and improve well-being. Body image concerns should be acknowledged when addressing HIV-related health in both health and family settings.
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Affiliation(s)
- Patrick Nyamaruze
- The Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
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Souza HCD, Mota MR, Alves AR, Lima FD, Chaves SN, Dantas RAE, Abdelmur SBM, Mota APVDS. Analysis of compliance to antiretroviral treatment among patients with HIV/AIDS. Rev Bras Enferm 2019; 72:1295-1303. [PMID: 31531654 DOI: 10.1590/0034-7167-2018-0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/13/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the compliance to antiretroviral therapy among HIV/AIDS patients. METHOD 99 HIV-positive volunteers undergoing treatment responded to a semi-structured sociodemographic interview and to a questionnaire that assessed compliance to antiretroviral treatment. RESULTS In the sample analyzed, 52.5% of the volunteers presented good/adequate treatment compliance, while 33.3% presented low/insufficient compliance. There was no significant difference between men and women in the questionnaire score, nor between groups with different levels of education. CONCLUSION The main items of the questionnaire that contributed to good/adequate compliance were: positive impact of treatment on health and quality of life, few side effects after initiation of therapy, and positive self-evaluation of participants regarding their compliance to antiretroviral therapy. The main barriers detected for compliance to antiretroviral therapy were the lack of knowledge about current medications and the lack of information on antiretroviral therapy drugs.
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Affiliation(s)
| | - Márcio Rabelo Mota
- Centro Universitário de Brasília. Brasília, Distrito Federal, Brazil.,Centro Universitário de Anápolis. Anápolis, Goiás, Brazil
| | | | | | | | - Renata Aparecida Elias Dantas
- Centro Universitário de Brasília. Brasília, Distrito Federal, Brazil.,Centro Universitário de Anápolis. Anápolis, Goiás, Brazil
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Abstract
: Elevation of liver transaminases is common in patients infected with the HIV. Although this is usually an incidental finding during regular work-up, HIV-infected patients with transaminase elevations require additional visits for laboratory studies and clinical assessments, and often undergo interruptions and changes in antiretroviral therapy (ART). Alanine aminotransferase is present primarily in the liver, thus being a surrogate marker of hepatocellular injury. Aspartate aminotransferase is present in the liver and other organs, namely cardiac and skeletal muscle, kidney and brain. Serum levels of both liver transaminases predict liver-related mortality. Moreover, serum fibrosis biomarkers based on alanine aminotransferase and aspartate aminotransferase predict all-cause mortality. In a busy clinical setting, a diagnostic approach to elevated liver transaminases could be complicated given the frequency and nonspecificity of this finding. Indeed, HIV-infected individuals present multiple risk factors for liver damage and chronic elevation of transaminases, including coinfection with hepatitis B and C viruses, alcohol abuse, hepatotoxicity due to ART, HIV itself and frequent metabolic comorbidities leading to nonalcoholic fatty liver disease. This review provides an update on epidemiology of elevated liver transaminases, summarizes the main etiologic contributors and discusses the prognostic significance and a pragmatic approach to this frequent finding in the clinical practice of HIV medicine. With the aging of the HIV-infected population following the successful implementation of ART in Western countries, liver-related conditions are now a major comorbidity in this setting. As such, clinicians should be aware of the frequency, clinical significance and diagnostic approach to elevated liver transaminases.
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22
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Dutta D, Sharma M, Anand A, Garga UC, Bansal R, Sharma N. Increased trunk fat along with decreased peripheral fat as an important predictor of hypertriglyceridaemia & hypercholesterolaemia in Indians with HIV infection. Indian J Med Res 2019; 148:411-421. [PMID: 30666003 PMCID: PMC6362718 DOI: 10.4103/ijmr.ijmr_236_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background & objectives: Dyslipidaemia is a major contributor to cardiovascular morbidity, which is increased in HIV. Data on dyslipidaemia in Indians with HIV are scant. This study was undertaken to determine the predictors of dyslipidaemia and lipoatrophy in Indians with HIV infection and their relation with body composition parameters. Methods: A total of 382 consecutive patients with HIV infection were screened, of whom 257 clinically stable patients, without any acute comorbidity, having at least one year follow up underwent biochemical and DEXA analysis. Results: The most common dyslipidaemia was hypertriglyceridaemia (47.08%), followed by hypercholesterolaemia [total cholesterol (TC)] (38.91%) and low high-density lipoprotein (HDL) cholesterol (38.52%), in patients having median age 37 (32-42) yr and HIV duration 57 (33-101) months. Patients with at least one dyslipidaemia (78.99%) had significantly higher insulin resistance (IR), per cent body fat, per cent trunk fat (PTF) and trunk limb fat ratio (TLFR). Baseline CD4 count and delta CD4 count (change in CD4 count 6-12 months following ART) had significant inverse correlation with triglycerides and TC. Patients with highest triglycerides and cholesterol quartiles had significantly higher immune reconstitution, metabolic syndrome, IR, trunk fat mass (FM), PTF and TLFR, with comparable total FM. Logistic regression revealed that body mass index, HIV duration and PTF were independent predictors of hypertriglyceridaemia, with only PTF being significant predictor of hypercholesterolaemia. Every unit increase in PTF was associated with 13 and 4.1 per cent increased hypertriglyceridaemia and hypercholesterolaemia. Lipoatrophy was present in 8.57 per cent patients and was a poor predictor of dyslipidaemia. Interpretation & conclusions: High occurrence of dyslipidaemia was observed in patients with HIV on anti retroviral therapy. Central adiposity (TFM) was the most important predictor of dyslipidaemia in these patients.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Diabetology & Metabolic Disorders, Venkateshwar Hospitals; Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Meha Sharma
- Department of Rheumatology, Venkateshwar Hospitals, New Delhi, India
| | - Atul Anand
- Department of Anti-retroviral Therapy Clinic, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Umesh Chandra Garga
- Department of Radiology, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rahul Bansal
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Bresciani E, Saletti C, Squillace N, Rizzi L, Molteni L, Meanti R, Omeljaniuk RJ, Biagini G, Gori A, Locatelli V, Torsello A. miRNA-218 Targets Lipin-1 and Glucose Transporter Type 4 Genes in 3T3-L1 Cells Treated With Lopinavir/Ritonavir. Front Pharmacol 2019; 10:461. [PMID: 31133852 PMCID: PMC6524698 DOI: 10.3389/fphar.2019.00461] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/11/2019] [Indexed: 12/23/2022] Open
Abstract
Background: Metabolic complications represent a common and serious problem associated with HIV infection and combined Antiretroviral Therapy (cART). Alterations in body fat distribution are associated with significantly increased risks of (i) metabolic derangements, (ii) cardiovascular pathologies, and (iii) insulin resistance. A case control study showed that in subcutaneous adipose tissue from HIV-infected patients on cART presenting lipodystrophy (LS), the levels of miRNA-218 were upregulated and those of lipin-1, a putative target gene of miRNA-218, were downregulated compared with HIV-negative subjects. Lipin-1 is one of the most important factors linked to development of LS. Lipin-1, by controlling PPARγ2, regulates the expression of specific genes, such as that of glucose transporter type 4 (GLUT-4), required for maturation and maintenance of adipocytes. Objectives: To determine whether lopinavir/ritonavir (LPV/RTV) can modulate lipogenesis in adipocytes affecting miRNA-218 and lipin-1 mRNA expression, and to investigate the functional link between miRNA-218 and GLUT-4 mRNA expression. Methods: Differentiated 3T3-L1 cells were treated with various combinations of LPV/RTV, followed by measurements of cell viability, lipid accumulation, lipin-1 and GLUT-4 mRNA and miRNA-218 levels. Transfection of anti-miR-218 or a miRNA-218 mimic were used to investigate the role of miRNA-218 in lipogenesis. Results: LPV/RTV treatment of 3T3-L1 cells did not affect the viability of differentiated 3T3-L1 cells, but caused (i) a significant decrease of lipid accumulation, (ii) an overexpression of miRNA-218, and (iii) a reduction of lipin-1 and GLUT-4 mRNA levels. The anti-miR-218 transfection of 3T3-L1 cells significantly ameliorated the adipogenic dysfunction and restored mRNA levels of lipin-1 and GLUT-4 consequent to LPV/RTV treatment. By contrast, 3T3-L1 cells transfected with a specific miRNA-218 mimic showed (i) an overexpression of miRNA-218, (ii) a reduced cellular lipid fraction, and (iii) decreased levels of mRNA for lipin-1 and GLUT-4. Conclusion: 3T3-L1 cells, treated with LPV/RTV, show altered lipid content due to increased miRNA-218 levels, which affects lipin-1 mRNA. Moreover, increased miRNA-218 levels were inversely correlated with changes in GLUT-4 expression, which suggests a role for miRNA-218 in mediating the insulin resistance consequent to cART.
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Affiliation(s)
- Elena Bresciani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cecilia Saletti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicola Squillace
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, Monza, Italy
| | - Laura Rizzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laura Molteni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ramona Meanti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Giuseppe Biagini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Vittorio Locatelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Antonio Torsello
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Oumar AA, Dakouo M, Tchibozo A, Maiga M, Landouré G, Abdi-Bogoreh R, Tulkens PM, Dao S, Yombi JC. Antiretroviral-induced adverse drug reactions in HIV-infected patients in Mali: a resource-limited setting experience. ACTA ACUST UNITED AC 2019; 8:831-836. [PMID: 31879663 PMCID: PMC6931397 DOI: 10.18203/2319-2003.ijbcp20191565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background There are few reports in the literature from sub-Saharan Africa (SSA) regarding antiretroviral-induced adverse drug reactions (ADRs). Antiretroviral therapy (ART) is now widely available in SSA, and ADRs during HIV infection are also frequent. In this study, we reported the frequency and risk factors of ART-induced ADRs in a Malian population. Methods This prospective cohort study was performed in the HIV Care and Counseling Centre (CESAC) of Mali from 2011 to 2012. Adult patients infected with HIV and who had recently started ART were included and followed-up clinically Were included in this study, adult patients living with HIV and had recently started ART who were followed up for at least 6 months to determine the incidence of ADRs using Naranjo's classification scale. Results During this study, 357 (42.3%) patients presented ADRs (40.1% of our patients (n=338) experienced at least one ADR, and 2.2% (n=19) experienced at least two ADRs). The prevalence of ADRs by organ system was: 45.9% neurological (n=164); 29.4% metabolic (blood chemistry) (n=105); 15.4% hematological (n=55). High probable rate of ADR was observed as indicated by the Naranjo score in 83.7% of the cases. Zidovudine (AZT) and stavudine (d4T) use was identified as a risk factor for either anaemia or peripheral neuropathy whereas nevirapine (NVP) and female gender were risk factors for skin reactions. Patients with advance disease had the highest rate of ADRs compared to the others. Conclusions Based on the Naranjo probability scale, our data show that ADRs such as peripheral neuropathy and anemia are very frequent. These ADR was linked to AZT and D4T. Our findings highlight the need for active monitoring, continuous pharmacovigilance of ART and change of some ART drug in this population.
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Affiliation(s)
| | - Mamadou Dakouo
- Department of Public Health, Université de Montreal, Montreal, Canada
| | - Anicet Tchibozo
- Department of Public Health, Université de Montreal, Montreal, Canada
| | - Mamoudou Maiga
- Department of Global Health, Northwestern University, Chicago, USA
| | - Guida Landouré
- Department of Neurology, Centre Hospital, University du Point «G», Bamako, Mali
| | | | - Paul M Tulkens
- Department of Cellular & Molecular Pharmacology, Catholic University of Louvain, Brussels, Belgium
| | - Sounkalo Dao
- Department of Infectious Diseases, Centre Hospital, University du Point «G», Bamako
| | - Jean Cyr Yombi
- Department of Internal Medicine & Infectious Diseases, AIDS Reference Center, Catholic University of Louvain, Brussels, Belgium
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25
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Silveira EA, Falco MO. [Nutritional diagnosis of people living with HIV/AIDS: a review of national and international protocols]. CIENCIA & SAUDE COLETIVA 2019; 25:5003-5016. [PMID: 33295518 DOI: 10.1590/1413-812320202512.36262018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
HIV infection is a predictor of several metabolic and body composition alterations, in addition to malnutrition, anemia, and hypovitaminosis. There are thus specificities of diagnosis and treatment depending on the stage of the disease and the outpatient or hospital environment. The scope of this narrative review was to update the conceptual and theoretical framework regarding the nutritional diagnosis of people living with HIV/AIDS. Current national and international scientific evidence published in scientific articles, recent books, protocols, consensuses, and guidelines were analyzed. The nutritional diagnosis encompasses several clinical aspects and abilities and specific knowledge about HIV/AIDS, such as: clinical history and current clinical situation, food consumption, anthropometric data, body composition, and biochemistry, blood pressure and physical examination. The nutritional diagnosis process was demonstrated in order to provide subsidies for the health teams in the identification of parameters that make it possible to establish a plan for nutritional care to promote, prevent and recuperate the alterations detected in people living with HIV/AIDS.
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Affiliation(s)
- Erika Aparecida Silveira
- Programa de Pós-Graduação Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás. Av. Primeira Avenida s/n, Setor Leste Universitário. 74605-050 Goiânia GO Brasil.
| | - Marianne Oliveira Falco
- Programa de Pós-Graduação Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás. Av. Primeira Avenida s/n, Setor Leste Universitário. 74605-050 Goiânia GO Brasil.
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26
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Immune Activation, Inflammation, and Non-AIDS Co-Morbidities in HIV-Infected Patients under Long-Term ART. Viruses 2019; 11:v11030200. [PMID: 30818749 PMCID: PMC6466530 DOI: 10.3390/v11030200] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 02/07/2023] Open
Abstract
Despite effective antiretroviral therapy (ART), people living with HIV (PLWH) still present persistent chronic immune activation and inflammation. This condition is the result of several factors including thymic dysfunction, persistent antigen stimulation due to low residual viremia, microbial translocation and dysbiosis, caused by the disruption of the gut mucosa, co-infections, and cumulative ART toxicity. All of these factors can create a vicious cycle that does not allow the full control of immune activation and inflammation, leading to an increased risk of developing non-AIDS co-morbidities such as metabolic syndrome and cardiovascular diseases. This review aims to provide an overview of the most recent data about HIV-associated inflammation and chronic immune exhaustion in PLWH under effective ART. Furthermore, we discuss new therapy approaches that are currently being tested to reduce the risk of developing inflammation, ART toxicity, and non-AIDS co-morbidities.
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27
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Araújo-Vilar D, Santini F. Diagnosis and treatment of lipodystrophy: a step-by-step approach. J Endocrinol Invest 2019; 42:61-73. [PMID: 29704234 PMCID: PMC6304182 DOI: 10.1007/s40618-018-0887-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/09/2018] [Indexed: 12/24/2022]
Abstract
AIM Lipodystrophy syndromes are rare heterogeneous disorders characterized by deficiency of adipose tissue, usually a decrease in leptin levels and, frequently, severe metabolic abnormalities including diabetes mellitus and dyslipidemia. PURPOSE To describe the clinical presentation of known types of lipodystrophy, and suggest specific steps to recognize, diagnose and treat lipodystrophy in the clinical setting. METHODS Based on literature and in our own experience, we propose a stepwise approach for diagnosis of the different subtypes of rare lipodystrophy syndromes, describing its more frequent co-morbidities and establishing the therapeutical approach. RESULTS Lipodystrophy is classified as genetic or acquired and by the distribution of fat loss, which can be generalized or partial. Genes associated with many congenital forms of lipodystrophy have been identified that may assist in diagnosis. Because of its rarity and heterogeneity, lipodystrophy may frequently be unrecognized or misdiagnosed, which is concerning because it is progressive and its complications are potentially life threatening. A basic diagnostic algorithm is proposed. Effective management of lipodystrophy includes lifestyle changes and aggressive, evidence-based treatment of comorbidities. Leptin replacement therapy (metreleptin) has been found to improve metabolic parameters in many patients with lipodystrophy. Metreleptin is approved in the United States as replacement therapy to treat the complications of leptin deficiency in patients with congenital or acquired generalized lipodystrophy and has been submitted for approval in Europe. CONCLUSIONS Here, we describe the clinical presentation of known types of lipodystrophy, present an algorithm for differential diagnosis of lipodystrophy, and suggest specific steps to recognize and diagnose lipodystrophy in the clinical setting.
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Affiliation(s)
- D Araújo-Vilar
- UETeM-Molecular Pathology Group, Institute of Biomedical Research (CIMUS), School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - F Santini
- Endocrinology Unit, Obesity Center, University Hospital of Pisa, Pisa, Italy
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28
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Derose KP, Palar K, Farías H, Adams J, Martínez H. Developing Pilot Interventions to Address Food Insecurity and Nutritional Needs of People Living With HIV in Latin America and the Caribbean: An Interinstitutional Approach Using Formative Research. Food Nutr Bull 2018; 39:549-563. [PMID: 30453759 DOI: 10.1177/0379572118809302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Food insecurity and malnutrition present challenges to HIV management, but little research has been done in Latin America and the Caribbean (LAC). OBJECTIVE To assess levels of food insecurity and malnutrition among people living with HIV (PLHIV) across multiple countries in LAC to inform pilot projects and policy. METHODS Through interinstitutional collaboration, we collected data on sociodemographics, household food security, anthropometry, and commonly consumed foods among adults seeking care at HIV clinics in Bolivia, Honduras, and the Dominican Republic (DR; N = 400) and used the results for pilot projects. RESULTS Most PLHIV had moderate or severe household food insecurity (61% in Bolivia, 71% in Honduras, and 68% in DR). Overweight and obesity were also highly prevalent, particularly among women (41%-53% had body mass index ≥25). High body fat was also prevalent, ranging from 36% to 59%. Among salient foods, fruits and vegetables were lacking. Country-specific pilot projects incorporated locally tailored nutrition counseling with a monthly household food ration, linkage to income-generating projects, or urban gardens. Nutritional counseling was conducted initially by professionals and later modified for peer counselors given the lack of nutritionists. CONCLUSION High levels of food insecurity and overweight among PLHIV in LAC have important implications, since prior interventions to address food insecurity among PLHIV have focused on underweight and wasting. Formative research and intersectoral collaboration facilitated locally appropriate nutritional materials and interventions, enhanced local capacities, and helped incorporate nutritional guidelines into policies and practice. Addressing human capital constraints in resource-poor settings and developing complementary strategies were key recommendations.
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Affiliation(s)
| | - Kartika Palar
- 2 Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Hugo Farías
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Jayne Adams
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Homero Martínez
- 1 RAND Corporation, Santa Monica, CA, USA.,4 Hospital Infantil de México Federico Gómez, Mexico City, Mexico.,5 Nutrition International, Ottawa, Canada
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29
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Bhagwat P, Ofotokun I, McComsey GA, Brown TT, Moser C, Sugar CA, Currier JS. Changes in Waist Circumference in HIV-Infected Individuals Initiating a Raltegravir or Protease Inhibitor Regimen: Effects of Sex and Race. Open Forum Infect Dis 2018; 5:ofy201. [PMID: 30465010 PMCID: PMC6239079 DOI: 10.1093/ofid/ofy201] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 10/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background This study investigates the association of clinical and demographic predictors with abdominal fat gain, measured using waist circumference (WC) and self-reported abdominal size. Methods We analyzed data from ACTG A5257, a clinical trial that randomized treatment-naïve HIV-infected participants to 1 of 3 antiretroviral regimens: raltegravir (RAL) or the protease inhibitors (PIs) atazanavir/ritonavir (ATV/r) or darunavir/ritonavir (DRV/r), each in combination with tenofovir disoproxil fumarate/emtricitabine. Associations of treatment and baseline/demographic characteristics with 96-week WC change were assessed using repeated-measures models. Ordinal logistic regression was used to examine the associations of predictors with week 96 self-reported abdominal changes. Results The study population (n = 1809) was 76.0% male and predominantly black non-Hispanic (41.9%) and white non-Hispanic (34.1%). Mean baseline WC was 90.6 cm, with an average 96-week increase of 3.4 cm. WC increases were higher in the RAL arm compared with DRV/r (P = .0130). Females experienced greater increases in WC on RAL vs ATV/r than males (P = .0065). Similarly, a larger difference in WC change was found for RAL vs DRV/r for black vs nonblack individuals (P = .0043). A separate multivariable model found that in addition to the treatment regimen, higher baseline viral load and lower CD4+ were also associated with WC increases. Conclusions With antiretroviral therapy initiation, higher WC increases in the RAL arm compared with PIs were more pronounced in female and black participants, and a more advanced baseline HIV disease state was a strong predictor of larger abdominal increases. Understanding factors predisposing individuals to abdominal fat gain could inform health management after therapy initiation.
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Affiliation(s)
- Priya Bhagwat
- University of California, Los Angeles, Los Angeles, California
| | - Ighovwerha Ofotokun
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | | | - Todd T Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carlee Moser
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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30
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Tsai FJ, Ho MW, Lai CH, Chou CH, Li JP, Cheng CF, Wu YC, Liu X, Tsang H, Lin TH, Liao CC, Huang SM, Lin JC, Lin CC, Hsieh CL, Liang WM, Lin YJ. Evaluation of Oral Antiretroviral Drugs in Mice With Metabolic and Neurologic Complications. Front Pharmacol 2018; 9:1004. [PMID: 30233379 PMCID: PMC6131569 DOI: 10.3389/fphar.2018.01004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/15/2018] [Indexed: 12/30/2022] Open
Abstract
Antiretroviral (ART) drugs has previously been associated with lipodystrophic syndrome, metabolic consequences, and neuropsychiatric complications. ART drugs include three main classes of protease inhibitors (PIs), nucleoside analog reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Our previous work demonstrated that a high risk of hyperlipidemia was observed in HIV-1-infected patients who received ART drugs in Taiwan. Patients receiving ART drugs containing either Abacavir/Lamivudine (Aba/Lam; NRTI/NRTI), Lamivudine/Zidovudine (Lam/Zido; NRTI/NRTI), or Lopinavir/Ritonavir (Lop/Rit; PI) have the highest risk of hyperlipidemia. The aim of this study was to investigate the effects of Aba/Lam (NRTI/NRTI), Lam/Zido (NRTI/NRTI), and Lop/Rit (PI) on metabolic and neurologic functions in mice. Groups of C57BL/6 mice were administered Aba/Lam, Lam/Zido, or Lop/Rit, orally, once daily for a period of 4 weeks. The mice were then extensively tested for metabolic and neurologic parameters. In addition, the effect of Aba/Lam, Lam/Zido, and Lop/Rit on lipid metabolism was assessed in HepG2 hepatocytes and during the 3T3-L1 preadipocyte differentiation. Administration with Aba/Lam caused cognitive and motor impairments in mice, as well as their metabolic imbalances, including alterations in leptin serum levels. Administration with Lop/Rit also caused cognitive and motor impairments in mice, as well as their metabolic imbalances, including alterations in serum levels of total cholesterol, and HDL-c. Treatment of mice with Aba/Lam and Lop/Rit enhanced the lipid accumulation in the liver, and the decrease in AMP-activated protein kinase (AMPK) phosphorylation and/or its downstream target acetyl-CoA carboxylase (ACC) protein expression. In HepG2 hepatocytes, Aba/Lam, Lam/Zido, and Lop/Rit also enhanced the lipid accumulation and decreased phosphorylated AMPK and ACC proteins. In 3T3-L1 pre-adipocyte differentiation, Aba/Lam and Lop/Rit reduced adipogenesis by decreasing expression of transcription factor CEBPb, implicating the lipodystrophic syndrome. Our results demonstrate that daily oral administration of Aba/Lam and Lop/Rit may produce cognitive, motor, and metabolic impairments in mice, regardless of HIV-1 infection.
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Affiliation(s)
- Fuu-Jen Tsai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Biotechnology, Asia University, Taichung, Taiwan
| | - Mao-Wang Ho
- Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Ho Lai
- Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan.,Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chen-Hsing Chou
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Ju-Pi Li
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Rheumatism Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Fung Cheng
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Yang-Chang Wu
- Graduate Institute of Natural Products and Research Center for Natural Products & Drug Development, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Xiang Liu
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Hsinyi Tsang
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Ting-Hsu Lin
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Chu Liao
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Shao-Mei Huang
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Chun Lin
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chien Lin
- Department of Cosmetic Science, Providence University, Taichung, Taiwan
| | - Ching-Liang Hsieh
- Graduate Institute of Integrated Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Ying-Ju Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Beraldo RA, Santos APD, Guimarães MP, Vassimon HS, Paula FJAD, Machado DRL, Foss-Freitas MC, Navarro AM. Body fat redistribution and changes in lipid and glucose metabolism in people living with HIV/AIDS. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 20:526-536. [PMID: 29160443 DOI: 10.1590/1980-5497201700030014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/23/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). OBJECTIVE To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. METHODS For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. RESULTS The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). CONCLUSION The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.
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Affiliation(s)
- Rebeca Antunes Beraldo
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - André Pereira Dos Santos
- Programa Interunidades de Doutoramento, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Mariana Palma Guimarães
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | | | | | - Dalmo Roberto Lopes Machado
- Escola de Educação Física e Esporte de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil.,Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Maria Cristina Foss-Freitas
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Anderson Marliere Navarro
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
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Mechanism of Change in Cognitive Behavioral Therapy for Body Image and Self-Care on ART Adherence Among Sexual Minority Men Living with HIV. AIDS Behav 2018; 22:2711-2717. [PMID: 29752620 DOI: 10.1007/s10461-018-2143-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Body image disturbance is a common problem reported among sexual minority men living with HIV, and is associated with poor antiretroviral therapy (ART) adherence. Recently, a novel integrated intervention (cognitive behavioral therapy for body image and self-care; CBT-BISC) was developed and pilot tested to simultaneously improve body image and ART adherence in this population. Although CBT-BISC has demonstrated preliminary efficacy in improving ART adherence, the mechanisms of change are unknown. Utilizing data from a two-armed randomized controlled trial (N = 44 sexual minority men living with HIV), comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition, sequential process mediation via latent difference scores was assessed, with changes in body image disturbance entered as the mechanism between treatment condition and changes in ART adherence. Participants assigned to CBT-BISC reported statistically significant reductions in body image disturbance post-intervention, which subsequently predicted changes in ART adherence from post-intervention to long term follow-up (b = 20.01, SE = 9.11, t = 2.19, p = 0.028). One pathway in which CBT-BISC positively impacts ART adherence is through reductions in body image disturbance. Body image disturbance represents one, of likely several, mechanism that prospectively predicts ART adherence among sexual minority men living with HIV.
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33
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Silva LLG, Santos EMD, Nascimento LCPD, Cavalcanti MCDF, Arruda IKGD, Luz MCL, Cabral PC. Lipodystrophic syndrome of HIV and associated factors: a study in a university hospital. CIENCIA & SAUDE COLETIVA 2018; 25:989-998. [PMID: 32159668 DOI: 10.1590/1413-81232020253.11772018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
Abstract
The use of antiretroviral drugs has increased the survival of HIV patients, but may have side effects, such as lipodystrophic syndrome. This article aims to identify the frequency of the lipodystrophic syndrome and its associated factors in patients with HIV using antiretroviral therapy. It involved a cross-sectional study with HIV patients, monitored on an outpatient basis. The syndrome was evaluated by the association of two parameters: peripheral weight loss through the lipodystrophy severity scale and central fat accumulation, measured by the hip waist ratio. Poisson regression analysis was performed to identify the associated variables. Of the 104 patients evaluated, 27.9% presented the syndrome. After adjustment, the female sex (PRadjusted = 2.16 CI95% 1.43-3.39), being overweight (PRadjusted = 2.23 CI95% 1.35-2.65) and a longer period of use of antiretrovirals (PRadjusted = 1.64 CI95% 1.16-2.78), remained positively associated with the syndrome. On the other hand, a negative association with CD4 count £ 350 (PRadjusted = 0.39 CI95% 0.10-0.97) was observed The high prevalence of the syndrome and its association with specific groups reinforce the need for adequate follow-up and early identification to intervene in modifiable factors.
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Affiliation(s)
- Lídia Laís Gomes Silva
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Eryka Maria Dos Santos
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Luciana Caroline Paulino do Nascimento
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Mikaella Carla de França Cavalcanti
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Ilma Kruze Grande de Arruda
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Marcella Campos Lima Luz
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Poliana Coelho Cabral
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
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Abrahams Z, Maartens G, Levitt N, Dave J. Anthropometric definitions for antiretroviral-associated lipodystrophy derived from a longitudinal South African cohort with serial dual-energy X-ray absorptiometry measurements. Int J STD AIDS 2018; 29:1194-1203. [PMID: 29945538 DOI: 10.1177/0956462418778649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of lipodystrophy is associated with the long-term use of antiretroviral therapy (ART). We assessed agreement between patient-reported lipodystrophy and body composition measures using dual-energy X-ray absorptiometry (DXA) and developed objective measures to define lipoatrophy and lipohypertrophy in black South Africans. One hundred and eighty-seven ART-naïve HIV-infected adults were enrolled in a 24-month longitudinal study. Self-reported information on regional fat loss and fat gain, anthropometry, and DXA measures were collected at baseline, three, six, 12, 18, and 24 months after starting ART. Receiver operating characteristic curves were used to describe the performance of anthropometric variables using change in limb and trunk fat measured by DXA, as the reference standard. The proportion of men and women who developed lipoatrophy and lipohypertrophy increased over the 24-month period, with lipoatrophy occurring more frequently in men (21% versus 10%). In women, lipoatrophy was best determined by thigh skinfold thickness (80.3% correctly classified) and mid-arm circumference (77.6% correctly classified). None of the anthropometric measures performed well for defining lipoatrophy in men. Anthropometric measures performed well for defining lipoatrophy in women, but not lipohypertrophy.
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Affiliation(s)
- Zulfa Abrahams
- 1 Department of Medicine, Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- 2 Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Naomi Levitt
- 1 Department of Medicine, Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa
| | - Joel Dave
- 1 Department of Medicine, Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa
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Mehraj V, Cox J, Lebouché B, Costiniuk C, Cao W, Li T, Ponte R, Thomas R, Szabo J, Baril J, Trottier B, Côté P, LeBlanc R, Bruneau J, Tremblay C, Routy J. Socio-economic status and time trends associated with early ART initiation following primary HIV infection in Montreal, Canada: 1996 to 2015. J Int AIDS Soc 2018; 21:e25034. [PMID: 29412520 PMCID: PMC5804015 DOI: 10.1002/jia2.25034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/17/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Guidelines regarding antiretroviral therapy (ART) initiation in HIV infection have varied over time, with the 2015 World Health Organization recommendation suggesting ART initiation at the time of diagnosis regardless of CD4 T-cell counts. Herein, we investigated the influence of socio-demographic and clinical factors in addition to time trends on early ART initiation among participants of the Montreal Primary HIV Infection Study. METHODS The Montreal Primary HIV Infection Study is a prospective cohort established in three community medical centres (CMCs) and two university medical centres (UMCs). Recently diagnosed HIV-infected adults were categorized as receiving early (vs. delayed) ART if ART was initiated within 180 days of the baseline visit. Associations between early ART initiation and socio-demographic, socio-economic and behavioural information were examined. Independent associations of factors linked with early ART initiation were determined using multivariable binary logistic regression analysis. RESULTS A total of 348 participants had a documented date of HIV acquisition of <180 days. The median interquartile range (IQR) age of participants was 35 (28; 42) years and the majority were male (96%), having paid employment (63%), men who have sex with men (MSM) (78%) and one to four sexual partners in the last three months (70%). Participants presented with a median IQR HIV plasma viral load of 4.6 (3.7; 5.3) log10 copies/ml, CD4 count of 510 (387; 660) cells/μl and were recruited in CMCs (52%) or UMCs (48%). Early ART initiation was observed in 47% of the participants and the trend followed a V-shaped curve with peaks in 1996 to 1997 (89%) and 2013 to 2015 (88%) with a dip in 2007 to 2009 (22%). Multivariable analyses showed that having a paid employment adjusted odds ratio (aOR: 2.43; 95% CI: 1.19, 4.95), lower CD4 count (aOR per 50 cell increase: 0.93; 95% CI: 0.87, 0.99) and care at UMCs (aOR: 2.03; 95% CI: 1.06 to 3.90) were independently associated with early ART initiation. CONCLUSIONS Early ART initiation during primary HIV infection was associated with diminished biological prognostic factors and calendar time mirroring evolution of treatment guidelines. In addition, socio-economic factors such as having a paid employment, contribute to early ART initiation in the context of universal access to care in Canada.
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Affiliation(s)
- Vikram Mehraj
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Joseph Cox
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQCCanada
| | - Bertrand Lebouché
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
- Department of Family MedicineMcGill UniversityMontrealQCCanada
| | - Cecilia Costiniuk
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Wei Cao
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
- Department of Infectious DiseasesPeking Union Medical College HospitalBeijingChina
| | - Taisheng Li
- Department of Infectious DiseasesPeking Union Medical College HospitalBeijingChina
| | - Rosalie Ponte
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | | | - Jason Szabo
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Clinique Médicale l'ActuelMontréalQCCanada
| | | | | | - Pierre Côté
- Clinique Médicale Quartier LatinMontréalQCCanada
| | | | - Julie Bruneau
- Centre de recherche du Centre Hospitalier de l'Université de MontréalMontréalQCCanada
| | - Cécile Tremblay
- Centre de recherche du Centre Hospitalier de l'Université de MontréalMontréalQCCanada
- Département de microbiologie infectiologie et immunologieUniversité de MontréalMontréalQCCanada
| | - Jean‐Pierre Routy
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQCCanada
- Research Institute of the McGill University Health CentreMontrealQCCanada
- Division of HematologyMcGill University Health CentreMontrealQCCanada
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Lake JE, Stanley TL, Apovian CM, Bhasin S, Brown TT, Capeau J, Currier JS, Dube MP, Falutz J, Grinspoon SK, Guaraldi G, Martinez E, McComsey GA, Sattler FR, Erlandson KM. Practical Review of Recognition and Management of Obesity and Lipohypertrophy in Human Immunodeficiency Virus Infection. Clin Infect Dis 2018; 64:1422-1429. [PMID: 28329372 DOI: 10.1093/cid/cix178] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background Obesity and lipohypertrophy are common in treated human immunodeficiency virus (HIV) infection and contribute to morbidity and mortality among HIV-infected adults on antiretroviral therapy (ART). Methods We present a consensus opinion on the diagnosis, clinical consequences, and treatment of excess adiposity in adults with treated HIV infection. Results Obesity and lipohypertrophy commonly occur among HIV-infected adults on ART and may have overlapping pathophysiologies and/or synergistic metabolic consequences. Traditional, HIV-specific, and ART-specific risk factors all contribute. The metabolic and inflammatory consequences of excess adiposity are critical drivers of non-AIDS events in this population. Although promising treatment strategies exist, further research is needed to better understand the pathophysiology and optimal treatment of obesity and lipohypertrophy in the modern ART era. Conclusions Both generalized obesity and lipohypertrophy are prevalent among HIV-infected persons on ART. Aggressive diagnosis and management are key to the prevention and treatment of end-organ disease in this population and critical to the present and future health of HIV-infected persons.
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Affiliation(s)
- Jordan E Lake
- Department of Medicine, University of Texas Health Science Center at Houston
| | - Takara L Stanley
- Department of Pediatrics, Harvard University School of Medicine and
| | - Caroline M Apovian
- Departments of Medicine and.,Pediatrics, Boston University School of Medicine, Massachusetts
| | | | - Todd T Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaqueline Capeau
- Department of Cell Biology and Metabolism, Univ-Paris 6, Inserm UMRS938, ICAN, Paris, France
| | - Judith S Currier
- Department of Medicine, University of California Los Angeles and
| | - Michael P Dube
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Julian Falutz
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Steven K Grinspoon
- Department of Medicine, Harvard University School of Medicine, Boston, Massachusetts
| | - Giovanni Guaraldi
- Department of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Grace A McComsey
- Department of Medicine and Pediatrics, Case Western University, Cleveland, Ohio; and
| | - Fred R Sattler
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles
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Grenha I, Oliveira J, Lau E, Santos AC, Sarmento A, Pereira J, Carvalho D, Freitas P. HIV-Infected Patients With and Without Lipodystrophy Under Combined Antiretroviral Therapy: Evaluation of Body Composition. J Clin Densitom 2018; 21:75-82. [PMID: 28034590 DOI: 10.1016/j.jocd.2016.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/23/2016] [Accepted: 07/27/2016] [Indexed: 11/21/2022]
Abstract
In HIV-infected patients, combined antiretroviral therapy (cART) is associated to adipose tissue redistribution known as lipodystrophy and associated cardiometabolic risk. This study aimed to evaluate the evolution of body composition in HIV-infected patients, with and without lipodystrophy, over 2 yr. We evaluated anthropometric parameters and body composition by whole-body dual-energy X-ray absorptiometry in 144 HIV-infected patients on cART. We defined lipodystrophy by fat mass ratio. Lipodystrophy was present in 45.77% of the patients. These patients presented higher HIV infection duration, cART duration, and CD4+ cell count, with no differences regarding gender, age, body mass index, and viral load. Patients with lipodystrophy showed an increase in total fat mass (9.9%) and upper-limbs fat mass (17.6%), with a decrease in total, trunk, and lower-limbs fat-free mass (2.2%; 2.2%, and 3.9%, respectively), over 2 yr. In patients without lipodystrophy, the trunk fat-free mass decreased 1.9% over time, and no changes were observed in the other studied parameters. In patients with lipodystrophy, there was predominantly a central fat mass gain, with no changes in lower limbs, suggesting that peripheral adipocytes lose their regenerative capacity.
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Affiliation(s)
- Inês Grenha
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Faculty of Medicine, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
| | - Joana Oliveira
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Faculty of Medicine, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Eva Lau
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Faculty of Medicine, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Ana Cristina Santos
- Clinical Epidemiology, Predictive Medicine and Public Health Department, Faculty of Medicine, University of Porto, Porto, Portugal; EPIUNIT-Institute of Public Health of University of Porto, Porto, Portugal
| | - António Sarmento
- Infectious Disease Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jorge Pereira
- Nuclear Medicine Department, Centro Hospitalar São João, Porto, Portugal
| | - Davide Carvalho
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, 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, Faculty of Medicine, i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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Osuna-Padilla IA, Aguilar-Vargas A, Villazón-De la Rosa A, Ablanedo-Terrazas Y, Vargas-Infante Y, Reyes-Terán G. Accuracy of Predictive Equations for Energy Expenditure in Mexicans Living With HIV/AIDS With and Without Antiretroviral Therapy. JPEN J Parenter Enteral Nutr 2017; 42:380-386. [PMID: 29187061 DOI: 10.1177/0148607117695250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/31/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Determination of the resting energy expenditure (REE) is essential for planning nutrition therapy in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) to help to improve their nutrition status. We aim to evaluate the agreement and accuracy of prediction equations that estimate the REE in a Mexican population with a diagnosis of HIV/AIDS with and without antiretroviral therapy (ART). METHODS A cross-sectional study in Mexican patients with HIV/AIDS with and without ART. Weight, height, and body composition measured with dual-energy x-ray absorptiometry were evaluated. The REE was determined with indirect calorimetry and estimated using the Mifflin-St Jeor (MSJ), Harris-Benedict (HB), Schofield 1 and 2, Cunningham, Melchior 91, Melchior 93, and Batterham equations. The Bland-Altman method assessed agreement between the real and estimated values, and the percent difference between these values was used to assess the prediction accuracy. RESULTS Sixty-five adults without ART and 102 adults with ART were included. The mean REE (kcal/kg) was 24.8 ± 2.4 and 23.8 ± 3.6 in patients without and with ART, respectively. Good agreement and reliability were observed in the HB (intraclass correlation coefficient [ICC], 0.75; P < .05), Batterham (ICC, 0.79; P < .05), Schofield 1 (ICC, 0.74; P < .05), and Schofield 2 (ICC, 0.78; P < .05) results in individuals without ART. In individuals with ART, good agreement and reliability were observed with the HB equation (ICC, 0.76; P < .05). The MSJ equation showed good agreement with poor reliability (ICC, 0.05; P < .05). CONCLUSION The equations with the best agreement and accuracy were Schofield 2, Batterham, and HB in individuals without ART and HB and MSJ in the population with ART.
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Affiliation(s)
- Iván Armando Osuna-Padilla
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Adriana Aguilar-Vargas
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Andrea Villazón-De la Rosa
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Yuria Ablanedo-Terrazas
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Yetlanezi Vargas-Infante
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
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Katirayi L, Chadambuka A, Muchedzi A, Ahimbisibwe A, Musarandega R, Woelk G, Tylleskar T, Moland KM. Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women's perspectives. Reprod Health 2017; 14:124. [PMID: 28982365 PMCID: PMC5629810 DOI: 10.1186/s12978-017-0387-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With the introduction of 2016 World Health Organization guidelines recommending universal antiretroviral therapy (ART), there has been increased recognition of the lack of men engaging in HIV testing and treatment. Studies in sub-Saharan Africa indicate there have been challenges engaging men in HIV testing and HIV-positive men into treatment. METHODS This qualitative study explored women's perspective of their male partner's attitudes towards HIV and ART and how it shapes woman's experience with ART. Data were collected through in-depth interviews and focus group discussions with HIV-positive pregnant and postpartum women on Option B+ and health care workers in Malawi and Zimbabwe. In Malawi, 19 in-depth interviews and 12 focus group discussions were conducted from September-December 2013. In Zimbabwe, 15 in-depth interviews and 21 focus-group discussions were conducted from July 2014-March 2014. RESULTS The findings highlighted that many men discourage their partners from initiating or adhering to ART. One of the main findings indicated that despite the many advancements in HIV care and ART regimens, there are still many lingering negative beliefs about HIV and ART from the earlier days of the epidemic. In addition to existing theories explaining men's resistance to/absence in HIV testing and treatment as a threat to their masculinity or because of female-focused health facilities, this paper argues that men's aversion to HIV may be a result of old beliefs about HIV and ART which have not been addressed. CONCLUSIONS Due to lack of accurate and up to date information about HIV and ART, many men discourage their female partners from initiating and adhering to ART. The effect of lingering and outdated beliefs about HIV and ART needs to be addressed through strengthened communication about developments in HIV care and treatment. Universal ART offers a unique opportunity to curb the epidemic, but successful implementation of these new guidelines is dependent on ART initiation and adherence by both women and men. Strengthening men's understanding about HIV and ART will greatly enhance women's ability to initiate and adhere to ART and improve men's health.
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Affiliation(s)
- Leila Katirayi
- Elizabeth Glaser Pediatric AIDS Foundation, 1140 Ave NW, Suite 200, Washington, D.C, CT 20036 USA
| | | | | | | | | | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, 1140 Ave NW, Suite 200, Washington, D.C, CT 20036 USA
| | - Thorkild Tylleskar
- Center for International Health/CISMAC (Centre for Intervention Science in Maternal and Child Health), University of Bergen, Bergen, Norway
| | - Karen Marie Moland
- Center for International Health/CISMAC (Centre for Intervention Science in Maternal and Child Health), University of Bergen, Bergen, Norway
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Maggi P, Di Biagio A, Rusconi S, Cicalini S, D'Abbraccio M, d'Ettorre G, Martinelli C, Nunnari G, Sighinolfi L, Spagnuolo V, Squillace N. Cardiovascular risk and dyslipidemia among persons living with HIV: a review. BMC Infect Dis 2017; 17:551. [PMID: 28793863 PMCID: PMC5550957 DOI: 10.1186/s12879-017-2626-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/20/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Aim of this review is to focus the attention on people living with HIV infection at risk of developing a cardiovascular event. What is or what would be the most suitable antiretroviral therapy? Which statin or fibrate to reduce the risk? How to influence behavior and lifestyles? DISCUSSION Prevention of cardiovascular disease (CVD) risk remains the first and essential step in a medical intervention on these patients. The lifestyle modification, including smoking cessation, increased physical activity, weight reduction, and the education on healthy dietary practices are the main instruments. Statins are the cornerstone for the treatment of hypercholesterolemia. They have been shown to slow the progression or promote regression of coronary plaque, and could also exert an anti-inflammatory and immunomodulatory effect. However the current guidelines for the use of these drugs in general population are dissimilar, with important differences between American and European ones. The debate between American and European guidelines is still open and, also considering the independent risk factor represented by HIV, specific guidelines are warranted. Ezetimibe reduces the intestinal absorption of cholesterol. It is effective alone or in combination with rosuvastatin. It does not modify plasmatic concentrations of antiretrovirals. A number of experimental new classes of drugs for the treatment of hypercholesterolemia are being studied. Fibrates represent the first choice for treatment of hypertriglyceridemia, however, the renal toxicity of fibrates and statins should be considered. Omega 3 fatty acids have a good safety profile, but their efficacy is limited. Another concern is the high dose needed. Other drugs are acipimox and tesamorelin. Current antiretroviral therapies are less toxic and more effective than regimens used in the early years. Lipodistrophy and dyslipidemia are the main causes of long-term toxicities. Not all antiretrovirals have similar toxicities. Protease Inhibitors may cause dyslipidemia and lipodystrophy, while integrase inhibitors have a minimal impact on lipids profile, and no evidence of lipodystrophy. There is still much to be written with the introduction of new drugs in clinical practice. CONCLUSIONS Cardiovascular risk among HIV infected patients, interventions on behavior and lifestyles, use of drugs to reduce the risk, and switch in antiretroviral therapy, remain nowadays major issues in the management of HIV-infected patients.
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Affiliation(s)
- Paolo Maggi
- Clinica Malattie Infettive Policlinico, Bari, Italy.
| | - Antonio Di Biagio
- Clinica Malattie Infettive, Policlinico Ospedale S. Martino, Genoa, Italy
| | - Stefano Rusconi
- Divisione Clinicizzata di Malattie Infettive, DIBIC L. Sacco, Università degli Studi di Milano, Milan, Italy
| | | | - Maurizio D'Abbraccio
- UOC. di Immunodeficienze e Malattie Infettive di Genere, P.O. "D. Cotugno", AORN Dei Colli, Naples, Italy
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Srdic D, Khawla AM, Soldatovic I, Nikolic J, Jevtovic D, Nair D, Dragovic G. Correlation of Leptin, Adiponectin, and Resistin Levels in Different Types of Lipodystrophy in HIV/AIDS Patients. Metab Syndr Relat Disord 2017; 15:153-159. [PMID: 28339344 DOI: 10.1089/met.2016.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Leptin, adiponectin, and resistin may play an important role in the development of lipodystrophy (LD) in HIV/AIDS patients. The aim of this study was to correlate levels of leptin, adiponectin, and resistin between HIV/AIDS patients with LD and without lipodystrophy (non-LD), as well as between subgroups of LD [lipoatrophy (LA), lipohypertrophy (LH), and mixed fat redistribution (MFR)] and non-LD patients. METHODS Cross-sectional study of 66 HIV/AIDS patients. Serum levels of leptin, adiponectin, and resistin were measured. The associations between adipocytokine levels and metabolic variables were estimated by Spearman correlation. Analysis of covariance with bootstrapping method was used to examine the relationship between adiponectin and leptin and lipodystrophy categories. RESULTS The LD was observed in 29 (44%) patients, while 15 (52%) of them had LA, 4 (14%) had LH, and 10 (34%) patients had MFR. No significant differences regarding leptin, adiponectin, and resistin levels, between LD and non-LD patients, were observed. LH patients had significantly higher levels of leptin and adiponectin in comparison with non-LD patients (P = 0.039, P = 0.011, respectively). Within the LD group, LA patients had significantly lower levels of leptin (LA vs. LH, P = 0.020; LA vs. MFR, P = 0.027), while LH patients had significantly higher levels of adiponectin (LH vs. LA, P = 0.027; LH vs. MFR, P = 0.028). Correlation of adiponectin with LD remains significant in the LH subgroup after adjustment for age, body mass index, cystatin-C, plasminogen activator inhibitor-1 (PAI-1), and interferon gamma (IFN-γ) (P = 0.001). CONCLUSIONS Adiponectin and leptin levels differ significantly between LH patients and non-LD patients, as well as between the LD subgroups. Adiponectin may be a more useful marker of LD in HIV/AIDS patients.
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Affiliation(s)
- Danica Srdic
- 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Al Musalhi Khawla
- 2 Department of Clinical Biochemistry, Royal Free Hospital, University College London , London, United Kingdom
| | - Ivan Soldatovic
- 3 Institute for Biomedical Statistics, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Jelena Nikolic
- 4 Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Djordje Jevtovic
- 4 Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - Devaki Nair
- 2 Department of Clinical Biochemistry, Royal Free Hospital, University College London , London, United Kingdom
| | - Gordana Dragovic
- 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade , Belgrade, Serbia
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Dragović G, Dimitrijević B, Khawla AM, Soldatović I, Andjić M, Jevtović D, Nair D. Lower levels of IL-4 and IL-10 influence lipodystrophy in HIV/AIDS patients under antiretroviral therapy. Exp Mol Pathol 2017; 102:210-214. [PMID: 28189545 DOI: 10.1016/j.yexmp.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/04/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The role of interleukins in the pathogenesis of lipodystrophy in HIV/AIDS-patients is still not understood. The aim of this study was to evaluate the relationship between serum levels of interleukins between HIV/AIDS-patients with or without lipodystrophy, as well as between different subgroups of lipodystrophy (lipoatrophy, lipohypertrophy, mixed-fat-redistribution) and patients without lipodystrophy. METHODS Cross-sectional study of 66 HIV/AIDS patients, all Caucasians. Serum levels of interleukins (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10) were measured using Cytokine-Array-1 on Evidence Investigator, Biochip Array Technology. The associations between interleukins and anthropometric and metabolic variables were estimated by Spearman-correlation. Analysis of covariance with bootstrapping method (ACBM) was used to examine relationship between interleukins and lipodystrophy categories adjusted for confounding variables. RESULTS The lipodystrophy was observed in 29 (44%) patients, while 15 (52%) had lipoatrophy, 4 (14%) lipohypertrophy and 10 (34%) patients had mixed fat redistribution. There were 37 (56%) patients without lipodystrophy. Significantly lower levels of IL-4 and IL-10 were observed in lipodystrophy vs. non-lipodystrophy (p=0.008; p=0.027, respectively). No differences were found relating IL-1α, IL-1β, IL-2, IL-6 and IL-8 levels in lipodystrophy vs. non-lipodystrophy. In patient subgroup with lipoatrophy, significantly lower levels of IL-4 and IL-10 were found when compared to non-lipodystrophy (p=0.043; p=0.031, respectively). In lipohypertrophy subgroup significantly lower levels of IL-4 were found when compared to non-lipodystrophy (p=0.003). In order to estimate the correlation of IL-4 and IL-10 and the presence of lipodystrophy, ACBM showed that correlation of IL-4 levels in patients with lipodystrophy remains statistically significant (p=0.004) in all types of lipodystrophy: lipoatrophy, lipohypertrophy and mix-fat-redistribution (p=0.027; p=0.009; p=0.017, respectively) after adjustment for age, BMI. CONCLUSIONS IL-4 and IL-10 levels were significantly lower in lipodystrophy vs. non-lipodystrophy. According to our knowledge, we showed for the first time significant correlation between IL-4 levels and lipodystrophy development in HIV/AIDS patients.
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Affiliation(s)
- Gordana Dragović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Božana Dimitrijević
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Al Musalhi Khawla
- Department of Clinical Biochemistry, Royal Free Hospital, London, United Kingdom; University College London, London, United Kingdom
| | - Ivan Soldatović
- Institute for Biomedical Statistics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mladen Andjić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Djordje Jevtović
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Devaki Nair
- Department of Clinical Biochemistry, Royal Free Hospital, London, United Kingdom; University College London, London, United Kingdom
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Takarinda KC, Mutasa-Apollo T, Madzima B, Nkomo B, Chigumira A, Banda M, Muti M, Harries AD, Mugurungi O. Malnutrition status and associated factors among HIV-positive patients enrolled in ART clinics in Zimbabwe. BMC Nutr 2017. [DOI: 10.1186/s40795-017-0132-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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44
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Alencastro PR, Barcellos NT, Wolff FH, Ikeda MLR, Schuelter-Trevisol F, Brandão ABM, Fuchs SC. People living with HIV on ART have accurate perception of lipodystrophy signs: a cross-sectional study. BMC Res Notes 2017; 10:40. [PMID: 28086977 PMCID: PMC5234247 DOI: 10.1186/s13104-017-2377-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/06/2017] [Indexed: 01/03/2023] Open
Abstract
Background The prevalence of lipodystrophy ranges from 31 to 65%, depending on the criteria adopted for diagnosis. The usual methods applied in the diagnosis vary from self-perception, medical examination, skinfolds measurements, or even imaging assessment for confirmation of fat distribution changes. Although several methods have been developed, there is no gold standard for characterization of LA and LH, or mixed forms. This study aimed to compare self-reported signs of lipodystrophy with objective measures by skinfolds and circumferences, and to evaluate the prevalence of lipoatrophy (LA) and lipohypertrophy (LH) among subjects living with HIV/AIDS on ART. Methods A cross-sectional study enrolled participants living with HIV/AIDS receiving ART, aged 18 years or older from an outpatient health care center, in Southern Brazil. Self-reported body fat enlargement in the abdomen, chest or breasts, and dorsocervical fat pad were used to determine LH, while LA was identified by self-reported fat wasting of the face, neck, legs, arms or buttocks. Measurements were obtained with a scientific caliper for infraorbital, buccal, and submandibular skinfolds, and using an inelastic tape to measure circumferences of waist, hip, neck, and arm. LH and LA were established by the presence of at least one self-reported sign. Results Comparisons of self-reported signs with objective measurements for men and women were carried out in 815 participants on ART, out of 1240 participants with HIV infection. Self-report of decreased facial fat and sunken cheeks was associated with lower infraorbital, buccal, and submandibular skinfolds. Participants who reported buffalo hump had, on average, greater neck circumference, as well as those who have increased waist circumference also reported abdominal enlargement, but no buttock wasting. Men were most commonly affected by lipoatrophy (73 vs. 53%; P < 0.001), and women by lipohypertrophy (79 vs. 56%; P < 0.001). Conclusion In conclusion, self-reported signs of lipodystrophy and lipoatrophy are prevalent, differ by gender, and are associated with objective measurements in people living with HIV/AIDS.
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Affiliation(s)
- Paulo R Alencastro
- Hospital Sanatório Partenon, State Department of Health, Rio Grande do Sul. Av. Bento Gonçalves, 3722, Porto Alegre, RS, 90650-001, Brazil.,Post-graduate Program of Collective Health, Universidade do Vale do Rio dos Sinos, Av. Unisinos, 950, São Leopoldo, RS, 93022-750, Brazil
| | - Nemora T Barcellos
- Post-graduate Program of Collective Health, Universidade do Vale do Rio dos Sinos, Av. Unisinos, 950, São Leopoldo, RS, 93022-750, Brazil
| | - Fernando H Wolff
- Postgraduate Studies Program in Sciences in Gastroenterology and Hepatology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, Porto Alegre, RS, 90035-003, Brazil
| | - Maria Letícia R Ikeda
- Post-graduate Program of Collective Health, Universidade do Vale do Rio dos Sinos, Av. Unisinos, 950, São Leopoldo, RS, 93022-750, Brazil.,Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, Porto Alegre, RS, 90035-003, Brazil
| | - Fabiana Schuelter-Trevisol
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, Porto Alegre, RS, 90035-003, Brazil
| | - Ajácio B M Brandão
- Post Graduate Studies Program in Medicine-Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Sandra C Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, Porto Alegre, RS, 90035-003, Brazil. .,Division of Cardiology, Centro de Pesquisa Clínica, 5º andar, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcellos, 2350, Porto Alegre, RS, 90035-903, Brazil.
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Pérez-Matute P, Iñiguez M, Recio-Fernández E, Oteo JA. Deciphering the molecular mechanisms involved in HIV-associated lipoatrophy by transcriptomics: a pilot study. J Physiol Biochem 2017; 73:431-443. [PMID: 28074419 DOI: 10.1007/s13105-016-0547-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/26/2016] [Indexed: 01/11/2023]
Abstract
HIV-associated lipoatrophy (LA) has considerable implications for risk of metabolic diseases, quality of life, and adherence to treatments. Although it has decreased in high-income countries, it is still very common in resource-limited countries. Understanding the pathophysiological mechanisms of LA can open the possibility to explore new ways to treat or prevent this condition. To identify new markers for an accurate and quick diagnosis will be also of interest. Thus, we aimed to examine functional classes of genes implicated in LA and to identify potential new markers for an accurate/quick diagnosis of LA and future complications. Eighteen participants were recruited: seven healthy volunteers, five non-LA-HIV patients, and six LA-HIV subjects. Clinical lipoatrophy was considered when changes in fat volume in the cheeks next to the nose, lateral aspect of the face, legs, arms, and buttocks were observed by the physicians. mRNA was isolated from peripheral blood mononuclear cells (PBMCs) to perform a transcriptomic and Gene Ontology analysis. To confirm RNA sequencing results, qPCRs were developed. A total of 55 genes were differentially expressed between LA and non-LA patients. Thirty-seven genes were overexpressed, whereas 18 genes were repressed. Functional analysis showed that overexpressed genes were involved in lymphocyte/neutrophil activation, inflammation, and atherogenesis. Several lymphoma markers and members of the lipocalin and aquaporin families were also found more expressed in LA patients. In contrast, most of the genes found less expressed in LA subjects were involved in angiogenesis and protection against myocardial infarction. Our results demonstrated a distinct transcriptomic signature in PBMCs of LA patients in comparison with non-LA-HIV subjects and, therefore, provided novel insights to the pathogenesis of HIV-associated lipoatrophy. Our study also highlights the potential usage of some of these genes as early markers of future complications.
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Affiliation(s)
- Patricia Pérez-Matute
- HIV and Associated Metabolic Alterations Unit, Infectious Diseases Department, Center for Biomedical Research of La Rioja (CIBIR)-Hospital San Pedro, Piqueras 98, 26006, Logroño, Spain.
| | - María Iñiguez
- Genomics Core Facility, Center for Biomedical Research of La Rioja (CIBIR), Piqueras 98, 26006, Logroño, Spain
| | - Emma Recio-Fernández
- HIV and Associated Metabolic Alterations Unit, Infectious Diseases Department, Center for Biomedical Research of La Rioja (CIBIR)-Hospital San Pedro, Piqueras 98, 26006, Logroño, Spain
| | - José-Antonio Oteo
- HIV and Associated Metabolic Alterations Unit, Infectious Diseases Department, Center for Biomedical Research of La Rioja (CIBIR)-Hospital San Pedro, Piqueras 98, 26006, Logroño, Spain
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Benedini S, Luzi L. Lipodystrophy HIV-related and FGF21: A new marker to follow the progression of lipodystrophy? J Transl Int Med 2016; 4:150-154. [PMID: 28191538 DOI: 10.1515/jtim-2016-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Recently new evidence about fibroblast growth factor 21 (FGF21) highlights the opportunities to use this molecule in new pharmaceutical formulations to combat type 2 diabetes and metabolic syndrome. It is well known that HIV is per se a condition of insulin resistance and in particular the patient with HIV-related lipodystrophy has a condition strictly related to metabolic syndrome. Lipodystrophy is associated with severe metabolic side effects, including dyslipidemia, hepatic insulin resistance, and lipid oxidation impairment. Research carried out showed that FGF21 levels were significantly increased in untreated HIV-1-infected patients and the increase was much marked in HIV-1-infected antiretroviral-treated patients that have developed lipodystrophy and in the patients with greatest metabolic alterations. FGF21 is expressed mainly by the liver, but also by other tissues such as the thymus, adipose tissue, and skeletal muscle. Therefore, many researchers have considered the investigation of possible variations of FGF21 in patients with significant alterations in body composition both in regard to fat mass and lean mass. In the light of the possible interactions between FGF21 and metabolic syndrome, it seems interesting to evaluate the implication of this hormone in patients with HIV-related lipodystrophy who have a severe metabolic picture of insulin resistance with important alterations in body composition.
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Affiliation(s)
- Stefano Benedini
- Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy; Endocrinology Unit, IRCCS Policlinico San Donato, San Donato M.se (MI), Italy
| | - Livio Luzi
- Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy; Endocrinology Unit, IRCCS Policlinico San Donato, San Donato M.se (MI), Italy; Metabolism Research Center, IRCCS Policlinico San Donato, Milan, Italy
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47
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Abstract
After the introduction of highly active antiretroviral therapy in the 1990s, the perception of the diagnosis of HIV infection gradually shifted from a 'death sentence' to a chronic disease requiring long-term treatment. The host genetic variability has been shown to play a relevant role in both antiretroviral drugs bioavailability and adverse effects susceptibility. Knowledge about pharmacogenetics role in HIV infection treatment has largely increased over the last years, and is reviewed in the present report, as well as future perspectives for the inclusion of pharmacogenetics information in the directing of HIV infection treatment.
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Affiliation(s)
- Vanessa S Mattevi
- Graduate Program in Biosciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Carmela Fs Tagliari
- Graduate Program in Biosciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
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48
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Identity and the body: Narrative accounts of two HIV-positive women with lipodystrophy in post-apartheid South Africa. SOCIAL THEORY & HEALTH 2016. [DOI: 10.1057/sth.2016.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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49
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HIV-positive pregnant and postpartum women's perspectives about Option B+ in Malawi: a qualitative study. J Int AIDS Soc 2016; 19:20919. [PMID: 27312984 PMCID: PMC4911420 DOI: 10.7448/ias.19.1.20919] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The implementation of lifelong antiretroviral treatment (ART) for all pregnant women (Option B+) in Malawi has resulted in a significant increase in the number of HIV-positive pregnant women initiating treatment. However, research has highlighted the challenge of retaining newly initiated women in care. This study explores barriers and facilitators that affect a woman's decision to initiate and to adhere to Option B+. METHODS A total of 39 in-depth interviews and 16 focus group discussions were conducted. Eligible women were ≥18 years old, living with HIV and either pregnant and receiving antenatal care from a study site or had delivered a child within the last 18 months, breastfed their child and received services at one of the study sites. Eligible women were identified by healthcare workers (HCWs) in the antenatal clinic and ART unit. Focus groups were also conducted with HCWs employed in these departments. Qualitative data were analyzed using Maxqda version 10 (VERBI Software, Berlin, Germany). RESULTS The general perception towards the drug regimen used in Option B+ was positive; women reported fewer side effects and acknowledged the positive benefits of ART. Women felt hopeful about prolonging their life and having an HIV-uninfected baby, yet grappled with the fact that ART is a lifelong commitment. Women and HCWs discussed challenges with the counselling services for prevention of mother-to-child HIV transmission under the new Option B+ guidelines, and many women struggled with initiating ART on the same day as learning their HIV status. Women wanted to discuss their circumstances with their husbands first, receive a CD4 count and obtain an HIV test at another facility to confirm their HIV status. HCWs expressed concern that women might just agree to take the drugs to please them. HCWs also discussed concerns around loss to follow-up and drug resistance. CONCLUSIONS Although Option B+ has significantly increased the number of women initiating ART, there are still challenges that need to be addressed to strengthen initiation, adherence and retention in care. Strategies to strengthen the counselling services upon diagnosis need to be developed to improve same-day initiation of ART and long-term adherence.
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50
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Pérez LM, Pareja-Galeano H, Sanchis-Gomar F, Emanuele E, Lucia A, Gálvez BG. 'Adipaging': ageing and obesity share biological hallmarks related to a dysfunctional adipose tissue. J Physiol 2016; 594:3187-207. [PMID: 26926488 DOI: 10.1113/jp271691] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 01/21/2016] [Indexed: 12/15/2022] Open
Abstract
The increasing ageing of our societies is accompanied by a pandemic of obesity and related cardiometabolic disorders. Progressive dysfunction of the white adipose tissue is increasingly recognized as an important hallmark of the ageing process, which in turn contributes to metabolic alterations, multi-organ damage and a systemic pro-inflammatory state ('inflammageing'). On the other hand, obesity, the paradigm of adipose tissue dysfunction, shares numerous biological similarities with the normal ageing process such as chronic inflammation and multi-system alterations. Accordingly, understanding the interplay between accelerated ageing related to obesity and adipose tissue dysfunction is critical to gain insight into the ageing process in general as well as into the pathophysiology of obesity and other related conditions. Here we postulate the concept of 'adipaging' to illustrate the common links between ageing and obesity and the fact that, to a great extent, obese adults are prematurely aged individuals.
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Affiliation(s)
- Laura M Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Helios Pareja-Galeano
- Universidad Europea de Madrid, Spain.,Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | | | | | - Alejandro Lucia
- Universidad Europea de Madrid, Spain.,Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | - Beatriz G Gálvez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Universidad Europea de Madrid, Spain
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