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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Oliva-Sánchez PF, Landeros-López S, Rosas-Dossetti MM, Grobeisen-Levin S, Islas-Martínez JA, Aznar-Guerra D, Valdez-Celiz AP, Soto-Ramírez L. Comparison of Four Predictive Scores for Cardiovascular Risk in Mexican People with HIV. AIDS Res Hum Retroviruses 2024. [PMID: 38666685 DOI: 10.1089/aid.2023.0085] [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: 05/16/2024] Open
Abstract
Persons with HIV (PWH) face an increased risk of cardiovascular events due to immune activation, comorbidities, and certain antiretrovirals (ARVs). However, the current cardiovascular risk (CVR) scores are not specifically directed toward PWH. This study aimed to assess the agreement between different predictive CVR scores and explore their relationship with clinical and demographic data in Mexican PWH. A descriptive cross-sectional analysis was conducted in 200 PWH with a mean age of 42 years who were treated at a Mexican urban center from 2017 to 2018. The majority (83%) was on ARV treatment and 79.5% had undetectable viral loads (VLs). Moderate- to high-risk scores were infrequent, with Framingham Risk Score for Hard Coronary Heart Disease scores showing higher values, with very low concordance among all scores. Logistic regression analysis revealed significant associations between the CVR scores and the initial recorded VL, CD4 cell count, and elevated triglyceride levels. However, no associations were found with measures such as body mass index or abdominal circumference. Treatment with integrase strand transfer inhibitors (INSTIs), particularly first-generation inhibitors, showed strong associations with all predictive scores, notably ASCVD (odds ratio = 7.03, 95% confidence interval 1.67-29.64). The poor concordance among the CVR scores in PWH highlights the need for a specific score that considers comorbidities and ARV drugs. Despite the relatively young age of the participants, significant correlations were observed between INSTI use, initial VL, CD4 cell count, and triglyceride levels, which are factors not considered in the existing risk scores. Regardless of the actual value of the scores, screening for CVR in PWH is recommended.
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Affiliation(s)
- P F Oliva-Sánchez
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana - Xochimilco, Mexico City, Mexico
| | - S Landeros-López
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - M M Rosas-Dossetti
- Hospital General "Vicente Villada", Instituto de Salud del Estado de México, Toluca, Mexico
| | - S Grobeisen-Levin
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana - Xochimilco, Mexico City, Mexico
| | - J A Islas-Martínez
- Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, Mexico
| | - D Aznar-Guerra
- Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, Mexico
| | - A P Valdez-Celiz
- Facultad de Medicina, Universidad Autónoma de Baja California, Mexicali, Mexico
| | - L Soto-Ramírez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de Mexico, Mexico
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Basta D, Latinovic OS, Tagaya Y, Silvestri G. Potential Advantages of a Well-balanced Nutrition Regimen for People Living with Human Immunodeficiency Virus Type -1. JOURNAL OF AIDS AND HIV TREATMENT 2024; 6:11-27. [PMID: 38845818 PMCID: PMC11155617 DOI: 10.33696/aids.6.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
This review underscores the important role of nutrition in enhancing the management of Human Immunodeficiency Virus type 1 (HIV-1). Highlighting the efficacy of dietary interventions, including, the importance of omega-3 fatty acids, vitamins D and B-12, and the Mediterranean diet, we delineate how these beneficial nutritional strategies can improve the effectiveness of combined antiretroviral therapy (cART), mitigate its side effects, and ameliorate metabolic disorders in people living with HIV-1 (PLWH). Our review advocates for the integration and implementation of personalized nutritional assessments into the care plan for PLWH, proposing actionable strategies for healthcare providers in HIV-1 field. Summarizing the current standing of the relevance of the nutritional and well-planned diet recommended for the PLWH and emphasizing on the future research directions, this review establishes a foundation for nutrition as a cornerstone in comprehensive HIV-1 management. Our review aims to improve patients' health outcomes and overall quality of life for PLWH.
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Affiliation(s)
- Daniele Basta
- Green Home scarl, Scientific Committee, Arcavacata di Rende (CS), Italy
| | - Olga S. Latinovic
- Department of Microbiology and Immunology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
| | - Yutaka Tagaya
- Division of Virology, Pathogenesis, and Cancer, Institute of Human Virology, University of Maryland School of Medicine, MD, 21201, USA
| | - Giovannino Silvestri
- Department of Medicine, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, 21201, USA
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Ambisa Lamesa T, Getachew Mamo A, Arega Berihun G, Alemu Kebede R, Bekele Lemesa E, Cheneke Gebisa W. Dyslipidemia and Nutritional Status of HIV-Infected Children and Adolescents on Antiretroviral Treatment at the Comprehensive Chronic Care and Training Center of Jimma Medical Center. HIV AIDS (Auckl) 2023; 15:537-547. [PMID: 37719174 PMCID: PMC10503505 DOI: 10.2147/hiv.s418729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023] Open
Abstract
Background Highly active antiretroviral treatment is beneficial to suppress human immune virus replication in infected individuals. However, dyslipidemia and other metabolic abnormalities have emerged due to antiretroviral treatment. The prevalence of dyslipidemia in children and adolescents on antiretroviral treatment varies from 20% to 70%. The lack of data on children and adolescents in Ethiopia was the rationale for conducting this study. We aimed to determine prevalence of dyslipidemia and nutritional status in children and adolescents on follow-up at Jimma medical center. Materials and Methods A hospital-based cross-sectional study was conducted with 150 children and adolescents on follow-up at Jimma medical center. A systematic sampling technique was employed. An interview was carried out to collect socioeconomic and demographic data and a review of medical records was carried out to collect patients' clinical data. Anthropometric data were computed using the CDC growth chart. About 3-5mL of fasting blood was collected to measure lipid profile. Multivariable logistic regression was performed to find the association between risk factors and lipid profile. Results The overall prevalence of dyslipidemia in this study was 72%. About 72% and 21.3% of study subjects had low high-density lipoprotein and high triglyceride, respectively. Significant associations were observed between BMI for age ≤5% (AOR: 2.02, 95% CI: 1.14-3.66; P=0.015) and low high-density lipoprotein; greater than 150 months on treatment (AOR: 1.02, 95% CI: 1.00-1.03; P=0.01) and high triglyceride; and BMI for age ≤5% (AOR: 1.86, 95% CI: 1.03-1.37; P=0.04) and high triglyceride. Conclusion BMI for age <5%, treatment duration of greater than 150 months, and parents' educational level were significantly associated with dyslipidemia, so it is recommended that monitoring of those variables will help to reduce dyslipidemia and its complications in children and adolescents receiving treatment.
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Mashi ML, Mambimbi MM, Situakibanza HNT, Ndona MM, Risassi JRM, Ngongo NM, Bepouka B, Ossam O, Tshibola JM, Tshienda FT, Kasongo EM, Nzita MN, Tuna L, Lulebo A, Sonzi DM, Lusunsi CK, Longo-Mbenza B. [Interventional study on Dolutegravir and other antiretrovirals in patients with subclinical atherosclerosis in the Kinshasa Hospital]. Pan Afr Med J 2023; 45:63. [PMID: 37637394 PMCID: PMC10460102 DOI: 10.11604/pamj.2023.45.63.39461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction After 2016, the World Health Organization (WHO) proposed Dolutegravir (DTG) as an alternative first-line treatment for adults. Thus, the purpose of this study was to identify biomarkers of cardiometabolic risk capable of demonstrating the beneficial effect of Dolutegravir (DTG) compared to other antiretrovirals in predicting atherosclerosis in people living with HIV (PLHIV) and hospitalized in Kinshasa Hospital. Methods we conducted an interventional study of people living with HIV who had received antiretroviral therapy (ART) for at least 6 months and were treated in the structures of the network coordinated by the Catholic Church (BDOM-Bureau Diocésain des Oeuvres Médicales) and of the University Clinics of Kinshasa (CUK) between January 2017 and December 2021. Subclinical atherosclerosis was defined as Pulsed Pressure (PP) ≥60 mm Hg; Carotid Intima-Media Thickness (CIMT) > 0.8 mm; and Systolic Pressure Index (SPI) < 0.9. Logistic regression was used in the statistical analysis of associations. Results a total of 334 PLHIV were recruited, of whom 96.1% (n=321) were on ART and 13.9% (n=13) were ART naïve patients. The mean age of PLHIV was 51±12 years with a female predominance (70.4%; n=235); the independent determinants of subclinical atherosclerosis were marital status (aOR: 4. 95% CI 1.5-10.5; p<0.006), low socioeconomic level (aOR: 10.7, 95% CI 2.3-48.7 p<0.002), duration of HIV infection (aOR: 6.6, 95% CI 2.8-16; p<0.0001), duration of antiretroviral therapy ≥9 years (aOR: 0.3, 95% CI 0.2-0.7; p<0.005) and total cholesterol ratio/high-density lipoprotein-cholesterol (CT/HDL-c)(aOR: 2, 95% CI 1.1-3.6; p= 0.034). The mean values of traditional and emergent variables were significantly higher in the previous ART regimen without DTG than in the new regimen with DTG. However, dyslipidemia was detected during the new DTG-based regimen. Conclusion dyslipidemia was common during the DTG-based regimen. Marital status, low socioeconomic level, duration of HIV infection, duration of antiretroviral treatment beyond 9 years and the TC/HDL-c ratio were identified as determinants of subclinical atherosclerosis in PLHIV on ART hospitalized in the Kinshasa hospital.
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Affiliation(s)
- Murielle Longokolo Mashi
- Service des Maladies infectieuses, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Marcel Mbula Mambimbi
- Service des Maladies infectieuses, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | | | - Madone Mandina Ndona
- Service des Maladies infectieuses, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Jean-Robert Makulo Risassi
- Service de Néphrologie, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Nadine Mayasi Ngongo
- Service des Maladies infectieuses, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Ben Bepouka
- Service des Maladies infectieuses, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Odio Ossam
- Service des Maladies infectieuses, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Jean Mukaya Tshibola
- Département de Radiologie, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Frédéric Tshibasu Tshienda
- Département de Radiologie, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Eric Mukenge Kasongo
- Service de Biologie Clinique, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Mamy Ngole Nzita
- Service de Biologie Clinique, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Lukiana Tuna
- Service de Biologie Clinique, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Aimée Lulebo
- École de Santé Publique, Université de Kinshasa, République Démocratique du Congo
| | - Donatien Mangala Sonzi
- Service des Maladies infectieuses, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Christian Kisoka Lusunsi
- Department of Public Health, Lomo University of Research, Kinshasa, Democratic Republic of Congo
| | - Benjamin Longo-Mbenza
- Department of Public Health, Lomo University of Research, Kinshasa, Democratic Republic of Congo
- Service de Cardiologie, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo
- Walter Sisulu University, Department of Health, Mthatha, South Africa
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Guaraldi G, Bonfanti P, Di Biagio A, Gori A, Milić J, Saltini P, Segala FV, Squillace N, Taramasso L, Cingolani A. Evidence gaps on weight gain in people living with HIV: a scoping review to define a research agenda. BMC Infect Dis 2023; 23:230. [PMID: 37060030 PMCID: PMC10103467 DOI: 10.1186/s12879-023-08174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/17/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Combined antiretroviral therapy (cART) dramatically improved survival in people living with HIV (PLWH) but is associated with weight gain (WG), raising concern for a possible obesity epidemic in PLWH. This scoping review aims to identify the gaps in the existing evidence on WG in PLWH and generate a future research agenda. METHODS This review was conducted according to the methodology for scoping studies and reported according to the PRISMA Extension for Scoping Review checklist. Articles published in English in the last 10 years indexed in Pubmed, WHO Global Index Medicus, or Embase were searched using specific queries focused on WG in PLWH. RESULTS Following the selection process, 175 included articles were reviewed to search for the available evidence on four specific topics: (I) definition of WG in PLWH, (II) pathogenesis of WG in PLWH, (III) impact of ART on WG, (IV) correlation of WG with clinical outcomes. A summary of the data enabled us to identify gaps and clearly define the following research agenda: (I) develop a data-driven definition of WG in PLWH and define noninvasive assessment methods for body weight and fat composition; (II) further investigate the interaction between HIV/cART and immunity, metabolism, and adipose tissue; (III) establish the specific role of individual drugs on WG; (IV) clarify the independent role of WG, cART, HIV, and metabolic factors on clinical events. CONCLUSIONS The proposed research agenda may help define future research and fill the knowledge gaps that have emerged from this review.
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Affiliation(s)
- Giovanni Guaraldi
- HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Jovana Milić
- HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Saltini
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesco V Segala
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Antonella Cingolani
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica Del Sacro Cuore, Rome, Italy
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Mulindwa F, Castelnuovo B, Brusselaers N, Bollinger R, Rhein J, Edrisa M, Buzibye A, Amutuhaire W, Yendewa G, Nabaggala S, Odongpiny ELA, Kiguba R, Nakawooza A, Dujanga S, Nabwana M, Schwarz JM. Blood glucose trajectories and incidence of diabetes mellitus in Ugandan people living with HIV initiated on dolutegravir. AIDS Res Ther 2023; 20:15. [PMID: 36915103 PMCID: PMC10009965 DOI: 10.1186/s12981-023-00510-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Following reports of anti-retroviral therapy (ART) experienced Ugandan people living with HIV (PLHIV) presenting with diabetic ketoacidosis weeks to months following a switch to dolutegravir (DTG), the Uganda Ministry of Health recommended withholding DTG in both ART naïve and experienced PLHIV with diabetes mellitus (T2DM), as well as 3-monthly blood glucose monitoring for patients with T2DM risk factors. We sought to determine if the risk of T2DM is indeed heightened in nondiabetic ART naïve Ugandan PLHIV over the first 48 weeks on DTG. METHODS Between January and October 2021, 243 PLHIV without T2DM were initiated on DTG based ART for 48 weeks. Two-hour oral glucose tolerance tests (2-h OGTT) were performed at baseline, 12, and 36 weeks; fasting blood glucose (FBG) was measured at 24 and 48 weeks. The primary outcome was the incidence of T2DM. Secondary outcomes included: incidence of pre-Diabetes Mellitus (pre-DM), median change in FBG from baseline to week 48 and 2-h blood glucose (2hBG) from baseline to week 36. Linear regression models were used to determine adjusted differences in FBG and 2hBG from baseline to weeks 48 and 36 respectively. RESULTS The incidence of T2DM was 4 cases per 1000 PY (1/243) and pre-DM, 240 cases per 1000 person years (PY) (54/243). There was a significant increase in FBG from baseline to week 48 [median change from baseline (FBG): 3.6 mg/dl, interquartile range (IQR): - 3.6, 7.2, p-value (p) = 0.005] and significant reduction in 2hBG (2hBG: - 7.26 mg/dl, IQR: - 21.6, 14.4, p = 0.024) at week 36. A high CD4 count and increased waist circumference were associated with 2hBG increase at week 36. CONCLUSION We demonstrated a low incidence of T2DM in Ugandan ART-naïve patients receiving DTG. We also demonstrated that longitudinal changes in BG were independent of conventional risk factors of T2DM in the first 48 weeks of therapy. Restricting the use of dolutegravir in Ugandan ART naïve patients perceived to be high risk for diabetes mellitus may be unwarranted.
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Affiliation(s)
- Frank Mulindwa
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda.
- Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Barbara Castelnuovo
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Nele Brusselaers
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska University, Stockholm, Sweden
| | | | - Joshua Rhein
- School of Medicine, Division of Infectious Diseases, University of Minnesota, Minneapolis, MN, USA
| | - Mutebi Edrisa
- Internal Medicine Department, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Allan Buzibye
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | - George Yendewa
- Department of Internal Medicine, Case Western Reserve University, Cleveland, USA
| | - Sarah Nabaggala
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, College of Health Sciences Makerere University, Kampala, Uganda
| | - Aisha Nakawooza
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Simon Dujanga
- Internal Medicine Department, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Martin Nabwana
- Makerere University Johns Hopkins Collaboration HIV Clinic, Kampala, Uganda
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, USA
- Department of Basic Sciences, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
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Mulindwa F, Kamal H, Castelnuovo B, Byonanebye DM, Schwarz JM, Bollinger R, Brusselaers N. Association between integrase strand transfer inhibitor use with insulin resistance and incident diabetes mellitus in persons living with HIV: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2023; 11:11/1/e003136. [PMID: 36754450 PMCID: PMC9923267 DOI: 10.1136/bmjdrc-2022-003136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
Whether integrase strand transfer inhibitors (INSTIs) are associated with a higher risk of incident type 2 diabetes mellitus (DM) than other antiretroviral therapies (ART) needs to be established.MEDLINE, Embase, Web of Science, and ClinicalTrials.gov registries were searched for studies published between 1 January 2000 and 15 June 2022. Eligible studies reported incident DM or mean changes in insulin resistance measured by Homeostatic Model for Insulin Resistance (HOMA-IR) in patients on INSTIs compared with other ARTs. We performed random-effects meta-analyses to obtain pooled relative risks (RRs) with 95% CIs.A total of 16 studies were pooled: 13 studies meta-analyzed for incident diabetes with a patient population of 72 404 and 3 for changes in HOMA-IR. INSTI therapy was associated with a lower risk of incident diabetes in 13 studies (RR 0.80, 95% CI 0.67 to 0.96, I2=29%), of which 8 randomized controlled trials demonstrated a 22% reduced risk (RR 0.88, 95% CI 0.81 to 0.96, I2=0%). INSTIs had a lower risk compared with non-nucleoside reverse transcriptase inhibitors (RR 0.75, 95% CI 0.63 to 0.89, I2=0%) but similar to protease inhibitor-based therapy (RR 0.78, 95% CI 0.61 to 1.01, I2=27%). The risk was lower in studies with longer follow-up (RR 0.70, 95% CI 0.53 to 0.94, I2=24%) and among ART-naïve patients (RR 0.78, 95% CI 0.65 to 0.94, I2=3%) but increased in African populations (RR 2.99, 95% CI 2.53 to 3.54, I2=0%).In conclusion, exposure to INSTIs was not associated with increased risk of DM, except in the African population. Stratified analyses suggested reduced risk among ART-naïve patients and studies with longer follow-up.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42021273040.
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Affiliation(s)
- Frank Mulindwa
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
- Global Health Institute, University of Antwerp, Antwerpen, Belgium
| | - Habiba Kamal
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Barbara Castelnuovo
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Dathan M Byonanebye
- Biostatistics and Databases Program, Kirby Institute University of New South Wales, Sydney, New South Wales, Australia
- Community and Behavioral Sciences, Makerere University, Kampala, Uganda
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Robert Bollinger
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nele Brusselaers
- Global Health Institute, University of Antwerp, Antwerpen, Belgium
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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9
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Morillo-Verdugo R, Aguilar Pérez T, Gimeno-Gracia M, Rodríguez-González C, Robustillo-Cortes MDLA. Simplification and Multidimensional Adaptation of the Stratification Tool for Pharmaceutical Care in People Living With HIV. Ann Pharmacother 2023; 57:163-174. [PMID: 35707861 DOI: 10.1177/10600280221096759] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV) require specific pharmaceutical care (PC). Although the 2017 Capacity-Motivation-Opportunity (CMO) PC model allows a multidisciplinary approach that focuses on patient needs, it is too complex and presents room for improvement. OBJECTIVE The aim of this study is to simplify and adapt the previous 2017 PC tool through a multidimensional approach to improve HIV patient care, to prove the validity of the model in real-life patients. METHODS The new PC tool was generated by keeping some of the variables of the 2017 document and conducting a literature search. Content validity was determined by a 2-round Delphi methodology with an expert panel of 42 pharmacists. Consensus for the first and second rounds was defined as ≥70% agreement. The tool generated was validated in 407 real-life patients. RESULTS Thirty-seven experts completed the first round of the Delphi survey and 36 the second. No consensus was reached for 3 variables, any of the frequency options and 4 interventions, while the experts agreed not to include 1 intervention in round 1. Consensus to include them was found for all but 1 variable and 1 intervention in round 2. The final tool obtained to select and stratify HIV-positive patients was composed of 9 dimensions divided into 17 variables. The new tool was validated with real-life patients and 3 priority levels were defined. CONCLUSIONS AND RELEVANCE We created a new pyramid of score thresholds to classify patients into priority levels. The new tool simplifies the 2017 model and improves its utility to help HIV-positive patients, owing to its multidimensional approach.
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10
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Morillo-Verdugo R, Lazaro-Lopez A, Alonso-Grandes E, Martin-Conde MT, Diaz-Ruiz P, Molina-Cuadrado E, Huertas-Fernandez MJ, Navarro-Aznares H, Areas Del Aguila V, Gimeno-Gracia M, Margusino-Framiñán L, Martínez-Sesmero JM. Patient Experience Evaluation of the CMO-Based Pharmaceutical Care Model vs Usual Care in People Living with HIV. J Multidiscip Healthc 2022; 15:2991-3003. [PMID: 36601427 PMCID: PMC9807066 DOI: 10.2147/jmdh.s392398] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022] Open
Abstract
Objective To compare patient experience in a real-life population of people living with HIV (PLWH) who received pharmaceutical care (PC) based on the Capacity-Motivation-Opportunity (CMO) model versus the traditional model. Methods Prospective cohort study in PLWH receiving either CMO-based PC or traditional PC in Spain between October 2019 and June 2021 (24 weeks), performed by the pharmacy department of 14 Spanish hospitals. Participants were adult patients with a clinical diagnosis of HIV treated with antiretrovirals who had been monitored in the participating hospital pharmacies for >1 year. Patient experience (IEXPAC questionnaire), clinical outcomes (cholesterol, triglycerides, HDL, glycated haemoglobin, and blood pressure), adherence to treatment, virologic control and patient satisfaction were determined. Results Patient experience in the CMO group at week 24 was significantly better (7.6 vs 6.9) than in the traditional group, with a higher mean improvement. Adherence was better in the CMO group, particularly with regard to concomitant medications (53.2% to 91.7%, p<0.001); no changes were observed in the traditional group. Patient satisfaction improved in the CMO group vs the traditional group (48 vs 44, p<0.001). Conclusion To our knowledge, this is the first study to compare CMO vs traditional methodology. The CMO model showed an overall improvement in real-life patient experience, satisfaction, and adherence to treatment compared to the traditional methodology.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Pharmacy Hospital Service, Hospital Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | - Alicia Lazaro-Lopez
- Pharmacy Hospital Service, Hospital Universitario de Guadalajara, Guadalajara, Spain,Correspondence: Alicia Lazaro-Lopez, Hospital Universitario de Guadalajara, C/Donante de Sangre s/n CP: 19002 (Castilla-La Mancha, Spain), Guadalajara, Spain, Tel +34 626915820, Email
| | | | | | - Pilar Diaz-Ruiz
- Pharmacy Hospital Service, Hospital Virgen de la Candelaria, Tenerife, Spain
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11
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Mechanisms of immune aging in HIV. Clin Sci (Lond) 2022; 136:61-80. [PMID: 34985109 DOI: 10.1042/cs20210344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022]
Abstract
Massive CD4+ T-cell depletion as well as sustained immune activation and inflammation are hallmarks of Human Immunodeficiency Virus (HIV)-1 infection. In recent years, an emerging concept draws an intriguing parallel between HIV-1 infection and aging. Indeed, many of the alterations that affect innate and adaptive immune subsets in HIV-infected individuals are reminiscent of the process of immune aging, characteristic of old age. These changes, of which the presumed cause is the systemic immune activation established in patients, likely participate in the immuno-incompetence described with HIV progression. With the success of antiretroviral therapy (ART), HIV-seropositive patients can now live for many years despite chronic viral infection. However, acquired immunodeficiency syndrome (AIDS)-related opportunistic infections have given way to chronic diseases as the leading cause of death since HIV infection. Therefore, the comparison between HIV-1 infected patients and uninfected elderly individuals goes beyond the sole onset of immunosenescence and extends to the deterioration of several physiological functions related to inflammation and systemic aging. In light of this observation, it is interesting to understand the precise link between immune activation and aging in HIV-1 infection to figure out how to best care for people living with HIV (PLWH).
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12
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Mohan J, Ghazi T, Chuturgoon AA. A Critical Review of the Biochemical Mechanisms and Epigenetic Modifications in HIV- and Antiretroviral-Induced Metabolic Syndrome. Int J Mol Sci 2021; 22:ijms222112020. [PMID: 34769448 PMCID: PMC8584285 DOI: 10.3390/ijms222112020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023] Open
Abstract
Metabolic syndrome (MetS) is a non-communicable disease characterised by a cluster of metabolic irregularities. Alarmingly, the prevalence of MetS in people living with Human Immunodeficiency Virus (HIV) and antiretroviral (ARV) usage is increasing rapidly. This study aimed to look at biochemical mechanisms and epigenetic modifications associated with HIV, ARVs, and MetS. More specifically, emphasis was placed on mitochondrial dysfunction, insulin resistance, inflammation, lipodystrophy, and dyslipidaemia. We found that mitochondrial dysfunction was the most common mechanism that induced metabolic complications. Our findings suggest that protease inhibitors (PIs) are more commonly implicated in MetS-related effects than other classes of ARVs. Furthermore, we highlight epigenetic studies linking HIV and ARV usage to MetS and stress the need for more studies, as the current literature remains limited despite the advancement in and popularity of epigenetics.
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13
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Gonçalves AJ, Braga MVA, Santana PH, Resende LAPR, da Silva VJD, Correia D. Linear and non-linear analysis of heart rate variability in HIV-positive patients on two different antiretroviral therapy regimens. BMC Infect Dis 2021; 21:1022. [PMID: 34587909 PMCID: PMC8482565 DOI: 10.1186/s12879-021-06648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background Cardiac autonomic dysfunction in HIV+ patients on different antiretroviral therapy (ART) regimens has been described. We aimed to characterize parameters of heart rate variability (HRV) and correlate with different classes of ART in HIV+ patients in three experimental conditions: rest, cold face, and tilt tests. Methods Cross-sectional study with three groups of age- and gender-matched individuals: group 1, 44 HIV+ patients undergoing combination therapy, with two nucleoside reverse transcriptase inhibitors (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI); group 2, 42 HIV+ patients using two NRTI and protease inhibitors (PI’s); and group 3, 35 healthy volunteers with negative HIV serology (control group). Autonomic function at rest and during cold face- and tilt-tests was assessed through computerized analysis of HRV, via quantification of time- and frequency domains by linear and non-linear parameters in the three groups. Results Anthropometric and clinical parameters were similar between both HIV groups, except CD4+ T lymphocytes, which were significantly lower in group 2 (p = 0.039). At baseline, time-domain linear HRV parameters, RMSSD and pNN50, and the correlation dimension, a non-linear HRV parameter (p < 0.001; p = 0.018; p = 0.019, respectively), as well as response of RMSSD to cold face test were also lower in the HIV+ group than in the control individuals (p < 0.001), while no differences among groups were detected in HRV parameters during the tilt test. Conclusions Despite ART regimens, HIV+ patients presented lower cardiac vagal modulation than controls, whereas no difference was observed among the HIV groups, suggesting that higher cardiovascular risk linked to PIs may be associated with factors other than autonomic dysfunction.
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Affiliation(s)
- Anderson José Gonçalves
- Infectious Diseases Division, Internal Medicine Department, Federal University of the Triângulo Mineiro, Av. Getúlio Guaritá, 430, Bairro Nossa Senhora da Abadia, PO Box: 118, Uberaba, Minas Gerais State, CEP: 38025-350, Brazil
| | | | | | | | - Valdo José Dias da Silva
- Physiology Division, Biological Science Department, Federal University of the Triângulo Mineiro, Uberaba, Minas Gerais State, Brazil
| | - Dalmo Correia
- Infectious Diseases Division, Internal Medicine Department, Federal University of the Triângulo Mineiro, Av. Getúlio Guaritá, 430, Bairro Nossa Senhora da Abadia, PO Box: 118, Uberaba, Minas Gerais State, CEP: 38025-350, Brazil.
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14
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Patel F, Kennedy C. Metabolic Changes in Pediatric HIV-Positive Patients and Potential Lifestyle Interventional Strategies. Cureus 2021; 13:e14556. [PMID: 34026373 PMCID: PMC8133514 DOI: 10.7759/cureus.14556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Metabolic changes in the HIV population have been well-studied, particularly after the advent of antiretroviral therapy. More notably, the emergence of the metabolic syndrome within the HIV population, due to prolonged survival, has led to an increasing rate of cardiovascular occurrence and mortality within the population in adult life. Importance of early intervention in HIV children, particularly lifestyle modifications, is necessary to reduce cardiovascular disease (CVD) risk and mortality in adulthood. Potential clinical interventions include routine anthropometric measurements as a measure of CVD risk, a low saturated fat and high fiber diet, and vigorous aerobic exercise have been shown to decrease CVD risk in the HIV population. The literature review found multiple knowledge gaps due to minimal studies completed on the HIV population and even less on HIV-positive children. Overall, a standardized protocol was required to better care for HIV-positive children and potential future CVD mortality.
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Affiliation(s)
- Falguni Patel
- Internal Medicine/Pediatrics, Alabama College of Osteopathic Medicine, Dothan, USA
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15
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Yanai H, Yoshida H. Secondary dyslipidemia: its treatments and association with atherosclerosis. Glob Health Med 2021; 3:15-23. [PMID: 33688591 PMCID: PMC7936375 DOI: 10.35772/ghm.2020.01078] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 04/15/2023]
Abstract
Dyslipidemia is classified into primary and secondary types. Primary dyslipidemia is basically inherited and caused by single or multiple gene mutations that result in either overproduction or defective clearance of triglycerides and cholesterol. Secondary dyslipidemia is caused by unhealthy lifestyle factors and acquired medical conditions, including underlying diseases and applied drugs. Secondary dyslipidemia accounts for approximately 30-40% of all dyslipidemia. Secondary dyslipidemia should be treated by finding and addressing its causative diseases or drugs. For example, treatment of secondary dyslipidemia, such as hyperlipidemia due to hypothyroidism, by using statin without controlling hypothyroidism, may lead to myopathy and serious adverse events such as rhabdomyolysis. Differential diagnosis of secondary dyslipidemia is very important for safe and effective treatment. Here, we describe an overview about diseases and drugs that interfere with lipid metabolism leading to secondary dyslipidemia. Further, we show the association of each secondary dyslipidemia with atherosclerosis and the treatments for such dyslipidemia.
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Affiliation(s)
- Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan
- Address correspondence to:Hidekatsu Yanai, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa, Chiba 272- 8516, Japan. E-mail:
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan
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