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Shengir M, Lebouche B, Elgretli W, Saeed S, Ramanakumar AV, Giannakis A, De Pokomandy A, Cox J, Costiniuk C, Routy JP, Klein MB, Sebastiani G. Switch to a raltegravir-based antiretroviral regimen in people with HIV and non-alcoholic fatty liver disease: A randomized controlled trial. HIV Med 2024; 25:135-142. [PMID: 37641534 DOI: 10.1111/hiv.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The effect of antiretroviral therapy (ART), particularly integrase strand transfer inhibitors (INSTIs), on non-alcoholic fatty liver disease (NAFLD) in people with HIV remains unclear. We evaluated the effect of switching non-INSTI backbone antiretroviral medications to raltegravir on NAFLD and metabolic parameters. MATERIALS AND METHODS This was a single-centre, phase IV, open-label, randomized controlled clinical trial. People living with HIV with NAFLD and undetectable viral load while receiving a non-INSTI were randomized 1:1 to the switch arm (raltegravir 400 mg twice daily) or the control arm (continuing ART regimens not containing INSTI). NAFLD was defined as hepatic steatosis by controlled attenuation parameter ≥238 dB/m in the absence of significant alcohol use and viral hepatitis co-infections. Cytokeratin 18 was used as a biomarker of non-alcoholic steatohepatitis. Changes over time in outcomes were quantified as standardized mean differences (SMDs), and a generalized linear mixed model was used to compare outcomes between study arms. RESULTS A total of 31 people with HIV (mean age 54 years, 74% male) were randomized and followed for 24 months. Hepatic steatosis improved between baseline and end of follow-up in both the switch (SMD -43.4 dB/m) and the control arm (-26.6 dB/m); the difference between arms was not significant. At the end of follow-up, aspartate aminotransferase significantly decreased in the switch arm compared with the control arm (SMD -9.4 vs. 5.5 IU/L). No changes in cytokeratin 18, body mass index, or lipids were observed between study arms. DISCUSSION Switching to a raltegravir-based regimen improved aspartate aminotransferase but seemed to have no effect on NAFLD, body weight, and lipids compared with remaining on any other ART.
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Affiliation(s)
- Mohamed Shengir
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouche
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wesal Elgretli
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Sahar Saeed
- Queen's University, Kingston, Ontario, Canada
| | | | - Andreas Giannakis
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alexandra De Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cecilia Costiniuk
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
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2
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Fehr D, Lebouché B, Ruppenthal L, Brownc M, Obasc N, Bourbonnière E, Girouard J, Massicotte A, Jenabian MA, Almomen AA, Frenette C, de Pokomandy A, Cox J, Giannakis A, Cheng M, Kronfli N, Tsoukas C, Zahedi N, Szabo J, Dehghani K, Brouillette MJ, Falutz J, Turner H, Hamel A, Duchesneau C, Lanthier-Brun J, Klein M, Routy JP, Costiniuk CT. Characterization of people living with HIV in a Montreal-based tertiary care center with COVID-19 during the first wave of the pandemic. AIDS Care 2021; 34:663-669. [PMID: 33779425 DOI: 10.1080/09540121.2021.1904500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People living with HIV (PLWH) often have worse health outcomes compared to HIV-uninfected individuals. We characterized PLWH followed at a tertiary care clinic in Montreal who acquired COVID-19 and described their outcomes during the first wave of the pandemic. A retrospective chart review was performed for PLWH followed at the Chronic Viral Illness Service with a positive COVID-19 nasopharyngeal PCR or symptoms suggestive of COVID-19 between 1 March and 15 June 2020. Data on demographics, socioeconomic status, co-morbidities and severity of COVID-19 and outcomes were extracted. Of 1702 individuals, 32 (1.9%) had a positive COVID-19 test (n = 24) or symptoms suspicious for COVID-19 (n = 3). Median age was 52 years [IQR 40, 62]. Nearly all (97%) earned $34,999 Canadian dollars or less. Eleven (34%) individuals worked in long-term care (LTC) homes while 5 (6%) lived in LTC homes. Median CD4 count was 566 cells/mm3 [347, 726] and six had detectable plasma HIV viral loads. Median duration of HIV was 17 years [7, 22] and 30 individuals had been prescribed antiretroviral therapy. Five persons were asymptomatic. Of symptomatic persons, 21 (12%), 1 (4%) and 3 (12%) individuals had mild, moderate and severe disease, respectively. Three individuals died with COVID-19. In one case, the cause of death was due to COVID-19, whereas in the other two cases, the individuals died with positive COVID-19 test results but the immediate cause of death is unclear. PLWH who tested positive for COVID-19 had low socioeconomic status and had employment or living conditions that put them at high risk. PLWH may be disproportionately impacted by the social determinants of health which predispose them to COVID-19.
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Affiliation(s)
- Derek Fehr
- Department of Psychiatry, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Luciana Ruppenthal
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Department of Nursing, McGill University Health Centre, Montreal, Canada.,Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Melodie Brownc
- Department of Nursing, McGill University Health Centre, Montreal, Canada.,Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Nancy Obasc
- Department of Nursing, McGill University Health Centre, Montreal, Canada.,Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Emilie Bourbonnière
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Department of Nursing, McGill University Health Centre, Montreal, Canada.,Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Josee Girouard
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Angie Massicotte
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Mohammad-Ali Jenabian
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, Canada
| | - Abdul-Aziz Almomen
- Department of Medical Microbiology, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Charles Frenette
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Department of Medical Microbiology, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Joseph Cox
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Andreas Giannakis
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Matthew Cheng
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Nadine Kronfli
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Christos Tsoukas
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, Canada
| | - Navid Zahedi
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Jason Szabo
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Kianoush Dehghani
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Marie-Josee Brouillette
- Department of Psychiatry, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Julian Falutz
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Howard Turner
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Alexandra Hamel
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Claire Duchesneau
- Department of Social Work, McGill University Health Centre, Montreal, Canada
| | | | - Marina Klein
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Jean-Pierre Routy
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, Canada.,Division of Hematology, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Cecilia T Costiniuk
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, Canada
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Mayer P, Giannakis A, Klauß M, Gaida MM, Bergmann F, Kauczor HU, Feisst M, Hackert T, Loos M. Radiological evaluation of pancreatic cancer: What is the significance of arterial encasement >180° after neoadjuvant treatment? Eur J Radiol 2021; 137:109603. [PMID: 33618209 DOI: 10.1016/j.ejrad.2021.109603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/16/2021] [Accepted: 02/08/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE This study aimed to evaluate contrast-enhanced computed tomography (CE-CT) features for prediction of arterial tumor invasion in pancreatic cancer (PDAC) patients in the event of arterial encasement >180° after neoadjuvant (radio-)chemotherapy (NAT). METHODS Seventy PDAC patients with seventy-five arteries showing encasement >180° after completion of NAT were analyzed. All patients underwent surgical exploration with either tumor resection including arterial resection, periadventitial dissection (arterial divestment) or confirmation of locally irresectable disease. CE-CT scans were assessed regarding tumor extent and artery-specific imaging features. The results were analyzed on a per-artery basis. Based on the intraoperative and histopathological findings, encased arteries were classified as either invaded or non-invaded. RESULTS Eighteen radiologically encased arteries were resected; of these, nine had pathologic evidence for tumor invasion. In 42 encased arteries, the tumor could be removed by arterial divestment. In 13 patients with 15 encased arteries, the tumor was deemed technically irresectable. Median tumor size, length of solid soft tissue contact, and degree of circumferential contiguity by solid soft tissue along the artery in CE-CT were significantly lower in the non-invaded than in the invaded artery group (p ≤ 0.017). Imaging features showed moderate accuracies for prediction of arterial invasion (≤72.0 %). The thresholds ≤26 mm for post-NAT solid soft tissue contact and ≤270° for circumferential contiguity by solid soft tissue had high negative predictive values (≥87.5 %). CONCLUSION Although post-NAT prediction of arterial invasion remains difficult, arteries with ≤270° contiguity by soft tissue and arteries with ≤26 mm length of solid soft tissue contact are unlikely to be invaded, with possible implications for surgical planning.
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Affiliation(s)
- P Mayer
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
| | - A Giannakis
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Klauß
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M M Gaida
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - F Bergmann
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - H U Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Feisst
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Loos
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
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4
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Costiniuk CT, Saneei Z, Salahuddin S, Cox J, Routy JP, Rueda S, Abdallah SJ, Jensen D, Lebouché B, Brouillette MJ, Klein M, Szabo J, Frenette C, Giannakis A, Jenabian MA. Cannabis Consumption in People Living with HIV: Reasons for Use, Secondary Effects, and Opportunities for Health Education. Cannabis Cannabinoid Res 2019; 4:204-213. [PMID: 31579835 DOI: 10.1089/can.2018.0068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: Rates of cannabis consumption range from 40% to 74% among people living with HIV (PLWH). Little is known about the reasons for cannabis use, related modes of administration, effectiveness for symptom relief, or undesirable effects in the modern antiretroviral therapy (ART) era. Our aim was to conduct an exploratory study to identify potential areas for further evaluation and intervention. Materials and Methods: From January to June 2018, health care providers at the Chronic Viral Illness Service in Montreal, Canada, asked their patients about cannabis use during routine visits. Patients reporting cannabis use were invited to complete a 20-min coordinator-administered questionnaire. Questions related to patterns of use, modes of administration, reasons for use, secondary effects, and HIV health-related factors (e.g., adherence to ART). Results: One hundred and four PLWH reporting cannabis use participated. Median age was 54 years (interquartile range [IQR] 46-59), 13% were female, and 42% were HIV-Hepatitis C co-infected. Median CD4 count was 590 cells/mm3 (IQR 390-821), 95% of participants were on ART, and 88% had suppressed viral loads. Reported cannabis use was more than once daily (32%); daily (25%); weekly (22%); monthly (17%); and rarely (twice to thrice per year; 6%). The majority of participants (97%) smoked dry plant cannabis. Other modes included vaping (12%), capsules (2%), edibles (21%), and oils (12%). Common reasons for cannabis use were for pleasure (68%) and to reduce anxiety (57%), stress (55%), and pain (57%). Many participants found cannabis "quite effective" or "extremely effective" (45%) for symptom relief. Secondary effects included feeling high (74%), increased cough (45%), paranoia (22%), palpitations (20%), and increased anxiety (21%). Over two-thirds of participants indicated that secondary effects were not bothersome at all. Most participants (68%) rarely missed doses of their ART, while 27% missed occasionally (once to twice per month). The most commonly accessed sources of information about cannabis were friends (77%) and the internet (55%). Conclusion: The most common reasons for cannabis use in our population were for pleasure, followed by reduction of stress/anxiety and symptoms associated with a medical condition. Most smoke cannabis and rate cannabis as quite effective for symptom relief. While many participants experience secondary effects, most are not bothered by these symptoms. Amid widespread changes in the regulatory landscape of recreational cannabis, health care providers should be prepared to answer questions about cannabis.
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Affiliation(s)
- Cecilia T Costiniuk
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Zahra Saneei
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Syim Salahuddin
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Biological Sciences, University of Quebec at Montreal (UQAM), Montreal, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Family Medicine, McGill University, Montreal, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sara J Abdallah
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Dennis Jensen
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Family Medicine, McGill University, Montreal, Canada.,Clinical Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Marie-Josée Brouillette
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Psychiatry, McGill University Health Centre, Montreal, Canada
| | - Marina Klein
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jason Szabo
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Charles Frenette
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Andreas Giannakis
- Chronic Viral Illness Service, Division of Infectious Diseases and Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Mohammad-Ali Jenabian
- Department of Biological Sciences, University of Quebec at Montreal (UQAM), Montreal, Canada
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Linthwaite B, Cox J, Klein MB, Peiris H, Salahuddin S, Routy JP, Lebouché B, Brouillette MJ, Szabo J, Giannakis A, LeBlanc R, Gilman S, Costiniuk CT. Use of Smoking Cessation Aids in a Convenience Sample of PLHIV in a Canadian Tertiary Care Clinic. Open AIDS J 2019. [DOI: 10.2174/1874613601913010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Tobacco smoking is among the most significant predictors of cardiovascular disease and lung cancer in People Living with HIV (PLHIV). Smoking rates in this population are high, necessitating more effective smoking cessation strategies. We conducted a descriptive analysis of tobacco-related clinical and sociodemographic characteristics of smokers at a tertiary care HIV clinic in Montreal and an exploratory analysis of smoking cessation methods in order to identify potential areas of improvement in the clinic’s approach to smoking cessation.
Methods:
A convenience sample of patients completed a 10-minute questionnaire on tobacco-related behaviours and outcomes. Use of smoking cessation methods was compared using McNemar’s exact test with a Bonferroni correction for multiple testing (p<0.01 considered significant).
Results:
Seventy-two PLHIV participated. Two-thirds of our total participants were interested in quitting within six months, but the use of effective cessation strategies was low, particularly for counseling and oral therapy. Overall, oral therapy (e.g. varenicline) (16.7%) and counseling for cessation (5.6%) were used less than nicotine patches (50.0%) or ‘other’ methods (50.0%), which included abstinence and nicotine gum (p<0.001).
Conclusion:
Despite a small and potentially unrepresentative sample of HIV positive tobacco smokers at our clinic, this study could help guide further research aiming to determine and address barriers to smoking cessation and access to effective smoking cessation aids in PLHIV. Future studies might consider factors that affect motivation to quit, such as co-morbid mental health and substance use disorders, or the attitudes of HIV healthcare providers.
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Costiniuk CT, Nitulescu R, Saneei Z, Wasef N, Salahuddin S, Wasef D, Young J, de Castro C, Routy JP, Lebouché B, Cox J, Smith BM, Ambroise S, Pexos C, Patel M, Szabo J, Haraoui LP, de Pokomandy A, Tsoukas C, Falutz J, LeBlanc R, Giannakis A, Frenette C, Jenabian MA, Bourbeau J, Klein MB. Prevalence and predictors of airflow obstruction in an HIV tertiary care clinic in Montreal, Canada: a cross-sectional study. HIV Med 2019; 20:192-201. [PMID: 30620136 PMCID: PMC6590155 DOI: 10.1111/hiv.12699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 12/27/2022]
Abstract
Objectives The reported prevalence of chronic obstructive pulmonary disease (COPD) in people living with HIV (PLWHIV) varies widely. Our objective was to estimate the prevalence of airflow obstruction and COPD in unselected PLWHIV and identify characteristics that increase the risk of nonreversible airflow obstruction in order to guide case finding strategies for COPD. Methods All adults attending the Chronic Viral Illness Service were invited to participate in the study, regardless of smoking status or history of known COPD/asthma. Individuals underwent spirometric testing both before and after use of a salbutamol bronchodilator. Airflow obstruction was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.7 post‐bronchodilation, whereas COPD was defined as FEV1/FVC < 0.7 post‐bronchodilation and Medical Research Council (MRC) score > 2. Multivariate logistic regression was used to evaluate risk factors associated with airflow obstruction, reported as adjusted odds ratios (aORs). Results Five hundred and three participants successfully completed spirometry testing. The median (Q1; Q3) age was 52 (44; 58) years. The median (Q1; Q3) CD4 count was 598 (438; 784) cells/μL and the median (Q1; Q3) nadir CD4 count was 224 (121; 351) cells/μL. There were 119 (24%) current smokers and 145 (29%) former smokers. Among those screened, 54 (11%) had airflow obstruction whereas three (1%) of the participants had COPD. Factors that were associated with airflow obstruction included a history of smoking [aOR 2.2; 95% confidence interval (CI) 1.1; 4.7], older age (aOR 1.6; 95% CI 1.2; 2.2), and lower CD4 count (aOR 0.8; 95% CI 0.7; 1.0). Conclusions Airflow obstruction was relatively uncommon. Our findings suggest that PLWHIV who are ≥50 years old, smokers and those with nadir CD4 counts ≤ 200 cells/μL could be targeted to undergo spirometry to diagnose chronic airflow obstruction.
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Affiliation(s)
- C T Costiniuk
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - R Nitulescu
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Z Saneei
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - N Wasef
- Department of Medicine, National University of Ireland, Galway, Ireland
| | - S Salahuddin
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - D Wasef
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - J Young
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - C de Castro
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - J P Routy
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - B Lebouché
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - J Cox
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - B M Smith
- Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada.,Division of Respirology, McGill University Health Centre, Montreal, QC, Canada
| | - S Ambroise
- Division of Respirology, McGill University Health Centre, Montreal, QC, Canada
| | - C Pexos
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - M Patel
- Division of Respirology, McGill University Health Centre, Montreal, QC, Canada
| | - J Szabo
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - L P Haraoui
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - A de Pokomandy
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada
| | - C Tsoukas
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - J Falutz
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - R LeBlanc
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - A Giannakis
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - C Frenette
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - M A Jenabian
- Department of Biological Sciences and BioMed Research Centre, University of Quebec at Montreal (UQAM), Montreal, QC, Canada
| | - J Bourbeau
- Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada.,Division of Respirology, McGill University Health Centre, Montreal, QC, Canada
| | - M B Klein
- Chronic Viral Illness Service/Division of Infectious Diseases, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada
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Linthewaite B, Cox J, Klein M, Fallu J, Peiris H, Salahuddin S, Routy JP, Lebouche B, Brouillette MJ, Szabo J, Giannakis A, Leblanc R, Jenabian MA, Gilman S, Costiniuk C. Identifying smoking cessation targets for people living with HIV and HIV-HCV. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kehler L, Heußel CP, Norajitra T, Giannakis A, Bauer-Kemény C, Maier-Hein KH, Kreuter M. Vollautomatische Quantifizierung der Lungenfibrose mittels CT vor und nach Exazerbation einer IPF – das LUng FIbrosis quantification Tool (LUFIT). Pneumologie 2018. [DOI: 10.1055/s-0037-1619184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- L Kehler
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
| | - CP Heußel
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - T Norajitra
- Abteilung Medizinische Bildverarbeitung, Deutsches Krebsforschungszentrum Heidelberg
| | - A Giannakis
- Radiologische Klinik, Universitätsklinikum Heidelberg
| | - C Bauer-Kemény
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
| | - KH Maier-Hein
- Abteilung Medizinische Bildverarbeitung, Deutsches Krebsforschungszentrum Heidelberg
| | - M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
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