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Abidi MZ, Umbleja T, Overton ET, Burdo T, Flynn JM, Lu MT, Taron J, Schnittman SR, Fitch KV, Zanni MV, Fichtenbaum CJ, Malvestutto C, Aberg JA, Fulda ES, Eckard AR, Manne-Goehler J, Tuan JJ, Ribaudo HJ, Douglas PS, Grinspoon SK, Brown TT, Erlandson KM. Cytomegalovirus IgG is Associated With Physical Function But Not Muscle Density in People With HIV. J Acquir Immune Defic Syndr 2024; 95:470-478. [PMID: 38180893 PMCID: PMC10947880 DOI: 10.1097/qai.0000000000003377] [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: 07/03/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Cytomegalovirus (CMV) seropositivity is associated with poor outcomes, including physical function impairment, in people without HIV. We examined associations between CMV IgG titer and physical function in virologically suppressed people with HIV (PWH). METHODS REPRIEVE is a double-blind randomized trial evaluating pitavastatin for primary prevention of atherosclerotic cardiovascular disease in PWH. This analysis focused on participants enrolled in a substudy with additional biomarker testing, imaging [coronary CT angiography], and physical function measures at entry. CMV IgG was measured using quantitative enzyme immunoassay, physical function by Short Physical Performance Battery, and muscle density and area by CT. Associations between CMV IgG (risk factor) and outcomes were evaluated using the partial Spearman correlation and linear and log-binomial regression. RESULTS Among 717 participants, 82% male, the median CMV IgG was 2716 (Q1, Q3: 807, 6672) IU/mL, all above the limit of quantification. Among 631 participants with imaging, there was no association between CMV IgG and CT-based muscle density or area, controlling for age (r = -0.03 and r = -0.01, respectively; P ≥ 0.38). Among 161 participants with physical function data, higher CMV IgG was associated with poorer overall modified Short Physical Performance Battery score ( P = 0.02), adjusted for age, nadir CD4, and high-sensitivity C-reactive protein. CONCLUSIONS Higher CMV IgG titer was associated with poorer physical function, not explained by previous immune compromise, inflammation, or muscle density or area. Further mechanistic studies are needed to understand this association and whether CMV-specific therapy can affect physical function in PWH.
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Affiliation(s)
- Maheen Z. Abidi
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO, USA
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edgar T. Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Tricia Burdo
- Department of Microbiology, Immunology, and Inflammation and Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jacqueline M. Flynn
- Department of Microbiology, Immunology, and Inflammation and Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Michael T. Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Medical Center – University of Freiburg, Germany
| | - Samuel R. Schnittman
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carlos Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, OH, USA
| | - Judith A. Aberg
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evelynne S. Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Allison Ross Eckard
- Departments of Pediatrics and Medicine, Divisions of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica J. Tuan
- Division of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Heather J. Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, U.S.A
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO, USA
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Giron LB, Liu Q, Adeniji OS, Yin X, Kannan T, Ding J, Lu DY, Langan S, Zhang J, Azevedo JLLC, Li SH, Shalygin S, Azadi P, Hanna DB, Ofotokun I, Lazar J, Fischl MA, Haberlen S, Macatangay B, Adimora AA, Jamieson BD, Rinaldo C, Merenstein D, Roan NR, Kutsch O, Gange S, Wolinsky SM, Witt MD, Post WS, Kossenkov A, Landay AL, Frank I, Tien PC, Gross R, Brown TT, Abdel-Mohsen M. Immunoglobulin G N-glycan markers of accelerated biological aging during chronic HIV infection. Nat Commun 2024; 15:3035. [PMID: 38600088 PMCID: PMC11006954 DOI: 10.1038/s41467-024-47279-4] [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: 09/01/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
People living with HIV (PLWH) experience increased vulnerability to premature aging and inflammation-associated comorbidities, even when HIV replication is suppressed by antiretroviral therapy (ART). However, the factors associated with this vulnerability remain uncertain. In the general population, alterations in the N-glycans on IgGs trigger inflammation and precede the onset of aging-associated diseases. Here, we investigate the IgG N-glycans in cross-sectional and longitudinal samples from 1214 women and men, living with and without HIV. PLWH exhibit an accelerated accumulation of pro-aging-associated glycan alterations and heightened expression of senescence-associated glycan-degrading enzymes compared to controls. These alterations correlate with elevated markers of inflammation and the severity of comorbidities, potentially preceding the development of such comorbidities. Mechanistically, HIV-specific antibodies glycoengineered with these alterations exhibit a reduced ability to elicit anti-HIV Fc-mediated immune activities. These findings hold potential for the development of biomarkers and tools to identify and prevent premature aging and comorbidities in PLWH.
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Affiliation(s)
| | - Qin Liu
- The Wistar Institute, Philadelphia, PA, USA
| | | | | | | | | | - David Y Lu
- The Wistar Institute, Philadelphia, PA, USA
- Cornell University, New York, NY, USA
| | | | | | | | - Shuk Hang Li
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason Lazar
- SUNY Downstate Health Sciences University, New York, NY, USA
| | - Margaret A Fischl
- Division of Infectious Disease, Department of Medicine, University of Miami, Miami, FL, USA
| | | | | | | | | | | | | | - Nadia R Roan
- Gladstone Institutes, San Francisco, CA, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Olaf Kutsch
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Mallory D Witt
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | | | - Ian Frank
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Phyllis C Tien
- University of California San Francisco, San Francisco, CA, USA
| | - Robert Gross
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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3
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Raju S, Siddharthan T, McCormack MC, Patel SR, Kunisaki KM, D'Souza G, Cho JHJ, Stosor V, Morris A, Margolick JB, Brown TT, Punjabi NM. Influence of Impaired Diffusing Capacity and Sleep-disordered Breathing on Nocturnal Hypoxemia and Health Outcomes in Men with and without HIV. Ann Am Thorac Soc 2024. [PMID: 38498872 DOI: 10.1513/annalsats.202309-757oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/18/2024] [Indexed: 03/20/2024] Open
Abstract
RATIONALE Nocturnal hypoxemia is common in sleep-disordered breathing (SDB) and is associated with increased morbidity and mortality. Although impaired diffusing capacity of the lungs for carbon monoxide (DLCO) is associated with daytime hypoxemia, its influence on SDB-related nocturnal hypoxemia is not known. OBJECTIVE To characterize the effects of DLCO impairment on SDB-related nocturnal hypoxemia and associated health outcomes. METHODS Data from a multi-center cohort of men with and without HIV, with concomitant measures of DLCO and home-based polysomnography (N=544), were analyzed. Multivariable quantile regression models characterized associations between DLCO and several measures of SDB-related hypoxemia (e.g., total sleep time with oxygen saturation [SpO2]<90% [T90]). Structural equation models assessed associations between impaired DLCO and SDB-related hypoxemia measures with prevalent hypertension and type 2 diabetes. RESULTS DLCO impairment (<80% predicted) was associated with sleep-related hypoxemia. Participants with severe SDB (apnea-hypopnea index≥30 events/hr) and impaired DLCO had a higher T90 (median difference: 15.0%; [95% CI: 10.3,19.7]) and average SDB-related desaturation (median difference: 1.0; [0.5, 1.5]), and lower nadir SpO2 (median difference: -8.2%; [-11.4, -4.9]) and average SpO2 during sleep (median difference: -1.1%; [-2.1, -0.01]), than those with severe SDB and preserved DLCO. A higher T90 was associated with higher adjusted odds of prevalent hypertension (OR 1.39; [1.14,1.70]) and type 2 diabetes (OR 1.25; [1.07,1.46]). CONCLUSIONS DLCO impairment in severe SDB was associated with sleep-related hypoxemia, prevalent hypertension and type 2 diabetes. Assessment of SDB should be considered in those with impaired DLCO to guide testing and risk-stratification strategies.
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Affiliation(s)
- Sarath Raju
- Johns Hopkins School of Medicine, Division of Pulmonary and Critical Care Medicine, BALTIMORE, Maryland, United States
- Johns Hopkins Division of Pulmonary and Critical Care Medicine;
| | | | - Meredith C McCormack
- Johns Hopkins University, Pulmonary and Critical Care, Baltimore, Maryland, United States
| | - Sanjay R Patel
- University of Pittsburgh, 6614, Medicine, Pittsburgh, Pennsylvania, United States
| | - Ken M Kunisaki
- Minneapolis VA Health Care System, 20040, Pulmonary and Sleep Medicine (111N), Minneapolis, Minnesota, United States
- University of Minnesota, 5635, Pulmonary, Allergy, Critical Care and Sleep Medicine, Minneapolis, Minnesota, United States
| | - Gypsamber D'Souza
- Johns Hopkins University Bloomberg School of Public Health, 25802, Baltimore, Maryland, United States
| | - Joshua Hyong-Jin Cho
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 145230, Los Angeles, California, United States
| | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, 12244, Chicago, Illinois, United States
| | - Alison Morris
- University of Pittsburgh Medical Center, pittsburgh, Pennsylvania, United States
| | - Joseph B Margolick
- Johns Hopkins University Bloomberg School of Public Health, 25802, Baltimore, Maryland, United States
| | - Todd T Brown
- Johns Hopkins School of Medicine, 1500, Baltimore, Maryland, United States
| | - Naresh M Punjabi
- University of Miami Miller School of Medicine, 12235, Division of Pulmonary and Critical Care Medicine, Miami, Florida, United States
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Lai M, Madden E, Shlipak MG, Scherzer R, Post WS, Vittinghoff E, Haberlen S, Brown TT, Wolinsky SM, Witt MD, Ho K, Abraham AG, Parikh CR, Budoff M, Estrella MM. Association of urine biomarkers of kidney health with subclinical cardiovascular disease among men with and without HIV. AIDS 2024; 38:465-475. [PMID: 37861689 PMCID: PMC10922264 DOI: 10.1097/qad.0000000000003761] [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] [Indexed: 10/21/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether urine biomarkers of kidney health are associated with subclinical cardiovascular disease among men with and without HIV. DESIGN A cross-sectional study within the Multicenter AIDS Cohort Study (MACS) among 504 men with and without HIV infection who underwent cardiac computed tomography scans and had urine biomarkers measured within the preceding 2 years. METHODS Our primary predictors were four urine biomarkers of endothelial (albuminuria), proximal tubule dysfunction (alpha-1-microglobulin [A1 M] and injury (kidney injury molecule-1 [KIM-1]) and tubulointerstitial fibrosis (pro-collagen-III N-terminal peptide [PIIINP]). These were evaluated for association with coronary artery calcium (CAC) prevalence, CAC extent, total plaque score, and total segment stenosis using multivariable regression. RESULTS Of the 504 participants, 384 were men with HIV (MWH) and 120 were men without HIV. In models adjusted for sociodemographic factors, cardiovascular disease risk factors, eGFR, and HIV-related factors, each two-fold higher concentration of albuminuria was associated with a greater extent of CAC (1.35-fold higher, 95% confidence interval 1.11-1.65), and segment stenosis (1.08-fold greater, 95% confidence interval 1.01-1.16). Associations were similar between MWH and men without HIV in stratified analyses. The third quartile of A1 M showed an association with greater CAC extent, total plaque score, and total segment stenosis, compared with the lowest quartile. CONCLUSION Worse endothelial and proximal tubule dysfunction, as reflected by higher urine albumin and A1 M, were associated with greater CAC extent and coronary artery stenosis.
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Affiliation(s)
- Mason Lai
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- Department of Medicine, University of California San Francisco
| | - Erin Madden
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System, San Francisco, California
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System, San Francisco, California
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System, San Francisco, California
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Eric Vittinghoff
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven M Wolinsky
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mallory D Witt
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison G Abraham
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Chirag R Parikh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Budoff
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco
- San Francisco VA Healthcare System, San Francisco, California
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, California, USA
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5
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Peterson TE, Hahn VS, Moaddel R, Zhu M, Haberlen SA, Palella FJ, Plankey M, Bader JS, Lima JA, Gerszten RE, Rotter JI, Rich SS, Heckbert SR, Kirk GD, Piggott DA, Ferrucci L, Margolick JB, Brown TT, Wu KC, Post WS. Proteomic Signature of HIV-Associated Subclinical Left Atrial Remodeling and Incident Heart Failure. medRxiv 2024:2024.02.13.24302797. [PMID: 38405757 PMCID: PMC10888991 DOI: 10.1101/2024.02.13.24302797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background People living with HIV (PLWH) are at higher risk of heart failure (HF) and preceding subclinical cardiac abnormalities, including left atrial dilation, compared to people without HIV (PWOH). Hypothesized mechanisms include premature aging linked to chronic immune activation. We leveraged plasma proteomics to identify potential novel contributors to HIV-associated differences in indexed left atrial volume (LAVi) among PLWH and PWOH and externally validated identified proteomic signatures with incident HF among a cohort of older PWOH. Methods We performed proteomics (Olink Explore 3072) on plasma obtained concurrently with cardiac magnetic resonance imaging among PLWH and PWOH in the United States. Proteins were analyzed individually and as agnostically defined clusters. Cross-sectional associations with HIV and LAVi were estimated using multivariable regression with robust variance. Among an independent general population cohort, we estimated associations between identified signatures and LAVi using linear regression and incident HF using Cox regression. Results Among 352 participants (age 55±6 years; 25% female), 61% were PLWH (88% on ART; 73% with undetectable HIV RNA) and mean LAVi was 29±9 mL/m 2 . Of 2594 analyzed proteins, 439 were associated with HIV serostatus, independent of demographics, hepatitis C virus infection, renal function, and substance use (FDR<0.05). We identified 73 of these proteins as candidate contributors to the independent association between positive HIV serostatus and higher LAVi, enriched in tumor necrosis factor (TNF) signaling and immune checkpoint proteins regulating T cell, B cell, and NK cell activation. We identified one protein cluster associated with LAVi and HIV regardless of HIV viral suppression status, which comprised 42 proteins enriched in TNF signaling, ephrin signaling, and extracellular matrix (ECM) organization. This protein cluster and 30 of 73 individual proteins were associated with incident HF among 2273 older PWOH (age 68±9 years; 52% female; 8.5±1.4 years of follow-up). Conclusion Proteomic signatures that may contribute to HIV-associated LA remodeling were enriched in immune checkpoint proteins, cytokine signaling, and ECM organization. These signatures were also associated with incident HF among older PWOH, suggesting specific markers of chronic immune activation, systemic inflammation, and fibrosis may identify shared pathways in HIV and aging that contribute to risk of HF.
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Slama L, Barrett BW, Abraham AG, Palella FJ, Magnani JW, Viard JP, Lake JE, Brown TT. Incident Proteinuria differs by HIV Serostatus among Men with Pre-diabetes: The Multicenter AIDS Cohort Study. Clin Infect Dis 2024:ciae065. [PMID: 38335094 DOI: 10.1093/cid/ciae065] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Pre-diabetes is associated with proteinuria, a risk factor for chronic kidney disease. While people living with HIV (PWH) have a higher risk of proteinuria than people without HIV (PWOH), it is unknown whether incident proteinuria differs by HIV serostatus among pre-diabetic persons. METHODS Urine protein-to-creatinine ratio (PCR) was measured at semi-annual visits among men in the Multicenter AIDS Cohort Study since April 2006. Men with pre-DM on or after April 2006 and no prevalent proteinuria or use of anti-diabetic medications were included. Pre-diabetes was defined as fasting glucose (FG) of 100-125 mg/dL confirmed within a year by a repeat FG or hemoglobin A1c 5.7-6.4%. Incident proteinuria was defined as PCR > 200 mg/g, confirmed within a year. We used Poisson regression models to determine whether incident proteinuria in participants with pre-diabetes differed by HIV serostatus and, among PWH, whether HIV-specific factors were related to incident proteinuria. RESULTS Between 2006 and 2019, among 1276 men with pre-diabetes, 128/613 PWH (21%) and 50/663 PWOH (8%) developed proteinuria over a median 10-year follow-up. After multivariable adjustment, the incidence of proteinuria in PWH with pre-diabetes was 3.3 times [95% CI: 2.3-4.8 times] greater than in PWOH (p < 0.01). Among PWH, current CD4 count <500 cells/mm3 (p < 0.01) and current use of protease inhibitors (p = 0.03) were associated with incident proteinuria, while lamivudine and integrase inhibitor use were associated with a lower risk. CONCLUSION Among men with pre-DM, the risk of incident proteinuria was 3 times higher in PWH. Strategies to preserve renal function are needed in this population.
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Affiliation(s)
- Laurence Slama
- APHP, Hotel-Dieu Hospital, Infectious diseases Unit, Paris, France
- University Paris Cité and University Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
- Feinberg School of Medicine, Northwestern University Chicago, IL, USA
| | | | | | - Frank J Palella
- Feinberg School of Medicine, Northwestern University Chicago, IL, USA
| | - Jared W Magnani
- University of Pittsburgh, School of Medicine, Pittsburgh, PA., USA
| | - Jean Paul Viard
- APHP, Hotel-Dieu Hospital, Infectious diseases Unit, Paris, France
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Lin H, Chen Y, Abror G, Price M, Morris A, Sun J, Palella F, Chew KW, Brown TT, Rinaldo CR, Peddada SD. The effect of sexual behavior on HIV-1 seroconversion is mediated by the gut microbiome and proinflammatory cytokines. Res Sq 2024:rs.3.rs-3868545. [PMID: 38343862 PMCID: PMC10854284 DOI: 10.21203/rs.3.rs-3868545/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The association between HIV-1 seroconversion and gut dysbiosis is well documented, and its association with sexual activity is also widely recognized. However, it is not known whether the gut dysbiosis mediates the effects of high-risk sexual behavior on HIV-1 seroconversion. In this report we focused on men who engaged in high-risk sexual behavior where they had receptive anal intercourse with multiple men. We demonstrate that proinflammatory cytokines, sCD14 and sCD163, and gut microbiota mediate the effects of this high-risk sexual behavior on subsequent HIV seroconversion. We discovered changes in the gut microbial ecology, prior to seroconversion, both in terms of the composition as well as inter-relationships among the commensal species. Furthermore, these changes correlate with future HIV seroconversion. Specifically, as the number of sexual partners increased, we discovered in a "dose-response" manner, a decrease in the abundance of commensal and short-chain fatty acid-producing species, A. muciniphila, B. caccae, B. fragilis, B. uniformis, Bacteroides spp., Butyricimonas spp., and Odoribacter spp, and an increase in proinflammatory species Dehalobacterium spp. and Methanobrevibacter spp. These changes were also observed among subsequent HIV seroconverters. Interestingly, we also discovered a reduction in correlations among these commensal and short-chain fatty acid producing bacteria in a "dose-response" manner with the number of sexual partners. Our mediation analysis not only provides a conceptual model for the disease process but also provides clues for future clinical interventions that will manipulate the gut microbiota to treat high-risk subjects to prevent HIV seroconversion.
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Affiliation(s)
- Huang Lin
- Co-first authors
- Biostatistics and Computational Biology, National Institute of Environmental Health Sciences (NIH), Research Triangle Park, NC USA
| | - Yue Chen
- Co-first authors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Grace Abror
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Meaghan Price
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Alison Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Jing Sun
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Frank Palella
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Kara W Chew
- School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Todd T Brown
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Charles R Rinaldo
- Co-senior authors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Shyamal D Peddada
- Co-senior authors
- Biostatistics and Computational Biology, National Institute of Environmental Health Sciences (NIH), Research Triangle Park, NC USA
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8
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Jankowski CM, Konigsberg IR, Wilson MP, Sun J, Brown TT, Julian CG, Erlandson KM. Skeletal muscle DNA methylation: Effects of exercise and HIV. Aging Cell 2024; 23:e14025. [PMID: 37920126 PMCID: PMC10776118 DOI: 10.1111/acel.14025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/04/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/04/2023] Open
Abstract
Aging, human immunodeficiency virus (HIV) infection, and antiretroviral therapy modify the epigenetic profile and function of cells and tissues, including skeletal muscle (SkM). In some cells, accelerated epigenetic aging begins very soon after the initial HIV infection, potentially setting the stage for the early onset of frailty. Exercise imparts epigenetic modifications in SkM that may underpin some health benefits, including delayed frailty, in people living with HIV (PWH). In this first report of exercise-related changes in SkM DNA methylation among PWH, we investigated the impact of 24 weeks of aerobic and resistance exercise training on SkM (vastus lateralis) DNA methylation profiles and epigenetic age acceleration (EAA) in older, virally suppressed PWH (n = 12) and uninfected controls (n = 18), and associations of EAA with physical function at baseline. We identified 983 differentially methylated positions (DMPs) in PWH and controls at baseline and 237 DMPs after training. The influence of HIV serostatus on SkM methylation was more pronounced than that of exercise training. There was little overlap in the genes associated with the probes most significantly differentiated by exercise training within each group. Baseline EAA (mean ± SD) was similar between PWH (-0.4 ± 2.5 years) and controls (0.2 ± 2.6 years), and the exercise effect was not significant (p = 0.79). EAA and physical function at baseline were not significantly correlated (all p ≥ 0.10). This preliminary investigation suggests HIV-specific epigenetic adaptations in SkM with exercise training but confirmation in a larger study that includes transcriptomic analysis is warranted.
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Affiliation(s)
| | - Iain R. Konigsberg
- Department of Biomedical InformaticsUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Melissa P. Wilson
- Division of Infectious Diseases, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Jing Sun
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthMarylandBaltimoreUSA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Department of MedicineJohns Hopkins UniversityMarylandBaltimoreUSA
| | - Colleen G. Julian
- Department of Biomedical InformaticsUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
- Division of Geriatric Medicine, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
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Giron LB, Liu Q, Adeniji OS, Yin X, Kannan T, Ding J, Lu DY, Langan S, Zhang J, Azevedo JLLC, Li SH, Shalygin S, Azadi P, Hanna DB, Ofotokun I, Lazar J, Fischl MA, Haberlen S, Macatangay B, Adimora AA, Jamieson BD, Rinaldo C, Merenstein D, Roan NR, Kutsch O, Gange S, Wolinsky S, Witt M, Post WS, Kossenkov A, Landay A, Frank I, Tien PC, Gross R, Brown TT, Abdel-Mohsen M. Plasma Glycomic Markers of Accelerated Biological Aging During Chronic HIV Infection. bioRxiv 2023:2023.08.09.551369. [PMID: 37609144 PMCID: PMC10441429 DOI: 10.1101/2023.08.09.551369] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
People with HIV (PWH) experience an increased vulnerability to premature aging and inflammation-associated comorbidities, even when HIV replication is suppressed by antiretroviral therapy (ART). However, the factors that contribute to or are associated with this vulnerability remain uncertain. In the general population, alterations in the glycomes of circulating IgGs trigger inflammation and precede the onset of aging-associated diseases. Here, we investigate the IgG glycomes of cross-sectional and longitudinal samples from 1,216 women and men, both living with virally suppressed HIV and those without HIV. Our glycan-based machine learning models indicate that living with chronic HIV significantly accelerates the accumulation of pro-aging-associated glycomic alterations. Consistently, PWH exhibit heightened expression of senescence-associated glycan-degrading enzymes compared to their controls. These glycomic alterations correlate with elevated markers of inflammatory aging and the severity of comorbidities, potentially preceding the development of such comorbidities. Mechanistically, HIV-specific antibodies glycoengineered with these alterations exhibit reduced anti-HIV IgG-mediated innate immune functions. These findings hold significant potential for the development of glycomic-based biomarkers and tools to identify and prevent premature aging and comorbidities in people living with chronic viral infections.
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Affiliation(s)
| | - Qin Liu
- The Wistar Institute, Philadelphia, PA, USA
| | | | | | | | | | - David Y. Lu
- The Wistar Institute, Philadelphia, PA, USA
- Cornell University, New York, NY, USA
| | | | | | | | - Shuk Hang Li
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason Lazar
- SUNY Downstate Health Sciences University, New York, NY, USA
| | | | | | | | | | | | | | | | - Nadia R. Roan
- Gladstone Institutes, San Francisco, CA, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Olaf Kutsch
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Mallory Witt
- Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | - Ian Frank
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Phyllis C. Tien
- University of California San Francisco, San Francisco, CA, USA
| | - Robert Gross
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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10
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Punjabi NM, Brown TT, Abreu AR, Aurora RN, Patel SR, Stosor V, Cho JHJ, D’Souza G, Wallace D, Margolick JB. Sleep-Disordered Breathing and Prevalent Hypertension in Men With and Without HIV. J Acquir Immune Defic Syndr 2023; 94:349-354. [PMID: 37643405 PMCID: PMC10824508 DOI: 10.1097/qai.0000000000003276] [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: 04/24/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a known risk factor for hypertension. Despite the well-established link between HIV infection and hypertension, it remains to be determined whether HIV infection modifies the association between SDB and hypertension. SETTING The Multicenter AIDS Cohort Study. METHODS SDB was assessed using in-home polysomnography in 779 men (436 with and 343 without HIV). The apnea-hypopnea index (AHI) based on oxyhemoglobin desaturation threshold of ≥3% or arousal (AHI 3a ) and ≥4% (AHI 4 ) along with oxygen desaturation index (ODI) were used to quantify SDB severity. Hypertension was defined as a blood pressure ≥140/90 mm Hg, use of antihypertensive medication, or self-report of a clinical diagnosis. The associations between HIV, SDB, and hypertension were characterized using multivariable logistic regression. RESULTS The prevalence of hypertension and SDB (AHI 3a ≥ 5 events/hr) was high, with estimates of 53.8% and 82.8%, respectively. Among men without SDB, HIV was independently associated with hypertension, with an adjusted odds ratio (OR) of 3.05 [95% confidence interval (CI): 1.33 to 7.01]. In men without HIV, SDB was associated with hypertension (OR: 2.93; 95% CI: 1.46 to 5.86). No significant increase in the odds of hypertension was noted in men with both HIV and SDB compared with men with either factor alone, with an OR of 3.24 (95% CI: 1.62 to 6.47). These results were consistent across different measures used to define SDB (AHI 3a , AHI 4 , ODI 3 , and ODI 4 ). CONCLUSIONS Predictors of hypertension differed by HIV status. SDB was associated with hypertension in men without HIV, but not in men with HIV. Among men with HIV, SDB did not affect the odds of hypertension.
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11
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Abdo M, Kunisaki KM, Morris A, Stosor V, Chang D, D'Souza G, Crothers K, Abdel-Maksoud M, DiGuiseppi C, Brown TT, Erlandson KM, MaWhinney S. Pulmonary Function and Quality of Life in Aging Men With and Without HIV from the Multicenter AIDS Cohort Study. AIDS Res Hum Retroviruses 2023; 39:621-632. [PMID: 37276144 PMCID: PMC10712368 DOI: 10.1089/aid.2023.0001] [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] [Indexed: 06/07/2023] Open
Abstract
People living with HIV have greater pulmonary function impairments and decreased health-related quality of life (HRQoL) compared to uninfected peers. We examined whether pulmonary impairment was associated with HRQoL or respiratory health status. Using Multicenter AIDS Cohort Study data (2017-2019), associations between outcomes [HRQoL (36-Item Short Form Survey) and respiratory health status (St. George's Respiratory Questionnaire)] with pulmonary impairment [diffusing capacity for carbon monoxide (DLCO) and forced expiratory volume in 1 s (FEV1), defined as <80% predicted for both] were examined. Adjusted analyses utilized linear and zero-inflated beta regression, the latter summarized by odds ratio (OR) and quotient ratios (QRs). We also considered whether the subset of adjustment variables age, HIV serostatus, or smoking modified the relationships examined. Of 1048 men, 55% had HIV, with median age 57 [interquartile range (IQR) = 48, 64] years and 1.2 (IQR = 0, 18.1) smoking pack-years. Impaired DLCO, but not impaired FEV1, was significantly associated with lower physical HRQoL [-2.71 (-4.09, -1.33); -1.46 (-3.45, 0.54), respectively]. Pulmonary impairment was associated with higher odds of any St. George's Respiratory Questionnaire (SGRQ) (total score) limitation [DLCO OR = 1.53 (1.15, 2.04); FEV1 OR = 2.48 (1.16, 5.30)] and was elevated in individuals with more severe SGRQ limitations [DLCO QR = 1.13 (0.94, 1.36); FEV1 QR = 1.27 (0.98, 1.64)]. HIV did not modify any associations examined. Age modified the DLCO and any respiratory limitation (SGRQ symptom score) association for every 10 mL CO/min/mmHg decrease in DLCO [age 30 OR = 1.03 (0.51, 2.08); age 50 OR = 1.85 (1.27, 3.85); and age 70 OR = 3.45 (2.00, 5.88)]. Similarly, age modified the DLCO and any respiratory limitation (SGRQ total score) association. FEV1 associations with SGRQ and HRQoL scores were similar across all ages. Impaired pulmonary function was associated with lower HRQoL and greater respiratory impairments. Future studies can determine if interventions aimed at preserving pulmonary function are effective in improving HRQoL and respiratory health among aging men with and without HIV.
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Affiliation(s)
- Mona Abdo
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ken M. Kunisaki
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dong Chang
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, California, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Healthcare System, University of Washington, Seattle, Washington, USA
| | - Madiha Abdel-Maksoud
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Division of Infectious Disease, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha MaWhinney
- Department of Biostatistics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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12
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Ziogos E, Kwapong YA, Weiss RG, Schär M, Brown TT, Bagchi S, Soleimanifard A, Harb T, Piggott DA, Gerstenblith G, Leucker TM, Hays AG. Coronary artery endothelial function and aging in people with HIV and HIV-negative individuals. Am J Physiol Heart Circ Physiol 2023; 325:H1099-H1107. [PMID: 37682238 PMCID: PMC10907030 DOI: 10.1152/ajpheart.00143.2023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Abstract
Coronary artery disease (CAD) is a common comorbidity in people with human immunodeficiency virus (HIV) (PWH) and impaired coronary endothelial function (CEF) plays a central role in the pathogenesis of CAD. Age-related impaired CEF among PWH, however, is not well characterized. We investigated the association between CEF and age in males and females with and without HIV using 3-T magnetic resonance imaging (MRI). We measured the changes in coronary cross-sectional area (CSA) and coronary blood flow during isometric handgrip exercise (IHE), an established endothelial-dependent stressor with smaller increases in CSA and coronary blood flow indicative of impaired CEF. We included 106 PWH and 82 individuals without HIV. Differences in demographic and clinical characteristics between PWH and individuals without HIV were explored using Pearson's χ2 test for categorical variables and Welch's t test for continuous variables. Linear regression models were used to examine the association between CEF and age. CEF was significantly lower in PWH as compared with individuals without HIV. Coronary endothelial dysfunction was also present at younger ages in PWH than in the individuals without HIV and there were significant differences in CEF between the PWH and individuals without HIV across age groups. Among the individuals without HIV, the percent changes in CSA were inversely related to age in unadjusted and adjusted models. There was no significant association between CEF and age in PWH. To the best of our knowledge, this is the first study to examine the relationship between age and CEF in PWH, and our results suggest that factors other than age significantly impair CEF in PWH across the life span.NEW & NOTEWORTHY This is the first study to examine the relationship between age and coronary endothelial function (CEF) in people with human immunodeficiency virus (HIV) (PWH). CEF was assessed using magnetic resonance imaging (MRI) in people with and without HIV. Although age and CEF were significantly inversely related in individuals without HIV, there was no association between age and CEF in PWH.
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Affiliation(s)
- Efthymios Ziogos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Yaa A Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Robert G Weiss
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Michael Schär
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Todd T Brown
- Division of Endocrinology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Shashwatee Bagchi
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Alborz Soleimanifard
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Tarek Harb
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Damani A Piggott
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Gary Gerstenblith
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Thorsten M Leucker
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Allison G Hays
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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13
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Martinez CA, Rikhi R, Fonseca Nogueira N, Pester MS, Salazar AS, Ashinne B, Aguilar N, Melara A, Porras V, Parker M, Mendez A, Cyrus E, De Santis JP, Jones DL, Brown TT, Hurwitz BE, Alcaide ML. Estrogen-Based Gender-Affirming Hormone Therapy and Subclinical Cardiovascular Disease in Transgender Women with HIV. LGBT Health 2023; 10:576-585. [PMID: 37459150 PMCID: PMC10712365 DOI: 10.1089/lgbt.2023.0010] [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] [Indexed: 12/07/2023] Open
Abstract
Purpose: Transgender women (TW) are disproportionately affected by HIV infection and cardiovascular disease (CVD). This study evaluated whether estrogen-based gender-affirming hormone therapy (GAHT) in TW with HIV (TWH-GAHT) is associated with indices of subclinical CVD. Methods: Of the 40 HIV-seropositive persons enrolled, 20-60 years of age, on antiretroviral treatment with undetectable viral load, assessments were performed on 15 TWH; of these persons, 11 were GAHT treated. These TWH-GAHT were matched with HIV+ cisgender men and women based on age, ethnicity/race, body mass index, and antihypertensive medication use. Sex hormones, and cardiometabolic (waist circumference, blood pressure, insulin resistance, lipid profile, and C-reactive protein), vascular (flow-mediated dilation [FMD] and arterial stiffness), and proinflammatory measures were obtained. Results: TWH-GAHT displayed elevated estradiol and suppressed testosterone levels relative to normative ranges. Analyses indicated the TWH-GAHT displayed lower low-density lipoprotein compared with cisgender groups (p < 0.05). Although no difference was seen on FMD, the central augmentation index of aortic stiffness was higher in cisgender HIV+ women than cisgender HIV+ men (p < 0.05). No other group difference on subclinical CVD markers was observed. For TWH, partial correlations indicated associations of certain sex hormones with selected cardiometabolic outcomes and the inflammatory cytokine, interleukin-8. Conclusion: When well matched to HIV+ cisgender men and women, subclinical CVD pathophysiology did not appear elevated in TWH-GAHT, although tendencies emerged suggesting that some subclinical CVD indices may be higher, but others lower than cisgender groups. Longitudinal studies of TWH are needed to more precisely evaluate the moderating effect of GAHT on cardiometabolic pathophysiology.
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Affiliation(s)
- Claudia A. Martinez
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rishi Rikhi
- Division of Cardiology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas Fonseca Nogueira
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mollie S. Pester
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
| | - Ana S. Salazar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Beteal Ashinne
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Natalie Aguilar
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Abraham Melara
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Valeria Porras
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Meela Parker
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
| | - Armando Mendez
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Joseph P. De Santis
- School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | - Deborah L. Jones
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Barry E. Hurwitz
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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14
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Harb T, Ziogos E, Schär M, Brown TT, Lai S, Gerstenblith G, Hays AG, Leucker TM. Rapid Improvement of Coronary Endothelial Function With PCSK9 Inhibition in People With HIV Is Associated With Reduced Lipoprotein (a) and Not LDL-cholesterol. Circ Cardiovasc Imaging 2023; 16:e015693. [PMID: 37772401 PMCID: PMC10591943 DOI: 10.1161/circimaging.123.015693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Tarek Harb
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Efthymios Ziogos
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Schär
- Division of Magnetic Resonance Research, Department of Radiology (M.S.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Todd T Brown
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine (T.T.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shenghan Lai
- Department of Epidemiology and Public Health, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD (S.L.)
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison G Hays
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thorsten M Leucker
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
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15
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Erlandson KM, Umbleja T, Lu MT, Taron J, Ribaudo HJ, Overton ET, Presti RM, Haas DW, Sax PE, Yin MT, Zhai BK, Louis R, Upadhyay N, Eslami P, Douglas PS, Zanni MV, Fitch KV, Fulda ES, Fichtenbaum CJ, Malvestutto CD, Grinspoon SK, Brown TT. Associations of Muscle Density and Area With Coronary Artery Plaque and Physical Function. J Acquir Immune Defic Syndr 2023; 94:174-184. [PMID: 37368931 PMCID: PMC10527277 DOI: 10.1097/qai.0000000000003244] [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: 11/29/2022] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE Skeletal muscle quality and mass are important for maintaining physical function during advancing age. We leveraged baseline data from Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) to evaluate whether paraspinal muscle density and muscle area are associated with cardiac or physical function outcomes in people with HIV (PWH). METHODS REPRIEVE is a double-blind randomized trial evaluating the effect of pitavastatin for primary prevention of major adverse cardiovascular events in PWH. This cross-sectional analysis focuses on participants who underwent coronary computed tomography at baseline. Lower thoracic paraspinal muscle density (Hounsfield units [HU]) and area (cm 2 ) were assessed on noncontrast computed tomography. RESULTS Of 805 PWH, 708 had paraspinal muscle measurements. The median age was 51 years and 17% were natal female patients. The median muscle density was 41 HU (male) and 30 HU (female); area 13.2 cm 2 /m (male) and 9.9 cm 2 /m (female). In adjusted analyses, greater density (less fat) was associated with a lower prevalence of any coronary artery plaque, coronary artery calcium score >0, and high plaque burden ( P = 0.06); area was not associated with plaque measures. Among 139 patients with physical function measures, greater area (but not density) was associated with better performance on a short physical performance battery and grip strength. CONCLUSIONS Among PWH, greater paraspinal muscle density was associated with a lower prevalence of coronary artery disease while greater area was associated with better physical performance. Whether changes in density or area are associated with changes in CAD or physical performance will be evaluated through longitudinal analyses in REPRIEVE.
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Affiliation(s)
- Kristine M Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Faculty of Medicine, Department of Radiology, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Edgar T Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Rachel M Presti
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - David W Haas
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Department of Internal Medicine, Meharry Medical College, Nashville, TN
| | - Paul E Sax
- Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael T Yin
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Bingxue Kris Zhai
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Rochelle Louis
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Namrata Upadhyay
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Parastou Eslami
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Markella V Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kathleen V Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Evelynne S Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Carl J Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Carlos D Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, OH; and
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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16
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Sadiq R, Bukhari MH, Brown TT, Bennett WL, Retnakaran R, Echouffo-Tcheugui JB. Association of cumulative social risk and gestational diabetes mellitus in the US, 2007-2018. Diabetes Res Clin Pract 2023; 203:110840. [PMID: 37482220 PMCID: PMC10592126 DOI: 10.1016/j.diabres.2023.110840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/03/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
AIMS Little is known regarding the association of multiple social risk factors and gestational diabetes mellitus (GDM). METHODS We analyzed the 2007-2018 National Health and Nutrition Examination Surveys including 10,439 women aged ≥20 years (8 % with history of GDM). We created a cumulative social risk score (CSR) by adding scores assigned to each of the following: race/ethnicity, citizenship status and country of birth, education, and family income (score of 0 used as reference group). Using logistic regression, we assessed the associations of individual social risk factors (education, income, race/ethnicity and citizenship status) and CSR score with GDM, adjusting for age, parity, insurance status, care access, smoking, diet, physical activity, and body mass index. RESULTS Among individual social risk factors, being a non-U.S. citizen (OR:1.51, 95% CI: 1.06-2.15) or belonging to a minority racial/ethnic group (OR:1.30, 95% CI: 1.04-1.59) was significantly associated with a greater odds of GDM. When examining the combined effects of social risk factors, a CSR score ≥3 was associated with an increased odds of GDM (OR:1.64, 95% CI: 1.22-2.1). CONCLUSIONS Women with a greater burden of social risk factors are more likely to have GDM, thus should be the focus of interventions to prevent and treat GDM.
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Affiliation(s)
- Rabail Sadiq
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Muhammad H Bukhari
- Department of Medicine, Norwalk Hospital affiliated with Yale University School of Medicine, Norwalk, CT, USA
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Collins LF, Palella FJ, Mehta CC, Holloway J, Stosor V, Lake JE, Brown TT, Topper EF, Naggie S, Anastos K, Taylor TN, Kassaye S, French AL, Adimora AA, Fischl MA, Kempf MC, Koletar SL, Tien PC, Ofotokun I, Sheth AN. Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019. JAMA Netw Open 2023; 6:e2327584. [PMID: 37548977 PMCID: PMC10407688 DOI: 10.1001/jamanetworkopen.2023.27584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Importance Despite aging-related comorbidities representing a growing threat to quality-of-life and mortality among persons with HIV (PWH), clinical guidance for comorbidity screening and prevention is lacking. Understanding comorbidity distribution and severity by sex and gender is essential to informing guidelines for promoting healthy aging in adults with HIV. Objective To assess the association of human immunodeficiency virus on the burden of aging-related comorbidities among US adults in the modern treatment era. Design, Setting, and Participants This cross-sectional analysis included data from US multisite observational cohort studies of women (Women's Interagency HIV Study) and men (Multicenter AIDS Cohort Study) with HIV and sociodemographically comparable HIV-seronegative individuals. Participants were prospectively followed from 2008 for men and 2009 for women (when more than 80% of participants with HIV reported antiretroviral therapy use) through last observation up until March 2019, at which point outcomes were assessed. Data were analyzed from July 2020 to April 2021. Exposures HIV, age, sex. Main Outcomes and Measures Comorbidity burden (the number of total comorbidities out of 10 assessed) per participant; secondary outcomes included individual comorbidity prevalence. Linear regression assessed the association of HIV status, age, and sex with comorbidity burden. Results A total of 5929 individuals were included (median [IQR] age, 54 [46-61] years; 3238 women [55%]; 2787 Black [47%], 1153 Hispanic or other [19%], 1989 White [34%]). Overall, unadjusted mean comorbidity burden was higher among women vs men (3.4 [2.1] vs 3.2 [1.8]; P = .02). Comorbidity prevalence differed by sex for hypertension (2188 of 3238 women [68%] vs 2026 of 2691 men [75%]), psychiatric illness (1771 women [55%] vs 1565 men [58%]), dyslipidemia (1312 women [41%] vs 1728 men [64%]), liver (1093 women [34%] vs 1032 men [38%]), bone disease (1364 women [42%] vs 512 men [19%]), lung disease (1245 women [38%] vs 259 men [10%]), diabetes (763 women [24%] vs 470 men [17%]), cardiovascular (493 women [15%] vs 407 men [15%]), kidney (444 women [14%] vs 404 men [15%]) disease, and cancer (219 women [7%] vs 321 men [12%]). In an unadjusted model, the estimated mean difference in comorbidity burden among women vs men was significantly greater in every age strata among PWH: age under 40 years, 0.33 (95% CI, 0.03-0.63); ages 40 to 49 years, 0.37 (95% CI, 0.12-0.61); ages 50 to 59 years, 0.38 (95% CI, 0.20-0.56); ages 60 to 69 years, 0.66 (95% CI, 0.42-0.90); ages 70 years and older, 0.62 (95% CI, 0.07-1.17). However, the difference between sexes varied by age strata among persons without HIV: age under 40 years, 0.52 (95% CI, 0.13 to 0.92); ages 40 to 49 years, -0.07 (95% CI, -0.45 to 0.31); ages 50 to 59 years, 0.88 (95% CI, 0.62 to 1.14); ages 60 to 69 years, 1.39 (95% CI, 1.06 to 1.72); ages 70 years and older, 0.33 (95% CI, -0.53 to 1.19) (P for interaction = .001). In the covariate-adjusted model, findings were slightly attenuated but retained statistical significance. Conclusions and Relevance In this cross-sectional study, the overall burden of aging-related comorbidities was higher in women vs men, particularly among PWH, and the distribution of comorbidity prevalence differed by sex. Comorbidity screening and prevention strategies tailored by HIV serostatus and sex or gender may be needed.
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Affiliation(s)
- Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - C. Christina Mehta
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - JaNae Holloway
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jordan E. Lake
- Department of Medicine, University of Texas Health Sciences Center, Houston
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth F. Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susanna Naggie
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, DC
| | - Audrey L. French
- Division of Infectious Diseases, CORE Center, Stroger Hospital of Cook County, Chicago, Illinois
| | - Adaora A. Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Margaret A. Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham
| | - Susan L. Koletar
- Division of Infectious Diseases, The Ohio State University Medical Center, Columbus
| | - Phyllis C. Tien
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco
- Medical Service, Department of Veterans Affairs, San Francisco, California
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
| | - Anandi N. Sheth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
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Sarkar S, Brown TT. CROI 2023: Metabolic and Other Complications of HIV Infection. Top Antivir Med 2023; 31:538-542. [PMID: 37704199 PMCID: PMC10424764] [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] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Comorbid conditions have major impacts on the health, quality of life, and survival of people with HIV, particularly as they age. The 2023 Conference on Retroviruses and Opportunistic Infections (CROI) featured excellent science related to specific comorbidities, such as cardiovascular disease (CVD), cancer, and obesity. Studies investigating factors that may contribute to CVD, such as mental health disorders, antiretroviral therapies, and activation of hormonal pathways, were featured prominently. Other studies sought to understand the epidemiology of non-AIDS-defining cancers in people with HIV. As at previous CROI conferences, weight gain attributable to antiretroviral therapies was a major theme, and several abstracts focused on the important question of whether weight decreases after discontinuation of antiretroviral therapy (ART) regimens associated with weight gain. This review focuses on abstracts presented at CROI 2023 in these areas, highlighting those with the most clinical impact.
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Masters MC, Granche J, Yang J, Overton ET, Letendre S, Koletar SL, Rubin LH, Brown TT, Tassiopoulos K, Erlandson KM, Palella F. Association Between Metformin Use and Cognitive and Physical Function in Persons with HIV and Diabetes. AIDS Res Hum Retroviruses 2023; 39:302-309. [PMID: 36792952 PMCID: PMC10278023 DOI: 10.1089/aid.2022.0129] [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] [Indexed: 02/17/2023] Open
Abstract
Older persons with HIV (PWH) experience high rates of cognitive impairment and frailty, and accelerated decline in physical function compared with the general population. Metformin use has been associated with beneficial effects on cognitive and physical function among older adults without HIV. The relationship between metformin use on these outcomes in PWH has not been evaluated. AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH with annual assessments for cognition and frailty, including measures of physical function (e.g., gait speed and grip strength). Participants with diabetes who were prescribed antihyperglycemic medications were included in this analysis to evaluate the association between metformin and functional outcomes. Cross-sectional, longitudinal, and time-to-event models were used to evaluate the relationship between metformin exposure with cognitive, physical function, and frailty outcomes. Ninety-eight PWH met inclusion criteria and were included in at least one model. No significant associations between metformin use, frailty, physical, or cognitive function were noted in unadjusted or adjusted cross-sectional, longitudinal, or time-to-event models (p > .1 for all models). This study is the first to examine the association between metformin use on functional outcomes among older PWH. Although it did not ascertain significant associations between metformin use and functional outcomes, our small sample size, restriction to persons with diabetes, and lack of randomization to metformin therapy were limitations. Larger randomized studies are needed to determine whether metformin use has beneficial effects on cognitive or physical function in PWH. Clinical Trial Registration numbers: 02570672, 04221750, 00620191, and 03733132.
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Affiliation(s)
- Mary Clare Masters
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Janeway Granche
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jingyan Yang
- Institute for Social and Economic Research and Policy, Columbia University, New York, New York, USA
| | - Edgar T. Overton
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Scott Letendre
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Susan L. Koletar
- Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University, Maryland, USA
| | - Katherine Tassiopoulos
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Frank Palella
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Castillo-Mancilla JR, Morrow M, Hunt PW, Schnittman SR, Phillips AN, Baker JV, Haberer JE, Janeiro MJ, Aragao F, Cohen C, Musinguzi N, Brown TT, Cavassini M, Glass TR, Serrano-Villar S, Mawhinney S, Siedner M. Beyond Undetectable: Modeling the Clinical Benefit of Improved Antiretroviral Adherence in Persons With Human Immunodeficiency Virus With Virologic Suppression. Open Forum Infect Dis 2023; 10:ofad230. [PMID: 37213424 PMCID: PMC10199113 DOI: 10.1093/ofid/ofad230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023] Open
Abstract
Background Incomplete antiretroviral therapy (ART) adherence has been linked to deleterious immunologic, inflammatory, and clinical consequences, even among virally suppressed (<50 copies/mL) persons with human immunodeficiency virus (PWH). The impact of improving adherence in the risk of severe non-AIDS events (SNAEs) and death in this population is unknown. Methods We estimated the reduction in the risk of SNAEs or death resulting from an increase in ART adherence by (1) applying existing data on the association between adherence with high residual inflammation/coagulopathy in virally suppressed PWH, and (2) using a Cox proportional hazards model derived from changes in plasma interleukin 6 (IL-6) and D-dimer from 3 randomized clinical trials. Comparatively, assuming 100% ART adherence in a PWH who achieves viral suppression, we estimated the number of persons in whom a decrease in adherence to <100% would need to be observed for an additional SNAE or death event to occur during 3- and 5-year follow-up. Results Increasing ART adherence to 100% in PWH who are suppressed on ART despite imperfect adherence translated into a 6%-37% reduction in the risk of SNAEs or death. Comparatively, based on an anticipated 12% increase in IL-6, 254 and 165 PWH would need to decrease their adherence from 100% to <100% for an additional event to occur over 3- and 5-year follow-up, respectively. Conclusions Modest gains in ART adherence could have clinical benefits beyond virologic suppression. Increasing ART adherence (eg, via an intervention or switch to long-acting ART) in PWH who remain virally suppressed despite incomplete adherence should be evaluated.
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Affiliation(s)
- Jose R Castillo-Mancilla
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Morrow
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Peter W Hunt
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
| | - Samuel R Schnittman
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew N Phillips
- Institute of Global Health, University College London, London, United Kingdom
| | - Jason V Baker
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- Division of Infectious Diseases, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jessica E Haberer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Filipa Aragao
- Incremental Action, Lisbon, Portugal
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Cal Cohen
- Medical Affairs, Gilead Sciences, Foster City, California, USA
| | - Nicholas Musinguzi
- Department of Medicine, Mbarara University of Science and Technology–Massachusetts General Hospital Global Health Collaborative, Mbarara, Uganda
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tracy R Glass
- Department of Medicine, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, and Centro de Investigación Biomédica en Red Enfermedades Infecciosas, Madrid, Spain
| | - Samantha Mawhinney
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Mark Siedner
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
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Lake JE, Hyatt AN, Feng H, Debroy P, Kettelhut A, Miao H, Peng L, Bhasin S, Bell S, Rianon N, Brown TT, Funderburg NT. A Randomized Clinical Trial of Transgender Women Switching to B/F/TAF: The (mo)BETTA Trial. Open Forum Infect Dis 2023; 10:ofad178. [PMID: 37096146 PMCID: PMC10122488 DOI: 10.1093/ofid/ofad178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Abstract
Background
Cardiometabolic disease in transgender women (TW) is affected by gender-affirming hormonal therapies (GAHT), HIV, and antiretroviral therapy (ART). We evaluated the 48-week safety/tolerability of switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) vs continued ART in TW on GAHT.
Methods
TW on GAHT and suppressive ART were randomized 1:1 to switch to B/F/TAF (Arm A) or continue current ART (Arm B). Cardiometabolic biomarkers, sex hormones, bone mineral density (BMD) and lean/fat mass by DXA scan, and hepatic fat (controlled continuation parameter, CAP) were measured. Wilcoxon rank-sum/signed rank and χ2 tests compared continuous and categorical variables.
Results
TW (Arm A n=12, Arm B n=9) had median age 45 years. 95% were non-white; 70% elvitegravir or dolutegravir, 57% TAF, 24% abacavir, and 19% TDF; 29% had hypertension, 5% diabetes, and 62% dyslipidemia. There were no adverse events. Arm A/B had 91%/89% undetectable HIV-1 RNA at week 48 (w48). Baseline (BL) osteopenia (Arm A/B 42%/25%) and osteoporosis (17%/13%) were common, without significant changes. BL lean/fat mass were similar. At w48, Arm A had stable lean mass but increased limb (3lbs) and trunk (3lbs) fat (within-arm p<0.05); fat in Arm B remained stable. No changes occurred in lipid or glucose profiles. Arm B had a greater w48 decrease (-25 vs -3 dB/m, p=0.03) in CAP. BL and w48 concentrations of all biomarkers were similar.
Conclusions
In this cohort of TW, switch to B/F/TAF was safe and metabolically neutral, though greater fat gain occurred on B/F/TAF. Further study is needed to better understand cardiometabolic disease burden in TW with HIV.
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Affiliation(s)
- Jordan E Lake
- Department of Medicine, UTHealth Houston , Houston, TX USA
| | - Ana N Hyatt
- Department of Medicine, UTHealth Houston , Houston, TX USA
| | - Han Feng
- Department of Biostatistics and Data Science, UTHealth School of Public Health , Houston, TX USA
| | - Paula Debroy
- Department of Medicine, UTHealth Houston , Houston, TX USA
| | - Aaren Kettelhut
- Division of Medical Laboratory Science, The Ohio State University , Columbus, OH USA
| | - Hongyu Miao
- Department of Biostatistics and Data Science, UTHealth School of Public Health , Houston, TX USA
| | - Liming Peng
- Department of Medicine, Brigham and Women's Hospital , Boston, MA USA
| | - Shalender Bhasin
- Department of Medicine, Brigham and Women's Hospital , Boston, MA USA
| | - Susan Bell
- Department of Medicine, UTHealth Houston , Houston, TX USA
| | - Nahid Rianon
- Department of Medicine, UTHealth Houston , Houston, TX USA
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University , Baltimore, MD USA
| | - Nicholas T Funderburg
- Division of Medical Laboratory Science, The Ohio State University , Columbus, OH USA
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Dalli J, Kitch D, O'Brien MP, Hunt PW, Funderburg N, Moisi D, Gupta A, Brown TT, Tien PC, Aberg JA, Shivakoti R. Pro-inflammatory and pro-resolving lipid mediators of inflammation in HIV: effect of aspirin intervention. EBioMedicine 2023; 89:104468. [PMID: 36791659 PMCID: PMC10025757 DOI: 10.1016/j.ebiom.2023.104468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/01/2022] [Revised: 12/25/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Persons with HIV (PWH) have an increased risk of cardiovascular disease (CVD) compared to HIV-seronegative individuals (SN). Inflammation contributes to this risk but the role of lipid mediators, with central roles in inflammation, in HIV infection remain to be established; further aspirin reduces CVD risk in the general population through production of some of these anti-inflammatory lipid mediators, but they have not been studied in PWH. METHODS We evaluated the relationship between plasma lipid mediators (i.e. 50 lipid mediators including classic eicosanoids and specialized pro-resolving mediators (SPMs)) and HIV status; and the impact of aspirin in PWH on regulating these autacoids. Plasma samples were obtained from 110 PWH receiving antiretroviral therapy (ART) from a randomized trial of aspirin (ACTG-A5331) and 107 matched SN samples (MACS-WIHS Combined Cohort). FINDINGS PWH had lower levels of arachidonic acid-derived pro-inflammatory prostaglandins (PGs: PGE2 and PGD2) and thromboxanes (Tx: TxB2), and higher levels of select pro-resolving lipid mediators (e.g. RvD4 and MaR2n-3 DPA) compared to SN. At the interval tested, aspirin intervention was observed to reduced PGs and Tx, and while we did not observe an increase in aspirin triggered mediators, we observed the upregulation of other SPM in aspirin treated PWH, namely MaR2n-3 DPA. INTERPRETATION Together these observations demonstrate that plasma lipid mediators profiles, some with links to systemic inflammation and CVD risk, become altered in PWH. Furthermore, aspirin intervention did not increase levels of aspirin-triggered pro-resolving lipid mediators, consistent with other reports of an impaired aspirin response in PWH. FUNDING NIH.
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Affiliation(s)
- Jesmond Dalli
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Center for Inflammation and Therapeutic Innovation, Queen Mary University of London, London, UK
| | - Douglas Kitch
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Peter W Hunt
- Department of Medicine, University of California, San Francisco School of Medicine, USA and Department of Veterans Affairs Medical Center, San Francisco, USA
| | - Nicholas Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, USA
| | - Daniela Moisi
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, USA
| | - Amita Gupta
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Todd T Brown
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco School of Medicine, USA and Department of Veterans Affairs Medical Center, San Francisco, USA
| | - Judith A Aberg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rupak Shivakoti
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
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Punjabi NM, Brown TT, Aurora RN, Patel SR, Stosor V, Hyong-Jin Cho J, D'Souza G, Margolick JB. Prevalence and Predictors of Sleep-Disordered Breathing in Men Participating in the Multicenter AIDS Cohort Study. Chest 2023; 163:687-696. [PMID: 36343689 PMCID: PMC9993338 DOI: 10.1016/j.chest.2022.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/24/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Data on the prevalence of sleep-disordered breathing (SDB) in people with HIV are limited. Moreover, whether the associations between SDB and age or BMI differ by HIV status is unknown. RESEARCH QUESTION Is SDB more prevalent in men with HIV than those without HIV, and do the predictors of SDB differ between the two groups? STUDY DESIGN AND METHODS Home polysomnography was used in the Multicenter AIDS Cohort Study to assess SDB prevalence in men with (n = 466; 92% virologically suppressed) and without (n = 370) HIV. SDB was defined using the oxygen desaturation index (ODI) and the apnea-hypopnea index (AHI), using four definitions: ≥ 5 events/h based on an ODI with a 3% (ODI3) or 4% (ODI4) oxygen desaturation, or an AHI with a 3% oxygen desaturation or EEG arousal (AHI3a) or with a 4% oxygen desaturation (AHI4). RESULTS SDB prevalence was similar in men with and without HIV using the ODI3 and AHI3a definitions. However, SDB prevalence was higher in men with than without HIV using the ODI4 (55.9% vs 47.8%; P = .04) and the AHI4 definitions (57.9% vs 50.4%; P = .06). Mild and moderate SDB were more common in men with than without HIV. Associations between SDB prevalence and age, race, and BMI were similar in men with and without HIV. Among men with HIV, viral load, CD4 cell count, and use of antiretroviral medications were not associated with SDB prevalence. INTERPRETATION SDB prevalence was high overall but greater in men with than without HIV using the ODI4 threshold definition. Efforts to diagnose SDB are warranted in people with HIV, given that SDB is associated with daytime sleepiness and impaired quality of life.
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Affiliation(s)
| | - Todd T Brown
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - R Nisha Aurora
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Sanjay R Patel
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Joshua Hyong-Jin Cho
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Gypsyamber D'Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Joseph B Margolick
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Abdo M, Kunisaki KM, Morris A, Stosor V, Chang D, D'Souza G, Crothers K, Abdel-Maksoud M, DiGuiseppi C, Brown TT, MaWhinney S, Erlandson KM. Pulmonary and physical function limitations in aging men with and without HIV from the Multicenter AIDS Cohort Study (MACS). Ann Epidemiol 2022; 76:50-60. [PMID: 36244514 PMCID: PMC9881119 DOI: 10.1016/j.annepidem.2022.10.005] [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: 02/03/2022] [Revised: 09/27/2022] [Accepted: 10/06/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE We examined the associations between pulmonary impairments and physical function and whether age, HIV serostatus, or smoking modified these relationships. METHODS Using Multicenter AIDS Cohort Study data, we examined associations between pulmonary function (diffusing capacity for carbon monoxide [DLCO], one-second forced expiratory volume [FEV1]) and subsequent physical outcomes (gait speed, grip strength, frailty [non-frail, pre-frail, frail]) using mixed models. RESULTS Of 1,048 men, 55% were living with HIV, median age was 57(IQR=48,64) and median cumulative pack-years was 1.2(IQR = 0,18.1); 33% and 13% had impaired DLCO and FEV1(<80% predicted), respectively. Participants with impaired DLCO had 3.5 kg (95%CI: -4.6, -2.4) weaker grip strength, 0.04 m/sec (95%CI: -0.06, -0.02) slower gait speed and 4.44-fold (95%CI: 1.81, 10.93) greater odds of frailty compared to participants with normal DLCO. Participants with impaired FEV1 had 3.1 kg (95%CI: -4.8, -1.4) weaker grip strength, similar gait speed (-0.001 m/sec [95%CI: -0.04, 0.03]) and 5.72-fold (95%CI: 1.90, 17.19) greater odds of frailty compared to participants with normal FEV1. Age, but not smoking or HIV, significantly modified the DLCO effect on gait speed and grip strength. CONCLUSIONS Pulmonary impairment and decreased physical function were associated. Preserving pulmonary function may help preserve physical function in aging men with and without HIV.
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Affiliation(s)
- Mona Abdo
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Ken M Kunisaki
- Minneapolis Veterans Affairs Health Care System, Pulmonary Section, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dong Chang
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, California
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kristina Crothers
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound and University of Washington, Seattle, WA
| | - Madiha Abdel-Maksoud
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD
| | - Samantha MaWhinney
- Department of Biostatistics, Colorado School of Public Health, Aurora, CO
| | - Kristine M Erlandson
- Division of Infectious Disease, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO.
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Jung I, Tu-Sekine B, Jin S, Anokye-Danso F, Ahima RS, Brown TT, Kim SF. Dolutegravir Suppresses Thermogenesis via Disrupting Uncoupling Protein 1 Expression and Mitochondrial Function in Brown/Beige Adipocytes in Preclinical Models. J Infect Dis 2022; 226:1626-1636. [PMID: 35512127 DOI: 10.1093/infdis/jiac175] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 01/18/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) containing integrase strand transfer inhibitors (INSTIs) has been associated with weight gain in both ART initiation and switch studies, especially in women, but the underlying mechanisms are unclear. METHODS The effects of dolutegravir (DTG) on food intake, energy expenditure, oxygen consumption in female mice, and gene expression from adipose tissues were assessed. Human and murine preadipocytes were treated with DTG either during differentiation into mature brown/beige adipocytes or postdifferentiation. Lipid accumulation, lipolysis, β-adrenergic response, adipogenic markers, mitochondrial respiration, and insulin response were analyzed. RESULTS Two-week administration of DTG to female mice reduced energy expenditure, which was accompanied by decreased uncoupling protein 1 (UCP1) expression in brown/beige adipose tissues. In vitro studies showed that DTG significantly reduced brown adipogenic markers, especially UCP1 in brown and beige adipocytes, whereas drugs from other classes did not. Furthermore, a loss of UCP1 by DTG led to a decrease in mitochondrial complex IV component, followed by a reduction in mitochondrial respiratory capacity and reduced insulin-stimulated glucose uptake. CONCLUSIONS Our findings show that DTG targets UCP1 and mitochondrial functions in brown and beige adipocytes and disrupts thermogenic functions in preclinical models, providing the potential mechanisms by which DTG suppresses energy expenditure leading to weight gain.
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Affiliation(s)
- IkRak Jung
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Becky Tu-Sekine
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sunghee Jin
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Frederick Anokye-Danso
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rexford S Ahima
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sangwon F Kim
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
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26
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Lake JE, Wang R, Barrett BW, Bowman E, Hyatt AN, Debroy P, Candelario J, Teplin L, Bodnar K, McKay H, Plankey M, Brown TT, Funderburg N, Currier JS. Trans women have worse cardiovascular biomarker profiles than cisgender men independent of hormone use and HIV serostatus. AIDS 2022; 36:1801-1809. [PMID: 35950945 PMCID: PMC9529791 DOI: 10.1097/qad.0000000000003346] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Feminizing hormonal therapy (FHT) and HIV potentially alter cardiovascular disease (CVD) risk in transgender women (TW). METHODS TW were enrolled in Los Angeles, California and Houston, Texas and frequency-matched to Multicenter AIDS Cohort Study cisgender men (CM) on age, race, substance use, and abacavir use. Biomarkers of CVD risk and inflammation were assessed via ELISA. Wilcoxon rank sum and Fisher's exact tests compared TW and CM. Multivariable linear regression assessed factors associated with biomarker concentrations. RESULTS TW (HIV+ n = 75, HIV- n = 47) and CM (HIV+ n = 40, HIV- n = 40) had mean age 43-45 years; TW/CM were 90%/91% non-Hispanic Black, Hispanic, or Multiracial, 26%/53% obese, and 34%/24% current smokers; 67% of TW were on FHT. Among people with HIV (PWH), TW had higher median extracellular newly-identified receptor for advanced glycation end-products (EN-RAGE), lipoprotein-associated phospholipase A2 (LpPLA2), oxidized low-density lipoprotein (oxLDL), soluble tumor necrosis factor receptor type (sTNFR) I/II, interleukin (IL)-8 and plasminogen activator inhibitor (PAI)-1, but lower soluble CD14, von Willebrand factor (vWF) and endothelin (ET)-1 levels than CM. Findings were similar for participants without HIV (all P < 0.05). In multivariable analysis, TW had higher EN-RAGE, IL-6, IL-8, P selectin, PAI-1, oxLDL and sTNFRI/II concentrations, and lower vWF, independent of HIV serostatus and current FHT use. Both being a TW and a PWH were associated with lower ET-1. CONCLUSIONS Compared to matched cisgender men, trans women have altered profiles of biomarkers associated with systemic inflammation and CVD. Further work is needed to decipher the contributions of FHT to CVD risk in TW with HIV.
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Affiliation(s)
- Jordan E Lake
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Ruibin Wang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Ana N Hyatt
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Paula Debroy
- University of Texas Health Science Center at Houston, Houston, Texas
| | | | | | | | - Heather McKay
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Todd T Brown
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Judith S Currier
- University of California Los Angeles, Los Angeles, California, USA
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Sarkar S, Brown TT. CROI 2022: metabolic and other complications of HIV infection or COVID-19. Top Antivir Med 2022; 30:522-527. [PMID: 36347058 PMCID: PMC9473897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Comorbid conditions have a major impact on the health, quality of life, and survival of people with HIV, particularly as this population ages. The 2022 Conference on Retroviruses and Opportunistic Infections (CROI) featured excellent science related to specific comorbidities, such as cardiovascular disease, type 2 diabetes, cancer, and frailty. The role of systemic inflammation in the pathogenesis of cardiovascular disease was an important theme, with strong evidence regarding the impact of microbial translocation. Other studies examined functional impairment, frailty, and potential important contributors, such as concomitant medications and sleep disturbances. The ANCHOR (Anal Cancer/High-grade Squamous Intraepithelial Lesions Outcomes Research) study provided crucial evidence that treatment of high-risk anal lesions reduces the incidence of anal cancer, which has important implications in the prevention of this devastating comorbidity. In addition, numerous presentations demonstrated the importance of comorbid conditions in COVID-19 outcomes in people with HIV and described persistent symptoms after acute SARS-CoV-2 infection has resolved. This review focuses on the abstracts presented at CROI 2022 in these areas, highlighting those with the most clinical impact.
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Affiliation(s)
| | - Todd T. Brown
- Send correspondence to Todd T. Brown, MD, PhD, Professor of Medicine and Epidemiology, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, 1830 East Monument Street, Suite 333, Baltimore, MD, 21287, or email
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28
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Erlandson KM, Fitch KV, McCallum SA, Ribaudo HJ, Overton ET, Zanni MV, Bloomfield GS, Brown TT, Fichtenbaum CJ, Bares S, Aberg JA, Douglas PS, Fulda ES, Santana-Bagur JL, Castro JG, Moran LE, Mave V, Supparatpinyo K, Ponatshego PL, Schechter M, Grinspoon SK. Geographical Differences in the Self-Reported Functional Impairment of People With Human Immunodeficiency Virus (HIV) and Associations With Cardiometabolic Risk. Clin Infect Dis 2022; 75:1154-1163. [PMID: 35165682 PMCID: PMC9525090 DOI: 10.1093/cid/ciac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/10/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We sought to explore multinational differences in functional status by global burden of disease (GBD) regions in the REPRIEVE cohort. METHODS REPRIEVE is a prospective, double-blind, randomized, placebo-controlled, multicenter, phase III primary cardiovascular prevention study of pitavastatin calcium vs placebo among people with human immunodeficiency virus (HIV, PWH) ages 40-75 on antiretroviral therapy (ART). GBD super regions were defined using World Health Organization classifications. Participants were categorized by impairment on the Duke Activity Status Instrument (DASI: none, some, moderate, severe). Logistic regression models examined risk factors and GBD regions associated with functional impairment. The association between functional impairment and cardiometabolic risk was also explored. RESULTS Of 7736 participants, the majority were from high-income countries (n = 4065), were male (65%), and had received ART for ≥ 10 years. The median DASI score was 58.2 (interquartile range [IQR] 50.2, 58.2); 36% reported at least some impairment. In adjusted analyses, functional impairment was significantly more frequent among participants from Southeast/East Asia. Other factors associated with greater impairment included female sex, Black race, older age, current/former smoking, higher body mass index, use of ART for ≥ 10 years, and select ART regimens; differences were seen in risks across GBD regions. Functional impairment was associated with increased cardiometabolic risk. CONCLUSIONS Over 1/3 of middle-aged and older PWH in a global cohort across diverse GBD regions demonstrate functional impairments. The associations between DASI and cardiometabolic risk suggest that a measure of functional status may improve risk prediction; these longitudinal associations will be further investigated over REPRIEVE trial follow-up.
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Affiliation(s)
| | - Kathleen V Fitch
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sara A McCallum
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Edgar T Overton
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Markella V Zanni
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Todd T Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sara Bares
- Specialty Care Center, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Judith A Aberg
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Evelynne S Fulda
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jose G Castro
- University of Miami Infectious Disease Research Unit At Jackson Memorial Hospital, Miami, Florida, USA
| | - Laura E Moran
- Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Medical College, Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | - Ponego L Ponatshego
- Gaborone Prevention/Treatment Trials, Princess Marina Hospital, Gaborone, Botswana
| | - Mauro Schechter
- Projeto Praça Onze Pesquisa Em Saúde, Cidade Nova, Rio de Janeiro, Brazil
| | - Steven K Grinspoon
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Peterson TE, Landon C, Haberlen SA, Bhondoekhan F, Plankey MW, Palella FJ, Piggott DA, Margolick JB, Brown TT, Post WS, Wu KC. Circulating biomarker correlates of left atrial size and myocardial extracellular volume fraction among persons living with and without HIV. BMC Cardiovasc Disord 2022; 22:393. [PMID: 36057773 PMCID: PMC9441072 DOI: 10.1186/s12872-022-02835-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Infection with human immunodeficiency virus (HIV) is associated with higher risk for myocardial disease despite modern combination antiretroviral therapy (cART). Factors contributing to this excess risk, however, remain poorly characterized. We aimed to assess cross-sectional relationships between elevations of left atrial volume index (LAVI) and myocardial extracellular volume (ECV) fraction that have been reported in persons living with HIV and levels of circulating biomarkers of inflammation, fibrosis, and myocyte stretch among persons living with and without HIV (PLWH, PLWOH). METHODS Participants from three cohorts of PLWH and PLWOH underwent cardiovascular magnetic resonance imaging for measurement of LAVI and ECV. Levels of circulating proteins (IL-6, sCD14, galectin-3, NT-proBNP, GDF-15, TIMP-2, MMP-2, and hsTnI) were measured using immunoassays. Associations were assessed using logistic and linear regression, adjusting for demographics, substance use, and clinical characteristics. RESULTS Among 381 participants with and without HIV, median age (IQR) was 55.1 (51.2, 58.4) years, 28% were female, 69% were Black, and 46% were current smokers. Sixty-two percent were PLWH (n = 235), of whom 88% were receiving cART and 72% were virally suppressed. PLWH had higher levels of sCD14 (p = < 0.001), GDF-15 (p = < 0.001), and NT-proBNP (p = 0.03) compared to PLWOH, while levels of other biomarkers did not differ by HIV serostatus, including IL-6 (p = 0.84). Among PLWH, higher sCD14, GDF-15, and NT-proBNP were also associated with lower CD4 + cell count, and higher NT-proBNP was associated with detectable HIV viral load. NT-proBNP was associated with elevated LAVI (OR: 1.79 [95% CI: 1.31, 2.44]; p < 0.001) with no evidence of effect measure modification by HIV serostatus. Other associations between HIV-associated biomarkers and LAVI or ECV were small or imprecise. CONCLUSIONS Our findings suggest that elevated levels of sCD14, GDF-15, and NT-proBNP among PLWH compared to PLWOH observed in the current cART era may only minimally reflect HIV-associated elevations in LAVI and ECV. Future studies of excess risk of myocardial disease among contemporary cohorts of PLWH should investigate mechanisms other than those connoted by the studied biomarkers.
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Affiliation(s)
- Tess E. Peterson
- grid.21107.350000 0001 2171 9311Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Christian Landon
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Sabina A. Haberlen
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Fiona Bhondoekhan
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
| | - Michael W. Plankey
- grid.411667.30000 0001 2186 0438Department of Medicine, Georgetown University Medical Center, Washington, DC USA
| | - Frank J. Palella
- grid.16753.360000 0001 2299 3507Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Damani A. Piggott
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Joseph B. Margolick
- grid.21107.350000 0001 2171 9311Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Todd T. Brown
- grid.21107.350000 0001 2171 9311Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Wendy S. Post
- grid.21107.350000 0001 2171 9311Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Katherine C. Wu
- grid.21107.350000 0001 2171 9311Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
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30
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Kwapong YA, Sharma G, Shade JK, Piggott DA, Brown TT, Soleimanifard A, Wu KC, Hays AG. Effect of HIV Serostatus on ICU Admission and Mortality Among Hospitalized Patients With Coronavirus Disease 2019 (COVID-19). J Acquir Immune Defic Syndr 2022; 90:e13-e16. [PMID: 35486524 PMCID: PMC9283311 DOI: 10.1097/qai.0000000000003009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yaa A Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie K Shade
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (ADVANCE), Johns Hopkins University, Baltimore, MD
| | - Damani A Piggott
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Todd T Brown
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alborz Soleimanifard
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katherine C Wu
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison G Hays
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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31
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Dias JP, Carlson O, Schweitzer M, Shardell M, Clark JM, Brown TT, Egan JM, Lee CJ. GDF15 and Cortisol Response to Meal Tolerance Test in Post-Sleeve Gastrectomy Patients with Weight Regain. Obes Surg 2022; 32:2641-2648. [PMID: 35672598 PMCID: PMC9972254 DOI: 10.1007/s11695-022-06140-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hormonal factors behind weight regain (WR) after surgical weight loss remain inadequately understood. Growth/differentiation factor 15 (GDF15) has emerged as a potential therapeutic target in obesity treatment. Cortisol, another stress hormone, has also been associated with weight gain at both low and high circulating concentrations. We aimed to compare meal-stimulated GDF15 and cortisol response in adults with and without WR after sleeve gastrectomy (SG). We hypothesized that GDF15 and cortisol response to meal tolerance test (MTT) will be lower in those with versus without WR after SG. METHODS Cross-sectional study comprised 21 adults without diabetes, who underwent SG. WR was defined as 100 × (current weight - nadir)/(preoperative weight - nadir) > 10%. GDF15, cortisol, insulin, glucose, and incretins (total glucagon-like peptide (GLP)-1 and glucose-dependent insulinotropic polypeptide (GIP) circulating concentrations) were measured during MTT (0-240 min) after 3-6 years post-bariatric surgery. RESULTS All participants were 48% White, 85% female, with mean (SD) age: 43(10) years, and BMI: 36.2(7.6) kg/m2. Compared to the non-WR group (n = 6), the WR group (n = 15) had significantly higher BMI (WR: 38.6 ± 7.6 kg/m2, non-WR: 30.3 ± 3.5 kg/m2, p = 0.02) and showed lower GDF15 response (WR AUC vs non-WR AUC (116143 ± 13973 vs 185798 ± 38884 ng*min/L, p = 0.047)) and lower cortisol response (WR AUC vs non-WR AUC (3492 ± 210 vs 4880 ± 655 µg*min/dL, p = 0.015)). Incretin response did not differ between the groups. CONCLUSIONS GDF15 and cortisol responses to MTT were lower in those who regained the weight after SG compared to those who did not, suggesting that dysregulation in GDF15 and cortisol response following bariatric surgery.
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Affiliation(s)
- Jenny Pena Dias
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument St., Baltimore, MD, 21205, USA. .,National Institute of Aging, NIH, Baltimore, MD, USA.
| | - Olga Carlson
- National Institute of Aging, NIH, Baltimore, MD, USA
| | - Michael Schweitzer
- Department of Surgery, Johns Hopkins University School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
| | - Michelle Shardell
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Jeanne M. Clark
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA,Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA,Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Clare J. Lee
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
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Psomas CK, Hoover DR, Shi Q, Brown TT, Vance DE, Holman S, Plankey MW, Tien PC, Weber KM, Floris-Moore M, Bolivar HH, Golub ET, McDonnell Holstad M, Radtke KK, Tamraz B, Erlandson KM, Rubin LH, Sharma A. Polypharmacy Is Associated With Falls in Women With and Without HIV. J Acquir Immune Defic Syndr 2022; 90:351-359. [PMID: 35333216 PMCID: PMC9203977 DOI: 10.1097/qai.0000000000002955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/02/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aging in people with HIV is associated with increased risk of developing synergistic conditions such as neurocognitive impairment, polypharmacy, and falls. We assessed associations between polypharmacy (use of 5 or more non-ART medications), use of neurocognitive adverse effects (NCAE) medications, and odds of falls in women with HIV (WWH) and without HIV (HIV-). METHODS Self-reported falls and medication use data were contributed semiannually by 1872 (1315 WWH and 557 HIV-) Women's Interagency HIV Study participants between 2014 and 2016. Polypharmacy and NCAE medication use were evaluated separately and jointly in multivariable models to assess their independent contributions to single and multiple falls risk. RESULTS The proportion of women who reported any fall was similar by HIV status (19%). WWH reported both greater polypharmacy (51% vs. 41%; P < 0.001) and NCAE medication use (44% vs. 37%; P = 0.01) than HIV- women. Polypharmacy conferred elevated odds of single fall [adjusted odds ratio (aOR) 1.67, 95% CI: 1.36 to 2.06; P < 0.001] and multiple falls (aOR 2.31, 95% CI: 1.83 to 2.93; P < 0.001); the results for NCAE medications and falls were similar. Both polypharmacy and number of NCAE medications remained strongly and independently associated with falls in multivariable models adjusted for HIV serostatus, study site, sociodemographics, clinical characteristics, and substance use. CONCLUSIONS Polypharmacy and NCAE medication use were greater among WWH compared with HIV-, and both were independently and incrementally related to falls. Deprescribing and avoidance of medications with NCAEs may be an important consideration for reducing fall risk among WWH and sociodemographically similar women without HIV.
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Affiliation(s)
- Christina K Psomas
- Department of Infectious Diseases and Internal Medicine, European Hospital Marseille, Marseille, France
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ
| | - Qiuhu Shi
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY
| | - Todd T Brown
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - David E Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL
| | - Susan Holman
- Department of Medicine/STAR Program, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Phyllis C Tien
- Department of VA Medical Center, San Fransisco, CA
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Kathleen M Weber
- Department of Medicine, Cook County Health/CORE Center and Hektoen Institute of Medicine, Chicago, IL
| | | | - Hector H Bolivar
- Department of Medicine, University of Miami Health System, Miami, FL
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Kendra K Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
| | - Leah H Rubin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
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Abdo M, Wu X, Sharma A, Tassiopoulos KK, Brown TT, Koletar SL, Yin MT, Erlandson KM. Regional Differences in Risk of Recurrent Falls Among Older U.S. Women and Men with HIV in the HIV Infection, Aging, and Immune Function Long-Term Observational Study. AIDS Res Hum Retroviruses 2022; 38:530-537. [PMID: 35018800 PMCID: PMC9297325 DOI: 10.1089/aid.2021.0162] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Geographic location was a strong predictor of falls among women with and without HIV in the Women's Interagency HIV Study. We examined regional variation in falls in a more geographically diverse cohort of older people with HIV (PWH) and explored whether physical activity, sex, or body-mass index modified these associations. PWH enrolled in the A5322 HAILO (HIV Infection, Aging, and Immune Function Long-Term Observational Study). Participants who reported falls in the 6 months before each semiannual visit and had ≥1 consecutive pair of fall assessments were included. We examined associations of geographic region [Northeast, Midwest, South, and West] with recurrent falls (≥2) over each 12-month period using repeated measures multinomial logistic regression models and assessed effect modification by adding an interaction term between geographic region and each potential effect modifier. A total of 788 men and 192 women with median age of 51 years at study entry contributed up to 240 weeks of data. U.S. regions included Northeast (22%), Midwest (29%), South (20%), and West (28%). In multivariable analyses, compared with the Western region, greater risk was seen among Midwestern (odds ratio [OR] = 2.35 [95% confidence interval (CI) = 1.29-4.28]) and Southern regions (OR = 2.09 [95% CI = 1.09-4.01]). Among those with higher physical activity, the Midwestern region had higher odds of recurrent falls than the Western region. Among obese individuals, the Southern region had higher odds of recurrent falls than the Western region. Sex did not modify the association between region and recurrent falls. Among older PWH, fall risk varied by geographic region. Associations between geographic region and recurrent falls appeared to be modified by physical activity and obesity. This may help identify subgroups of older PWH for targeted fall screening/interventions.
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Affiliation(s)
- Mona Abdo
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Xingye Wu
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan L. Koletar
- Division of Infectious Diseases, Department of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Michael T. Yin
- Division of Infectious Diseases, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, School of Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.,Address correspondence to: Kristine M. Erlandson, Division of Infectious Diseases, School of Medicine, University of Colorado-Anschutz Medical Center, 12700 East 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA
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Chebrolu P, Sangle S, Nimkar S, Salvi S, Chavan A, Kulkarni V, Shere D, Deshpande P, Brown TT, Mathad JS, Marbaniang I, Mave V. Inflammatory profile associated with insulin resistance in non-overweight versus overweight people living with HIV in Pune, Western India. Diabetes Metab Syndr 2022; 16:102551. [PMID: 35777254 PMCID: PMC9912190 DOI: 10.1016/j.dsx.2022.102551] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND People living with HIV have greater diabetes (T2DM) than the general population despite lower prevalence of overweight/obesity. Both insulin resistance (IR), a T2DM precursor, and HIV are independently associated with chronic inflammation. Inflammation may be a pathophysiological link explaining IR in people living with HIV who are not overweight but is not well understood. AIMS To study the association between inflammation and IR in non-overweight and overweight people living with HIV. METHODS In a cohort of adult people living with HIV with undetectable viral load in Pune, India, we measured fasting insulin, glucose, and 9 inflammatory markers. IR was defined as HOMA-IR ≥2, and non-overweight as BMI ≤23 kg/m2. We used modified Poisson regression to evaluate the association between inflammatory markers and IR in overweight and non-overweight. RESULTS Of 288 participants, 66% (n = 189) were non-overweight. Among non-overweight, prevalence of IR was 34% (n = 65). Each doubling of MCP-1 and leptin was associated with IR on univariate analysis (prevalence ratio (PR) 1.29, 95%CI 1.07-1.53, p < 0.01; PR 1.13 95%CI 1.01-1.26, p = 0.03). Leptin remained associated with IR after adjustment for age, MCP-1, gender, cholesterol, and waist circumference (adjusted PR 1.20 95%CI 1.06-1.36, p < 0.01). Among overweight, prevalence of IR was 69% and no markers were associated with IR. CONCLUSIONS One in 3 non-overweight people living with HIV in India with controlled viremia have IR. Leptin was associated with IR among non-overweight people living with HIV and may provide insight into the pathophysiology of metabolic disease in this population.
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Affiliation(s)
- Puja Chebrolu
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
| | | | - Smita Nimkar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Sonali Salvi
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Vandana Kulkarni
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Dhananjay Shere
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Prasad Deshpande
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Todd T Brown
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jyoti S Mathad
- Department of Medicine and Obstetrics & Gynecology, Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Ivan Marbaniang
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India; Department of Epidemiology, McGill University, Montreal, QC, Canada
| | - Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
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Dias JP, Piggott DA, Sun J, Wehbeh L, Garza J, Abraham A, Astemborski J, Moseley KF, Basaria S, Varadhan R, Brown TT. SHBG, Bone Mineral Density, and Physical Function Among Injection Drug Users With and Without HIV and HCV. J Clin Endocrinol Metab 2022; 107:e2971-e2981. [PMID: 35293996 PMCID: PMC9202730 DOI: 10.1210/clinem/dgac144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Sex hormone-binding globulin (SHBG) is a glycoprotein that regulates the bioavailability of sex hormones and is higher in people with HIV (PWH) and hepatitis C virus (HCV). SHBG is associated with aging-related diseases, including osteoporosis and frailty in the general population. However, the relationship between SHBG concentration and bone mineral density (BMD) and physical function among PWH and HCV is unclear. OBJECTIVE This study aimed to evaluate the association between chronic infection with HIV and HCV and SHBG, and to assess the relationship of circulating SHBG concentrations with low BMD, physical function impairment, and frailty. METHODS A cross-sectional study was conducted of 278 HCV-exposed (HCV antibody positive) adults enrolled with and without HIV and HCV from the AIDS Linked to the IntraVenous Experience cohort study into 4 groups: HCV-/HIV-, HCV-/HIV+, HCV+/HIV-, and HCV+/HIV+. We evaluated the association between SHBG concentrations and grip strength, gait speed, Short Physical Performance Battery score, frailty (Fried Frailty Phenotype), and BMD (lumbar spine, total hip, and femoral neck T-score) by using adjusted multivariable regression stratified by sex. RESULTS SHBG concentrations were higher in women, in those with HIV RNA greater than 400 copies/mL (P = .02) and HCV RNA greater than 15 IU/mL (P < .001). In adjusted models, higher SHBG concentrations among women were statistically significantly associated with lower grip strength (-0.43 [95% CI, -0.77 to -0.081] kg/10 nmol/L, P < .05), higher odds of frailty (odds ratio, 1.49 [95% CI, 1.07 to 2.08], P < .05), and lower T-scores at the lumbar spine (-0.070 [95% CI, -0.15 to -0.001] SD/10 nmol/L T-score BMD, P < .05). Similar associations were not observed among men. CONCLUSION Higher SHBG concentrations are associated with the presence of HIV and HCV viremia. Among women, but not men, higher SHBG concentrations were associated with lower grip strength, higher odds of frailty, and lower lumbar spine BMD. The underlying mechanisms of these associations require further investigation.
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Affiliation(s)
- Jenny Pena Dias
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Damani A Piggott
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jing Sun
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Leen Wehbeh
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joshua Garza
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alison Abraham
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health; Department of Epidemiology, School of Public Health and Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Colorado, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kendall F Moseley
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shehzad Basaria
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ravi Varadhan
- Department of Oncology; Biostatistics and Bioinformatics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Todd T Brown
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Goerlich E, Schär M, Bagchi S, Soleimani-Fard A, Brown TT, Sarkar S, Bonanno G, Streeb V, Gerstenblith G, Barditch-Crovo P, Weiss RG, Hays AG. Coronary Endothelial Dysfunction in People Living With HIV Is Related to Body Fat Distribution. J Acquir Immune Defic Syndr 2022; 90:201-207. [PMID: 35131972 PMCID: PMC9203878 DOI: 10.1097/qai.0000000000002932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/07/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND People living with HIV (PLWH) on antiretroviral therapy (ART) are at increased risk of atherosclerotic disease. Abnormal adipose distribution is common in PLWH and may contribute to atherosclerosis. Because coronary artery endothelial function (CEF) is impaired in early atherosclerosis, predicts future cardiovascular events, and is reduced in PLWH, we investigated associations between body fat distribution and CEF in PLWH. SETTING Prospective cohort study. METHODS PLWH on stable ART underwent MRI to quantify CEF, measured as change in coronary cross-sectional area from rest to that during isometric handgrip exercise, an endothelial-dependent stressor. Abdominal visceral and subcutaneous fat area (axial L4 level) and liver fat fraction were quantified using MRI. Linear regression was used to determine associations between CEF and independent variables. RESULTS Among 84 PLWH (52 ± 11 years; 33% women), mean cross-sectional area change was 0.74 ± 11.7%, indicating impaired CEF. On univariable regression analysis, CEF was inversely related to waist circumference (R = -0.31, P = 0.014), hip circumference (R = -0.27, P = 0.037), and subcutaneous fat area (R = -0.25, P = 0.031). We did not observe significant relationships between CEF and liver fat fraction, waist/hip ratio, or visceral fat area. On multivariable regression adjusted for age, sex, and race, CEF was associated with waist circumference, hip circumference, subcutaneous fat, and liver fat fraction. CONCLUSION Waist and hip circumference and subcutaneous fat area are associated with impaired CEF, an established metric of abnormal vascular health in PLWH on stable ART, and may contribute to the increased rate of heart disease in this population.
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Affiliation(s)
- Erin Goerlich
- Division of Cardiology, Johns Hopkins University, Baltimore, MD
| | - Michael Schär
- Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - Shashwatee Bagchi
- Division of Infectious Disease and Institute of Human Virology, University of Maryland, Baltimore, MD; and
| | | | | | | | - Gabriele Bonanno
- Division of Cardiology, Johns Hopkins University, Baltimore, MD
- Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - Valerie Streeb
- Division of Cardiology, Johns Hopkins University, Baltimore, MD
| | | | | | - Robert G Weiss
- Division of Cardiology, Johns Hopkins University, Baltimore, MD
- Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - Allison G Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD
- Department of Radiology, Johns Hopkins University, Baltimore, MD
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Kiweewa Matovu F, Kiwanuka N, Nabwana M, Scholes D, Musoke P, Glenn Fowler M, Beksinska ME, Pettifor JM, Brown TT, Kiweewa FM, Nakabiito C, Nawagi F, Kamira B, Isingel E, Bule S, Kukundakwe V, Kateregga A, Musisi M(M, Namayanja PM, Mirembe D, Mbabali MS, Mulebeke S, Nabisere J, Nakakande J, Matovu N, Nakaye D, Wynne J, Mulumba F, Mukasa R, Ssewanyana M, Nabunya HK, Biira FA, Kyomukama E, Nampiira S, Zalwago A, Namuganga ML, Mwebaza D, Namuli PE, Tulina C, Kikonyogo FS, Nabatanzi RB, Muwawu R, Musisi JN, Saava MN, Najjemba MMK, Kaahwa W, Mukalazi RN, Takhuli MM, Sawsan O, Mugenyi M, Mugagga MA, Sserugo F, Namuddu A, Kemigisha D, Nakyeyune J, Nassozi CK, Asello J, Nakawungu ZZ, Kaboggoza OH, Ssebabi SB, Birungi B, Ssentogo RL, Mubiru MC, Nansamba W, Kalungi SN, Bukenya LE, Asiimwe P, Bazira JA, Katongole S, Nabwana M, Twinomujuni W, Nakacwa S, Baddokwaya JN, Elwana AM, Nanyonjo J, Adikini S, Nalwoga J, Rwanzogyera G, Okello F, Kiiza DK, Mayanja E, Katongole F, Kiwewa M, Onen F, Mutebo J, Mukasa D, Tamale J, Kibirige I, Nabwana M. Intramuscular depot medroxyprogesterone acetate accentuates bone loss associated with tenofovir disoproxil fumarate-containing antiretroviral therapy initiation in young women living with HIV (the BONE: CARE study): a prospective cohort study in Uganda. The Lancet Global Health 2022; 10:e694-e704. [PMID: 35427526 PMCID: PMC9449816 DOI: 10.1016/s2214-109x(22)00080-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 01/01/2023] Open
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Masters MC, Yang J, Lake JE, Abraham AG, Kingsley L, Brown TT, Palella FJ, Erlandson KM. Diabetes mellitus is associated with declines in physical function among men with and without HIV. AIDS 2022; 36:637-646. [PMID: 34999609 PMCID: PMC8957604 DOI: 10.1097/qad.0000000000003160] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the longitudinal relationships between abnormal glucose metabolism and physical function in persons with HIV (PWH) and without HIV. DESIGN Prospective cohort study of men with or at risk for HIV in four United States cities between 2006 and 2018. METHODS Men with or at risk for HIV from the Multicenter AIDS Cohort Study (MACS) had semi-annual assessments of glycemic status, grip strength, and gait speed. We used linear mixed models with random intercept to assess associations between glycemic status and physical function. Glycemic status was categorized as normal, impaired fasting glucose (IFG), controlled diabetes mellitus [hemoglobin A1C (HbA1C) <7.5%], or uncontrolled diabetes mellitus (HbA1C ≥ 7.5%). RESULTS Of 2240 men, 52% were PWH. Diabetes mellitus was similar among PWH (7.7%) vs. persons without HIV (6.7%, P = 0.36) at baseline. PWH had slower gait speed (1.17 vs. 1.20 m/s, P < 0.01) but similar grip strength (40.1 vs. 39.8 kg, P = 0.76) compared with persons without HIV at baseline. In multivariate models, gait speed decline was greater with controlled diabetes mellitus [-0.018 m/s (-0.032 to -0.005), P = 0.01] and grip strength decline was greater with controlled [-0.560 kg (-1.096 to -0.024), P = 0.04] and uncontrolled diabetes mellitus [-0.937 kg (-1.684 to -0.190), P = 0.01), regardless of HIV serostatus compared with normoglycemic individuals. DISCUSSION Abnormal glucose metabolism was associated with declines in gait speed and grip strength regardless of HIV serostatus. These data suggest that improvement in glucose control should be investigated as an intervenable target to prevent progression of physical function limitations among PWH.
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Affiliation(s)
- Mary C Masters
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jingyan Yang
- Department of Epidemiology, Mailman School of Public Heath, Columbia University, New York, New York
| | - Jordan E Lake
- Department of Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins University School of Medicine
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Frank J Palella
- Department of Medicine, Northwestern University, Chicago, Illinois
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Koethe JR, Moser C, Brown TT, Stein JH, Kelesidis T, Dube M, Currier J, McComsey GA. Adipokines, Weight Gain and Metabolic and Inflammatory Markers After Antiretroviral Therapy Initiation: AIDS Clinical Trials Group (ACTG) A5260s. Clin Infect Dis 2022; 74:857-864. [PMID: 34117756 PMCID: PMC8906713 DOI: 10.1093/cid/ciab542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/11/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The adipokines leptin and adiponectin, produced primarily by adipose tissue, have diverse endocrine and immunologic effects, and circulating levels reflect adipocyte lipid content, local inflammation, and tissue composition. We assessed relationships between changes in regional fat depots, leptin and adiponectin levels, and metabolic and inflammatory markers over 96 weeks in the AIDS Clinical Trials Group (ACTG) A5260s metabolic substudy of the A5257 randomized trial of tenofovir disoproxil fumarate/emtricitabine plus atazanavir/ritonavir, darunavir/ritonavir, or raltegravir among treatment-naive persons with human immunodeficiency virus (PWH). METHODS Fat depots were measured using dual-energy absorptiometry and abdominal computed tomographic imaging at treatment initiation and 96 weeks later. Serum leptin and adiponectin, homeostatic model assessment of insulin resistance (HOMA-IR), and high-sensitivity C-reactive protein (hsCRP) were measured at the same timepoints. Multivariable regression models assessed relationships between fat depots, adipokines, HOMA-IR, and hsCRP at week 96. RESULTS Two hundred thirty-four participants maintained viral suppression through 96 weeks (90% male, 29% black, median age 36 years). Serum leptin increased over 96 weeks (mean change 22%) while adiponectin did not (mean change 1%), which did not differ by study arm. Greater trunk, limb, and abdominal subcutaneous and visceral fat were associated with higher HOMA-IR and hsCRP at 96 weeks, but serum leptin level was a stronger determinant of these endpoints using a mediation model approach. A similar mediating effect was not observed for adiponectin. CONCLUSIONS Higher circulating leptin is associated with greater HOMA-IR and hsCRP independent of fat depot size, suggesting that greater adipocyte lipid content may contribute to impaired glucose tolerance and systemic inflammation among PWH starting antiretroviral therapy.
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Affiliation(s)
- John R Koethe
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlee Moser
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Todd T Brown
- Johns Hopkins University, Baltimore, Maryland, USA
| | - James H Stein
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Michael Dube
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Judith Currier
- University of California, Los Angeles, Los Angeles, California, USA
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Shaikh K, Bhondoekhan F, Haberlen S, Nakanishi R, Roy SK, Alla VM, Brown TT, Lee J, Osawa K, Almeida S, Rahmani S, Nezarat N, Sheidaee N, Kim M, Jayawardena E, Kim N, Hathiramani N, Palella FJ, Witt M, Ahmad K, Kingsley L, Post WS, Budoff MJ. Coronary artery plaque progression and cardiovascular risk scores in men with and without HIV-infection. AIDS 2022; 36:215-224. [PMID: 34608042 PMCID: PMC8702479 DOI: 10.1097/qad.0000000000003093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to assess the association of cardiovascular disease (CVD) risk scores and coronary artery plaque (CAP) progression in HIV-infected participants. METHODS We studied men with and without HIV-infection enrolled in the Multicenter AIDS Cohort Study (MACS) CVD study. CAP at baseline and follow-up was assessed with cardiac computed tomography angiography (CCTA). We examined the association between baseline risk scores including pooled cohort equation (PCE), Framingham risk score (FRS), and Data collect of Adverse effects of anti-HIV drugs equation (D:A:D) and CAP progression. RESULTS We studied 495 men (211 HIV-uninfected, 284 HIV-infected). The adjusted odds ratio (aOR) of total plaque volume (TPV) and noncalcified plaque volume (NCPV) progression in the highest relative to lowest tertile was 9.4 [95% confidence interval (95% CI) 2.4-12.1, P < 0.001)] and 7.7 (95% CI 3.1-19.1, P < 0.001) times greater, respectively, among HIV-uninfected men in the PCE atherosclerotic cardiovascular disease (ASCVD) high vs. low-risk category. Among HIV-infected men, the association for TPV and NCPV progression for the same PCE risk categories, odds ratio (OR) 2.8 (95% CI 1.4-5.8, P < 0.01) and OR 2.4 (95% CI 1.2-4.8, P < 0.05), respectively (P values for interaction by HIV = 0.02 and 0.08, respectively). Similar results were seen for the FRS risk scores. Among HIV-uninfected men, PCE high risk category identified the highest proportion of men with plaque progression in the highest tertile, although in HIV-infected men, high-risk category by D:A:D identified the greatest percentage of men with plaque progression albeit with lower specificity than FRS and PCE. CONCLUSION PCE and FRS categories predict CAP progression better in HIV-uninfected than in HIV-infected men. Improved CVD risk scores are needed to identify high-risk HIV-infected men for more aggressive CVD risk prevention strategies.
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Affiliation(s)
- Kashif Shaikh
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
- Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska
| | - Fiona Bhondoekhan
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Rine Nakanishi
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Sion K Roy
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Venkata M Alla
- Division of Cardiology, Creighton University Medical Center, Omaha, Nebraska
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Juhwan Lee
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Kazuhiro Osawa
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Shone Almeida
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Sina Rahmani
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Negin Nezarat
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Nasim Sheidaee
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Michael Kim
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Eranthi Jayawardena
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Nicolas Kim
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Nicolai Hathiramani
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Frank J. Palella
- Feinberg School of Medicine, Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Mallory Witt
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Khadije Ahmad
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Wendy S. Post
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew J. Budoff
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, California
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Coburn SB, Dionne-Odom J, Alcaide ML, Moran CA, Rahangdale L, Golub ET, Massad LS, Seidman D, Michel KG, Minkoff H, Murphy K, Brown TT, Visvanathan K, Lau B, Althoff KN. The Association Between HIV Status, Estradiol, and Sex Hormone Binding Globulin Among Premenopausal Women in the Women's Interagency HIV Study. J Womens Health (Larchmt) 2022; 31:183-193. [PMID: 35041528 PMCID: PMC8864429 DOI: 10.1089/jwh.2021.0276] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Characterizing estradiol among women with HIV may have implications for breast cancer and cardiovascular disease risk but has not been adequately explored. We quantified differences in total (E2), free (FE2) estradiol, and sex hormone binding globulin (SHBG) by HIV and viral suppression status. Methods: Women from a substudy (2003-2006) within the Women's Interagency HIV Study (IRB approved at each participating site) were included if they reported: a period in the last six months, were not pregnant/breastfeeding, no oophorectomy, and no exogenous hormone use in the prior year. Serum was collected on days 2-4 of the menstrual cycle. We assessed differences in biomarkers at 25th, 50th, and 75th percentiles by HIV and viral suppression status using weighted quantile regression. Results: Among 643 women (68% with HIV) median age was 37 years. All E2 percentiles were significantly (p < 0.05) lower in women with suppressed viral load versus women without HIV (4-10 pg/mL). The 25th and 50th percentile of E2 were 4-5 pg/mL lower in women with unsuppressed viral load compared to women without HIV (p < 0.05). The 25th and 50th percentile of SHBG was significantly higher in women with unsuppressed viral load compared to women without HIV (10 and 12 nmol/L, respectively). There were no consistent differences in estradiol or SHBG by suppression status. Conclusions: There were no differences in FE2 but significantly lower E2 and higher SHBG among women with HIV versus without HIV. Further research is merited in a large contemporary sample to clarify the clinical implications of these findings.
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Affiliation(s)
- Sally B. Coburn
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.,Address correspondence to: Sally B. Coburn, PhD, MPH, Department of Epidemiology, Johns Hopkins University, 615 N Wolfe Street, No. E7008, Baltimore, MD 21205, USA
| | - Jodie Dionne-Odom
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maria L. Alcaide
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Caitlin A. Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lisa Rahangdale
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leslie Stewart Massad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Katherine G. Michel
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Georgetown University Medical Center, Georgetown University, Washington, District of Columbia, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Downstate, Brooklyn, New York, USA
| | - Kerry Murphy
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
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D’Souza G, Tong W, Gustafson D, Alcaide ML, Lahiri CD, Sharma A, French AL, Palella FJ, Kempf MC, Mimiaga MJ, Ramirez C, Kassaye S, Rinaldo CR, Brown TT, Tien PC, Adimora AA. SARS-CoV-2 Infection Among People Living With HIV Compared With People Without HIV: Survey Results From the MACS-WIHS Combined Cohort Study. J Acquir Immune Defic Syndr 2022; 89:1-8. [PMID: 34878431 PMCID: PMC8667184 DOI: 10.1097/qai.0000000000002822] [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: 04/09/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) symptoms among people living with HIV (PLWH) are not well described. SETTING Longitudinal survey within the MACS/WIHS Combined Cohort Study (MWCCS) of PLWH compared with similar HIV-seronegative (SN) individuals. METHODS Telephone-administered survey of MWCCS participants at 13 clinical research sites across the United States addressing COVID-19 symptoms, SARS-CoV-2 testing, and pandemic impact on social distancing and antiretroviral therapy (ART) use. Primary data collection occurred during May (wave 1), June-July (wave 2), and August-September, 2020 (wave 3). RESULTS One-third of MWCCS participants were tested for SARS-CoV-2 infection; 10% was tested ≥2 times. Similar proportions of PLWH and SN participants were tested, but SARS-CoV-2 positivity was higher among PLWH than among SN individuals (9.4% vs 4.8%, P = 0.003). Odds of SARS-CoV-2 positivity remained higher among PLWH after adjusting for age, sex, race/ethnicity, and study site (adjusted odds ratio = 2.0, 95% confidence interval = 1.2 to 3.2). SARS-CoV-2 positivity was not associated with CD4 cell counts among PLWH. Among SARS-CoV-2 positive participants, 9% had no symptoms, 7% had 1-2 mild symptoms, and 84% had ≥3 symptoms. Most of the (98%) participants reported physical distancing during all survey waves; self-reported ART adherence among PLWH was not adversely affected during the pandemic compared with the previous year (similar adherence in 89% of participants, improved in 9% of participants, and decreased in 2% of participants). CONCLUSIONS Despite similar SARS-CoV-2 testing and physical distancing profiles by HIV serostatus among MWCCS participants, PLWH who reported SARS-CoV-2 testing were more likely to have a positive test result. Additional studies are needed to determine whether and why PLWH are at increased risk of SARS-CoV-2 infection.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Weiqun Tong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Deborah Gustafson
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Maria L. Alcaide
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Fl, USA
| | - Cecile D. Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Audrey L. French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago IL
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew J. Mimiaga
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles 90095-1772
| | - Catalina Ramirez
- Department of Medicine, UNC School Division of Medicine, The Infectious Diseases, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seble Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University, Washington DC, USA
| | - Charles R. Rinaldo
- Department of Infectious Diseases and Microbiology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco and Department of Veterans Affairs, San Francisco, CA, USA
| | - Adaora A. Adimora
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Erlandson KM, Langan S, Lake JE, Sun J, Sharma A, Adrian S, Scherzinger A, Palella F, Kingsley L, Gange SJ, Tien PC, Yin MT, Brown TT. Differences in Muscle Quantity and Quality by HIV Serostatus and Sex. J Frailty Aging 2022; 11:309-317. [PMID: 35799438 PMCID: PMC9334131 DOI: 10.14283/jfa.2022.11] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE People with HIV (PWH) experience greater declines in both muscle function and muscle mass with aging. Whether changes in muscle quality and quantity with aging differ between men and women with HIV and the implications on muscle function are not established. DESIGN In coordinated substudies of the Multicenter AIDS Cohort Study and Women's Interagency HIV Study, participants completed physical function and falls assessments; total trunk/thigh density, inversely related to fatty infiltration, and area were quantified from computed tomography (CT) scans. METHODS Generalized linear models were used to explore variables affecting density/area, and associations between area/density and physical function and falls. RESULTS CT scans were available on 387 men (198 PWH) and 184 women (118 PWH). HIV serostatus was associated with greater lateralis, paraspinal, and hamstring area, but lower psoas area and density. Older age and female sex were associated with smaller trunk muscle area and lower density. Both lower muscle area and muscle density were associated with several measures of impaired physical function. The odds of falling were lower with greater hamstring density, but not associated with other measurers of muscle area or density. CONCLUSIONS In summary, older adults with HIV appear to have smaller and less dense (fattier) psoas, a key component in truncal stability and hip flexion that could have implications on physical function. The longitudinal associations of muscle area and density with physical function require careful investigation, with a particular focus on characteristics and interventions that can preserve muscle area, density, and function over time.
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Affiliation(s)
- K M Erlandson
- Kristine Erlandson, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO 80111, , (p) 303-724-4941 (f) 303-724-4926
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Jao J, Balmert LC, Sun S, McComsey GA, Brown TT, Tien PC, Currier JS, Stein JH, Qiu Y, LeRoith D, Kurland IJ. Distinct Lipidomic Signatures in People Living With HIV: Combined Analysis of ACTG 5260s and MACS/WIHS. J Clin Endocrinol Metab 2022; 107:119-135. [PMID: 34498048 PMCID: PMC8684537 DOI: 10.1210/clinem/dgab663] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Disentangling contributions of HIV from antiretroviral therapy (ART) and understanding the effects of different ART on metabolic complications in persons living with HIV (PLHIV) has been challenging. OBJECTIVE We assessed the effect of untreated HIV infection as well as different antiretroviral therapy (ART) on the metabolome/lipidome. METHODS Widely targeted plasma metabolomic and lipidomic profiling was performed on HIV-seronegative individuals and people living with HIV (PLHIV) before and after initiating ART (tenofovir/emtricitabine plus atazanavir/ritonavir [ATV/r] or darunavir/ritonavir [DRV/r] or raltegravir [RAL]). Orthogonal partial least squares discriminant analysis was used to assess metabolites/lipid subspecies that discriminated between groups. Graphical lasso estimated group-specific metabolite/lipid subspecies networks associated with the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Correlations between inflammatory markers and metabolites/lipid subspecies were visualized using heat maps. RESULTS Of 435 participants, 218 were PLHIV. Compared to HIV-seronegative individuals, ART-naive PLHIV exhibited higher levels of saturated triacylglycerols/triglycerides (TAGs) and 3-hydroxy-kynurenine, lower levels of unsaturated TAGs and N-acetyl-tryptophan, and a sparser and less heterogeneous network of metabolites/lipid subspecies associated with HOMA-IR. PLHIV on RAL vs ATV/r or DRV/r had lower saturated and unsaturated TAGs. Positive correlations were found between medium-long chain acylcarnitines (C14-C6 ACs), palmitate, and HOMA-IR for RAL but not ATV/r or DRV/r. Stronger correlations were seen for TAGs with interleukin 6 and high-sensitivity C-reactive protein after RAL vs ATV/r or DRV/r initiation; these correlations were absent in ART-naive PLHIV. CONCLUSION Alterations in the metabolome/lipidome suggest increased lipogenesis for ART-naive PLHIV vs HIV-seronegative individuals, increased TAG turnover for RAL vs ATV/r or DRV/r, and increased inflammation associated with this altered metabolome/lipidome after initiating ART. Future studies are needed to understand cardiometabolic consequences of lipogenesis and inflammation in PLHIV.
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Affiliation(s)
- Jennifer Jao
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Department of Medicine, Division of Adult Infectious Diseases, Chicago, Illinois 60611, USA
| | - Lauren C Balmert
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Division of Biostatistics, Chicago, Illinois 60611, USA
| | - Shan Sun
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Department of Pediatrics, Division of Pediatric Infectious Diseases, Chicago, Illinois 60611, USA
| | - Grace A McComsey
- University Hospitals Cleveland Medical Center and Case Western Reserve University, Department of Pediatrics, Department of Medicine, Cleveland, Ohio 44106, USA
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Phyllis C Tien
- University of California, San Francisco, Department of Medicine and Department of Veterans Affairs Medical Center, Division of Infectious Diseases, San Francisco, California 94121, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California Los Angeles, Los Angeles, California 90095, USA
| | - James H Stein
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Cardiovascular Medicine Division, Madison, Wisconsin 53726, USA
| | - Yunping Qiu
- Stable Isotope and Metabolomics Core Facility, Department of Medicine, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, New York 10461, USA
| | - Derek LeRoith
- Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Endocrinology, New York, New York 10029, USA
| | - Irwin J Kurland
- Stable Isotope and Metabolomics Core Facility, Department of Medicine, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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45
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Breger TL, Westreich D, Edmonds A, Edwards JK, Zalla LC, Cole SR, Ramirez C, Ofotokun I, Kassaye SG, Brown TT, Konkle-Parker D, Jones DL, D'Souza G, Cohen MH, Tien PC, Taylor TN, Anastos K, Adimora AA. A new smoking cessation 'cascade' among women with or at risk for HIV infection. AIDS 2022; 36:107-116. [PMID: 34586086 PMCID: PMC8819357 DOI: 10.1097/qad.0000000000003089] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to define a smoking cessation 'cascade' among USA women with and without HIV and examine differences by sociodemographic characteristics. DESIGN An observational cohort study using data from smokers participating in the Women's Interagency HIV Study between 2014 and 2019. METHODS We followed 1165 women smokers with and without HIV from their first study visit in 2014 or 2015 until an attempt to quit smoking within approximately 3 years of follow-up, initial cessation (i.e. no restarting smoking within approximately 6 months of a quit attempt), and sustained cessation (i.e. no restarting smoking within approximately 12 months of a quit attempt). Using the Aalen-Johansen estimator, we estimated the cumulative probability of achieving each step, accounting for the competing risk of death. RESULTS Forty-five percent of smokers attempted to quit, 27% achieved initial cessation, and 14% achieved sustained cessation with no differences by HIV status. Women with some post-high school education were more likely to achieve each step than those with less education. Outcomes did not differ by race. Thirty-six percent [95% confidence interval (95% CI): 31-42] of uninsured women attempted to quit compared with 47% (95% CI: 44-50) with Medicaid and 49% (95% CI: 41-59) with private insurance. CONCLUSION To decrease smoking among USA women with and without HIV, targeted, multistage interventions, and increased insurance coverage are needed to address shortfalls along this cascade.
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Affiliation(s)
- Tiffany L. Breger
- Department of Medicine, University of North Carolina School of Medicine,Chapel Hill
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Jessie K. Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Lauren C. Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
| | - Catalina Ramirez
- Department of Medicine, University of North Carolina School of Medicine,Chapel Hill
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Seble G. Kassaye
- Department of Medicine, Georgetown University, Washington, District of Columbia
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Gypsyamber D'Souza
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County Health and Hospitals System, Chicago, Illinois
| | - Phyllis C. Tien
- Department of Medicine, University of California San Francisco, and Department of Veterans Affairs, San Francisco, California
| | - Tonya N. Taylor
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina School of Medicine,Chapel Hill
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, at Chapel Hill, North Carolina
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Kousari A, Moser C, Olefsky M, Brown TT, Currier JS, McComsey GA, Scherzinger A, Stein JH, Lake JE, Erlandson KM. Poorer Muscle Quality and Quantity With ART Initiation Is Associated With Greater Inflammation and Immune Activation. J Acquir Immune Defic Syndr 2021; 88:399-405. [PMID: 34326283 PMCID: PMC8556226 DOI: 10.1097/qai.0000000000002776] [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: 04/02/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We have previously shown that the initiation of antiretroviral therapy (ART) is associated with a decrease in skeletal muscle density (greater fat accumulation), suggesting that gains in lean body mass seen in many ART studies may reflect gains in low quality, fatty muscle. Here, we explore whether skeletal muscle density and area are associated with markers of inflammation and immune activation. METHODS ART-naïve people with HIV were randomized to raltegravir or ritonavir-boosted atazanavir or darunavir, each with tenofovir disoproxil fumarate/emtricitabine. Abdominal computed tomography scans from baseline and week 96 were reanalyzed for psoas density and area and correlations explored with inflammation [interleukin-6 (IL-6) and high-sensitivity C-reactive protein] and immune activation [soluble CD14 (sCD14), soluble CD163 (sCD163), and %CD38+HLADR+ on CD4+ or CD8+ T cells]. RESULTS Two hundred twenty-two participants had available inflammation/immune activation markers and paired computed tomography scans. At baseline, lower psoas density (greater fat) correlated with higher IL-6 (r = -0.26, P < 0.001) and sCD163 (r -0.15, P = 0.03) and lower lean psoas area correlated with higher IL-6, high-sensitivity C-reactive protein, sCD14, sCD163, and %CD38+HLADR+ on CD4+ T cells (r = -0.30-0.13; all P ≤ 0.05). From baseline to week 96, greater percent decrease in total psoas density (more fat) correlated with greater increase in IL-6 (r = -0.14; P = 0.04); greater % decrease in lean psoas area correlated greater increases in IL-6, sCD14, sCD163, and %CD38+HLADR+ on CD8+ T cells (r = -0.15 to -0.18; all P < 0.04). CONCLUSIONS Greater fat infiltration within the psoas muscle (lower density) and greater loss in lean psoas muscle area were associated with higher inflammation and immune activation, which may portend important effects on muscle function and cardiometabolic risk.
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Affiliation(s)
| | - Carlee Moser
- Harvard T.H. Chan School of Public Health; Boston, MA
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Brown TT, Yuhas K, Mayer KH, Landovitz RJ, Marzinke MA, Hendrix CW, Chen YQ, Klingman KL, Chege W, Mccauley MB, Gulick RM, Wilkin TJ. Bone changes with candidate PrEP regimens containing tenofovir disoproxil fumarate and/or maraviroc and/or emtricitabine in US men and women: HPTN 069/ACTG A5305. J Antimicrob Chemother 2021; 77:500-506. [PMID: 34791296 DOI: 10.1093/jac/dkab400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/28/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Tenofovir disoproxil fumarate-containing pre-exposure prophylaxis (PrEP) has been associated with decreases in bone mineral density (BMD), but the bone effects of other non-tenofovir disoproxil fumarate candidate PrEP regimens are not well described. METHODS The HPTN 069/ACTG A5305 study randomized 406 US cisgender men and transgender women, and 188 cisgender women at risk for HIV infection to one of four double-blinded regimens: (i) maraviroc; (ii) maraviroc + emtricitabine; (iii) maraviroc + tenofovir disoproxil fumarate; or (iv) tenofovir disoproxil fumarate + emtricitabine. BMD was measured in a subset of participants at the lumbar spine (LS) and hip by dual-energy X-ray absorptiometry (DXA) at baseline and 48 weeks. Percentage change in LS and hip BMD was compared between the tenofovir disoproxil fumarate- and non-tenofovir disoproxil fumarate-containing arms by Wilcoxon rank-sum tests and multiple linear regression adjusting for sex, race and baseline BMI. RESULTS At baseline (n = 307), the median age was 33 years, 56% male and 43% black. At the hip, the median percentage change in BMD at 48 weeks was -1.05% in the tenofovir disoproxil fumarate arms and 0.0% in the non-tenofovir disoproxil fumarate arms (between group P = 0.001). No interaction by sex was observed. The median percentage change in LS BMD was not different between arms. CONCLUSIONS Tenofovir disoproxil fumarate-containing PrEP was associated with significantly greater bone loss compared with maraviroc ± emtricitabine PrEP at the hip, but not the LS. The BMD changes at the hip were similar in magnitude in men and women.
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Affiliation(s)
- Todd T Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Krista Yuhas
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Kenneth H Mayer
- Fenway Health, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, USA
| | - Raphael J Landovitz
- Department of Medicine, University of California, Los Angeles, Los Angeles,, CA 90025, USA
| | - Mark A Marzinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Craig W Hendrix
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ying Q Chen
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Karen L Klingman
- HIV Research Branch, Therapeutics Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Wairimu Chege
- Clinical Prevention Research Branch, Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Roy M Gulick
- Department of Medicine, Weill, Cornell, Medicine, New York, NY 10065, USA
| | - Timothy J Wilkin
- Department of Medicine, Weill, Cornell, Medicine, New York, NY 10065, USA
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48
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Kamkwalala AR, Garg A, Roy U, Matthews A, Castillo-Mancilla J, Lake JE, Sebastiani G, Yin M, Brown TT, Kamer AR, Jabs DA, Ellis RJ, Boffito M, Greene M, Schmalzle S, Siegler E, Erlandson KM, Moore DJ. Current Considerations for Clinical Management and Care of People with HIV: Findings from the 11th Annual International HIV and Aging Workshop. AIDS Res Hum Retroviruses 2021; 37:807-820. [PMID: 34405689 DOI: 10.1089/aid.2021.0059] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The number of people with HIV (PWH) aged 50 years or older continues to steadily increase. The convergence of age- and HIV-related complications in these individuals presents a challenge for both patients and clinicians alike. New findings continue to emerge, as numerous researchers evaluate the combined impact of these two factors on quality of life, physiological systems, and mental health in PWH. Since its first occurrence in 2009, the International Workshop on HIV and Aging has served as a multidisciplinary meeting to share basic biomedical data, clinical trial results, treatment strategies, and epidemiological recommendations, toward better understanding and outcomes among like-minded scientific professionals. In this article, we share a selection of key findings presented in plenary talks at the 11th Annual International Workshop on HIV and Aging, held virtually from September 30, 2020 to October 2, 2020. We will also address the future directions of HIV and aging research, to further assess how the aging process intersects with chronic HIV.
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Affiliation(s)
| | - Ankita Garg
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Upal Roy
- Department of Health and Biomedical Sciences, The University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Avery Matthews
- Department of Psychiatry, South Texas Veteran Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jose Castillo-Mancilla
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jordan E. Lake
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Giada Sebastiani
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Michael Yin
- Department of Infectious Disease, Columbia University, New York, New York, USA
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Angela R. Kamer
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Douglas A. Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald J. Ellis
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Marta Boffito
- Department of HIV Services, Chelsea and Westminster Hospital, London, United Kingdom
| | - Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sarah Schmalzle
- Department of Infectious Disease, University of Maryland, Baltimore, Maryland, USA
| | - Eugenia Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Kristine M. Erlandson
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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49
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El Kamari V, Rodriguez K, Moser C, Currier JS, Kelesidis T, Stein JH, Brown TT, Howell SK, Beisswenger PJ, McComsey GA. Advanced Glycation End Products Associated With Cardiometabolic Biomarkers in Treated Human Immunodeficiency Virus Infection. Open Forum Infect Dis 2021; 8:ofab423. [PMID: 34631914 PMCID: PMC8496763 DOI: 10.1093/ofid/ofab423] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background Despite advances in antiretroviral therapy (ART), people living with human immunodeficiency virus (HIV) continue to be at increased risk of cardiometabolic complications compared to HIV-uninfected individuals. Advanced glycation end products (AGEs) are implicated in the development and progression of cardiometabolic complications in the general population. Their role in HIV remains unclear. Methods ACTG A5260s is a prospective open-label randomized trial in which ART-naive people living with HIV were randomized to tenofovir disoproxil fumarate /emtricitabine plus atazanavir/ritonavir, darunavir/ritonavir, or raltegravir over 96 weeks. Changes in circulating AGEs with ART initiation were assessed, and linear regression was used to examine the associations between serum AGEs with carotid intima-media thickness (cIMT), visceral and subcutaneous adipose tissue, total fat, lean mass, body mass index, insulin resistance, leptin, and adiponectin. Results Overall, 214 participants were included. Ninety percent were male, 48% were White, the median age was 36 years, median HIV-1 RNA was 4.58 log10 copies/mL, and median CD4 count was 338 cells/µL. Most AGEs remained relatively unchanged following 96 weeks of ART initiation, except for methylglyoxal-derived hydroimidazolone 1 (MG-H1), which increased following 96 weeks of ART (mean fold change, 1.15 [95% confidence interval, 1.02–1.30]). No differences were detected across ART regimens. Increases in AGE levels over time were associated with worsening body fat composition measures, insulin resistance, and cIMT, even after adjusting for clinically relevant factors. Conclusions AGE levels did not decrease following ART initiation. Most AGE levels remained stable, except for MG-H1, which increased. In people with HIV on ART, the accumulation of circulating AGEs over time appears to be independently associated with worsening cardiometabolic biomarkers. Summary: Antiretroviral therapy (ART) does not appear to be effective in reducing advanced glycation end product (AGE) levels. On the contrary, AGE levels seem to increase following ART initiation. Accumulation of AGEs was found to be independently associated with cardiometabolic complications in treated people living with HIV.
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Affiliation(s)
- Vanessa El Kamari
- Case Western Reserve University, Cleveland, Ohio, USA.,University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Carlee Moser
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Judith S Currier
- David Geffen School of Medicine at UCLA, Los Angeles, California,USA
| | | | | | - Todd T Brown
- Johns Hopkins University, Baltimore, Maryland,USA
| | - Scott K Howell
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,PreventAGE Health Care, LLC, Lebanon, New Hampshire, USA
| | - Paul J Beisswenger
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,PreventAGE Health Care, LLC, Lebanon, New Hampshire, USA
| | - Grace A McComsey
- Case Western Reserve University, Cleveland, Ohio, USA.,University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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50
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Sarkar S, Haberlen S, Metkus TS, Kingsley L, Budoff M, Witt MD, Palella FJ, Post WS, Brown TT. HIV serostatus and incident coronary artery stenosis in men with a baseline zero coronary artery calcium. AIDS 2021; 35:2061-2063. [PMID: 34471076 PMCID: PMC8496999 DOI: 10.1097/qad.0000000000002991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | | | - Frank J. Palella
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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